Cancer In Greece Research Articles

Feasibility, safety, and cost outcomes of laparoscopic management of early endometrial and cervical malignancy.

The role of laparoscopy in the management of early stage endometrial and cervical cancer is continuously validated by many reports throughout the world. Interestingly, such data are still unavailable in many European countries, as it is in Greece. In this prospective study, we report on initial feasibility, safety, and cost outcomes of laparoscopic management of early stage endometrial and cervical cancer, recently introduced in our country. This was a prospective pilot study comprising a case series. Patients referred to a tertiary referral medical center with a recent diagnosis of endometrial or cervical cancer were evaluated, and those meeting inclusion criteria were offered laparoscopic surgical staging. Out of 64 patients evaluated, 17 with early clinical stage endometrial cancer and 8 with early clinical stage cervical cancer underwent successful laparoscopic staging. Mean patient age was 61.6 and 39.2 years, mean BMI was 32.3 and 24.1kg/m(2), mean operative time was 243 and 284 minutes, mean estimated blood loss was 190mL and 270mL, mean lymph node count was 27.2 and 29.1, and mean hospital stay was 2 and 3 days for endometrial and cervical cancer cases, respectively. The overall costs for the procedures performed were not greater than their laparotomy counterpart. One intraoperative complication was managed laparoscopically, and 2 cases occurred of postoperative lymphocyst formation. To our knowledge, this is the first study of laparoscopic management of early endometrial and cervical cancer in Greece. Our preliminary data support the feasibility, safety, and cost effectiveness of laparoscopic management of early endometrial and cervical cancer in our country and are in accordance with series reported in the international literature.

Evaluating depression in a sample of children and adolescents with cancer in Greece

Several studies have found that serious illness increases the risk of depression. One of the most common psychiatric disorders related to the diagnosis and treatment of cancer is depression. The aim of the present study was to investigate the rate of depression in children with cancer compared with that in healthy children. The present study is an ongoing prospective study. The research group consisted of 80 children with cancer followed up by an oncology inpatient clinic of a Greek Children's hospital. The control group consisted of 84 healthy children. After parental consent was obtained, data were collected using the Children's Depression Inventory (CDI) and a socio-demographic data form. At the time that this study was carried out, neither the research group nor the control group suffered from depression. In particular, there was no statistically significant difference between the two groups with respect to symptoms of depression (mean = 5.88 for children with cancer vs. mean = 7.23 for healthy children, U = 3013, P = 0.25). Our findings suggest that the children in this study with malignancies did not have higher depression scores than their healthy peers, although many previous surveys confirm that children with cancer are at high risk for depression.

Economic analysis of a multicentre, randomised, phase III trial comparing FOLFOXIRI with FOLFIRI in patients with metastatic colorectal cancer in Greece

ABSTRACTIntroduction: An economic evaluation of the irinotecan, leucovorin, 5-fluorouracil (FOLFIRI) combination versus the irinotecan, oxaliplatin, leucovorin, 5-fluorouracil (FOLFOXIRI) regimen in patients with metastatic colorectal cancer was performed in the context of a randomised phase III study.Methods: The trial did not find any differences in efficacy and, therefore, a cost-minimisation analysis was undertaken. Treatment cost accounts for the administration of first and second line chemotherapy, for concomitant medications, for laboratory and other examinations and hospitalisations due to treatment side effects. Unit prices used reflect 2006 and are common among NHS hospitals in Greece.Results: The mean total cost of therapy in the FOLFOXIRI group (€18 344, 95% CI: €16 951–€19 776), was significantly higher than the FOLFIRI group (€12 201, 95% CI: €11 011–€13 427). Mean chemotherapy cost of the FOLFOXIRI group (€9016; 95% CI: €8338–€9669) was significantly higher than that of the FOLFIRI group (€4830; 95% CI: €4435–€5231). The next largest component of cost involves second line drugs, where the average cost per patient was €3306 (95% CI: €2479–€4237) in the FOLFIRI group and €3996 (95% CI: €3196–€4892) in the FOLFOXIRI group. The cost of hospitalisations was €1814 (95% CI: €1672–€1954) in the first group and €2663 (95% CI: €2469–€2859) in the second. The rest of the components represent a small part of the total cost and there are no differences in the two groups.Conclusion: The combination of irinotecan, leucovorin, 5-fluorouracil has the same effectiveness as the combination of irinotecan, oxaliplatin, leucovorin, 5-fluorouracil in patients with metastatic colorectal cancer, nonetheless it is associated with a much lower overall treatment cost and it should be the preferred treatment regimen in this context.

