Claudia Cirilli
University of Modena and Reggio Emilia
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Featured researches published by Claudia Cirilli.
Lancet Oncology | 2012
Heikki Joensuu; Aki Vehtari; Jaakko Riihimäki; Toshirou Nishida; Sonja E. Steigen; Peter Brabec; Plank L; Bengt Nilsson; Claudia Cirilli; Chiara Braconi; A. Bordoni; Magnus Karl Magnusson; Zdenek Linke; Jozef Sufliarsky; Massimo Federico; Jon G. Jonasson; Angelo Paolo Dei Tos; Piotr Rutkowski
BACKGROUND The risk of recurrence of gastrointestinal stromal tumour (GIST) after surgery needs to be estimated when considering adjuvant systemic therapy. We assessed prognostic factors of patients with operable GIST, to compare widely used risk-stratification schemes and to develop a new method for risk estimation. METHODS Population-based cohorts of patients diagnosed with operable GIST, who were not given adjuvant therapy, were identified from the literature. Data from ten series and 2560 patients were pooled. Risk of tumour recurrence was stratified using the National Institute of Health (NIH) consensus criteria, the modified consensus criteria, and the Armed Forces Institute of Pathology (AFIP) criteria. Prognostic factors were examined using proportional hazards and non-linear models. The results were validated in an independent centre-based cohort consisting of 920 patients with GIST. FINDINGS Estimated 15-year recurrence-free survival (RFS) after surgery was 59·9% (95% CI 56·2-63·6); few recurrences occurred after the first 10 years of follow-up. Large tumour size, high mitosis count, non-gastric location, presence of rupture, and male sex were independent adverse prognostic factors. In receiver operating characteristics curve analysis of 10-year RFS, the NIH consensus criteria, modified consensus criteria, and AFIP criteria resulted in an area under the curve (AUC) of 0·79 (95% CI 0·76-0·81), 0·78 (0·75-0·80), and 0·82 (0·80-0·85), respectively. The modified consensus criteria identified a single high-risk group. Since tumour size and mitosis count had a non-linear association with the risk of GIST recurrence, novel prognostic contour maps were generated using non-linear modelling of tumour size and mitosis count, and taking into account tumour site and rupture. The non-linear model accurately predicted the risk of recurrence (AUC 0·88, 0·86-0·90). INTERPRETATION The risk-stratification schemes assessed identify patients who are likely to be cured by surgery alone. Although the modified NIH classification is the best criteria to identify a single high-risk group for consideration of adjuvant therapy, the prognostic contour maps resulting from non-linear modelling are appropriate for estimation of individualised outcomes. FUNDING Academy of Finland, Cancer Society of Finland, Sigrid Juselius Foundation and Helsinki University Research Funds.
BMC Cancer | 2007
Claudia Mucciarini; Giulio Rossi; Federica Bertolini; Riccardo Valli; Claudia Cirilli; Ivan Rashid; Luigi Marcheselli; Gabriele Luppi; Massimo Federico
BackgroundAlthough the diagnostic criteria and pathogenesis of gastrointestinal stromal tumors (GIST) have recently been elucidated, knowledge of the epidemiology of this malignancy is still limited. This study examined the incidence of GIST in the province of Modena, including pathologic features and clinical outcome.MethodsGastrointestinal mesenchymal tumors identified by the Modena Cancer Registry between 1991 and 2004 were analyzed with an immunohistochemical panel that included staining for CD-117 and PDGFRα. Size, mitotic rate, and other pathologic parameters were recorded. Each tumor was categorized into National Institutes of Health risk categories (very low, low, intermediate, and high risk).ResultsOne hundred twenty-four cases were classified as GIST. The age-adjusted incidence rate was 6.6 per million. Seventy-five percent of patients were symptomatic; 34% had a previous or concomitant history of cancer. High-risk features were present in 47% of cases. Seventy-eight percent were submitted to radical surgery. After complete resection, the 5-year disease-free survival rates were 94%, 92%, 100%, and 40% for patients at very low, low, intermediate, and high risk, respectively. In multivariate analysis, high risk was the main predictor of recurrence.ConclusionThis population-based study shows that the incidence of GIST in Northern Italy is comparable to that reported in other European countries. Survival was favorable in lower risk categories and in most of the resected cases. In our study, resected patients at very low, low, and intermediate risk had a similar outcome. Our data support the need to consider high-risk patients after complete surgical resection for treatment with the best available approach.
