Benedetto Terracini

Parental occupation and other environmental factors in the etiology of leukemias and non-Hodgkin's lymphomas in childhood: a case-control study.

We report the results of a hospital-based, case-control study on acute lymphocytic leukemia (ALL), acute non-lympocytic leukemia (AnLL) and non-Hodgkin lymphoma (NHL) in childhood. The study was conducted from 1981 to 1984 in Turin (Italy). One hundred and forty-two children with ALL, 22 with AnLL and 19 with NHL were included, as well as 307 controls. Information on parental smoking habits, parental occupation, ionizing radiation and childhood diseases were collected using a standard questionnaire during a personal interview of the relative attending the child in the hospital. The odds ratios for antenatal diagnostic radiation were 1.1 (NS) for ALL and 2.4 (NS) for AnLL. No association was found with diseases in childhood. Paternal and maternal smoking habits were similar for ALL cases and controls. Both maternal and paternal smoking were associated with NHL: for paternal smoking, odds ratios were around 5, but without a correlation with number of cigarettes. Positive associations observed with maternal employment were: ALL with teacher and cleaner; AnLL and textile worker; NHL and baker. Corresponding association with paternal jobs were: ALL with clerks, farmers and employment in office equipment production; AnLL and workers in building, tire or textile industries; NHL and lorry drivers, workers in the building or in the wood and furniture industry.

Physical impairment and social life goals among adult long-term survivors of childhood cancer: a population-based study from the childhood cancer registry of Piedmont, Italy.

Aims and Background The study describes the health status and the attainment of life goals in the adult survivors of childhood cancer recorded at the Childhood Cancer Registry of Piedmont. Methods and Study Design A postal questionnaire was sent to the general practitioner of the 690 cases born before 1976 and alive in 1991 after at least 5 years from diagnosis. The answer was received for 485 (72.9%) included in the analyses. Items in the questionnaire were: sequelae related to cancer and its treatment, health-related quality of life (according to Blooms criteria), educational level attained, and employment status. Results Vital and marital status were obtained for all 690 cases at the offices of the town of residence. No medical condition was reported for 309 cases (63.7%). The overall proportion with a high school or university education was compared to corresponding figures for Piedmont in 1991, adjusted by age, and was as high as in the general population. Similar results are observed for occupation. Patients of both genders were married less than expected. Patients with leukemia (112 cases), non-Hodgkins lymphoma (34) or Hodgkins lymphoma (52) were reported to have the highest quality of life. In contrast, patients with tumors of the central nervous system (151) had the highest frequency of sequelae and the lowest score for health-related quality of life. They also presented the lowest educational achievement, the lowest proportion of employment and, among males, the lowest frequency of marriage. Conclusions Our study shows a good social adjustment of adult survivors from childhood cancer, with the exception of central nervous system tumors. From the methodologic point of view, the present study shows the feasibility of surveillance surveys on health-related quality of life with the contribution of general practitioners.

Risk factors for soft tissue sarcomas in childhood: a case-control study.

A hospital-based case-control study on soft tissue sarcomas (STS) was conducted in 1983-84 in Torino and in Padova (Italy). Cases (36 children with rhabdomyosarcoma (RMS) and 16 non RMS-STS) were compared to 326 controls. Histories of parental smoking habits and occupations, parental and childrens exposure to ionizing radiation, childrens diseases and some other variables were collected through interviews to the relatives attending the child in the hospital. A non statistically significant association was observed with both maternal age above 30 at childs birth (STS: OR = 1.5, C.I. = 0.8-2.9; RMS: OR = 1.9, C.I. = 0.9-4.0) and « in utero » exposure to diagnostic radiation (STS: OR = 1.9, C.I. = 0.5-6.5, based on 4 cases). No association was found with childrens previous diseases. Paternal and maternal smoking habits were similar for RMS and STS cases and controls. Some positive associations with either maternal or paternal occupational histories were identified. They are difficult to interpret in view of the large number of comparisons and small absolute figures. They included maternal employment as medical doctor and nurse, farmer, textile worker and machine tool operator. An association was also observed with paternal occupation as butcher, building worker or employment in the production of domestic appliances. One case and no controls reported a maternal aunt affected by breast cancer.

Survival of children with cancer in Italy, 1989-98. A report from the hospital based registry of the Italian Association of Paediatric Haematology and Oncology (AIEOP).