Economic evaluation of docetaxel/gemcitabine versus docetaxel as frontline treatment of patients with advanced/metastatic non-small cell lung cancer in Greece

The combination of docetaxel/gemcitabine is an acceptable chemotherapy regimen for the treatment of non-small cell lung cancer. An economic evaluation is undertaken alongside a multi-centre randomized phase III trial, which compares docetaxel/gemcitabine combination with docetaxel monotherapy, in untreated patients with advanced/metastatic non-small cell lung cancer. Trial resource utilisation data are combined with unit price data used to evaluate the cost of chemotherapy, concomitant medications, hospitalisations, diagnostic and laboratory tests and second-line chemotherapy. Treatment cost is combined with survival to estimate the incremental cost per-life-year-saved with the combination therapy versus monotherapy. To deal with uncertainty, stochastic analysis is used to plot cost-effectiveness acceptability curves. Median survival is 9.1 months (range 1-36.2) and 8.3 months (range 1-26.8) (p: 0.025) in the combination and monotherapy groups, respectively. The mean total treatment cost of patients with docetaxel is estimated at Euro5736 and with docetaxel/gemcitabine at Euro7417, a difference of Euro1542 (95%CI: Euro499-2561). The incremental cost per-life-year-saved of the combination therapy is euro9538 and the probability to be cost-effective is 91% at a threshold of Euro20,000, 97% at a threshold of Euro35,000 and 98% at a threshold of Euro50,000. The data support that docetaxel/gemcitabine combination represents a cost-effective treatment option in relation to docetaxel monotherapy for patients with non-small cell lung cancer in the Greek NHS setting.

Frequency of impalpable prostate adenocarcinoma and precancerous conditions in Greek male population: an autopsy study

A series of 212 prostate specimens of men dead between August 2002-August 2004, have been sectioned in consecutive autopsies and subjected to whole mount analysis in purpose to determine the epidemiology of impalpable prostate cancer in Greece. Impalpable prostate carcinomas were found in 40 cases (18.8%) most in the peripheral region. In all, 29 of 40 impalpable cancers (70.7%) had volume less than 1 cm3. Most of impalpable carcinomas were of favorable (Gleason score 2-4) or intermediate (Gleason score 5 and 6) histological type (55 and 27.7%, respectively) while only five (12.5%) were undifferentiated (Gleason score 7 and 8). In all, 24 (60%) of the 40 impalpable carcinomas were multifocal and consisted of two or more foci, most of small size (<0.5 cm3). Most of the impalpable cancers found in this autopsy study were potentially insignificant tumors (relatively low volume, favorable or intermediate histological pattern and absence of invasiveness). Prostate intraepithelial neoplasia (PIN) coexisted with impalpable carcinomas, in almost half of the cancer-positive specimens. There was a positive correlation between PIN foci and coexistent cancer foci in most of the cases. Frequency rate and pathological features of both entities show significant variations in medical literature. Since the incidence of clinical prostate cancer in Greece is relatively low, and according to our autopsy findings, it is plausible that the frequency of clinical prostate cancer in a certain population could be related to the prevalent model of impalpable cancer as well as to the frequency and extend of the precancerous lesions.

