title: Survival After Surgical Treatment of Lung Cancer Arising in the Population Exposed to Illegal Dumping of Toxic Waste in the Land of Fires ('Terra dei Fuochi') of Southern Italy.
abstract: OBJECTIVE
  Terra dei Fuochi (TdF), the so-called 'Land of Fires' in Southern Italy, is an agricultural territory characterized by illegal dumping of toxic waste known to occur since the 1980s. It is unknown whether prognosis of patients developing cancer and living in that area may differ compared to those living in areas not exposed to this specific type of pollution. We retrospectively analyzed the 5-year survival rates of patients originating from the TdF diagnosed with lung cancer compared to patients from other areas.
  
  
  METHODS
  Patients consecutively operated on for non-small cell lung cancer (NSCLC) between November 2004 and April 2013 at the Division of Thoracic Surgery of the National Cancer Institute of Naples were eligible. The study outcome was overall survival (OS). In addition, the TdF and non-TdF groups were compared through propensity score matching (PSM).
  
  
  RESULTS
  Overall, 439 patients with resectable NSCLC were operated on, 123 (28%) from the TdF and 316 (72%) from other referral centers of our catchment area. There were 301 males and 138 females; the median age of the entire surgical population was 65 years (range=25-83) years. Apart from a different prevalence of hypertension and underweight patients, preoperative factors were evenly distributed between the two groups. At univariate analysis, OS was not different between the TdF and non TdF group (median 72 and 68 months, respectively; p=0.75 log-rank test). Multivariable analysis confirmed that living in the TdF area had no prognostic impact (hazard ratio=1.05; 95% confidence interval=0.70-1.57; p=0.78) on OS. PSM confirmed no statistically significant difference of OS (hazard ratio=1.01, 95% confidence interval=0.67-1.52; p=0.93).
  
  
  CONCLUSIONS
  Following surgery for lung cancer, TdF and non-TdF surgical candidates had similar long-term survival. Originating from the TdF does not seem to be associated with worse outcomes after surgical treatment of patients with lung cancer.
authors.affiliation: Division of Thoracic Surgery, Department of Thoracic Surgery and Oncology, G. Pascale Foundation, National Cancer Institute, IRCCS, Naples, Italy g.rocco@istitutotumori.na.it.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Rocco
authors.affiliation: Hygiene, Public Health an Statistics Research Unit, University Campus Biomedico, Rome, Italy.
authors.forename: Tommasangelo
authors.initials: T
authors.lastname: Petitti
authors.affiliation: Division of Thoracic Surgery, Department of Thoracic Surgery and Oncology, G. Pascale Foundation, National Cancer Institute, IRCCS, Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Martucci
authors.affiliation: Clinical Trials Unit, Department of Experimental Oncology, G. Pascale Foundation, National Cancer Institute, IRCCS, Naples, Italy.
authors.forename: Maria Carmela
authors.initials: MC
authors.lastname: Piccirillo
authors.affiliation: Division of Thoracic Surgery, Department of Thoracic Surgery and Oncology, G. Pascale Foundation, National Cancer Institute, IRCCS, Naples, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: LA Rocca
authors.affiliation: Division of Thoracic Surgery, Department of Thoracic Surgery and Oncology, G. Pascale Foundation, National Cancer Institute, IRCCS, Naples, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: LA Manna
authors.affiliation: Division of Thoracic Surgery, Department of Thoracic Surgery and Oncology, G. Pascale Foundation, National Cancer Institute, IRCCS, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: DE Luca
authors.affiliation: Division of Medical Oncology, Department of Thoracic Surgery and Oncology, G. Pascale Foundation, National Cancer Institute, IRCCS, Naples, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Morabito
authors.affiliation: Department of Psychology of Developmental and Socialization Processes, Sapienza University of Rome, Rome, Italy Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, U.S.A.
authors.forename: Andrea
authors.initials: A
authors.lastname: Chirico
authors.affiliation: Division of Pathology, Department of Experimental Oncology, G. Pascale Foundation, National Cancer Institute, IRCCS, Naples, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Franco
authors.affiliation: Division of Anesthesiology, Department of Experimental Oncology, G. Pascale Foundation, National Cancer Institute, IRCCS, Naples, Italy.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Accardo
authors.affiliation: Division of Cell Biology, Department of Experimental Oncology, G. Pascale Foundation, National Cancer Institute, IRCCS, Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Normanno
authors.affiliation: Division of Pathology, Department of Experimental Oncology, G. Pascale Foundation, National Cancer Institute, IRCCS, Naples, Italy.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Botti
authors.affiliation: Strategic Direction, G. Pascale Foundation, National Cancer Institute, IRCCS, Naples, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Lodato
authors.affiliation: Scientific Direction, G. Pascale Foundation, National Cancer Institute, IRCCS, Naples, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Ciliberto
authors.affiliation: Scientific Direction, G. Pascale Foundation, National Cancer Institute, IRCCS, Naples, Italy.
authors.forename: Tonino
authors.initials: T
authors.lastname: Pedicini
authors.affiliation: Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, U.S.A. Department of Medicine, Surgery & Neuroscience, University of Siena, Siena, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Giordano
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000139:chemically induced / Q000601:surgery*; D004785:Environmental Pollutants / Q000633:toxicity*; D005260:Female; D006801:Humans; D007558:Italy; D008175:Lung Neoplasms / Q000139:chemically induced / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D004785:Environmental Pollutants
keywords: Lung cancer; Terra dei Fuochi; pollution; surgery; waste dumping