Gemma Gatta

Istituto Nazionale Tumori "Fondazione Pascale", Napoli, Campania, Italy

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Publications (165)845.52 Total impact

  • European Journal of Surgical Oncology 04/2015; DOI:10.1016/j.ejso.2015.04.002 · 2.89 Impact Factor
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    ABSTRACT: Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75 000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems. Canadian Partnership Against Cancer (Toronto, Canada), Cancer Focus Northern Ireland (Belfast, UK), Cancer Institute New South Wales (Sydney, Australia), Cancer Research UK (London, UK), Centers for Disease Control and Prevention (Atlanta, GA, USA), Swiss Re (London, UK), Swiss Cancer Research foundation (Bern, Switzerland), Swiss Cancer League (Bern, Switzerland), and University of Kentucky (Lexington, KY, USA). Copyright © 2014 Allemani et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd. All rights reserved.
    The Lancet 03/2015; 385:977-1010. DOI:10.1016/50140-6736(14)62038-9 · 45.22 Impact Factor
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    ABSTRACT: O_ST_ABS>Background<$C_ST_ABS>Cancer survivorship is an increasingly important issue in cancer control. Life expectancy of patients diagnosed with breast, colon, and testicular cancers, stratified by age at diagnosis and time since diagnosis, is provided as an indicator to evaluate future mortality risks and health care needs of cancer survivors. <$O_ST_ABS>Patients and methods<$C_ST_ABS>The standard period life table methodology was applied to estimate excess mortality risk for cancer patients diagnosed in 1985–2011 from SEER registries and mortality data of the general US population. The sensitivity of life expectancy estimates on different assumptions was evaluated. <$O_ST_ABS>Results<$C_ST_ABS>Younger patients with colon cancer showed wider differences in life expectancy compared with that of the general population (11.2 years in women and 10.7 in men at age 45–49 years) than older patients (6.3 and 5.8 at age 60–64 years, respectively). Life expectancy progressively increases in patients surviving the first years, up to 4 years from diagnosis, and then starts to decrease again, approaching that of the general population. For breast cancer, the initial drop in life expectancy is less marked, and again with wider differences in younger patients, varying from 8.7 at age 40–44 years to 2.4 at ages 70–74 years. After diagnosis, life expectancy still decreases with time, but less than that in the general population, slowly approaching that of cancer-free women. Life expectancy of men diagnosed with testicular cancer at age 30 years is estimated as 45.2 years, 2 years less than cancer-free men of the same age. The difference becomes 1.3 years for patients surviving the first year, and then slowly approaches zero with increasing survival time. <$O_ST_ABS>Conclusions<$C_ST_ABS>Life expectancy provides meaningful information on cancer patients, and can help in assessing when a cancer survivor can be considered as cured.
    Annals of Oncology 03/2015; 26(6). DOI:10.1093/annonc/mdv131 · 6.58 Impact Factor
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    ABSTRACT: Thymic epithelial tumors (TETs) are rare primary mediastinal tumors arising from thymic epithelium. Their rarity and complexity hinder investigations of their causes and therapy development. Here we summarize the existing knowledge regarding medical treatment of these tumors, and thoroughly review the known genetic aberrations associated with TETs and the present status of potential biological treatments. Epidermal growth factor receptor (EGFR), stem cell factor receptor (KIT), insulin-like growth factor-1 receptor (IGF1R), and vascular endothelial growth factors (VEGF-A, VEGF-B, and VEGF-2) are overexpressed in TETs. EGFR overexpression in TETs is associated with higher stage, and IGF-1R overexpression has poor prognostic value. Data indicate that anti-IGF1R monoclonal antibodies, and inhibitors of angiogenesis, somatostatin (SST) receptors, histone deacetylase (HDAC), mammalian target of rapamycin (mTOR), and cyclin-dependent kinases (CDK) may be active against TETs. Continued investigations in this field could lead to advancement of targeted and biological therapies for TETs. © The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email:
    Annals of Oncology 11/2014; 26(5). DOI:10.1093/annonc/mdu527 · 6.58 Impact Factor
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    G. Gatta, A. Trama
  • G. Gatta, L. Botta, S. Rossi
    The Lancet Oncology 02/2014; 15(2):E52-E52. · 24.73 Impact Factor