Leptin and Body Mass Index in Relation to Endometrial Cancer Risk

Background/Aim: Because leptin is a hormone associated with obesity and reproduction, we attempted to examine whether there is a relationship between leptin and endometrial cancer. Methods: Cases were 84 women with histologically confirmed incident endometrial cancer, whereas controls were 84 women admitted to the same hospital for small surgical operations. The serum leptin levels were determined in fasting morning blood samples by using radioimmunoassay. The mean values of leptin levels among cases and controls were compared with simple t test, and the data were further analyzed using multiple logistic regression procedures. Results: The serum leptin levels were 36.7 ± (SD) 25.7 ng/ml among cases and 26.9 ± 19.8 ng/ml among controls (p = 0.006). After adjustment for known risk factors of endometrial cancer, components of the insulin-like growth factor system did not confound the association of leptin with endometrial cancer, but this association was eliminated, when the body mass index was adjusted for. Thus, the odds ratio for an increment of 1 SD of blood leptin was 1.52 (p = 0.03) before adjustment for body mass index, but only 1.13 (p = 0.62) after adjustment for it. Conclusions: In a case-control study of incident endometrial cancer in Greece, we found evidence that leptin is strongly positively associated with endometrial cancer. It cannot be conclusively inferred, however, whether leptin elevation, as a consequence of obesity, plays a role in endometrial carcinogenesis or whether it is a simple correlate of obesity.

Differentiated thyroid cancer in Greece: 1963-2000. Relation to demographic and environmental factors

Thyroid cancer (TC) is a relatively rare neoplasia, accounting for 0.35%-0.38% of total deaths due to cancer in Greece. Environmental/nutritional factors are considered to play a role in its pathogenesis. The aim of this retrospective review of patients' histories from three of the largest specialized centers in southern Greece, from 1963 to 2000, was to assess associations of differentiated TC (DTC) with demographic and environmental factors. The total number of DTC cases was 610 (119 men or 19.5%, and 491 women or 80.5%), of which 442 cases (72%) were papillary DTCs (pure papillary type: 54.5% and mixed papillary-follicular type: 45.5%), 90 cases (15%) were of the pure follicular type, while 78 cases (13%) were classified as suspicious lesions, requiring follow-up, but not definitively carcinomas. The mean age (+/-SD) at diagnosis for all groups was 42.3+/-1.3 years. Fifty percent of the patients were living in Athens at the time of diagnosis. The diagnosis was delayed in patients living in villages compared to those living in cities (mean age +/-SD): 43.7+/-14.1 years and 40.9+/-13.8 years, respectively; p<0.05, t-test). Patients who were born in iodine-sufficient areas (n=162/193, 84%; X(2)=5.09, P=0.02) had papillary carcinoma more frequently compared to patients who were born in previously iodine-deficient areas (n=159/214, 74%). During the observation period (1963-2000) there appeared to be three different trends in the incidence of newly diagnosed cases: a random variation during the first nine years and a steady increase during the second two decades (starting before the Chernobyl nuclear accident) followed by a significant decline during the last few years. We suggest that the observed variations in the incidence of DTC could be related to the availability of diagnostic tools as well as to increased awareness.

Factors Associated with Delay in the Diagnosis of Oral Cancer

Early detection and treatment improve the prognosis for oral cancer. Delays from the onset of symptoms to clinical diagnosis are common. Our aim is to identify factors associated with this delay. Between 1995 and 1998, we interviewed 105 consecutive patients with histologically confirmed oral cancer in Greece. If 21 or more days elapsed from the time the patient noticed major symptoms to a definitive diagnosis, we called it a delay (52% of cases). We used logistic and linear regression to estimate odds ratios of delayed diagnosis and to identify correlates of length of delay, respectively. Former smokers had a 4.3 times greater risk of delayed diagnosis compared with current smokers (95% confidence interval: 1.1-17.1). The length of delay was greater among single patients, non-smokers, or those with stage IV tumors. Clinicians should be advised that delay in the diagnosis of oral cancer occurs frequently, even in individuals who do not smoke heavily.

Factors Associated with Delay in the Diagnosis of Oral Cancer

Early detection and treatment improve the prognosis for oral cancer. Delays from the onset of symptoms to clinical diagnosis are common. Our aim is to identify factors associated with this delay. Between 1995 and 1998, we interviewed 105 consecutive patients with histologically confirmed oral cancer in Greece. If 21 or more days elapsed from the time the patient noticed major symptoms to a definitive diagnosis, we called it a delay (52% of cases). We used logistic and linear regression to estimate odds ratios of delayed diagnosis and to identify correlates of length of delay, respectively. Former smokers had a 4.3 times greater risk of delayed diagnosis compared with current smokers (95% confidence interval: 1.1-17.1). The length of delay was greater among single patients, non-smokers, or those with stage IV tumors. Clinicians should be advised that delay in the diagnosis of oral cancer occurs frequently, even in individuals who do not smoke heavily.

