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1. Minor Hepatectomies: Focusing a Blurred Picture: Analysis of the Outcome of 4471 Open Resections in Patients Without Cirrhosis

Author

Viganò, L, Torzilli, G, Troisi, R, Aldrighetti, L, Ferrero, A, Majno, P, Toso, C, Figueras, J, Cherqui, D, Adam, R, Kokudo, N, Hasegawa, K, Guglielmi, A, Krawczyk, M, Giuliante, Felice, Hilal, Ma, Costa-Maia, J, Pinna, Ad, Cescon, M, De Santibanes, E, Urbani, L, Pawlik, T, Costa, G, Zugna, D, Clisco, Group., Vigano, L., Torzilli, G., Troisi, R., Aldrighetti, L., Ferrero, A., Majno, P., Toso, C., Figueras, J., Cherqui, D., Adam, R., Kokudo, N., Hasegawa, K., Guglielmi, A., Krawczyk, M., Giuliante, F., Hilal, M. A., Costa-Maia, J., Pinna, A. D., Cescon, M., De Santibanes, E., Urbani, L., Pawlik, T., Costa, G., Zugna, D., Vigano L., Torzilli G., Troisi R., Aldrighetti L., Ferrero A., Majno P., Toso C., Figueras J., Cherqui D., Adam R., Kokudo N., Hasegawa K., Guglielmi A., Krawczyk M., Giuliante F., Hilal M.A., Costa-Maia J., Pinna A.D., Cescon M., De Santibanes E., Urbani L., Pawlik T., Costa G., and Zugna D.

Subjects
Liver surgery, Liver Cirrhosis, Male, Cirrhosis, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, Severity of Illness Index, Cohort Studies, 0302 clinical medicine, Postoperative Complications, Laparotomy/methods, Medicine, liver surgery, ddc:617, Liver Cirrhosis/mortality/pathology/surgery, Liver Diseases, Middle Aged, Prognosis, Postoperative Complications/mortality/physiopathology, Treatment Outcome, 030220 oncology & carcinogenesis, classification of hepatectomie, 030211 gastroenterology & hepatology, Female, Adult, Minor Hepatectomies, Hepatectomy/adverse effects/methods, medicine.medical_specialty, classification of hepatectomies, Liver Diseases/mortality/pathology/surgery, 03 medical and health sciences, Severity of illness, overall and severe morbidity, Hepatectomy, Humans, In patient, Aged, Retrospective Studies, Analysis of Variance, Laparotomy, business.industry, Background data, liver failure, minor hepatectomy, Retrospective cohort study, bile leak, medicine.disease, Survival Analysis, Surgery, major hepatectomy, Multicenter study, Multivariate Analysis, parenchyma-sparing surgery, business, Hospitals, High-Volume
Abstract

OBJECTIVE: To elucidate minor hepatectomy (MiH) outcomes. SUMMARY BACKGROUND DATA: Liver surgery has moved toward a parenchyma-sparing approach, favoring MiHs over major resections. MiHs encompass a wide range of procedures. METHODS: We retrospectively evaluated consecutive patients who underwent open liver resections in 17 high-volume centers. EXCLUSION CRITERIA: cirrhosis and associated digestive/biliary resections. Resections were classified as (Brisbane nomenclature): limited resections (LR); (mono)segmentectomies/bisegmentectomies (Segm/Bisegm); right anterior and right posterior sectionectomies (RightAnteriorSect/RightPosteriorSect). Additionally, we defined: complex LRs (ComplexLR = LRs with exposed vessels); postero-superior segmentectomies (PosteroSuperiorSegm = segment (Sg)7, Sg8, and Sg7+Sg8 segmentectomies); and complex core hepatectomies (ComplexCoreHeps = Sg1 segmentectomies and combined resections of Sg4s+Sg8+Sg1). Left lateral sectionectomies (LLSs, n = 442) and right hepatectomies (RHs, n = 1042) were reference standards. Outcomes were adjusted for potential confounders. RESULTS: Four thousand four hundred seventy-one MiHs were analyzed. Compared with RHs, MiHs had lower 90-day mortality (0.5%/2.2%), severe morbidity (8.6%/14.4%), and liver failure rates (2.4%/11.6%, P < 0.001), but similar bile leak rates. LR and LLS had similar outcomes. ComplexLR and Segm/Bisegm of anterolateral segments had higher bile leak rates than LLS rates (OR = 2.35 and OR = 3.24), but similar severe morbidity rates. ComplexCoreHeps had higher bile leak rates than RH rates (OR = 1.94); the severe morbidity rate approached that of RH. PosteroSuperiorSegm, RightAnteriorSect, and RightPosteriorSect had severe morbidity and bile leak rates similar to RH rates. MiHs had low liver failure rates, except RightAnteriorSect (vs LLS OR = 4.02). CONCLUSIONS: MiHs had heterogeneous outcomes. Mortality was low, but MiHs could be stratified according to severe morbidity, bile leak, and liver failure rates. Some MiHs had postoperative outcomes similar to RH.