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    ABSTRACT: Background Cancer survival is a key measure of the effectiveness of health-care systems. EUROCARE—the largest cooperative study of population-based cancer survival in Europe—has shown persistent differences between countries for cancer survival, although in general, cancer survival is improving. Major changes in cancer diagnosis, treatment, and rehabilitation occurred in the early 2000s. EUROCARE-5 assesses their effect on cancer survival in 29 European countries. Methods In this retrospective observational study, we analysed data from 107 cancer registries for more than 10 million patients with cancer diagnosed up to 2007 and followed up to 2008. Uniform quality control procedures were applied to all datasets. For patients diagnosed 2000–07, we calculated 5-year relative survival for 46 cancers weighted by age and country. We also calculated country-specific and age-specific survival for ten common cancers, together with survival differences between time periods (for 1999–2001, 2002–04, and 2005–07). Findings 5-year relative survival generally increased steadily over time for all European regions. The largest increases from 1999–2001 to 2005–07 were for prostate cancer (73·4% [95% CI 72·9–73·9] vs 81·7% [81·3–82·1]), non-Hodgkin lymphoma (53·8% [53·3–54·4] vs 60·4% [60·0–60·9]), and rectal cancer (52·1% [51·6–52·6] vs 57·6% [57·1–58·1]). Survival in eastern Europe was generally low and below the European mean, particularly for cancers with good or intermediate prognosis. Survival was highest for northern, central, and southern Europe. Survival in the UK and Ireland was intermediate for rectal cancer, breast cancer, prostate cancer, skin melanoma, and non-Hodgkin lymphoma, but low for kidney, stomach, ovarian, colon, and lung cancers. Survival for lung cancer in the UK and Ireland was much lower than for other regions for all periods, although results for lung cancer in some regions (central and eastern Europe) might be affected by overestimation. Survival usually decreased with age, although to different degrees depending on region and cancer type. Interpretation The major advances in cancer management that occurred up to 2007 seem to have resulted in improved survival in Europe. Likely explanations of differences in survival between countries include: differences in stage at diagnosis and accessibility to good care, different diagnostic intensity and screening approaches, and differences in cancer biology. Variations in socioeconomic, lifestyle, and general health between populations might also have a role. Further studies are needed to fully interpret these findings and how to remedy disparities. Funding Italian Ministry of Health, European Commission, Compagnia di San Paolo Foundation, Cariplo Foundation.
    The Lancet Oncology 12/2013; DOI:10.1016/51470-2045(13)70546-1 · 24.73 Impact Factor
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    ABSTRACT: Summary Background Survival and cure rates for childhood cancers in Europe have greatly improved over the past 40 years and are mostly good, although not in all European countries. The EUROCARE-5 survival study estimates survival of children diagnosed with cancer between 2000 and 2007, assesses whether survival differences among European countries have changed, and investigates changes from 1999 to 2007. Methods We analysed survival data for 157 499 children (age 0—14 years) diagnosed between Jan 1, 1978 and Dec 31, 2007. They came from 74 population-based cancer registries in 29 countries. We calculated observed, country-weighted 1-year, 3-year, and 5-year survival for major cancers and all cancers combined. For comparison between countries, we used the corrected group prognosis method to provide survival probabilities adjusted for multiple confounders (sex, age, period of diagnosis, and, for all cancers combined without CNS cancers, casemix). Age-adjusted survival differences by area and calendar period were calculated with period analysis and were given for all cancers combined and the major cancers. Findings We analysed 59 579 cases. For all cancers combined for children diagnosed in 2000—07, 1-year survival was 90·6% (95% CI 90·2—90·9), 3-year survival was 81·0 % (95% CI 80·5—81·4), and 5-year survival was 77·9% (95% CI 77·4—78·3). For all cancers combined, 5-year survival rose from 76·1% (74·4—77·7) for 1999—2001, to 79·1% (77·3—80·7) for 2005—07 (hazard ratio 0·973, 95% CI 0·965—0·982, p<0·0001). The greatest improvements were in eastern Europe, where 5-year survival rose from 65·2% (95% CI 63·1—67·3) in 1999—2001, to 70·2% (67·9—72·3) in 2005—07. Europe-wide average yearly change in mortality (hazard ratio) was 0·939 (95% CI 0·919—0·960) for acute lymphoid leukaemia, 0·959 (0·933—0·986) for acute myeloid leukaemia, and 0·940 (0·897—0·984) for non-Hodgkin lymphoma. Mortality for all of Europe did not change significantly for Hodgkin's lymphoma, Burkitt's lymphoma, CNS tumours, neuroblastoma, Wilms' tumour, Ewing's sarcoma, osteosarcoma, and rhabdomyosarcoma. Disparities for 5-year survival persisted between countries and regions, ranging from 70% to 82% (for 2005—07). Interpretation Several reasons might explain persisting inequalities. The lack of health-care resources is probably most important, especially in some eastern European countries with limited drug supply, lack of specialised centres with multidisciplinary teams, delayed diagnosis and treatment, poor management of treatment, and drug toxicity. In the short term, cross-border care and collaborative programmes could help to narrow the survival gaps in Europe. Funding Italian Ministry of Health, European Commission, Compagnia di San Paolo Foundation.
