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Emanuele Crocetti

Publications and source records attributed to Emanuele Crocetti.

At least 19 recordsLinked to original sources
PubMed2007

Melanoma incidence in central Italy will go on increasing also in the near future: a registry-based, age-period-cohort analysis.

The aim of the study was to evaluate malignant melanoma incident trends in central Italy by means of an age-period-cohort approach. A total of 1977 malignant melanoma (15-84 years) incidents in the area of the Tuscany Cancer Registry between 1987 and 2001 were analysed. Poisson regression has been used to estimate age, cohort and period effect. A nonlinear regression model was used to estimate the expected number of new cases in the period 2002-2006. Incidence rates increased in all age, period and cohort groups. The model that best fitted the data included age and 'drift'. The linear effect ('drift') showed, in each age group, an increase of the risk of malignant melanoma diagnosis of about 36.6% every 5 years of period or cohort. For the period 2002-2006, 1112 new cases were predicted with a standardized rate (age 15-84 years) of 19.2x100.000. In the Tuscany Cancer Registry area, no clues for malignant melanoma incidence rates levelling off were documented. Growing rates and number of malignant melanoma are expected in the near future.

Adolescent↗
PubMed2006

Prognostic variability among nonsmall cell lung cancer patients with pathologic N1 lymph node involvement. Epidemiological figures with strong clinical implications.

BACKGROUND: Patients who have nonsmall cell lung cancer with N1 lymph node status are an intermediate group of patients who have a variable prognosis. Differences in lymph node level (hilar or pulmonary lymph nodes) may influence patient survival. The authors retrospectively analyzed the factors that influenced prognosis, including the level of N1 lymph node involvement. METHODS: The authors used the Tuscan Cancer Registry archives to retrieve records on 2523 patients who had lung tumors diagnosed during the period from 1996 and 1998 in the provinces of Florence and Prato, central Italy. To analyze the survival of patients according to the level of lymph node involvement, the prognoses of patients with nonsmall cell lung cancer who had N1 lymph node status were compared in a population-based case series. Among 112 patients with pathologic N1 status, the following variables were analyzed for their influence on postoperative survival: gender, age, cell type, pathologic tumor status, the number of metastatic lymph nodes, the level of metastatic lymph nodes (hilar or pulmonary), and the type of surgical resection. RESULTS: The 5-year survival rates for patients who had involvement of pulmonary and hilar lymph nodes were 41.2% and 21.8%, respectively (P =.005). A Cox proportional hazards model analysis indicated that the presence of hilar lymph node involvement was an independent prognostic factor. CONCLUSIONS: N1 pathologic lymph node status was identified in a combination of subgroups with different prognoses, and the presence of hilar lymph node disease had prognostic significance. This difference in survival may lead to the use of different therapies for these subgroups of patients with pathologic N1 non-small cell lung cancer.

Adult↗
PubMed2006

Prostate cancer specific mortality in the Florence screening pilot study cohort 1992-1993.

The impact of screening on prostate cancer mortality is still unknown. A favourable impact is suggested by uncontrolled and possibly biased studies. Mortality from all causes and from prostate cancer was assessed in a cohort of 6,861 males aged 60-74 years, participants to a pilot screening study during 1991-1994. Observed/expected mortality was determined by linkage with cancer and mortality registries. Prostate cancer standardised mortality rate (SMR) in the overall series (751 subjects excluded by GPs for disabling illness or prostate cancer; 3,448 refusers, 2,662 attenders; 67,321.2 men-year) was 0.96 (95% confidence interval (CI)=0.74-1.22) when deaths from prevalent cancers diagnosed before screening were considered. Reduced prostate cancer mortality (SMR=0.48; 95% CI=0.26-0.83), persisting beyond five years after study entry (SMR=0.48; 95% CI=0.22-0.90), was observed in attenders and not in refusers (SMR=0.99; 95% CI=0.69-1.37). This finding might suggest a screening effect, but might also be ascribed to an healthy screening effect, and cannot be assumed as a reliable evidence of screening efficacy.

Aged↗
PubMed2006

Baseline factors influencing decisions on digital follow-up of melanocytic lesions in daily practice: an Italian multicenter survey.