Published
2019

2. Smoking addiction and the risk of upper-aerodigestive-tract cancer in a multicenter case-control study

Author

Lee, Y.C., Zugna, D., Richiardi, L., Merletti, F., Marron, M., Ahrens, W., Pohlabeln, H., Lagiou, P., Trichopoulos, D., Agudo, A., Castellsague, X., Betka, J., Holcatova, I., Kjaerheim, K., Macfarlane, G.J., Macfarlane, T.V., Talamini, R., Barzan, ., Canova, C., Simonato, L., Conway, D.I., McKinney, P.A., Thomson, P., Znaor, Ariana, Healy, C.M., McCartan, B.E., Boffetta, P., Brennan, P., Hashibe, M., Lee, Y.-C.A., Zugna, D., Richiardi, L., Merletti, F., Marron, M., Ahrens, W., Pohlabeln, H., Lagiou, P., Trichopoulos, D., Agudo, A., Castellsague, X., Betka, J., Holcatova, I., Kjaerheim, K., Macfarlane, G.J., Macfarlane, T.V., Talamini, R., Barzan, L., Canova, C., Simonato, L., Conway, D.I., McKinney, P.A., Thomson, P., Znaor, A., Healy, C.M., McCartan, B.E., Boffetta, P., Brennan, P., and Hashibe, M.

Subjects
Adult, Male, Alcohol Drinking, alcohol, Smoking, Middle Aged, tobacco, Europe, Logistic Models, smoking addiction, upper-aerodigestive-tract cancer, Head and Neck Neoplasms, Risk Factors, Case-Control Studies, Surveys and Questionnaires, Carcinoma, Squamous Cell, Humans, Female, Mouth Neoplasms, upper-aerodigestive-tract (UADT) cancers, Aged
Abstract

Although previous studies on tobacco and alcohol and the risk of upper-aerodigestive-tract (UADT) cancers have clearly shown dose-response relations with the frequency and duration of tobacco and alcohol, studies on addiction to tobacco smoking itself as a risk factor for UADT cancer have not been published, to our knowledge. The aim of this report is to assess whether smoking addiction is an independent risk factor or a refinement to smoking variables (intensity and duration) for UADT squamous cell carcinoma (SCC) risk in the multicenter case-control study (ARCAGE) in Western Europe. The analyses included 1,586 ever smoking UADT SCC cases and 1,260 ever smoking controls. Addiction was measured by a modified Fagerström score (first cigarette after waking up, difficulty refraining from smoking in places where it is forbidden and cigarettes per day). Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for UADT cancers with addiction variables were estimated with unconditional logistic regression. Among current smokers, the participants who smoked their first cigarette within 5 min of waking up were two times more likely to develop UADT SCC than those who smoked 60 min after waking up. Greater tobacco smoking addiction was associated with an increased risk of UADT SCC among current smokers (OR = 3.83, 95% CI: 2.56-5.73 for score of 3-7 vs. 0) but not among former smokers. These results may be consistent with a residual effect of smoking that was not captured by the questionnaire responses (smoking intensity and smoking duration) alone, suggesting addiction a refinement to smoking variables. What's new? Previous studies have clearly shown dose-response relationships between tobacco/alcohol use and the risk of upper-aerodigestive- tract (UADT) cancers, but these studies have focused only on the variables of frequency and duration of use. In this study, the authors asked whether addiction to smoking might be an independent risk factor. They found that addiction was indeed associated with UADT cancer risk among current smokers. This addiction-cancer association suggests that it is important to include questions that elicit information regarding smoking addiction when accounting for smoking effect through questionnaire information. Copyright © 2013 UICC.