Cost analysis and estimation of thoracic surgical patients with lung cancer in Greece: the case of Sotiria ICU.

This study aimed to estimate the hospitalization cost of thoracic surgical patients with lung cancer, treated in the intensive care unit (ICU) of Sotiria Hospital in Athens. This is the largest specialist thoracic disease hospital in the greater region of Central and Southern Greece. Methodology was based on the prospective study of patients' medical records, from which clinical and economic data were derived for a six-month period. The study sample consisted of 95 thoracic surgical patients. Economic analysis and cost estimation were based on the differentiation between nominal and real prices, occurring in the public hospital sector in Greece. Real ICU cost per patient is estimated at US$ 2,011 in 1998, while the total patients hospitalization cost was US$ 6,958. The patient's ICU cost represents about 29% of his total hospitalization cost, while the price deviation in the amounts covered by social insurance compared to the real hospitalization cost is also confirmed. It is believed that the use of economic analysis techniques could substantially contribute to the assessment of resource consumption, initially at a microeconomic and later at a macroeconomic level, and thus to the adoption of prospective payment systems, as these are encountered on an international level.

Prognostic significance of factors affecting disease free interval and overall survival for Stage II breast cancer in Greece: A multivariate cohort study

Background: Univariate analysis evaluates the impact of a prognostic factor on survival rates, either disease free (DFI) or overall (OS). Since many of the factors are interrelated, it is difficult to predict the prognosis of an individual patient. Multivariate analysis is therefore required in order to allow factors act together thus ending in the best possible combined predicting result. Methods: A step-up procedure (Cox’s Proportional Hazards Regression model) was used to include various prognostic parameters, relating to patients themselves, to the pathology of their tumours and to the treatment schedule followed. Two hundred and sixty-nine Stage II breast cancer Greek patients, treated from 1981 until 1991 and with a median 12-year of follow-up are studied. Results: Five factors were found to be significant for patients DFI. In order of relevant importance, these were the number of infiltrated nodes, tumour size, postoperative radiotherapy, adjuvant chemotherapy and patients age. Regarding patients OS, tumour size, number of positive nodes, patients’ age at entry and ER/PR status were the most important ones. Conclusion: Our long-term (12-year), single institution, single area results, suggest that, the prognostic factors for patients DFI and OS are the same with those of series from Europe and USA. Additionally, they remain unchanged after long-term follow-up, compared to a previously reported short-term national-wide study from this country.

Fraction of prostate cancer incidence attributed to diet in Athens, Greece.

Diet appears to be a major determinant in the incidence of prostate cancer. In a case-control study conducted in Athens, Greece, we found that dairy products, butter and seed oils were positively associated with risk of prostate cancer, whereas cooked and raw tomatoes were inversely associated. We utilized the data from this study to calculate the population attributable fractions under alternative assumptions of feasible dietary changes. For each subject, a dietary score was calculated and categorized into approximately quintiles, representing increasing levels of prostate cancer risk as a function of the intake of the five discriminatory food groups or items. Population attributable fractions in terms of this dietary score were calculated taking into account multivariate adjustment. We observed that, if all individuals were shifted to the baseline category, the incidence of prostate cancer in this study population would be reduced by 41% (95% confidence interval 23-59%). However, if all individuals were shifted to the adjacent lower risk quintile, the expected incidence reduction would be a more modest 19%. The incidence of prostate cancer in Greece could be reduced by about two-fifths if the population increased the consumption of tomatoes and reduced the intake of dairy products, and substituted olive oil for other added lipids.

Clinicoepidemiologic features of non-melanoma skin cancer in greece

Clinicoepidemiologic features of non-melanoma skin cancer in greece

Haplotypes of human leukocyte antigens among patients with nasopharyngeal cancer in Greece.

