Survival of pleural malignant mesothelioma in Italy: a population-based study.

A median survival time of about 9 months is generally reported among malignant pleural mesothelioma cases. Recently, better results in terms of survival and performance status have been reported in clinical trials that included highly selected patients. We describe the survival of pleural mesothelioma patients and the factors predictive of survival in an unselected, population-based setting. Pleural mesothelioma cases (4,100) registered from 1990 to 2001 by 9 Italian regional mesothelioma registries contributing to the network of the National Mesothelioma Registry were followed until December 31, 2005. Univariate (Kaplan-Meier) and multivariate (Cox proportional hazards regression) analyses of survival were carried out according to selected individual characteristics, including limited information on treatment in a subset of 578 cases. The median survival time was 9.8 months (95% confidence interval: 9.4-10.1). In multivariate analysis, younger age at diagnosis and epithelioid histotype were associated with significantly reduced hazard ratios. Positive effects of gender (women) and being diagnosed in a hospital with a thoracic surgery unit were of border-line statistical significance. No association with calendar period of diagnosis or asbestos exposure was present. Treatment was not associated with a statistically significant improvement in survival. This is the largest population-based study on survival in patients with pleural mesothelioma to date. Age and morphology were the main prognostic factors. Results regarding the effect of treatment were disappointing but may be useful to assess the future impact, at the population level, of recently introduced therapies.

Survival of peritoneal malignant mesothelioma in Italy: a population-based study.

In some population-based studies, a shorter median survival was observed in peritoneal as compared with pleural, malignant mesothelioma, but in others, longer median survival times or higher proportions of long-term survivors were reported. Statistical instability could have caused these differences. We analyzed survival in peritoneal mesothelioma in a large and unselected population-based case series. Cases (338) registered from 1990 to 2001 by 9 Italian regional mesothelioma registries contributing to the network of the National Mesothelioma Registry were followed until December 31, 2005. Univariate (Kaplan-Meier) and multivariate (Cox proportional hazards regression) analyses of survival were performed according to selected individual characteristics, including limited treatment information in a subset of 194 cases. The results were compared with those obtained in a parallel study on pleural mesothelioma cases. Epithelioid histotype, younger age at diagnosis and, to a lesser degree, gender (women), and being diagnosed in a hospital with a thoracic surgery unit positively and significantly affected survival. The effect of treatment was positive but not statistically significant. No trend in the risk of death according to calendar period of diagnosis was present. Peritoneal mesothelioma cases had shorter median survival time than pleural cases, but a larger proportion of long-term survivors. Survival patterns after peritoneal and pleural mesothelioma differed markedly. Treatment was not associated with a statistically significant improvement in survival, but our study included cases first diagnosed before the introduction of the most recent therapeutic approaches. This provides a large historical comparison for future studies on survival trends at the population level.

[Malignant mesothelioma in the Veneto Region (north-east of Italy), 1988-2002: incidence, geographical analysis, trends and comparison with mortality]. / L'incidenza del mesotelioma maligno in Regione Veneto nel periodo 1988-2002: analisi geografica, trend e confronto con la mortalità.

OBJECTIVE: The study assesses incidence and trend of malignant mesothelioma (MM), and mortality from primary pleural tumour (PPT) among residents of the Veneto region (North-east of Italy 4,450,000 inhabitants at the last census). The study also aims at identifying areas at high risk, by applying geographical analysis techniques. METHOD: The results have been obtained through the activity ofa Mesothelioma Registry, established in 2001, thus collecting largely retrospective data. Incidence and trends are estimated on MM diagnosed between 1988 and 2002 by means of histological or cytological techniques. Deaths from PPT are derived through the availability of mortality records for the period 1988-1999 (latest year available). Direct age-standardization was applied to provincial rates (7 provinces), whereas standardized mortality and incidence ratios according to Kernel estimates and spatial scan statistics have been used to identify clusters at the municipality level (581 municipalities). RESULTS AND CONCLUSIONS: the incidence of MM in the Veneto region appears similar to that of other northern Italian regions (904 new MM cases from 1988 to 2002, 650 among males, 819 pleural; age-standardized annual incidence rates x 100,000 in the period 1988-1999): 1.75 (IC 95% 1.59-1.91) among males, based on 460 cases, and 0.67 (IC 95% 0.57-0.77) among females, based on 196 cases, and displays an increasing trend among both genders. Among males incidence doubles during the study period. High risks are detected among males in a cluster formed by the city of Venice and surrounding municipalities (Standardized Incidence Ratio, SIR, for pleural mesothelioma, 1988-1999, 2.94 (p = 0.001) for the cluster based on 110 observed cases), and, in addition to Venice, in the province of Padua among females (SIR from pleural mesothelioma, 1988-1999, 1.98 (p = 0.001) for the cluster based on 95 observed cases). Mortality from TPP turns out to be higher than incidence and tends to approach incidence in more recent years; this may be explained by the increasing application of diagnostic procedures, inclusive of histopathological tests, among old patients.