Published
2013

3. Marriage and parenthood among childhood cancer survivors: a report from the Italian AIEOP Off-Therapy Registry

Author

Pivetta, E, Maule, Mm, Pisani, P, Zugna, D, Haupt, R, Jankovic, M, Aricò, M, Casale, F, Clerico, A, Cordero di Montezemolo, L, Kiren, V, Locatelli, F, Palumbo, G, Pession, A, Pillon, M, Santoro, N, Terenziani, M, Valsecchi, Mg, Dama, E, Magnani, C, Merletti, F, Pastore, G, Fagioli, F, Bona, G, Dini, G, Carnelli, V, Biondi, A, Zecca, M, Conter, V, Porta, F, Fedeli, F, Massimino, M, Nespoli, L, Roncarolo, Mg, Carli, M, Cesaro, S, Memo, L, Colleselli, P, Battisti, L, Tamaro, Paolo, Mascarin, M, Nocerino, A, Izzi, G, Paolucci, P, Borgna, Pc, Vecchi, V, Abate, Me, Acquaviva, A, Favre, C, Aversa, F, Pierani, P, Felici, L, Visani, G, Fioritoni, G, Foa, R, Riccardi, R, Frega, G, Poggi, V, Amendola, G, Filosa, A, Ladogana, S, Presta, G, Pozzi, S, De Mattia, D, Consarino, C, Nobile, F, Sperlì, D, D'Angelo, P, Marino, S, Gallisai, D, Targhetta, R., Pivetta, E, Maule, M, Pisani, P, Zugna, D, Haupt, R, Jankovic, M, Aricò, M, Casale, F, Clerico, A, Cordero di Montezemolo, L, Kiren, V, Locatelli, F, Palumbo, G, Pession, A, Pillon, M, Santoro, N, Terenziani, M, Valsecchi, M, Dama, E, Magnani, C, Merletti, F, Pastore, G, Maule, Mm, Valsecchi, Mg, Fagioli, F, Bona, G, Dini, G, Carnelli, V, Biondi, A, Zecca, M, Conter, V, Porta, F, Fedeli, F, Massimino, M, Nespoli, L, Roncarolo, Mg, Carli, M, Cesaro, S, Memo, L, Colleselli, P, Battisti, L, Tamaro, Paolo, Mascarin, M, Nocerino, A, Izzi, G, Paolucci, P, Borgna, Pc, Vecchi, V, Abate, Me, Acquaviva, A, Favre, C, Aversa, F, Pierani, P, Felici, L, Visani, G, Fioritoni, G, Foa, R, Riccardi, R, Frega, G, Poggi, V, Amendola, G, Filosa, A, Ladogana, S, Presta, G, Pozzi, S, De Mattia, D, Consarino, C, Nobile, F, Sperlì, D, D'Angelo, P, Marino, S, Gallisai, D, and Targhetta, R.

Subjects
Adult, Male, Parents, Pediatrics, medicine.medical_specialty, Total fertility rate, media_common.quotation_subject, Population, Editorials and Perspectives, Fertility, off-therapy, cancer survival, Cohort Studies, Quality of life, Marriage and parenthood, Medicine, Humans, cancer, cancer survivors, childhood, Registries, Survivors, Marriage, education, Child, media_common, education.field_of_study, business.industry, Infant, Newborn, Infant, Hematology, Original Articles, Middle Aged, childhood cancer, fertility, long-term survivors, marriage, quality of life, El Niño, Italy, Child, Preschool, Hematologic Neoplasms, Cohort, Marital status, Female, business, Cohort study, Follow-Up Studies
Abstract