We describe the survival patterns of 10,791 Italian children (age 0-14) diagnosed with cancer during 1989-1998 and who were included in the hospital-based registry of the Italian Association of Paediatric Haematology and Oncology. Five-year cumulative survival percentages were 76% for lymphoproliferative disorders and 68% for solid tumours. Survival rates in 1994-1998 significantly improved for acute lymphocytic leukaemia (ALL), acute non-lymphocytic leukaemia, Hodgkins lymphoma and Wilms tumour. Gender and age were determinants of survival for some specific types of cancer. Girls with ALL and neuroblastoma exhibited a significant advantage (hazard ratio HR 0.72, 0.62-0.83) and disadvantage (HR 0.73, 0.59-0.90) over boys, respectively. Children with a Wilms tumour diagnosed above age 3 had a worse prognosis than younger children (HR 2.3, 1.4-4.1). The persisting gender-related difference in survival rate for ALL requires understanding as to whether it is attributable to delays in the adoption of more recent therapeutic protocols, while the corresponding findings for Wilms tumour and neuroblastoma deserve further biological interpretation.

A case-control study of carcinomas of the nose and paranasal sinuses in the woolen textile manufacturing industry.

A population-based case-control study was conducted in Biella, which is located in northwestern Italy, to investigate the reported association between sinonasal carcinomas and woolen fabrics production. The study included 33 cases diagnosed during 1976-1988 (14 adenocarcinomas, 11 epidermoid carcinomas, 3 other specified carcinomas, 1 unspecified carcinoma, and 4 cases without histologic confirmation) and 131 controls. No association was found with smoking. As reported previously, excess risks were observed in wood and furniture workers (odds ratio [OR] = 4.4, 95% confidence interval [95% CI] = 1.41-13.4) and in the leather industry (OR = 3.5, 95% CI = 0.6-20.3). Odds ratios in the wood and furniture industry were 22.0 (95% CI = 4.4-124.0) for adenocarcinomas and 0.9 (95% CI = 0.4-8.3) for epidermoid carcinomas. No association was found with the woolen textile or garment industries (OR = 0.8, 95% CI = 0.2-2.8), nor with farming, construction, metal works, and transport. Odds ratios for the textile industry did not vary with length of exposure or histologic type. Power for detecting an odds ratio of 3.0 at the 95% level of significance was 40%.

Incidence of second primary malignancies after a malignant tumor in childhood a population-based survey in Piedmont (ITALY)

We have studied the frequency of second primary malignancies (SPM) among the 2,328 children registered in 1967–1989 at the Childhood Cancer Registry of Piedmont, the largest population‐based childhood cancer registry in Southern Europe. Since the population of Piedmont is not served by a conventional cancer registry covering all ages, SPMs were identified through a number of ad hoc surveys within a variety of sources. Eighteen SPM (all histologically diagnosed) were observed after a thorough survey conducted in the oncological departments in Piedmont and after a postal questionnaire addressed to general practitioners. Death certificates were also examined. The crude incidence rate was 116.5 per 100,000 person‐years. Risk was higher among children whose first malignancy was diagnosed more recently (SIR=9.8 for diagnoses in 1983–1989 vs. 4.5 for diagnoses in 1967–1974). The same tendency was confirmed in analyses restricted to children in whom leukemia was diagnosed as the first cancer. Clinical data regarding the treatment of the first malignancy were available for 16 children out of 18:15 had received chemotherapy and 12 radiotherapy (9 SPM originated in the irradiation field). The interest of measuring the risk of SPM on a population basis (and not only in clinical series) and the advantage of close cooperation between epidemiologists and clinical oncologists are underlined.

SURVIVAL AFTER PLEURAL MALIGNANT MESOTHELIOMA A POPULATION-BASED STUDY IN ITALY

Aims and Background The study analyzed survival after malignant mesothelioma in the population-based Registry of Malignant Mesothelioma of Piedmont (NW Italy, 4.5 million total population). It focused on possible differences related to period of diagnosis a proxy of changes in diagnostic or therapeutic procedures. Methods Cases were actively searched in pathology units and files of hospital admissions and discharges. In 1990-1998, 693 incident cases were diagnosed in residents in the region: 590 of them had a histologic diagnosis of pleural mesothelioma in life and were included in the study. Vital status was ascertained at the municipality of residence as of January 1, 2000. Results Fifty-eight cases were alive (9.8%) and 20 were lost (3.6%) at the end of the follow-up. Median survival was 0.71 years (95% Cl, 0.64-0.78). Cumulative survival was 35.9% at 1 year (95% Cl, 32.0-39.8) and 14.2% at 2 years (95% Cl, 11.2-17.1). Survival was associated to age (longer survival for younger subjects at diagnosis; P <0.0001) and to histology (longer survival for epithelial mesothelioma, shorter for fibrous and intermediate for mixed or unspecified types; P <0.0001). There was no difference in survival for period of diagnosis. The results were confirmed in multivariate analyses. Analyses according to type of hospital (with vs without thoracic surgery) did not show any statistically significant difference. Discussion The study on survival after malignant mesothelioma is the second largest of the three population-based studies in the world, which showed results similar to ours. Survival measured in published clinical series ranged between 18.4% and 57.6% at 1 year for pleural and 24.1% and 33.8% for peritoneal mesothelioma. The most striking effect of the present study was the absence of improvement in survival with period of diagnosis. Either there was no change in treatment efficacy or the effect was limited to small subgroups and could not be noticed when the analysis included larger categories.