    The Lancet Oncology 12/2013; DOI:10.1016/S1470-2045(13)70548-5 · 24.73 Impact Factor
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    ABSTRACT: This paper describes the usage and the performance evaluation of the completeness index method in the ‘Surveillance of Rare Cancers in Europe project’ (RARECARE) for estimating rare cancer prevalence in Europe. The 15-year prevalence at 1st January 2003 for 255 cancers is obtained from a pool of 22 RARECARE cancer registries (CRs). Incidence and survival models are applied to the RARECARE database to estimate the parameters from which the completeness indices are calculated. Complete prevalence is obtained adjusting the observed 15-year prevalence by the completeness index, to account for those cancer survivors diagnosed before the CR activity started. Main factors influencing the performance of the completeness index method for rare cancers are the same as for common cancers: age distribution of incidence and lethality of the cancer. For cancers occurring in the elderly, with low survival rates and consequently a restricted number of long-term survivors we obtained completeness indices higher than 0.9. Values lower than 0.7 correspond to those cancers with good prognosis and/or incidence more concentrated at the younger ages, indicating that 15 years of follow up are insufficient to detect all prevalent cases. Validation analysis shows that for a restricted subgroup of rare cancers with very low incidence and low survival, the completeness indices were not able to adequately correct the observed prevalence even considering a registration period of 20 years. On average, sensitivity analyses show a slight overestimation of complete prevalence for rare and common cancers whose increasing incidence is known in literature. RARECARE is the largest project on rare cancers conducted to date. Improving health care programs for cancer survivors is a public health priority and prevalence data which provides important information in this field should be regularly asked to Member States and included in the EU health statistics.
    12/2013; 37(6):850–856. DOI:10.1016/j.canep.2013.08.001
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    ABSTRACT: To assess the extent to which stage at diagnosis and adherence to treatment guidelines may explain the persistent differences in colorectal cancer survival between the USA and Europe. A high-resolution study using detailed clinical data on Dukes' stage, diagnostic procedures, treatment and follow-up, collected directly from medical records by trained abstractors under a single protocol, with standardised quality control and central statistical analysis. 21 population-based registries in seven US states and nine European countries provided data for random samples comprising 12 523 adults (15-99 years) diagnosed with colorectal cancer during 1996-1998. Logistic regression models were used to compare adherence to 'standard care' in the USA and Europe. Net survival and excess risk of death were estimated with flexible parametric models. The proportion of Dukes' A and B tumours was similar in the USA and Europe, while that of Dukes' C was more frequent in the USA (38% vs 21%) and of Dukes' D more frequent in Europe (22% vs 10%). Resection with curative intent was more frequent in the USA (85% vs 75%). Elderly patients (75-99 years) were 70-90% less likely to receive radiotherapy and chemotherapy. Age-standardised 5-year net survival was similar in the USA (58%) and Northern and Western Europe (54-56%) and lowest in Eastern Europe (42%). The mean excess hazard up to 5 years after diagnosis was highest in Eastern Europe, especially among elderly patients and those with Dukes' D tumours. The wide differences in colorectal cancer survival between Europe and the USA in the late 1990s are probably attributable to earlier stage and more extensive use of surgery and adjuvant treatment in the USA. Elderly patients with colorectal cancer received surgery, chemotherapy or radiotherapy less often than younger patients, despite evidence that they could also have benefited.