Background The aim of this study was to describe the patterns of marriage and parenthood in a cohort of childhood cancer survivors included in the Off-Therapy Registry maintained by the Italian Association of Pediatric Hematology and Oncology. Design and Methods We analyzed a cohort of 6,044 patients diagnosed with cancer between 1960 and 1998, while aged 0 to 14 years and who were 18 years old or older by December 2003. They were followed up through the regional vital statistics registers until death or the end of follow up (October 30, 2006), whichever occurred first, and their marital status and date of birth of their children were recorded. The cumulative probabilities of being married and having a first child were computed by gender and compared by tumor type within the cohort. Marriage and fertility rates (the latter defined as the number of live births per woman-year) were compared with those of the Italian population of the same age, gender, area of residence and calendar period by means of the observed to expected (O/E) ratios. Results During the follow-up period, 4,633 (77%) subjects had not married. The marriage O/E ratios were 0.56 (95% CI: 0.51-0.61) and 0.70 (95% CI: 0.65-0.76) among men and women, respectively. Overall, 263 men had 367 liveborn children, and 473 women had 697 liveborn children. The female fertility O/E ratio was 0.57 (95% CI: 0.53-0.62) overall, and 1.08 (95% CI: 0.99-1.17) when analyses were restricted to married/cohabiting women Conclusions Childhood cancer survivors are less likely to marry and to have children than the general population, confirming the life-long impact of their previous disease on their social behavior and choices. The inclusion of counseling in the strategies of management and long-term surveillance of childhood cancer patients could be beneficial to survivors as they approach adulthood. ©2011 Ferrata Storti Foundation.

Published
2011

4. Stratification of Major Hepatectomies According to Their Outcome

Author

Viganò, Luca, Torzilli, Guido, Aldrighetti, Luca, Ferrero, Alessandro, Troisi, Roberto, Figueras, Joan, Cherqui, Daniel, Adam, René, Kokudo, Norihiro, Hasegawa, Kiyoshi, Guglielmi, Alfredo, Majno, Pietro, Toso, Christian, Krawczyk, Marek, Abu Hilal, Mohammad, Pinna, Antonio Daniele, Cescon, Matteo, Giuliante, Felice, De Santibanes, Eduardo, Costa-Maia, José, Pawlik, Timothy, Urbani, Lucio, Zugna, Daniela, CLISCO group, Vigano, L., Torzilli, G., Aldrighetti, L., Ferrero, A., Troisi, R., Figueras, J., Cherqui, D., Adam, R., Kokudo, N., Hasegawa, K., Guglielmi, A., Majno, P., Toso, C., Krawczyk, M., Abu Hilal, M., Pinna, A. D., Cescon, M., Giuliante, F., De Santibanes, E., Costa-Maia, J., Pawlik, T., Urbani, L., and Zugna, D.

Subjects
Liver Cirrhosis, Male, Cirrhosis, medicine.medical_treatment, Outcome analysis, Stratification (mathematics), 0302 clinical medicine, liver surgery, extended hepatectomy, Right hepatectomy, ddc:617, Liver Diseases, Liver Neoplasms, Confounding, Middle Aged, postoperative mortality, Outcome and Process Assessment, Health Care, Classification of hepatectomies, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, medicine.medical_specialty, Major hepatectomy, right hepatectomy, MEDLINE, classification of hepatectomies, Outcome and Process Assessment, 03 medical and health sciences, Text mining, medicine, Hepatectomy, Humans, Bile leak, bile leak, liver failure, major hepatectomy, severe morbidity, Aged, Retrospective Studies, In patient, Liver surgery, Postoperative mortality, business.industry, General surgery, Liver failure, Retrospective cohort study, Odds ratio, medicine.disease, Surgery, Health Care, Extended hepatectomy, Severe morbidity, Liver function, business
Abstract