BACKGROUND: Guidelines for optimized use of digital follow-up of melanocytic lesions are not yet available, and little is known about inclusion criteria adopted in clinical practice. OBJECTIVE: Our purpose was to describe the frequency of digital follow-up adoption in melanoma screening, the characteristics of patients and lesions selected, and the predictors of duration of the intervals of digital follow-up. METHODS: Baseline characteristics of patients and lesions selected for digital follow-up in 12 Italian pigmented lesion clinics were examined. Predictors of a short follow-up interval ( 4.75) was associated only with a marginal effect on the scheduled duration of follow-up interval (OR 1.34, 95% CI 0.97-1.86). These findings were confirmed by a multivariate analysis. LIMITATIONS: The adoption of different digital dermoscopy systems in the participating centers may have limited the reliability of the TDS assigned by a central group to dermoscopy images. CONCLUSIONS: Practicing dermatologists who use digital epiluminescence microscopy in screening for melanoma decided to submit at least one melanocytic lesion to digital follow-up for approximately 1 patient for every 5 examined. This implies costs and time spent that need to be evaluated together with the benefits of this procedure from a large-scale perspective. The lack of well-defined guidelines for inclusion and exclusion criteria may hamper optimized use of digital follow-up in daily practice.

Adult↗
PubMed2006

Time trends of cancer incidence in European children (1978-1997): report from the Automated Childhood Cancer Information System project.

Within the framework of the Automated Childhood Cancer Information System (ACCIS), time trend analyses for childhood cancer were performed using data from 33 population-based cancer registries in 15 European countries for the period 1978-1997. The overall incidence rate based on 77,111 cases has increased significantly (P<0.0001), with an average annual percentage change (AAPC) of 1.1%. The rising trend was observed in all five geographical regions and in the majority of the disease groups (in order of AAPC): soft tissue sarcomas (1.8%), brain tumours, tumours of the sympathetic nervous system, germ-cell tumours, carcinomas, lymphomas, renal tumours, and leukaemias (0.6%). No change was seen in incidence of bone tumours, hepatic tumours and retinoblastoma. The increased incidence can only partly be explained by changes in diagnostic methods and by registration artefacts. The patterns and magnitude of these increases suggest that other factors, e.g. changes in lifestyle and in exposure to a variety of agents, have contributed to the increase in childhood cancer in the recent decades.

Adolescent↗
PubMed2006

Prognostic variables and prognostic groups for malignant melanoma. The information from Cox and Classification And Regression Trees analysis: an Italian population-based study.

The common way to analyse the prognostic role of selected variables in cutaneous melanoma patients is by means of Cox proportional hazard model. The prognostic effect of the simultaneous presence of more than one independent variable in the same patient is, however, difficult to establish. This hampers the possibility of tailoring a survival expectance for a selected patient as well as to communicate it to the patient himself/herself. The objectives of the study were to compare information on cutaneous melanoma prognosis from multivariate Cox proportional hazard model and from Classification And Regression Trees analysis. Classification And Regression Trees analysis is an automatic method that splits data by means of a binary recursive process creating a 'tree' of groups with different profiles according to the analysed outcome, for example, the risk of death. This approach automatically produces data that is easily interpreted by clinicians. A total of 1403 invasive cutaneous melanoma patients, 1110 from the Tuscan Cancer Registry and 293 from the Reggio Emilia Cancer Registry, Italy, were included. Cases were incident during 1996-2001 and followed up at the end of 2003. Cox proportional hazard model and Classification And Regression Trees analysis were applied to the following variables: age, sex, Breslow thickness, Clark level, registry, subsite and morphologic type. The Classification And Regression Trees analysis identified 10 categories with statistically different survival; this results were summarized into six classes of different risks based on Breslow thickness, age and sex. The best prognostic group (5-year observed survival, 98.1%) included those subjected with Breslow less than 0.94 mm and age 19-44 years. The same thickness but an older age (50-69 years) was associated with a statistically significant different prognosis (5-year observed survival, 92.8%). The Cox proportional hazard model found sex, age, Breslow thickness, Clark and morphologic type to have a significant independent prognostic value. In conclusion, compared with the conventional approach based on Cox hazard model, Classification And Regression Trees analysis produces data closer to the clinical need of defining the prognostic profile of a specific patient. This may help the clinician both in the communication of risk and in the follow-up strategy.

Adult↗
PubMed2006

Mortality among discharged psychiatric patients in Florence, Italy.