    BMJ Open 09/2013; 3(9):e003055. DOI:10.1136/bmjopen-2013-003055 · 2.06 Impact Factor
  • JNCI Monographs 08/2013; 2013(46):124-30. DOI:10.1093/jncimonographs/lgt011
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    ABSTRACT: Cancer survival varies markedly across Europe. We analyzed variations in all-cancer 5-year relative survival in relation to macroeconomic and health-care indicators, and 5-year relative survival for three major cancers (colorectal, prostate, breast) in relation to application of standard treatments, to serve as baseline for monitoring the efficacy of new European initiatives to improve cancer survival. Five-year relative survival data were from the European cancer registry-based study of cancer patients' survival and care (EUROCARE-4). Macroeconomic and health system data were from the Organisation for Economic Co-operation and Development, and European Observatory on Health Care Systems. Information on treatments given was from EUROCARE studies. Total national health spending varied widely across Europe and correlated linearly with survival (R = 0.8). Countries with high spending had high numbers of diagnostic and radiotherapy units, and 5-year relative survival was good (>50%). The treatments given for major cancers also varied; advanced stage at diagnosis was associated with poor 5-year relative survival and low odds of receiving standard treatment for breast and colorectal cancer.
    JNCI Monographs 08/2013; 2013(46):79-87. DOI:10.1093/jncimonographs/lgt004
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    ABSTRACT: J.M. van der Zwan), (A. Trama), (R. Otter), (N. Larrañ aga), (A. Tavilla), (R. Marcos-Gragera), (A.P. Dei Tos), (E. Baudin), (G. Poston), (T. Links). l The RARECARE working group consists of: Austria: N. Zielonke (Austrian National Cancer Registry); Belgium: E. Van Eycken (Belgian Cancer Registry), H. Sundseth (European Cancer Patient Coalition); France: G. Hedelin (Bas-Rhin Cancer Registry), J. Faivre (Cô te d'Or Digestive Cancer Registry A v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e j c a n c e r . c o m (Varese Cancer Registry), A. Fiore (Veneto Cancer Registry), Abstract Because of the low incidence, and limited opportunities for large patient volume experiences, there are very few relevant studies of neuroendocrine tumours (NETs). A large population-based database (including cancer patients diagnosed from 1978 to 2002 and registered in 76 population-based cancer registries [CRs]), provided by the project 'surveil-lance of rare cancers in Europe' (RARECARE) is used to describe the basic indicators of inci-dence, prevalence and survival of NETs, giving a unique overview on the burden of NETs in Europe. NETs at all cancer sites, excluding lung, were analysed in this study. In total over 20,000 incident cases of NETs were analysed and a data quality check upon specific NETs was performed. The overall incidence rate for NETs was 25/1,000,000 and was highest in patients aged 65 years and older with well differentiated endocrine carcinomas (non-function-ing pancreatic and gastrointestinal) (40 per 1,000,000). We estimated that slightly more than 100,000 people were diagnosed with NETs and still alive in EU27 at the beginning of 2008. Overall, NETs had a 5 year relative survival of 50%; survival was low (12%) for poorly differ-entiated endocrine carcinoma, and relatively high (64%) for well differentiated carcinoma (not functioning of the pancreas and digestive organs). Within NETs, endocrine carcinoma of thy-roid gland had the best 5-year relative survival (82%). Because of the complexity and number of the different disciplines involved with NETs (as they arise in many organs), a multidisciplinary approach delivered in highly qualified reference cen-tres and an international network between those centres is recommended.