Objective To stratify major hepatectomies (MajHs) according to their outcomes. Summary of background data MajHs are associated with non-negligible operative risks, but they include a wide range of procedures. Detailed depiction of the outcomes of different MajHs is the basis for a new classification of liver resections. Methods We retrospectively considered patients that underwent hepatectomy in 17 high-volume centers. Patients with an associated digestive/biliary resection were excluded. We analyzed open MajHs in non-cirrhotic patients. MajHs were classified according to the Brisbane nomenclature. Right hepatectomies (RHs) were reference standards. Outcomes were adjusted for potential confounders, including indication, liver function, preoperative portal vein embolization, and enrolling center. Results We analyzed a series of 2212 patients. In comparison with RH, left hepatectomy had lower mortality [0.6% vs 2.2%, odds ratio (OR) = 0.25], severe morbidity (11.7% vs 14.4%, OR = 0.62), and liver failure rates (2.1% vs 11.6%, OR = 0.16). Left hepatectomy+Sg1 and mesohepatectomy+/-Sg1 had outcomes similar to RH, except for higher bile leak rate (31.3% and 13.5% vs 6.7%, OR = 4.36 and OR = 2.29). RH + Sg1 had slightly worse outcomes than RH. Right and left trisectionectomies had higher mortality (5.0% and 7.3% vs 2.2%, OR = 2.07 and OR = 2.71) and liver failure rates than RH (19.0% and 22.0% vs 11.6%, OR = 2.03 and OR = 2.21). Left trisectionectomy had even higher severe morbidity (25.6% vs 14.4%, OR = 2.07) and bile leak rates (14.6% vs 6.7%, OR = 2.31). Conclusions The term "major hepatectomy" includes resections having heterogeneous outcome. Different MajHs can be stratified according to their mortality, severe morbidity, liver failure, and bile leak rates.

Published
2020

5. Maternal complications in pregnancy and wheezing in early childhood: a pooled analysis of 14 birth cohorts

Author

Daniela Zugna, John Penders, Lorenzo Richiardi, Claudia Galassi, Agnes M.M. Sonnenschein-van der Voort, Ulrike Steuerwald, Isabella Annesi-Maesano, Sofia Correia, Henrique Barros, Francesco Forastiere, Mikel Basterrechea, Nour Baïz, Pernille Stemann Larsen, Maria Skaalum Petersen, Jordi Sunyer, Martine Vrijheid, Maria Pia Fantini, Anne-Marie Nybo Andersen, Monique Mommers, Hazel Inskip, Ana Esplugues, Franca Rusconi, Daniela Porta, Mireia Gascon, Maties Torrent, Davide Gori, Katharine C. Pike, Liesbeth Duijts, Zugna D, Galassi C, Annesi-Maesano I, Baïz N, Barros H, Basterrechea M, Correia S, Duijts L, Esplugues A, Fantini MP, Forastiere F, Gascon M, Gori D, Inskip H, Larsen PS, Mommers M, Nybo Andersen AM, Penders J, Petersen MS, Pike K, Porta D, Sonnenschein-van der Voort A, Steuerwald U, Sunyer J, Torrent M, Vrijheid M, Richiardi L, Rusconi F, Instituto de Saúde Pública, Obstetrics & Gynecology, Pediatrics, Epidemiologie, Med Microbiol, Infect Dis & Infect Prev, RS: CAPHRI School for Public Health and Primary Care, RS: NUTRIM - R2 - Gut-liver homeostasis, and RS: CAPHRI - R5 - Optimising Patient Care

Subjects
Pediatrics, PRESCHOOL-CHILDREN, Epidemiology, PREPREGNANCY OBESITY, INFANTS, Overweight, DISEASE, Body Mass Index, Pregnancy, Risk Factors, Gestational diabetes, Obesity, Pre-eclampsia, Pregnancy induced hypertension, Birth Weight, Diabetes, Gestational, Female, Humans, Hypertension, Pre-Eclampsia, Pregnancy Complications, Prevalence, Respiratory Sounds, Medicine (all), 2. Zero hunger, GESTATIONAL WEIGHT-GAIN, RISK, Diabetes, General Medicine, 3. Good health, Gestational diabete, Gestational, GROWTH, Generation R, medicine.symptom, medicine.medical_specialty, Offspring, Birth weight, EARLY-LIFE, medicine, OVERWEIGHT, business.industry, ASTHMA SYMPTOMS, medicine.disease, Relative risk, GENERATION R, business, Body mass index
Abstract

