Francesco Marinelli

Axillary surgery in breast cancer has progressively evolved over the past decades toward less invasive approaches. This population-based study analyzed 10,955 women diagnosed with invasive breast cancer between 2000 and 2022 in Reggio Emilia, Italy, to assess long-term trends in axillary management. A marked decline in axillary lymph node dissection (ALND) was observed—from 47.9% in 2000–2004 to 18.1% in 2017–2022—with a parallel increase in sentinel lymph node biopsy (SLNB) from 43.8% to 74.7%. The shift was particularly pronounced in stage I tumors, where ALND dropped from 44.7% to 2.9%. Overall survival at 15 years was significantly higher in the SLNB group (78%) compared to the ALND group (72%). These results align with major clinical trials (e.g. ACOSOG Z0011, SINODAR-ONE), confirming their applicability in unselected populations. Although ALND remained more frequent in patients with larger tumors or undergoing mastectomy, its role has substantially diminished. Our findings reinforce the safety and effectiveness of conservative axillary approaches and reflect their successful implementation in real-world practice. Further research should address the impact of these trends on quality of life and incorporate additional data on radiotherapy and tumor biology to guide future surgical decision-making.

Background/Objectives: In high-income settings, the incidence of metastatic breast cancer (MBC) at diagnosis has declined, reflecting the impact of effective screening and therapeutic advances. This study examined long-term trends in MBC incidence, mortality, and survival in a province of North Italy, an area characterized by high screening participation and broad access to modern systemic treatments. Methods: All invasive breast cancer cases (n = 10,966) diagnosed between 2000 and 2022 were retrieved from the Reggio Emilia Cancer Registry (population: 532,000). Metastatic cases were defined “early” if distant metastases occurred within six months of diagnosis. Mortality trends were assessed using joinpoint regression to estimate annual percentage changes (APCs). One-, three-, and five-year survival probabilities were calculated, with follow-up through December 2024. Results: Overall, 511 cases (4.7%) were “early” metastatic breast cancers at diagnosis. This proportion declined from 6.4% in 2000–2003 to 3.8% in 2019–2022. One-year mortality decreased from 38.4% to 26.7% (APC = −6.6; 95% CI −13.1 to −0.5), and two-year mortality from 54.5% to 34.9% (APC = −7.3; 95% CI −12.3 to −1.4) after 2017. One- and three-year survival increased from 63% to 66% and from 39% to 42%, respectively, while five-year survival improved from 21% to 30%. Conclusions: Over more than two decades, the incidence of MBC at diagnosis and early mortality both declined, accompanied by improved survival. These trends temporally coincide with the widespread adoption of targeted therapies and sustained high screening coverage, suggesting a possible combined contribution of early detection and advances in precision medicine to the observed outcomes.

Purpose: Lymph node involvement is critical for colorectal cancer (CRC) staging and prognosis. The lymph node ratio (LNR), defined as the ratio of metastatic to total examined lymph nodes, has shown promise as a superior prognostic metric compared to traditional TNM staging and total lymph node yield (LNY). This study compared the prognostic value of LNR, N staging, and LNY and developed an LNR-based survival risk score (LNR-SRS_CRC). Secondary objectives included evaluating the impact of multidisciplinary team (MDT) care and molecular markers (KRAS, NRAS, BRAF) on survival. Patients and Methods: A population-based cohort of 2013 CRC cases (2013– 2018) from the Reggio Emilia Cancer Registry was analyzed. Prognostic models, including T-LNR-M, TNM, and T-LNY-M, were compared using Harrell’s C-index, Akaike Information Criterion (AIC), and net reclassification improvement (NRI). Patients were randomly assigned to training (1026) and validation (987) cohorts. Multivariable analysis identified significant predictors, and a survival risk score (SRS_CRC) was validated. The study also assessed the independent prognostic role of MDT care and molecular markers. Results: The T-LNR-M model outperformed TNM (C-index 71% vs 70%; NRI 4.7%, P = 0.002) and T-LNY-M (C-index 71% vs 70%) with the lowest AIC (8356). Predictors of mortality included T4 stage, LNR, metastasis, and age > 78.6 years. LNR-SRS_CRC stratified patients into low, intermediate, intermediate-high, and high-risk groups with distinct survival probabilities. Validation confirmed its prognostic accuracy (C-index 71.4%). MDT care was associated with significantly improved survival (HR = 1.63; P = 0.047), while molecular markers (KRAS, NRAS, BRAF) were not significant. Conclusion: LNR provides superior prognostic value compared to N staging or LNY. The LNR-SRS_CRC enhances risk stratification and, together with MDT care, may enhance personalized CRC management. Prospective validation is warranted.