Population-based survival after childhood lymphoblastic leukaemia in time periods corresponding to specific clinical trials from 1979 to 1998--a report from the Childhood Cancer Registry of Piedmont (Italy).

This study evaluated the outcome after childhood acute lymphoblastic leukaemia (ALL) in a population aged 0-14 years served by the Childhood Cancer Registry of Piedmont (CCRP) during the accrual periods to nationwide clinical studies run by the Italian Association for Paediatric Haematology and Oncology (AIEOP). In the time period considered (March 1979-December 1998) the CCRP recorded 498 incident cases of ALL. The living status on 31 December 2000 was known for 497 cases. Overall survival at 5 years was 74.1% standard error (S.E.) 2.0%). It increased from 58.6% (S.E. 4.9%) for cases diagnosed in March 1979-July 1982 to 87.3 (S.E. 3.6) in May 1995-December 1998. Results observed from data in our population-based study in Piedmont were similar to those presented in the nationwide clinical trials. Survival was better (statistically significant) for children aged 1-4 years, with a white blood cell (WBC) count lower than 10 000 x 10(3) cells/litre and for B-precursor ALL. Differences by immunophenotype were statistically significant only in the univariate analyses. Girls showed a non-statistically significant survival advantage over boys. Results of the present study show the impact on the population of recent clinical trials and emphasise the role of population-based cancer registries in evaluating childhood cancer care delivery in a given population.

Early deaths from childhood cancer

The population-based Childhood Cancer Registry of Piedmont (CCRP) has collected data on incidence since 1967. The occurrence of early death (i.e. within 30 days of diagnosis) was investigated in 3006 cases of childhood cancer diagnosed during the period 1967–1998. The proportion of early deaths (178 of the 3006 cases) was analysed by period of diagnosis (three decennial periods), age group, major diagnostic group and hospital category, with univariate statistics and logistic regression. The proportion of children with cancer who died within 1 month of diagnosis was 10.8%, 5.3% and 1.8% for cases diagnosed during 1967–1978, 1979–1988 and 1989–1998, respectively. This trend may reflect earlier diagnosis, improved diagnosis, more effective therapy or more frequent referral to specialised centres. The risk factors for early death were: age <1xa0year and diffuse disease at diagnosis, diagnosis during 1967–1978, a diagnosis of acute non lymphocytic leukaemia, non-Hodgkin lymphoma, central nervous system tumour or hepatic tumour. Early death was not related to the sex of the child. Care in an extra-regional specialised centre was associated with lower risk of early death. Conclusion:no temporal changes in early mortality were found among children with acute non lymphocytic leukaemia diagnosed in the first, second or third decade of activity of the CCRP, the percentages of children dying within 1 month being 12.8%, 10.7% and 12.8%, respectively. This pattern clearly differed from the corresponding trend for acute lymphoid leukaemia (6.4%, 2.0%, 0.4%).

Time trends of childhood cancer mortality rates: a report from the Childhood Cancer Registry of Piedmont, Italy, 1971-1998.

Time changes in mortality rates can be used to suggest future trends in the prognosis of childhood cancer. Estimates provided from recent studies led to divergent previsions of future trends. In this study we used data from the population‐based Childhood Cancer Registry of Piedmont (CCRP) in order to measure the decrease in mortality. The study included 1,060 deaths in the period 1971–1998. Analyses were carried out using Poisson regression models and considered separately the total tumours, acute lymphoblastic leukaemia (ALL) and tumours of the central nervous system (CNS). We observed a progressive decline in the mortality rates: for all tumours the estimated annual percentage change was −3.6% (Pu2009<u20090.05), for ALL it was −5.2%, (Pu2009<u20090.05) and for CNS tumours it was −3.8% (Pu2009<u20090.05). The statistical test for effect modification due to age at death was not significant. For all cancer types, the Poisson model fits the data well, corresponding to an exponential decrease of mortality rates and leading to the conclusion that current therapies, despite their proven effectiveness, are not sufficient to cure all cases of childhood cancer. Pediatr Blood Cancer 2004;43:788–791.