    European Journal of Cancer 07/2013; 49:2565-2578. DOI:10.1016/j.ejca.2013.02.029 · 4.82 Impact Factor
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    ABSTRACT: Background Complete cancer prevalence data in Europe have never been updated after the first estimates provided by the EUROPREVAL project and referred to the year 1993. This paper provides prevalence estimates for 16 major cancers in Europe at the beginning of the year 2003.Patients and methodsWe estimated complete prevalence by the completeness index method. We used information on cancer patients diagnosed in 1978-2002 with vital status information available up to 31 December 2003, from 76 European cancer registries.ResultsAbout 11.6 millions of Europeans with a history of one of the major considered cancers were alive on 1 January 2003. For breast and prostate cancers, about 1 out of 73 women and 1 out of 160 men were living with a previous diagnosis of breast and prostate cancers, respectively. The demographic variations alone will increase the number of prevalent cases to nearly 13 millions in 2010.Conclusions Several factors (early detection, population aging and better treatment) contribute to increase cancer prevalence and push for the need of a continuous monitoring of prevalence indicators to properly plan needs, resource allocation to cancer and for improving health care programs for cancer survivors. Cancer prevalence should be included within the EU official health statistics.
    Annals of Oncology 04/2013; DOI:10.1093/annonc/mdt030 · 6.58 Impact Factor
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    ABSTRACT: Background. Proportion cured is a potentially more informative cancer outcome measure than five-year survival. We present population-based cured estimates for young patients diagnosed with acute lymphoblastic leukemia in Europe from 1982 to 2002. Design and methods. Thirty-five European cancer registries provided data. Survival was estimated by age, period of diagnosis and European region, and used as input for parametric cure models, which assume cured patients have the same mortality as the general population. Results. For acute lymphoblastic leukemia diagnosed in 1-14 year-olds in 2000-2002, over 77% were estimated cured. The proportion cured improved significantly over the study period: an impressive 26% to 58% in infants (up to 1 year), 70% to 90% in 1-4 year-olds, 63% to 86% in 5-9 year-olds, 52% to 77% in 10-14 year-olds, and 44% to 50% in 15-24 year-olds. Regional variations in proportion cured reduced over time for 1-14 year-olds, but persisted in infants and 15-24 year-olds. Five-year survival was always slightly higher than proportion cured. Conclusions. Considerable proportions of young patients were estimated cured of acute lymphoblastic leukemia, nevertheless a small excess risk of dying persisted beyond five years after diagnosis when patients remained at risk for late treatment effects and second primaries.
    Haematologica 02/2013; DOI:10.3324/haematol.2012.071597 · 5.87 Impact Factor
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    ABSTRACT: Aims and background. The project Surveillance of rare cancers in Italy (RITA) provides, for the first time, estimates of the burden of rare cancers in Italy based on the list of rare cancers proposed in collaboration with the European project Surveillance of Rare Cancers in Europe (RARECARE).Methods. RITA analyzed data from Italian population-based cancer registries (CR). The period of diagnosis was 1988 to 2002, and vital status information was available up to December 31, 2003. Incidence rates were estimated for the period 1995-2002, survival for the years 2000-2002 (with the period method of Brenner), and complete prevalence at January 1, 2003. Results. Rare cancers are those with an incidence <6/100,000/year. In Italy, every year there are 60,000 new diagnoses of rare cancers corresponding to 15% of all new cancer diagnoses. Five-year relative survival was on the average worse for rare cancers (53%) than for common cancers (73%). A total of 770,000 patients were living in Italy in 2008 with a diagnosis of a rare cancer, 22% of the total cancer prevalence. Conclusions. Our estimates constitute a useful base for further research and support the idea that rare cancers are a public health problem that deserves attention. Centers of expertise for rare cancers that pool cases, expertise and resources could ensure an adequate clinical management for these diseases. Our data also showed that cancer registries are suitable sources of data to estimate incidence, prevalence and survival for rare cancers and should continue to monitoring rare cancers in Italy.