Background: Evidence on the effect of maternal complications in pregnancy on wheezing in offspring is still insufficient. Methods: A pooled analysis was performed on individual participant data from fourteen European birth cohorts to assess the relationship between several maternal pregnancy complications and wheezing symptoms in the offspring. Exposures of interest included hypertension and preeclampsia, diabetes, as well as pre-pregnancy overweight (body mass index between 25 and 29.9) and obesity (body mass index >= 30) compared with normal weight (body mass index between 18.5 and 24.9). Outcomes included both ever and recurrent wheezing from birth up to 12-24 months of age. Cohort-specific crude and adjusted risk ratios (RR) were calculated using log-binomial regression models and then pooled using a random effects model. Results: The study included 85 509 subjects. Cohort-specific prevalence of ever wheezing varied from 20.0% to 47.3%, and of recurrent wheezing from 3.0% to 14.3%. Adjusted pooled RR for ever and recurrent wheezing were: 1.02 (95% CI: 0.98-1.06) and 1.20 (95% CI: 0.98-1.47) for hypertensive disorders; 1.09 (95% CI: 1.01-1.18) and 1.23 (95% CI: 1.07-1.43) for preeclampsia; 1.04 (95% CI: 0.97-1.13) and 1.24 (95% CI: 0.86-1.79) for diabetes; 1.08 (95% CI: 1.05-1.11) and 1.19 (95% CI: 1.12-1.26) for overweight; 1.12 (95% CI: 1.08-1.17) and 1.16 (95% CI: 0.97-1.39) for obesity. No heterogeneity was found in RR estimates among the cohorts, except for diabetes and recurrent wheezing (P = 0.027). Conclusions: Preeclampsia, maternal pre-pregnancy overweight and obesity are associated with an increase risk of wheezing in the offspring.

Published
2015

6. Global patterns of care in advanced stage mycosis fungoides/Sezary syndrome: a multicenter retrospective follow-up study from the Cutaneous Lymphoma International Consortium

Author

Alessandro Pileri, K. Rogers, G. Ognibene, C. Postigo-Llorente, Larisa J. Geskin, M. Kheterpal, S. Alberti Violetti, Daniela Zugna, Paolo Fava, Youn H. Kim, V. Nikolaou, A. Stevens, Evangelia Papadavid, Joan Guitart, Nicola Pimpinelli, P L Ortiz-Romero, Emilio Berti, Ch. Antoniou, Iris Amitay-Laish, F. Child, René Stranzenbach, Tomomitsu Miyagaki, Denis Miyashiro, R. Knobler, Pier Luigi Zinzani, Maarten H. Vermeer, Teresa Estrach, Francesco Onida, Stephen Morris, S. Chaganti, Martina Sanlorenzo, Ellen Kim, Cristina Muniesa, José Antonio Sanches, Pietro Quaglino, Makoto Sugaya, M. Duvic, J. Scarisbrick, N. Spaccarelli, Vieri Grandi, Steve Horwitz, Simona Osella-Abate, Alain H. Rook, Martine Bagot, Chiara Astrua, Octavio Servitje, Emmilia Hodak, Rakhshandra Talpur, Sean Whittaker, Milena Maule, Christopher McCormack, S. Fabbro, A. Combalia, Rein Willemze, Rudolf Stadler, Estela Martinez-Escala, Pierluigi Porcu, S. Porkert, M.T. Fierro, Caroline Ram-Wolff, Simone Ribero, Henry Miles Prince, Richard T. Hoppe, Constanze Jonak, Quaglino, P, Maule, M, Prince, H. M, Porcu, P, Horwitz, S, Duvic, M, Talpur, R, Vermeer, M, Bagot, M, Guitart, J, Papadavid, E, Sanches, J. A, Hodak, E, Sugaya, M, Berti, E, Ortiz-Romero, P, Pimpinelli, N, Servitje, O, Pileri, A, Zinzani, P. L, Estrach, T, Knobler, R, Stadler, R, Fierro, M. T, Alberti Violetti, S, Amitay-Laish, I, Antoniou, C, Astrua, C, Chaganti, S, Child, F, Combalia, A, Fabbro, S, Fava, P, Grandi, V, Jonak, C, Martinez-Escala, E, Kheterpal, M, Kim, E. J, Mccormack, C, Miyagaki, T, Miyashiro, D, Morris, S, Muniesa, C, Nikolaou, V, Ognibene, G, Onida, F, Osella-Abate, S, Porkert, S, Postigo-Llorente, C, Ram-Wolff, C, Ribero, S, Rogers, K, Sanlorenzo, M, Stranzenbach, R, Spaccarelli, N, Stevens, A, Zugna, D, Rook, A. H, Geskin, L. J, Willemze, R, Whittaker, S, Hoppe, R, Scarisbrick, J, and Kim, Y.