OBJECTIVE: Psychiatric disorders involve an increased risk of mortality. In Italy psychiatric services are community based, and hospitalization is mostly reserved for patients with acute illness. This study examined mortality risk in a cohort of psychiatric inpatients for 16 years after hospital discharge to assess the association of excess mortality from natural or unnatural causes with clinical and sociodemographic variables and time from first admission. METHODS: At the end of 2002 mortality and cause of death were determined for all patients (N=845) who were admitted during 1987 to the eight psychiatric units active in Florence. The mortality risk of psychiatric patients was compared with that of the general population of the region of Tuscany by calculating standardized mortality ratios (SMRs). Poisson multivariate analyses of the observed-to-expected ratio for natural and unnatural deaths were conducted. RESULTS: The SMR for the sample of psychiatric patients was threefold higher than that for the general population (SMR=3.0; 95 percent confidence interval [CI]=2.7-3.4). Individuals younger than 45 years were at higher risk (SMR=11.0; 95 percent CI 8.0-14.9). The SMR for deaths from natural causes was 2.6 (95 percent CI=2.3-2.9), and for deaths from unnatural causes it was 13.0 (95 percent CI=10.1-13.6). For deaths from unnatural causes, the mortality excess was primarily limited to the first years after the first admission. For deaths from natural causes, excess mortality was more stable during the follow-up period. CONCLUSIONS: Prevention of deaths from unnatural causes among psychiatric patients may require promotion of earlier follow-up after discharge. Improving prevention and treatment of somatic diseases of psychiatric patients is important to reduce excess mortality from natural causes.

Adolescent↗
PubMed2005

Early diagnosis, not differential treatment, explains better survival in service screening.

Italian population-based breast cancer screening programmes with 2-year, high-quality mammography started in the cities of Florence and Turin in the early 1990s. Breast cancer cases from the local Tumour Registry were classified by method of detection and tumour characteristics (size, nodal-status and grade). Follow-up was at December 2001. In total, 4444 breast cancer cases were analysed. The Hazard Ratio comparing before and after-invitation breast cancer cases indicated a 27% reduction (HR=0.73; 95%CI: 0.61-0.87) in the risk of dying for the disease. After adjustment for tumour characteristics, survival rate was comparable by invitation status, whereas the proportion of early cancer was 33.7% and 46.6% in the before and after-invitation group. Survival rates by tumour characteristic subgroups was comparable by invitation status. Late stage and grade 3 were indicators of poor prognosis. Adjustment for tumour characteristics confirmed screening and not differential treatment as the most important reason for the observed survival benefit. The survival analysis by specific subgroups did not support the hypothesis that the difference in prognosis was attributable to differential treatment.

Aged↗
PubMed2005

Determining overdiagnosis by screening with DRE/TRUS or PSA (Florence pilot studies, 1991-1994).

The rate of overdiagnosis of prostate carcinoma was assessed by following 6890 participants in pilot screening studies from 1991 to 1994. Observed/expected incidence and mortality were determined using data from the Cancer and Mortality Registry. The cancer detection rate (1.75%) and observed/expected ratio (12.5:1) were high at the first screening, and substantially lower at the second screening (0.65% or 4.10:1). According to the registry follow-up, prostate cancer occurred in 225 subjects in the whole study cohort, while 178.2 were expected with 50652 men/years at risk. The standardised incidence rate was 1.66 in the screened (95%CI=1.4-2.0), 0.97 in the non-responders (95%CI=0.8-1.2) and 1.23 in subjects excluded from invitation due to previous cancer or major illness (95%CI=0.8-1.5). A 66% excess incidence rate was observed in the screened subjects over a 9-year period, confirming previous estimates of overdiagnosis.

Aged↗
PubMed2005

Seasonal variation in the diagnosis of cutaneous melanoma and non-cutaneous malignancies: an Italian population-based study.