Breast Cancer Research | 2006
Eugenio Paci; Guido Miccinesi; Donella Puliti; Paola Baldazzi; Vincenzo De Lisi; Fabio Falcini; Claudia Cirilli; Stefano Ferretti; Lucia Mangone; Alba Carola Finarelli; Stefano Rosso; Nereo Segnan; Fabrizio Stracci; Adele Traina; Rosario Tumino; Manuel Zorzi
IntroductionExcess of incidence rates is the expected consequence of service screening. The aim of this paper is to estimate the quota attributable to overdiagnosis in the breast cancer screening programmes in Northern and Central Italy.MethodsAll patients with breast cancer diagnosed between 50 and 74 years who were resident in screening areas in the six years before and five years after the start of the screening programme were included. We calculated a corrected-for-lead-time number of observed cases for each calendar year. The number of observed incident cases was reduced by the number of screen-detected cases in that year and incremented by the estimated number of screen-detected cases that would have arisen clinically in that year.ResultsIn total we included 13,519 and 13,999 breast cancer cases diagnosed in the pre-screening and screening years, respectively. In total, the excess ratio of observed to predicted in situ and invasive cases was 36.2%. After correction for lead time the excess ratio was 4.6% (95% confidence interval 2 to 7%) and for invasive cases only it was 3.2% (95% confidence interval 1 to 6%).ConclusionThe remaining excess of cancers after individual correction for lead time was lower than 5%.
Annals of Oncology | 2011
L. Dal Maso; Mauro Lise; Paola Zambon; Fabio Falcini; Emanuele Crocetti; D. Serraino; Claudia Cirilli; Roberto Zanetti; Marina Vercelli; Stefano Ferretti; Fabrizio Stracci; V De Lisi; Susanna Busco; Giovanna Tagliabue; M. Budroni; Rosario Tumino; Adriano Giacomin; Silvia Franceschi
BACKGROUND In Italy, some of the highest incidence rates (IRs) of thyroid cancer (TC) worldwide have been reported. PATIENTS AND METHODS TC cases <85 years of age reported to Italian cancer registries during 1991-2005 were included. Age-standardized IRs were computed for all TC and age-period-cohort effects were estimated for papillary TC. RESULTS IRs of TC were twofold higher in 2001-2005 than in 1991-1995 (18 and 8 per 100,000 women, 6 and 3 per 100,000 men, respectively). Increases were similar in the two sexes and nearly exclusively due to papillary TC. Increases of papillary TC by birth cohort were found in both sexes and among all age groups between 20 and 79 years. Age-period-cohort models showed a strong period effect in both sexes (rate ratio for 2001-2009 versus 1991-1995 = 2.5 in women and 2.3 in men), although IRs peaked at an earlier age in women (45-49 years) than men (65-69 years). CONCLUSION The strength of the period effect in both sexes and the earlier onset in women than men strongly implicated increased medical surveillance in the upward trends of papillary TC incidence in Italy. The consequences of the current intense search for TC on morbidity and possible overtreatment, especially among young women, should be carefully evaluated.
International Journal of Cancer | 2013
Claudia Allemani; Milena Sant; Hannah K. Weir; Lisa C. Richardson; Paolo Baili; Hans H. Storm; Sabine Siesling; Ana Torrella-Ramos; Adri C. Voogd; Tiiu Aareleid; Eva Ardanaz; Franco Berrino; Magdalena Bielska-Lasota; S.W. Bolick; Claudia Cirilli; Marc Colonna; Paolo Contiero; Rosemary D. Cress; Emanuele Crocetti; John Fulton; Pascale Grosclaude; Timo Hakulinen; M. Isabel Izarzugaza; Per Malmström; Karin Peignaux; Maja Primic-Žakelj; Jadwiga Rachtan; Chakameh Safaei Diba; María José Sánchez; Maria J. Schymura
Breast cancer survival is reportedly higher in the US than in Europe. The first worldwide study (CONCORD) found wide international differences in age‐standardized survival. The aim of this study is to explain these survival differences. Population‐based data on stage at diagnosis, diagnostic procedures, treatment and follow‐up were collected for about 20,000 women diagnosed with breast cancer aged 15–99 years during 1996–98 in 7 US states and 12 European countries. Age‐standardized net survival and the excess hazard of death up to 5 years after diagnosis were estimated by jurisdiction (registry, country, European region), age and stage with flexible parametric models. Breast cancers were generally less advanced in the US than in Europe. Stage also varied less between US states than between European jurisdictions. Early, node‐negative tumors were more frequent in the US (39%) than in Europe (32%), while locally advanced tumors were twice as frequent in Europe (8%), and metastatic tumors of similar frequency (5–6%). Net survival in Northern, Western and Southern Europe (81–84%) was similar to that in the US (84%), but lower in Eastern Europe (69%). For the first 3 years after diagnosis the mean excess hazard was higher in Eastern Europe than elsewhere: the difference was most marked for women aged 70–99 years, and mainly confined to women with locally advanced or metastatic tumors. Differences in breast cancer survival between Europe and the US in the late 1990s were mainly explained by lower survival in Eastern Europe, where low healthcare expenditure may have constrained the quality of treatment.