Subjects
Oncology, Male, medicine.medical_treatment, Medical Oncology, Cutaneous lymphoma, 030207 dermatology & venereal diseases, 0302 clinical medicine, Photopheresis, CTCL, Japan, Child, Bexarotene, Aged, 80 and over, treatment, Follow up studies, Hematology, Middle Aged, Chemotherapy regimen, Europe, Mycosis fungoides, Prognosis, Survival, Treatment, 030220 oncology & carcinogenesis, Female, prognosi, Brazil, medicine.drug, mycosis fungoide, Mycosis fungoides/Sezary syndrome, Adult, medicine.medical_specialty, Adolescent, survival, 03 medical and health sciences, Young Adult, Internal medicine, medicine, Humans, Sezary Syndrome, Aged, Neoplasm Staging, Retrospective Studies, Patterns of care, Chlorambucil, business.industry, mycosis fungoides, Advanced stage, Australia, Retrospective cohort study, medicine.disease, Dermatology, Gemcitabine, United States, Relative risk, prognosis, business
Abstract

Background Advanced-stage mycosis fungoides (MF)/Sezary syndrome (SS) patients are weighted by an unfavorable prognosis and share an unmet clinical need of effective treatments. International guidelines are available detailing treatment options for the different stages but without recommending treatments in any particular order due to lack of comparative trials. The aims of this second CLIC study were to retrospectively analyze the pattern of care worldwide for advanced-stage MF/SS patients, the distribution of treatments according to geographical areas (USA versus non-USA), and whether the heterogeneity of approaches has potential impact on survival. Patients and methods This study included 853 patients from 21 specialist centers (14 European, 4 USA, 1 each Australian, Brazilian, and Japanese). Results Heterogeneity of treatment approaches was found, with up to 24 different modalities or combinations used as first-line and 36% of patients receiving four or more treatments. Stage IIB disease was most frequently treated by total-skin-electron-beam radiotherapy, bexarotene and gemcitabine; erythrodermic and SS patients by extracorporeal photochemotherapy, and stage IVA2 by polychemotherapy. Significant differences were found between USA and non-USA centers, with bexarotene, photopheresis and histone deacetylase inhibitors most frequently prescribed for first-line treatment in USA while phototherapy, interferon, chlorambucil and gemcitabine in non-USA centers. These differences did not significantly impact on survival. However, when considering death and therapy change as competing risk events and the impact of first treatment line on both events, both monochemotherapy (SHR = 2.07) and polychemotherapy (SHR = 1.69) showed elevated relative risks. Conclusion This large multicenter retrospective study shows that there exist a large treatment heterogeneity in advanced MF/SS and differences between USA and non-USA centers but these were not related to survival, while our data reveal that chemotherapy as first treatment is associated with a higher risk of death and/or change of therapy and thus other therapeutic options should be preferable as first treatment approach.

