Prognostic factors associated with survival in a large cohort of gastric cancer patients resected over a decade at a single Italian center: the Cremona experience.

BACKGROUND: Incidence of gastric cancer (GC) shows different distribution in Italy, with higher incidence in the north and center. We retrospectively analyzed the clinical data of patients resected at the Hospital of Cremona between January 2007 and December 2016. Available clinical variables were linked with survival to identify possible prognostic factors. MATERIALS AND METHODS: Variables analyzed were age, sex, type of surgery, site, histology, invasion, nodal status, resection margins, grade, HER2 status, Helicobacter pylori infection (neo)adjuvant chemotherapy, adjuvant chemoradiotherapy, neutrophil-to-lymphocyte ratio, number of nodes removed and type of lymphadenectomy. Overall survival (OS) was estimated by the Kaplan-Meier method and differences between groups by the log-rank test. Data on OS were analyzed by Cox regression and the final model was obtained using the step-wise method. RESULTS: 379 patients were considered, out of which 195 were operated from 2007 to 2011 and 184 from 2012 to 2016. Median follow-up was 25.5 months, median OS 31.3 months and time to recurrence 23.2 months. D2 resection rate increased from 36% (period 2007-2011) to 74% in 2012-2016 (p = 0.01) with a higher mean number of nodes collected (20.98 for 2007-2011 and 23.53 for 2012-2016, p = 0.040). Only 37% of patients received a postoperative treatment. At multivariate analysis, variables associated with OS were age (p = 0.002), stage (p < 0.001), resection margins status (p < 0.001), adjuvant chemotherapy (p < 0.010) and tumor location (cardia vs non-cardia) (p = 0.029). CONCLUSIONS: Our analysis shows that completeness of resection and lower stage are strong predictors of long-term survival in GC, providing the rationale for adjuvant and neoadjuvant approaches (chemotherapy, radiotherapy or combined). Cardial GC has worse prognosis compared to distal cancers. TRIAL REGISTRATION NUMBER: Service evaluation number 256, protocol 16821/17, date 05 June 2017.

[E-learning and occupational medicine: results of one experience in Italy]. / E-learning e Medicina del Lavoro: risultati di una sperimentazione in Italia.

In Italy, there is at present a certain drive in order to make e-learning for Continuous Medical Education (CME) to take off, even though a normative framework for distance CME has not been completely defined yet. This paper describes the phases of course supply and usage of an e-learning system in the occupational medicine area in Italy. The system provides 10 courses for occupational physicians and one course for nurses, physiotherapists and occupational physiotherapists. During the span of time of 11 months, 2034 users have registered to the website and 1804 of them enrolled themselves into at least one course, for a total number of 5183 course enrolments, with a mean number of course enrolments per person of about 3, and 3710 courses were successfully concluded. This study points out on one hand a wide request for this kind of educational sessions, and on the other hand good results in terms of knowledge acquisition. Since the present experimental project was aimed at contributing to the definition of the normative framework for distance education for CME, it can be expected that e-learning for CME in Italy will get off the ground in the near future.