British Journal of Haematology | 2013
Samantha Pozzi; Luigi Marcheselli; Alessia Bari; Eliana Valentina Liardo; Raffaella Marcheselli; Stefano Luminari; Micol Quaresima; Claudia Cirilli; Paola Ferri; Massimo Federico; Stefano Sacchi
Novel treatments for multiple myeloma (MM) have shown promising results in clinical trials, but the advantage in unselected patients is still unclear. In order to evaluate whether novel therapies impact survival of MM patients, we performed a population‐based analysis on data collected by the Modena Cancer Registry from 1989 to 2009. The analysis evaluated 1206 newly diagnosed MM patients collected in the years 1988–96 (conventional therapy), 1997–05 (high dose melphalan and autologous transplant), and 2006–09 (novel agents era). Both relative survival (RS) and overall survival (OS) improved over the years, but not equally in the three groups. For patients aged <65 years, RS improved in 1997–05 and 2006–09 compared with previous years and a trend to improvement was observed from 1997–05 to 2006–09. For patients aged 65–74 years, RS improved significantly in 2006–09 compared with 1988–96 and 1997–05. No amelioration was observed for patients 75+ years old. OS confirmed RS. In conclusion, the survival of MM patients aged <65 and, in particular, 65–74 years, has improved over time, especially after 2006. This observation provides circumstantial evidence that novel therapies might impact patient survival. Despite the limits of this study, these data refer to an unselected population, giving a picture of every day clinical practice.
BMC Cancer | 2006
Laura Cortesi; Vincenzo E Chiuri; Silvia Ruscelli; Valeria Bellelli; Rossella Negri; Ivan Rashid; Claudia Cirilli; Antonella Fracca; Ennio Gallo; Massimo Federico
BackgroundThe reduced mortality rate from breast carcinoma among women offered screening mammography is demonstrated after 15–20 years of follow-up. However, the assessment of 5-year overall and event-free survival could represent an earlier measure of the efficacy of mammography screening program (MSP).MethodsAll cases of breast cancer diagnosed in the Province of Modena between years 1996 and 2000 in women aged 50 to 69 years, were identified through the Modena Cancer Registry (MCR). Stage of disease and treatment information were obtained from clinical records. All the events occurring up to June 30, 2003 were retrieved by experienced monitors. Five-year overall and event-free survival were the principal end-points of the study.ResultsDuring a 5-year period, 587 primary breast cancers were detected by the MSP and 471 primary breast cancers were diagnosed out of the MSP. The screen-detected breast cancers were smaller, more likely node negative, with low histological grade, low proliferative activity and positive receptors status. Furthermore, the breast cancer diagnosed through the MSP more frequently received a conservative surgery. The 5-year survival rate was 94% in the screen-detected group, versus 84% in the other group (p = 0.0001). The rate of 5-year event-free survival was 89% and 75% for the MSP participants and not participants, respectively (p = 0.0001).ConclusionsOur data confirm a favourable outcome of screen-detected breast cancers in terms of five-year overall and event-free survival, which reflect the good quality assurance parameters of the MSP. Finally, a cancer registry should be implemented in every area covered by screening programs.