[Domestic accidents: a study on children attending the emergency department of the city of Padua]. / Infortuni domestici: uno studio sui bambini presentatisi nel pronto soccorso di Padova.

OBJECTIVE: This study analyzes the causes of domestic accidents in children (age <15) living in the Local Social Sanitary Unit of Padua (Ulss). ME Italy, with regard to the circumstances of the accident and the socioeconomic level of the family. METHOD: the subjects were recruited in the Emergency Department of the local hospital between January 15 and March 15, 2004 following an accident at home (n=392). Each case was contacted on that occasion, and a telephone interview was made to one of the parents at a later stage. The latter was accepted by 74% cases. RESULTS: The bimonthly incidence of domestic accidents in the Ulss of Padua was 7.74% per hundred. The incidence was higher in males than in females and in pre-school than in school age. Only 5% children required hospitalisation. Falls are the most frequent type of accident (65%), one third of the events occurred in the living room, half of them occurred during free games. CONCLUSION: The incidence of the Ulss of Padua is higher than the national incidence: the gap is limited to pre-school age for which the incidence of Padua, age-standardized on Italian population and extrapolated for three months, is 18.8% per hundred while tri-monthly national incidence is 11.7% per hundred. No differences in rates were noticed in school age (6.5% per hundred for Padua vs. 6.4% per hundred for Italy). Findings regarding the circumstances of injuries are consistent with other surveys carried out in Italy and elsewhere. No particular causing factor of accidents emerged. However, the avoidability of accidents attributable to the adult's behaviour is to be noticed.

[An increased mortality from lung cancer among workers of a bright electroplating factory]. / Aunmentata mortalità per tumori polmonari tra gli addetti a una cromatura a strato sottile.

OBJECTIVE: to evaluate cancer mortality especially from lung tumours, in a cohort of workers of a bright electroplating factory, an industrial activity suspected of increasing the risk of cancer because of exposure to hexavalent chromium. Workers of this and other similar factories have been the target of a health surveillance program in the early '80s. DESIGN: the cohort members have been selected from the roster of employees as workers or technical clerks with at least 6 month of presence between the beginning of the activity (January 1968) until December 1994. Vital status has been updated to December 2003. The mortality rates of both the Italian and regional population have been used as standards. RESULTS: mortality from lung cancer was strongly increased among workers (based on 7 deaths among males, and one among females). Among males, lung cancer mortality was stratified by duration of work, latency and period of entry: the excess is evident in all categories and appeared higher among the workers recruited in more recent years. CONCLUSION: we suggest that the results are in agreement with the hypothesis of an occupational exposure to a carcinogenic hazard, as observed in other studies, and correlates with the increase of chromosomal aberrations observed in the past among these workers. This type of industrial activity deserves more epidemiological studies and close attention on the side of industrial hygiene.

Mesotheliomas among Italians, returned to the home country, who worked when migrant at a cement-asbestos factory in Switzerland.

OBJECTIVES: To report the occurrence of mesotheliomas in Italy among subjects who worked, when migrant, at a cement-asbestos factory in Niederurnen, Switzerland, and had resettled to the home country. METHODS: Information about the disease and on the working history of subjects was collected by regional mesothelioma registries. Only cases diagnosed by means of histo-pathological examinations have been considered here. RESULTS: 15 mesotheliomas (13 pleural, 2 perithoneal; 12 among males, 3 among females) have been identified among Italians, who had worked at the factory. None of them had other occupational exposure to asbestos. The majority was living in the Veneto Region (North East of Italy), and in Puglia (Southern Italy). CONCLUSIONS: Exposure to asbestos at this factory has already caused an important number of occupational cancers among the employees, a large fraction being constituted of migrants. In order to avoid under-estimation of risks and to allow compensation, diseases which occur among foreign workers returned to their home country should be evaluated. Migration for work is at the genesis of asbestos-related mesotheliomas now occurring in Italy.