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LEGAME TRA L¿IMMUNODEFICIENZA HIV-CORRELATA E L¿INSORGENZA DI TUMORI: ASPETTI DI METODOLOGIA STATISTICA
Get PDFThe aim of the present Ph.D. program was exploring methodological issues arising in studies of cancer incidence, relative risk, and survival in patients with HIV/AIDS (PHA). Aspects related to the first two objectives were explored in the first two years.
This thesis described a record-linkage study conducted between the national Italian AIDS Registry and 24 Italian cancer registries to estimate survival after a cancer diagnosis in PHA. More than 2600 cancer cases diagnosed between 1986 and 2005 were included. Survival in PHA was compared with that reported in patients without AIDS using, as comparison group, patients matched for site (1:1 for Kaposi Sarcoma, 1:2 for non-Hodgkin lymphoma, 1:5 for other cancers), sex, age, period of diagnosis, and area of residence. Overall survival and death hazard ratios (HR) compared survival in PWA with cancer to that in cancer patients without AIDS have been calculated.
Overall, the 3-year survival rate of PHA with cancer increased from 16% in 1986-1995 to 41% in 1996-2005 period, after the widespread use of antiretroviral therapy (cART). In this period, HR remained higher in PHA than in persons without AIDS (3.0, 95% confidence interval [CI]: 2.7–3.4), in particular for cancer with good prognosis, e.g., Hodgkin lymphomas (HR=8.6), non-melanoma skin cancer (H=5.0), and anal cancer (HR=4.0).
A sensitivity analysis was performed to evaluate the impact on survival and on HR of different study designs and comparison groups
Invasive cervical cancer as an AIDS-defining illness in Europe
No full textObjective(s): To evaluate the frequency and correlates of invasive cervical cancer (ICC) as an AIDS-defining illness (ADI) in Europe. Design: Statistical analysis of data from: national AIDS surveillance systems of 15 European countries with ≥ 50 female AIDS cases; and from population-based cancer registries of the same nations. Methods: AIDS cases notified between 1993 (when ICC was included among ADI) and 1999 in women aged 20-49 years were taken into consideration. The association between the presence of ICC as an ADI and potential determinants was assessed by calculation of odds ratios (OR) and 95% confidence intervals (CI). Country-specific incidence rates of ICC in women aged 20-49 years were correlated with selected AIDS-associated variables by means of the Pearson correlation coefficient (r). Results: The OR of having ICC as an ADI increased with age and was significantly elevated in southern (3.1) and central (2.5) compared with northern Europe. It was also increased among injecting drug users (IDU; 1.5). The proportion of ICC as ADI was inversely correlated with incidence rates of ICC in the general female population, but directly correlated with the proportion of IDU among female AIDS cases. Conclusions: The frequency of ICC as an ADI in Europe was independent from the background risk of ICC in the general population. It was higher where IDU predominated among female AIDS cases and where population-based ICC screening programs were less effective
Risk factors for thyroid cancer : an epidemiological review focused on nutritional factors
No full textObjectives: The present review summarizes epidemiological evidence on risk factors for thyroid cancer (TC), in particular, nutritional factors. Methods: Searches of articles on the issue were conducted using MEDLINE. Results: Exposure to ionizing radiation, particularly during childhood, is the best-established risk factor for TC. There is also a strong association with history of benign nodules/adenoma or goiter. Iodine deficiency may induce an increasing incidence of benign thyroid conditions, but very high iodine intake also affects thyroid function and, possibly, TC risk. Among dietary factors, fish-the major natural source of iodine in human diet-is not consistently related to TC risk. High intake of cruciferous vegetables shows a weak inverse association with TC. Among other food groups, vegetables other than cruciferous are the only food group showing a favorable effect on TC, with an approximate 20% reduction in risk for subjects with the highest consumption. No effect on TC risk of alcohol, coffee, or other food-groups/nutrients emerged. Height and weight at diagnosis show a moderate positive association with TC risk. Conclusion: At present, the only recognized measures for reducing TC risk is to avoid ionizing radiation and iodine deficiency, particularly in childhood and young women, and to increase vegetable consumption
Advances in the epidemiology of HIV-associated non-Hodgkin's lymphoma and other lymphoid neoplasms
No full textThe spectrum of HIV-related lymphoid malignancies certainly includes non-Hodgkin's lymphoma (NHL; i.e,, chiefly large-cell lymphoma and Burkitt's lymphoma), primary lymphoma of the brain (PBL) and, possibly, Hodgkin's disease (HD). Since the mid-1990s, several epidemiological studies have led to better quantification of the burden of lymphomas in HIV infected populations. AIDS surveillance data from 17 western European countries show that between 1988 and 1997 a total of 7,148 AIDS cases had NHL as the AIDS-defining illness, The yearly number of cases rose steadily from 1988 to 1995 but declined thereafter. As a percentage of AIDS-defining illnesses, NHL increased from 3.6% in 1994 to 4.9% in 1997. Percent increases were observed in different strata by area, age group, sex and HIV-transmission group, To estimate relative risk (RR) of NHL and other lymphoid neoplasms in unselected HIV-seropositive populations, records of population-based cancer registries and AIDS registries were linked in the United States, Italy and Australia. RRs for NHL in adults with HIV/AIDS ranged between 14 (for low-grade NHL) to over 300 (for high-grade NHL). For HD, the RR was approximately 10, Limited findings from studies based on death certificates and cohorts of HIV-seropositive persons were consistent with those from registry linkage studies. In developing countries, the risk of HIV-associated NHL appears to be much lower than in developed countries, but under-ascertainment and earlier death from other AIDS manifestations may explain the lack of HIV-associated lymphomas in Africa