The aim of the present study was to investigate whether or not the diagnosis of cutaneous melanoma and non-cutaneous tumours shows seasonal variations. Data from the Tuscany Cancer Registry, central Italy, for malignant cutaneous melanomas (no. 2062) and non-skin cancers (no. 114,755), diagnosed during 1985-2000, were used to evaluate the monthly variation in the number of diagnoses. The chi-squared test was used to evaluate the heterogeneity in the monthly number of cancer diagnoses throughout the year and to compare monthly proportions between groups. Poisson multivariate regression was used to estimate the monthly risk of cancer diagnosis. Clear monthly variations were evident for both melanoma and non-cutaneous cancers, but the monthly diagnosis distributions differed. Statistically significant peaks in June [relative risk (RR), 1.54] and July (RR, 1.40) and a lower risk for January (RR, 0.76), in comparison with the mean monthly value, were documented for melanoma. Monthly risks were similar for thin (< or =1 mm) and thick (>1 mm) melanomas and for males and females. A peak in May-June and October and significantly lower numbers of cases in August and December were detected for all non-skin cancers. The holiday periods may influence the seasonality in the diagnosis of melanomas and non-cutaneous cancers. However, the monthly fluctuation for melanoma differed from that for non-cutaneous cancers; the peak in July suggests an additional effect of summer clothing, with fewer clothes worn and more skin visible, on melanoma diagnosis.

Female↗
PubMed2004

Increasing trends of cervical adenocarcinoma incidence in Central Italy despite Extensive Screening Programme, 1985-2000.

Incidence rates of adenocarcinoma of the uterine cervix have been reported to be increasing in several countries, but not in Italy. The aim of the present study was to analyse trends in cervical cancer incidence by histological type in two districts of Central Italy (Florence and Prato), covered by the Tuscany Cancer Registry (RTT), where cytological screening had been available since the 1970s. Incident cervical cancers during 1985-2000 were 1012. Estimated Annual Percent Change (EAPC) by age-groups and histological type were computed. Incidence increased for adenocarcinoma (EAPC = +5.7%; 95% confidence interval (CI)+2.8; +8.6); whereas, it decreased for squamous cancer (EAPC = -1.9%; 95% CI-3.8; 0) and for other or not specified types (EAPC = -4.4%; 95% CI-10.0; +1.5). Adenocarcinoma increased significantly among younger women (<55 years) but not among older ones, whereas squamous cell cancer decreased among older women only. The burden of cervical cancers might increase in the future if no specific preventive strategies for adenocarcinoma are implemented.

Adenocarcinoma↗
PubMed2004

Addition of dermoscopy to conventional naked-eye examination in melanoma screening: a randomized study.

OBJECTIVE: We sought to assess the difference in lesion management between combined examination (naked-eye and dermoscopy) and conventional naked-eye examination in evaluations for melanoma; and to assess the impact on patient treatment of facilities for digital follow-up of diagnostically equivocal lesions. METHODS: We conducted a randomized, controlled trial at a pigmented lesion clinic in a university hospital. A total of 938 consecutive subjects presenting between November 1, 2001, and March 31, 2002, were eligible and 25 were excluded because they were younger than 12 years of age; hence 913 subjects were enrolled. Participants were randomized to combined examination with mandatory excision of equivocal lesion (arm B) and with possibility of digital follow-up according to the clinician's decision (arm C), or to conventional naked-eye examination (mandatory excision of equivocal lesion) (arm A). The same pigmented lesion clinic staff examined all subjects. RESULTS: Combined examination determined a significant reduction in the percentage of patients referred for operation (9.0% vs 15.6%) (P =.013). When facilities for digital follow-up of equivocal lesions were available, the percentage of patients classified as harboring lesions difficult to diagnose increased (group C, 35.8%; group B, 17.8%; P <.01). About half of them were immediately referred for operation whereas the remainder submitted to second examination (digital follow-up). Two melanomas (1 in situ and 1 invasive, 0.40-mm thick) were diagnosed after second examination performed 6 months later. The number of melanomas eventually excised within the study were similar among the 3 allocation groups (3, 2, and 3, respectively). CONCLUSIONS: the addition of dermoscopy to conventional naked-eye examination is associated with a significant reduction of number of pigmented skin lesions excised for diagnostic verification. The possibility of digital follow-up of equivocal lesions is associated with a not negligible occurrence of initial melanomas left unexcised until the second consultation.

Adult↗
PubMed2004

Frequency and characteristics of melanomas missed at a pigmented lesion clinic: a registry-based study.