Background/Objectives: The COVID-19 pandemic has impacted cancer diagnosis and treatment. This study assessed the effects of the pandemic on the stage and delays between diagnosis and treatment in endometrial cancer. Methods: The study included 543 cases diagnosed between 2017 and 2023 in a population-based cancer registry. Data on stage, diagnostic procedures, treatments, and time to surgery (TTS) were compared across the pre-COVID (2017—2019), COVID (2020—2022), and post-COVID (2023) periods. Multiple regression analysis was used to identify factors influencing TTS. Results: During the three periods, stages I and II showed no variation, whereas a significant increase was recorded in stage III (7.5%, 9.5%, and 17.8%, respectively; p < 0.05), as well as a slight increase in grade 3 (15.4%, 13.6%, and 19.2%, respectively). A significant decrease in laparotomies (30.3%, 11.6%, and 11.0%, respectively; p < 0.01) and an increase in laparoscopies (60.1%, 78.1%, and 80.8%, respectively; p < 0.05) were observed. TTS decreased for interventions performed within 30 days (10.1%, 3.7%, and 1.4%, respectively; p < 0.01) and within 60 days (38.6%, 19.4%, and 6.9%, respectively; p < 0.01), while a significant increase was observed for >60 days (22.8%, 29.8%, and 37.0%, respectively; p < 0.05) and >90 days (7.5%, 23.1%, and 20.5%, respectively; p < 0.01). Multivariable analysis confirmed a reduction in TTS in the pre-COVID period (β −19.63; CI 95% −31.31; −7.95) and an increase in the post-COVID period (β 31.60; CI 95% 13.68; 49.53); while an increase was confirmed only for stage IV (β 48.80; CI 95% 23.15; 74.45). Conclusions: The COVID-19 pandemic has led to an increase in more advanced cancers and delays in surgery.

This study aimed to assess whether multidisciplinary team (MDT) management improves outcomes in patients with stage I–III colorectal cancer (CRC) compared to non-MDT care. This study included 460 CRC patients diagnosed from 2017 to 2018 in a northern Italian province, of whom 300 (65%) were managed by MDT. MDT patients were younger, more frequently had rectal cancers, were diagnosed at earlier stages, and were more likely to undergo surgery and chemotherapy. Disease-free survival (DFS) and overall survival (OS) were significantly better in the MDT group. The recurrence rate was 8.5%, with no significant differences between MDT and non-MDT patients, although MDT patients exhibited lower recurrence rates for early-stage tumors. A multivariable analysis showed that DFS and OS were adversely affected by older age, advanced stage, and lack of MDT management. Kaplan–Meier estimates demonstrated a 3-year DFS of 78% in the MDT group versus 65% in the non-MDT group, as well as an OS of 83% versus 69%, respectively. The MDT approach was associated with improved treatment adherence and better management of recurrences. While limited by a small sample size, this population-based study highlights the beneficial impact of MDT care on CRC outcomes. Further research with extended follow-up is warranted to confirm these findings.

International studies have shown an increase in cancer incidence among young adults, raising public concern. This study aims examines trends in the cancer incidence among individuals aged 15–49 years in a province of Northern Italy, covering diagnoses from 1996 to 2021, and compares the annual percentage change (APC) with national and international data. In males, the overall cancer incidence showed a modest increase between 1996 and 2013 (APC 1.6), followed by a decline in the subsequent years (APC −2.5). In females, there was a modest increase over the entire period (APC 1.0). The lung cancer incidence decreased in both sexes (APC −3.9 in males and APC −3.3 in females), while a decrease was observed for colorectal cancers in women (APC −2.4). Since 2015, the thyroid cancer incidence declined significantly in females (APC −10.2), while an increase was noted in males (APC 2.5). The testicular cancer incidence rose in males (APC 1.5), and the melanoma incidence increased in both sexes (APC 3.4 in males and APC 3.9 in females). The breast cancer incidence remained stable (APC 0.3). These results underline the importance of promoting healthy lifestyles even among younger generations to address emerging cancer trends and support cancer prevention efforts.