The concept that the major histocompatibility complex (MHC) plays an important role in the pathogenesis of nasopharyngeal cancer (NPC) in several ethnic groups has gained increased attention during the last 15 years. Earlier studies have suggested that an increased risk of NPC is associated with specific phenotypes of human leukocyte antigens (HLA). The present study was performed to examine the association of HLA specificities and haplotypes with NPC in a Greek population. In a genotypical study of 53 patients, a significant association between the haplotype HLA-B5DR11 and NPC was found, mainly in patients > 45 years. Also, the above haplotype was significantly associated with longer disease-free interval. HLA-B5 and HLA-B5DR11 were more often seen among patients with squamous cell histology than among those with the undifferentiated type. These results suggest that MHC loci are probably implicated in the pathogenesis and outcome of NPC in Greek patients.

Diet and ovarian cancer: A case‐control study in greece

In a hospital-based case-control study of common malignant epithelial tumors of the ovary, conducted in Athens (1989-1991), 189 cases were compared with 200 hospital visitor controls. Personal interviews were conducted in all cases and diet was ascertained through a semi-quantitative food frequency questionnaire. Nutrient intakes for individuals were estimated by multiplying the nutrient content of a typical portion size for each specified food item by the frequency at which the food was consumed per month and summing these estimates for all food items. Data were analyzed using logistic regression, controlling for non-dietary confounding factors, total energy intake and, among nutrients, mutual confounding influences. Adjusted odds ratios (rate ratios) for ovarian cancer, associated with particular nutritional variables, were expressed in terms of increments approximately equal to the standard deviations of (the residual of) the respective nutrients, on a daily basis. The adjusted odds ratios (and 95% confidence intervals) were 0.80 (0.65-0.99) for mono-unsaturated fat and 0.73 (0.61-0.87) for crude fiber. No substantial, statistically significant or consistent independent associations were noted for total energy, total protein, saturated fat, polyunsaturated fat, dietary cholesterol, total carbohydrates, sucrose, vitamin C, vitamin A, riboflavin or calcium. These associations, if causal, could explain to some extent the relatively low incidence of ovarian cancer in Greece and other Mediterranean countries as well as the increasing incidence trends noted in these countries during the last few decades.

Tobacco Smoking, Coffee Drinking, and Occupation as Risk Factors for Bladder Cancer in Greece

Patients with bladder cancer (250 males and 50 females), consecutively admitted during a 2-year period in the major cancer hospital of Athens, and an equal number of age- and gender-matched comparison patients with orthopedic conditions were interviewed regarding demographic, socioeconomic, and biomedical characteristics, including their occupations and their use of coffee and tobacco prior to the onset of their present disease or condition. Analyses of the data showed that cigarette smoking is an important, statistically significant and dose-dependent risk factor for bladder cancer, particularly in males (tobacco smoking is rare among older Greek women); drinking 2 or more cups of Greek coffee per day appears to be a risk factor for bladder cancer, independent of tobacco smoking, although the association is neither strong nor dose dependent; and a priori specified high-risk occupations were associated with an increased rate ratio for bladder cancer among men less than 65 years and among women in general but not among older men. The overall results of this study indicate that the established risk factors for bladder cancer in the United States and in other developed countries are, apparently, equally important for bladder cancer in Greece, despite the differences in composition and conditions of use of Oriental tobacco and Greek coffee and in the activities and exposures to carcinogens in the Greek work place.

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Patients with bladder cancer (250 males and 50 females), consecutively admitted during a 2-year period in the major cancer hospital of Athens, and an equal number of age- and gender-matched comparison patients with orthopedic conditions were interviewed regarding demographic, socioeconomic, and biomedical characteristics, including their occupations and their use of coffee and tobacco prior to the onset of their present disease or condition. Analyses of the data showed that cigarette smoking is an important, statistically significant and dose-dependent risk factor for bladder cancer, particularly in males (tobacco smoking is rare among older Greek women); drinking 2 or more cups of Greek coffee per day appears to be a risk factor for bladder cancer, independent of tobacco smoking, although the association is neither strong nor dose dependent; and a priori specified "high-risk" occupations were associated with an increased rate ratio for bladder cancer among men less than 65 years and among women in general but not among older men. The overall results of this study indicate that the established risk factors for bladder cancer in the United States and in other developed countries are, apparently, equally important for bladder cancer in Greece, despite the differences in composition and conditions of use of Oriental tobacco and Greek coffee and in the activities and exposures to carcinogens in the Greek work place.