Published
2017

7. The independent role of prenatal and postnatal exposure to active and passive smoking on the development of early wheeze in children

Author

Maria Vassilaki, Alet H. Wijga, Daniela Zugna, Erol A. Gaillard, I. Annesi-Maesano, Claudia E. Kuehni, Mikel Basterrechea, Monique Mommers, Davide Gori, Carel Thijs, Liesbeth Duijts, Leda Chatzi, Susanne Lau, J. J. Aurrekoetxea, Rémy Slama, Anna Bergström, Raquel Granell, Mark J. Nieuwenhuijsen, Maria Pia Fantini, Constantine I. Vardavas, Costanza Pizzi, Jordi Sunyer, M. Torrent, David Martinez, Thomas Keil, Evridiki Patelarou, C. Hohmann, Ferran Ballester, Ulrike Gehring, J. C. de Jongste, A. J. Henderson, Esben Eller, Mario Murcia, Joachim Heinrich, Manolis Kogevinas, Eva Morales, Christina Tischer, Epidemiologie, RS: CAPHRI - R5 - Optimising Patient Care, RS: NUTRIM - R4 - Gene-environment interaction, Complexe Genetica, Epidemiology, Pediatrics, Vardavas, C.I., Hohmann, C., Patelarou, E., Martinez, D., Henderson, A.J., Granell, R., Sunyer, J., Torrent, M., Fantini, M.P., Gori, D., Annesi-Maesano, I., Slama, R., Duijts, L., De Jongste, J.C., Aurrekoetxea, J.J., Basterrechea, M., Morales, E., Ballester, F., Murcia, M., Thijs, C., Mommers, M., Kuehni, C.E., Gaillard, E.A., Tischer, C., Heinrich, J., Pizzi, C., Zugna, D., Gehring, U., Wijga, A., Chatzi, L., Vassilaki, M., Bergström, A., Eller, E., Lau, S., Keil, T., Nieuwenhuijsen, M., Kogevinas, M., LS IRAS EEPI ME (Milieu epidemiologie), Geneeskunde van gezelschapsdieren, and dIRAS RA-2

Subjects
Male, Pulmonary and Respiratory Medicine, Pediatrics, medicine.medical_specialty, Passive smoking, Tobacco Smoke Pollution/adverse effects, medicine.disease_cause, Tobacco smoke, 03 medical and health sciences, Prenatal Exposure Delayed Effects/epidemiology, 0302 clinical medicine, Pregnancy, Risk Factors, Wheeze, Smoking/adverse effects, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Respiratory sounds, Risk factor, Family history, 610 Medicine & health, Maternal Exposure/adverse effects, medicine.diagnostic_test, business.industry, Respiratory Sounds/etiology, Infant, Newborn, Infant, medicine.disease, Passive Smoke Exposure, Europe, Logistic Models, 030228 respiratory system, Child, Preschool, Female, medicine.symptom, business, 360 Social problems & social services
Abstract

Maternal smoking during pregnancy increases childhood asthma risk, but health effects in children of nonsmoking mothers passively exposed to tobacco smoke during pregnancy are unclear. We examined the association of maternal passive smoking during pregnancy and wheeze in children aged ≤2 years.Individual data of 27 993 mother–child pairs from 15 European birth cohorts were combined in pooled analyses taking into consideration potential confounders.Children with maternal exposure to passive smoking during pregnancy and no other smoking exposure were more likely to develop wheeze up to the age of 2 years (OR 1.11, 95% CI 1.03–1.20) compared with unexposed children. Risk of wheeze was further increased by children's postnatal passive smoke exposure in addition to their mothers' passive exposure during pregnancy (OR 1.29, 95% CI 1.19–1.40) and highest in children with both sources of passive exposure and mothers who smoked actively during pregnancy (OR 1.73, 95% CI 1.59–1.88). Risk of wheeze associated with tobacco smoke exposure was higher in children with an allergic versus nonallergic family history.Maternal passive smoking exposure during pregnancy is an independent risk factor for wheeze in children up to the age of 2 years. Pregnant females should avoid active and passive exposure to tobacco smoke for the benefit of their children's health.

Published
2016

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