PURPOSE: This study aimed to develop a multivariable, weighted overall survival (OS) risk score (SRS) for nonmetastatic (M0) invasive breast cancer (M0-BC, SRS _M0-BC ). MATERIALS AND METHODS: This study included a training (1,890 patients) and a validation cohort (850 patients) from the Reggio Emilia Cancer Registry (RE-CR). Ten traditional prognostic variables were evaluated. RESULTS: In the training set, all the variables but the human epidermal growth factor receptor were significantly associated with OS at univariable analysis. A multivariable model identified an increased death risk for estrogen receptor (hazard ratio [HR], 2.0 [95% CI, 1.1 to 3.1]; P = .021), tumor stages T2-T3 (HR, 2.4 [95% CI, 1.3 to 4.7]; P = .009) and T4 (HR, 5.1 [95% CI, 2.0 to 13.0]; P < .001), and age >74 years (HR, 5.7 [95% CI, 4.0 to 8.2]; P < .001). By assigning scores according to HRs, four risk categories were generated ( P for trend <.001). The HRs of death in the high- (282 patients, 15.6%), intermediate-high (275 patients, 15.2%), and intermediate-risk (349 patients, 19.2%) categories patients were, respectively, 27.3, 12.9, and 3.5 times higher, compared with the low-risk (909 patients, 50%) group. Harrell'C index was 81.1%, and the explained variation in mortality was 66.6. Internal cross-validation performed on the accrual index dates yielded a Harrell’C index ranging from 79.5% to 82.3% and an explained variation in mortality ranging from 60.3% to 69.4%. In the validation set, the same risk categories ( P for trend <.001) were devised. The Harrell’C index and the explained variation in mortality were 76.1% and 53.7%, respectively, in the whole cohort, maintaining an elevated percentage according to the two accrual index dates. CONCLUSION: SRS _M0-BC using the real-world RE-CR data set may represent a low-cost, accessible, globally applicable model in daily clinical practice, helping to prognostically stratify patients with invasive M0-BC.

The COVID-19 pandemic has caused delays in cancer diagnoses and reductions in treatments. The aim of this work is to evaluate the impact of the pandemic on prostate cancer by evaluating whether there has been a shift towards more aggressive (Gleason) and more advanced tumors (stage IV) and a decline in treatments. The study was conducted on 1123 cases of prostate cancer incident in the Province of Reggio Emilia, Northern Italy, in the period of 2018–2021. In 2020, there was a decline in new diagnoses of prostate cancer (−31%), followed by a slight recovery in 2021 (+5%). While Gleason 7 and 8–10 values remained constant, a significant decrease was recorded in stage I (38.7%, 41.6%, 35.5%, and 27.7%) and an increase in stage IV (13.1%, 13%, 15.4%, and 20%) cases in the years 2018, 2019, 2020, and 2021, respectively. However, there was no impact on surgical treatment (which remained constant at around 35%) and radiotherapy (around 39%). Our findings underline the profound impact of COVID-19 on prostate cancer management, highlighting the importance of healthcare resilience in the face of unprecedented disruptions.

Colorectal cancer emerged as the third most prevalent malignancy worldwide, affecting nearly 2 million individuals in the year 2020. This study elucidates the pivotal role of a multidisciplinary team (MDT) in influencing the prognosis, as measured by relative survival rates, depending upon the stage and age. Cases recorded in an Italian Cancer Registry between 2017 and 2018 were included. Relative survival was reported at 1 and 3 years after diagnosis comparing MDT vs. no-MDT approaches. During the study period, 605 CRCs were recorded while 361 (59.7%) were taken care of by an MDT. Compared to no-MDT, MDT patients were younger with earlier stages and received more surgery. One year after diagnosis, survival was 78.7% (90% in MDT vs. 62% in no-MDT); stratifying by stage, in the MDT group there was no survival advantage for stage I (97.2% vs. 89.9%) and II (96.8% vs. 89.4%), but an advantage was observed for stage III (86.4% vs. 56.9%) and stage IV (63.7% vs. 27.4%). Similar values were observed at 3 years where a marked advantage was observed for stages III (69.9% vs. 35.1%) and IV (29.2% vs. 5.1%). The univariable analysis confirmed an excess risk in the no-MDT group (HR 2.6; 95% CI 2.0–3.3), also confirmed in the multivariable regression analysis (HR 2.0; 95% CI 1.5–2.5). Despite the increase in the number of MDT patients in 2018 (from 50% to 69%), this does not correspond to an improvement in outcome.