Studies in gastric carcinogenesis. II. Absence of elevated concentrations of N-nitroso compounds in the gastric juice of Greek hypochlorhydric individuals.

The concentrations of nitrate, nitrite, N-nitroso compounds and bacteria were measured in 96 samples of fasting gastric juice, pH 0.90-8.50, obtained from 56 individuals just before or at various times (8 days - 1 year) after gastric operation. The mean pH of the post-operative samples [4.66 +/- 0.39 (SEM)] was significantly higher than that of the pre-operative ones [3.29 +/- 0.33 (SEM)]. A positive correlation with pH was observed for the concentrations of total and nitrate-reducing bacteria (median values 5.0 X 10(5) organisms/ml and 9.2 X 10(4) organisms/ml, respectively, for samples with pH greater than or equal to 1.2 X 10(3) organisms/ml and 0 organisms/ml, respectively, for samples with pH less than or equal to 2.5) and nitrite [mean values 22.5 +/- 3.1 (SEM) microM and 3.20 +/- 0.5 (SEM) microM for samples with pH greater than or equal to 6.5 and pH less than or equal to 2.5, respectively]. No correlation with pH was seen for the concentrations of nitrate [mean value 0.48 +/- 0.06 (SEM) mM] or N-nitroso compounds [mean value 0.30 +/- 0.06 (SEM) microM]. The concentrations of bacteria and nitrite, although increased in hypochlorhydric individuals, were lower than those reported for corresponding individuals in other, primarily British, studies. It is suggested that the relatively low concentrations of nitrite observed in our hypochlorhydric population may account for the absence of elevated concentrations of N-nitroso compounds and that the latter phenomenon may be related to the relatively low frequency of gastric cancer in Greece.

The epidemiology of ovarian cancer in Greece: A case-control study

One hundred and fifty women with common malignant epithelial tumors of the ovary (cases) and 250 comparison women hospitalized for various orthopedic conditions were interviewed regarding demographic, reproductive, socio-economic and biomedical characteristics, including their use of coffee, tobacco, alcohol, drugs and exogenous estrogens. The data were analyzed with standard χ 2 procedures and by modelling relative risk ( r) through multiple logistic regression. The main results are as follows: women with ovarian cancer had fewer liveborn children (one-tailed, P ⋍ 0.13, for women with 4+ children, r = 0.6) and later menarche ( P ⋍ 0.02, for women with age at menarche 15+, r = 1.9) and menopause ( P ⋍ 0.07, for women with age at menopause 50+, r = 1.5); they were slightly taller and heavier ( P ⋍ 0.15 and 0.30 respectively); they belonged to smaller sibships ( P ⋍ 0.05); they reported more frequently than controls familial occurrence of ovarian, endometrial and breast cancer ( P < 0.05 in each instance); they were regular consumers of alcoholic beverages more frequently than controls, and the excess was both statistically significant ( P ⋍ 0.02) and dose-related; they were regular users of coffee slightly more frequently than controls ( r = 1.2) but the excess was small and it was neither statistically significant nor dose-related ( P ⋍ 0.27); and they reported less frequently than controls the use of oral contraceptives (relative risk for users, 0.4; 95% confidence interval, 0.1–1.1).

Biosocial correlates of colorectal cancer in Greece.

One hundred consecutive patients with histologically confirmed colorectal cancer and an equal number of age- and sex-matched orthopaedic patients as hospital controls were interviewed about demographic, socioeconomic, biometric and medical variables. Cholecystectomy was significantly more frequent among cases than controls, but there was no side-predilection of the post-cholecystectomy tumours. The frequency of bowel evacuation was significantly higher among cases, particularly those with rectal cancer, an observation which appears contradictory to the 'prolonged bowel transit time--high colorectal cancer risk' hypothesis. No significant differences were found between cases and controls with respect to socioeconomic status, height and weight, smoking habits, use of laxatives and (for females) parity, age at first pregnancy, and age at menopause; however, cases appeared to be younger at menarche.