To ensure the removal of all melanomas at an early phase, a number of benign lesions are currently excised for diagnostic evaluation. Nevertheless, little is known about the frequency of melanomas missed (neither recognized nor excised for diagnostic verification) by early detection practices. This study aimed to investigate the diagnostic performance of a specialized pigmented lesion clinic (PLC) through linkage with a local cancer registry. In 1997, 1741 individuals resident in the area of Florence and Prato, Italy, the catchment area of the Tuscany Cancer Registry (RTT), were consecutively examined at a specialized PLC that has been running since 1992 at the Department of Dermatology of Florence. The outcomes of dermatological consultations retrieved from PLC case notes were compared with all the diagnoses of both in situ and invasive melanoma recorded by the RTT until 31 December 1999. The performance of the PLC in detecting cutaneous melanoma was evaluated in terms of sensitivity, specificity and predictive values, with the RTT data as the gold standard. In the population examined at the PLC, 15 newly incident melanomas, all histologically demonstrated, were recorded by the RTT. In 13 of the 15 cases, excision of the lesion had been recommended by PLC staff, while two melanomas, one in situ and one level II 0.60 mm thick invasive, were missed and were subsequently excised 586 and 824 days, respectively, after the first PLC examination. The clinical and dermoscopic features of the invasive lesion were in agreement with a 'featureless' melanoma, and lacked the well-established parameters of malignancy. A total of 67 benign pigmented skin lesions were excised for diagnostic evaluation. Thus the PLC showed a sensitivity in detecting cutaneous melanoma of 86.7% (95% confidence interval [CI] 85.1-88.3%), a specificity of 95.4% (95% CI 94.3-96.3%), a positive predictive value of 13.7% (95% CI 12.1-15.3%) and a negative predictive value of 99.9% (95% CI 99.7-100.0%). The ratio of melanomas to benign skin lesions excised was 1:5.1. In conclusion, specialized examination of pigmented skin lesions at the PLC offered good level of diagnostic performance, with an acceptable cost in terms of benign lesions removed and overall a low risk of missing melanomas.

Adult↗
PubMed2003

Expansion of natural killer cells in patients with head and neck cancer: detection of "noninhibitory" (activating) killer Ig-like receptors on circulating natural killer cells.

BACKGROUND: In a group of patients with head and neck cancers (H&NC), the expansion of the population of CD3-,CD16+ natural killer (NK) cells in the peripheral blood was studied. METHODS: Cytofluorimetric analysis of the expression of killer Ig-like receptors (KIR, namely p58.1, p58.2, p58.3, p70, and p140) and CD94-NKG2a was performed. Cytolytic activities were studied using 51Cr release assay. T and NK cell cloning was performed using limiting dilution culture conditions. Cytokine production was analyzed using commercial enzyme immunoassays. RESULTS: Phenotypic analysis showed that the expanded populations were heterogeneous. Even in the presence of a large number of circulating NK cells, "nonspecific" cytolytic capacities were heavily reduced, whereas cytolytic capacity related to T cells was virtually normal. Unlike NK cell clones derived from healthy donors, most NK cells derived from H&NC patients expressed surface "activating" NK cell receptors (KAR) for HLA, detected by use of a redirected cytolytic assay. Analysis of the CD4+ subpopulation at the clonal level demonstrated that they had a severe proliferative defect. CONCLUSION: These experimental data indicated that H&NC patients have a polyclonal expansion of functionally deficient NK cells expressing KAR. In addition, the proliferative capacity of patients' "helper" cells was strongly inhibited, thus accounting for a severe impairment of cytolytic activity of the expanded NK cells.

Cohort Studies↗
PubMed2003

Palliative home care reduces time spent in hospital wards: a population-based study in the Tuscany Region, Italy.

OBJECTIVE: To estimate the reduction of time spent in hospital obtained through palliative home care. METHODS: Retrospective analysis of the hospital admissions occurred during the last year of life. Cancer patients who were resident in the province of Florence, were registered at the Tuscan Cancer Registry, and died during the year 1997 were included in the study. Three palliative home care services were operating in the study area in 1997. MAIN RESULTS: 3423 cancer patients died in the study area during 1997. 9.2% of them received palliative home care. Palliative home care was effective in reducing the utilization of hospital care during the last three months of life. A 25% reduction of the relative risk (CI: 34-14%) to have in-patient admissions and a 49% reduction of relative risk (CI: 52-47%) of spending days in the hospital during the last 3 months of life were estimated through multivariable regression models. CONCLUSIONS: Palliative home care was effective in reducing time spent in hospital during the last 3 months of life.

Adult↗