    09/2012; 98(5):550-558. DOI:10.1700/1190.13194
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    ABSTRACT: Embryonal cancers are a heterogeneous group of rare cancers which mainly occur in children and adolescents. The aim of the present study was to estimate the burden (incidence, prevalence, survival and proportion of cured) for the principal embryonal cancers in Europe (EU27), using population-based data from cancer registries (CRs) participating in RARECARE. We identified 3322 cases diagnosed from 1995 to 2002 (latest period for which data are available): 44% neuroblastoma, 35% nephroblastoma, 13% retinoblastoma and 6% hepatoblastoma. Very few cases of pulmonary blastoma (43 cases) and pancreatoblastoma (seven cases) were diagnosed. About 2000 new embryonal cancers were estimated every year in EU27, for an annual incidence rate of 4 per million (1.8 neuroblastoma, 1.4 nephroblastoma, and 0.5 retinoblastoma); 91% of cases occurred in patients under 15 years. Five-year relative survival for all embryonal cancers was 80% (99% retinoblastoma, 90% nephroblastoma, 71% hepatoblastoma and 68% neuroblastoma). Overall survival was lower in adolescents and adults than in those under 15 years. The cure rate was estimated at 80%. Slightly less than 40,000 persons were estimated alive in EU27 with a diagnosis of embryonal cancer in 2008. Nephroblastoma was the most prevalent (18,150 cases in EU27), followed by neuroblastoma (12,100), retinoblastoma (5200), hepatoblastoma (2700) and pulmonary blastoma (614). This is the first study to delineate the embryonal cancer burden in Europe by age, sex and European region. Survival/cure rate is generally high, but there are considerable gaps in our understanding of the natural histories of these rare diseases particularly in adults.
    European journal of cancer (Oxford, England: 1990) 02/2012; 48(10):1425-33. DOI:10.1016/j.ejca.2011.12.027 · 4.82 Impact Factor
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    ABSTRACT: The RARECARE project aims at increasing knowledge of rare cancers in Europe. This manuscript describes the epidemiology (incidence, prevalence, survival) of rare urogenital cancers, taking into account the morphological characterisation of these tumours. We used data gathered by RARECARE on cancer patients diagnosed from 1995 to 2002 and archived in 64 European population-based cancer registries, followed up to December 31st, 2003 or later. The annual number of males that develop penile cancer in the EU is estimated at 3100, which is equivalent to an age standardised rate (ASR) of 12 per million males. The 5-year relative survival rate is 69%, while squamous cell carcinoma is the predominant morphological entity. Each year around 650 persons in the EU develop cancer of the urethra and 7200 develop cancer of the renal pelvis or ureter (RPU). The ASR for cancer of the urethra and RPU is 1.1 (males 1.6; females 0.6) and 12 (males 16; females 7) per million inhabitants, respectively. The 5-year relative survival rate for cancer of the urethra and RPU is 54% and 51%, respectively. Transitional cell carcinoma is the predominant morphological entity of cancer of the urethra and RPU. In view of the low number of cases and the fact that one third to one half of the patients die of their disease, centralisation of treatment of these rare tumours to a select number of specialist centres should be promoted.
    European journal of cancer (Oxford, England: 1990) 11/2011; 48(4):456-64. DOI:10.1016/j.ejca.2011.10.031 · 4.82 Impact Factor
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    ABSTRACT: Epidemiologic information on rare cancers is scarce. The project Surveillance of Rare Cancers in Europe (RARECARE) provides estimates of the incidence, prevalence and survival of rare cancers in Europe based on a new and comprehensive list of these diseases. RARECARE analysed population-based cancer registry (CR) data on European patients diagnosed from 1988 to 2002, with vital status information available up to 31st December 2003 (latest date for which most CRs had verified data). The mean population covered was about 162,000,000. Cancer incidence and survival rates for 1995-2002 and prevalence at 1st January 2003 were estimated. Based on the RARECARE definition (incidence <6/100,000/year), the estimated annual incidence rate of all rare cancers in Europe was about 108 per 100,000, corresponding to 541,000 new diagnoses annually or 22% of all cancer diagnoses. Five-year relative survival was on average worse for rare cancers (47%) than common cancers (65%). About 4,300,000 patients are living today in the European Union with a diagnosis of a rare cancer, 24% of the total cancer prevalence. Our estimates of the rare cancer burden in Europe provide the first indication of the size of the public health problem due to these diseases and constitute a useful base for further research. Centres of excellence for rare cancers or groups of rare cancers could provide the necessary organisational structure and critical mass for carrying out clinical trials and developing alternative approaches to clinical experimentation for these cancers.