Cancer Epidemiology | 2012
Milena Sant; Pamela Minicozzi; Claudia Allemani; Claudia Cirilli; Massimo Federico; Riccardo Capocaccia; M. Budroni; Pina Candela; Emanuele Crocetti; Fabio Falcini; Stefano Ferretti; Mario Fusco; Adriano Giacomin; Francesco La Rosa; Lucia Mangone; Maurilio Natali; Maurizio Ponz de Leon; Adele Traina; Rosario Tumino; Paola Zambon
BACKGROUND Population-based cancer registry studies of care patterns can help elucidate reasons for the marked geographic variation in cancer survival across Italy. The article provides a snapshot of the care delivered to cancer patients in Italy. METHODS Random samples of adult patients with skin melanoma, breast, colon and non-small cell lung cancers diagnosed in 2003-2005 were selected from 14 Italian cancer registries. Logistic models estimated odds of receiving standard care (conservative surgery plus radiotherapy for early breast cancer; surgery plus chemotherapy for Dukes C colon cancer; surgery for lung cancer; sentinel node biopsy for >1mm melanoma, vs. other treatment) in each registry compared to the entire sample (reference). RESULTS Stage at diagnosis for breast, colon and melanoma was earlier in north/central than southern registries. Odds of receiving standard care were lower than reference in Sassari (0.68, 95%CI 0.51-0.90) and Napoli (0.48, 95%CI 0.35-0.67) for breast cancer; did not differ across registries for Dukes C colon cancer; were higher in Romagna (3.77, 95%CI 1.67-8.50) and lower in Biella (0.38, 95%CI 0.18-0.82) for lung cancer; and were higher in Reggio Emilia (2.37, 95%CI 1.12-5.02) and lower in Ragusa (0.27, 95%CI 0.14-0.54) for melanoma. CONCLUSIONS Notwithstanding limitations due to variations in the availability of clinical information and differences in stage distribution between north/central and southern registries, our study shows that important disparities in cancer care persist across Italy. Thus the public health priority of reducing cancer survival disparities will not be achieved in the immediate future.
BMC Cancer | 2010
Laura Cortesi; Cristina Masini; Claudia Cirilli; Veronica Medici; Isabella Marchi; Giovanna Cavazzini; Giuseppe Pasini; Daniela Turchetti; Massimo Federico
BackgroundThe purpose of our study was to compare differences in the prognosis of breast cancer (BC) patients at high (H) risk or intermediate slightly (IS) increased risk based on family history and those without a family history of BC, and to evaluate whether ten-year overall survival can be considered a good indicator of BRCA1 gene mutation.MethodsWe classified 5923 breast cancer patients registered between 1988 and 2006 at the Department of Oncology and Haematology in Modena, Italy, into one of three different risk categories according to Modena criteria. One thousand eleven patients at H and IS increased risk were tested for BRCA1/2 mutations. The overall survival (OS) and disease free survival (DFS) were the study end-points.ResultsEighty BRCA1 carriers were identified. A statistically significantly better prognosis was observed for patients belonging to the H risk category with respect to women in the IS and sporadic groups (82% vs.75% vs.73%, respectively; p < 0.0001). Comparing only BRCA1 carriers with BRCA-negative and sporadic BC (77% vs.77% vs.73%, respectively; p < 0.001) an advantage in OS was seen.ConclusionsPatients belonging to a population with a high probability of being BRCA1 carriers had a better prognosis than those with sporadic BC. Considering these results, women who previously had BC and had survived ten years could be selected for BRCA1 analysis among family members at high risk of hereditary BC during genetic counselling. Since only 30% of patients with a high probability of having hereditary BC have BRCA1 mutations, selecting women with a long term survival among this population could increase the rate of positive analyses, avoiding the use of expensive tests.
Waste Management | 2010
Massimo Federico; Monica Pirani; Ivan Rashid; Nicola Caranci; Claudia Cirilli
We conducted a retrospective ecological study to assess cancer incidence during the period 1991-2005 in proximity of a municipal waste incinerator (MWI) in Modena (Italy). We identified three bands of increasing distance from the MWI, up to a radius of 5 km and used the residence as surrogate marker of the exposure. Residential history for Modenas population was reconstructed and residents were associated to the most appropriate census unit. Age-standardized incidence ratios (ASR) and standardized incidence ratios (SIR) were estimated for all cancers and selected sites. Variations in cancer incidence were investigated using space and space-time scan statistic. Deprivation index was taken into account as potential confounding factor. During the 15-year study period, 16,443 new cases of cancer were diagnosed among residents in Modena. The space-time clustering test identified three significant clusters but their shapes were not associable to the MWI exposition. The purely spatial analysis not showed statistically significant clusters. The SIR computed for all cancers and selected sites did not show any excess of risk in the area closest to the plant. Higher SIR for leukaemia was found in the second band from MWI (2-3.5 km) for females (SIR, age and DI adjusted: 1.35, 95%CI: 1.01-1.79) and for both sexes (SIR, age and DI adjusted: 1.28, 95%CI: 1.03-1.57), but not a spatial trend was observed, thus excluding a possible link with MWI. In conclusion, bearing in mind the intrinsic limits of the study, the results suggest that there is no detectable increase of cancer risk for people living in proximity to the Modena MWI.