Giovanni Boscaino

Breast cancer subtypes can be determinant in the decision making process to avoid surgical axillary staging: A retrospective cohort study

INTRODUCTION The need for performing axillary lymph-node dissection in early breast cancer when the sentinel lymph node (SLN) is positive has been questioned in recent years. The purpose of this study was to identify a low-risk subgroup of early breast cancer patients in whom surgical axillary staging could be avoided, and to assess the probability of having a positive lymph-node (LN). METHODS We evaluated the cohort of 612 consecutive women affected by early breast cancer. We considered age, tumor size, histological grade, vascular invasion, lymphatic invasion and cancer subtype (Luminal A, Luminal B HER-2+, Luminal B HER-2-, HER-2+, and Triple Negative) as variables for univariate and multivariate analyses to assess probability of there being a positive SLN o nonsentinel lymph node (NSLN). Chi-square, Fishers Exact test and Students t tests were used to investigate the relationship between variables; whereas logit models were used to estimate and quantify the strength of the relationship among some covariates and SLN or the number of metastases. RESULTS A significant positive effect of vascular invasion and lymphatic invasion (odds ratios are 4 and 6), and a negative effect of TN (odds ratios is 10) were noted. With respect to positive NSLN, size alone has a significant (positive) effect on tumor presence, but focusing on the number of metastases, also age has a (negative) significant effect. CONCLUSION This work shows correlation between subtypes and the probability of having positive SLN. Patients not expressing vascular invasion, lymphatic invasion and, moreover, a triple-negative tumor subtype may be good candidates for breast conservative surgery without axillary surgical staging.

Degree course change and student performance: a mixed-effect model approach

This paper focuses on students credits earning speed over time and its determinants, dealing with the huge percentage of students who do not take the degree within the legal duration in the Italian University System. A new indicator for the performance of the student career is proposed on real data, concerning the cohort of students enrolled at a Faculty of the University of Palermo (followed for 7 years). The new indicator highlights a typical zero-inflated distribution and suggests to investigate the effect of the degree course (DC) change on the student career. A mixed-effect model for overdispersed data is considered, with the aim of taking into account the individual variability as well, due to the longitudinal nature of data. Results show the significant positive effect of the DC change on the student performance.

Can the Students’ Career be Helpful in Predicting an Increase in Universities Income?

The students’ academic failure and the delay in obtaining their final degree are a significant issue for the Italian universities and their stakeholders. Based on indicators proposed by the Italian Ministry of University, the Italian universities are awarded a financial incentive if they reduce the students’ attrition and failure. In this paper we analyze the students’ careers performance using: (1) aggregate data; (2) individual data. The first compares the performances of the Italian universities using the measures and the indicators proposed by the Ministry. The second analyzes the students’ careers through an indicator based on credit earned by each student in seven academic years. The primary goal of this paper is to highlight elements that can be used by the policy makers to improve the careers of the university students.