    European journal of cancer (Oxford, England: 1990) 11/2011; 47(17):2493-511. DOI:10.1016/j.ejca.2011.08.008 · 4.82 Impact Factor
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    ABSTRACT: Head and neck cancer Cancer of eye and adnexa Cancer of middle ear Population based study Incidence Prevalence Survival Europe A B S T R A C T The RARECARE project has proposed a different and more detailed grouping of cancers, based on localisation and histological type, in order to identify rare entities with clinical meaning. RARECARE gathered data on cancer patients diagnosed from 1978 to 2002 and archived in 76 population-based cancer registries, all of which had vital status information available up to at least 31st December 2003. This study provides incidence, prevalence and survival rates for rare head and neck epithelial (H&N) cancers. Among the rare H&N cancers, those of oral cavity had the highest annual crude incidence rate of 48 per million, followed by oropharynx and 'major salivary glands and salivary gland type tumours' (28 and 13 per million, respectively). Incidence rates of epithelial tumours of nasal cavities, nasopharynx, eye and adnexa and middle ears were all lower than 5 per million. The prevalence for all investigated entities was lower than 35 per 100,000. The 5-year relative survival rates ranged from 40% for epithelial cancer of oropharynx to 85% for epithelial cancer of eye and adnexa. Survival rates were lower for men and for patients aged P65 years. With few exceptions, the lowest and highest survival figures were observed for Eastern Europe and Northern Europe, respectively. According to the definition for rare tumours by RARECARE (incidence < 6 per 100,000), as well as according to the definition for rare diseases by the European Commission (preva-lence < 50 per 100,000) the H&N cancers described in this paper should be considered rare and diagnosis and treatment of these cancers should therefore be centralised.
    European Journal of Cancer 11/2011; 48(2012):783-796. DOI:10.1016/j.ejca.2011.08.021 · 4.82 Impact Factor

Publication Stats

7k Citations
845.52 Total Impact Points


  • 1998–2015
    • Istituto Nazionale Tumori "Fondazione Pascale"
      Napoli, Campania, Italy
  • 1988–2014
    • Fondazione IRCCS Istituto Nazionale dei Tumori di Milano
      • • s.c. Medicina Oncologica 1
      • • Dipartimento di Medicina Predittiva e per la Prevenzione
      Milano, Lombardy, Italy
  • 2009
    • German Cancer Research Center
      • Division of Clinical Epidemiology and Aging Research
      Heidelberg, Baden-Wuerttemberg, Germany
    • Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica in Piemonte
      Torino, Piedmont, Italy
  • 1992–2009
    • CRO Centro di Riferimento Oncologico di Aviano
      • Division of Medical Oncology A
      Aviano, Friuli Venezia Giulia, Italy
  • 1990–2009
    • Istituto Superiore di Sanità
      • National Centre for Epidemiology, Surveillance and Health Promotion
      Roma, Latium, Italy
  • 2008
    • University of Florence
      Florens, Tuscany, Italy
  • 1996–2008
    • Erasmus Universiteit Rotterdam
      • Daniel den Hoed Cancer Center
      Rotterdam, South Holland, Netherlands
  • 1991–2008
    • Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori
      Meldola, Emilia-Romagna, Italy
  • 2007
    • Istituto di Cura e Cura a Carattere Scientifico Basilicata
      Rionero in Vulture, Basilicate, Italy
  • 2005
    • University of Oxford
      Oxford, England, United Kingdom
  • 2004
    • IEO - Istituto Europeo di Oncologia
      Milano, Lombardy, Italy
  • 2003
    • London School of Hygiene and Tropical Medicine
      • Faculty of Epidemiology and Population Health
      London, ENG, United Kingdom