HIV transmission and Kaposi's sarcoma among European women
No full textObjective: To assess the association between the presence of Kaposi's sarcoma (KS) as an AIDS-defining illness and HIV transmission categories among European women with AIDS. Design: Comparison of the prevalence of KS as an AIDS-defining illness in different HIV transmission categories. Methods: Odds ratios (OR) and 95% confidence intervals (CI) for KS were computed by means of unconditional multiple logistic regression equations. Results: KS was reported in 344 (2.2%) out of 15 809 women diagnosed with AIDS. Women who reported HIV infection via heterosexual intercourse had a >twofold increase of KS risk than intravenous drug users (OR, 2.4; 95% CI, 1.9-3.0). Particularly elevated OR were observed among women originating from African or Caribbean countries (OR, 4.9; 95% CI, 3.7-6.5), and in partners of bisexual men (OR, 4.8; 95% CI, 2.8-8.2). Such risk patterns for KS were consistent in different countries, age groups and year of AIDS diagnosis. Conclusions: These results are in agreement with similar analyses from the United States, and support the existence of some putative KS agent(s) which can be acquired via sexual intercourse with bisexual men, or earlier in life in countries where non-AIDS-associated KS is frequent
Italian cancer figures, report 2010 : Cancer prevalence in Italy. Patients living with cancer, long-term survivors and cured patients
No full textObjectives: the aim of the present monograph is to update the estimation of the number of people living with cancer in Italy,
to describe geographic variability, and estimate the number of long-term survivors, i.e., people living five years or more after a cancer diagnosis.
Materials and Methods: the study included the data of the AIRTUM database. Twenty-four Cancer Registries (CRs) (covering 27% of the Italian population) collected information on
the incidence and vital status of 1,275,353 cases diagnosed between 1978 and 2005. For each CR, the observed prevalence was calculated up to the maximum observable duration. To estimate the complete prevalence (all living patients, independently from time since diagnosis) and the prevalence for lengths of time
exceeding the CR maximum duration of registration, the observed prevalence was corrected through a completeness index. Completeness indices, gender, age and site specific, were estimated by means of statistical regression models using cancer incidence and survival data available from CRs with more than 15 years of observation. As of 1 January 2006, the prevalence was estimated (as absolute numbers and as a proportion per 100,000 inhabitants) for 46 cancer sites, by gender, age class, years since diagnosis and geographic areas.
Results: as of 2006, 2,244,000 persons (4%of the Italian population) were alive with a cancer diagnosis. A relevant geographic
variability emerged, with proportions between 4%-5% among CRs in the Centre and North of Italy, and proportions between
2%-3% in the South. Forty-four percent of prevalent subjects (988,000) were males and 56% (1,256,000) females. Fiftyseven-
percent (1,285,680 people, 2.2% of total population) of these patients was represented by long-term survivors. In patients aged 75 years or more, the proportions of prevalent cases were
19%in males and 13%in females, and 10%between 60 and 75 years of age in both genders.More than half a million Italian
women were alive with a breast cancer diagnosis (42% of women with a neoplasm), followed by women with cancers of the colonrectum (12%), corpus uteri (7%), thyroid (5%), and cervix uteri (4%). In men, 22%of prevalent cases (216,716) included
patients with prostate cancer, 18% with bladder cancer, and 15%with colon-rectum cancer. Percentages of long-term survivors
higher than 70% were reported for cancers of the cervix uteri (82% at five years, and 55% at 15 years from diagnosis), Hodgkin lymphoma, testis, brain and central nervous system, bone and connective tissue. Many patients with these types of cancers (often occurring in young people) can be considered
“cured”, i.e., with a life expectancy overlapping that of the general population. The estimated proportions of prevalent cases emerging from this study in Italy were quite similar to those reported in Northern Europe, but at least 15%lower than those in the United States.
Conclusions: in 2006, the number of prevalent cases nearly doubled compared to 1992. The increase over time in the proportion of elderly patients, related to population ageing, requires adequate health policies. Knowing the number of people alive
many years after cancer diagnosis (either cured or long-term survivors) provides the scientific bases for the definition of health
policies focusing on them. Furthermore, it promotes the conduction of studies aimed at improving the present knowledge on the
quality of life of these patients during and after the active phase of treatments, in addition to studies on the long-term effects of treatments.
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