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Niechoda A, Milewska K, Roslan J, Ejsmont K, Holownia A. Cell cycle-specific phosphorylation of p53 protein in A549 cells exposed to cisplatin and standardized air pollutants. Front Physiol 2023; 14:1238150. [PMID: 37645562 PMCID: PMC10460999 DOI: 10.3389/fphys.2023.1238150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
Exposure to particulate matter is associated with DNA damage and the risk of lung cancer. Protein p53 is activated by multi-site phosphorylation in the early stages of DNA damage and affects cell outcome. Our study aimed to assess the effect of (100 µg/mL-1/24 h) standardized air pollutants: carbon black (CB), urban dust (UD), and nanoparticle carbon black (NPCB) on cell cycle, DNA damage and 53 phosphorylation at Ser 9, Ser 20, Ser 46, and Ser 392 in proliferating and quiescent A549 cells and in cells that survived cisplatin (CisPT) exposure. Phosphorylated p53 was quantified in cell subpopulations by flow cytometry using specific fluorochrome-tagged monoclonal antibodies and analysis of bivariate fluorescence distribution scatterplots. CisPT, UD and NPCB increased site-specific p53 phosphorylation producing unique patterns. NPCB activated all sites irrespectively on the cell cycle, while the UD was more selective. p53 Ser 9-P and p53 Ser 20-P positively correlated with the numbers of CisPT-treated cells at G0/G1, and NPCB and NPCB + CisPT produced a similar effect. A positive correlation and integrated response were also found between Ser 20-P and Ser 392-P in resting A549 cells treated with NPCB and CisPT but not UD. Interdependence between the expression of p53 phosphorylated at Ser 20, and Ser 392 and cell cycle arrest show that posttranslational alterations are related to functional activation. Our data suggest that p53 protein phosphorylation in response to specific DNA damage is driven by multiple independent and integrated pathways to produce functional activation critical in cancer prevention and treatment.
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Affiliation(s)
| | | | | | | | - Adam Holownia
- Department of Pharmacology, Medical University of Bialystok, Bialystok, Poland
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2
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Xie XJ, Liu SY, Chen JY, Zhao Y, Jiang J, Wu L, Zhang XW, Wu Y, Duan H, He B, Luo H, Han D. Development of unenhanced CT-based imaging signature for BAP1 mutation status prediction in malignant pleural mesothelioma: Consideration of 2D and 3D segmentation. Lung Cancer 2021; 157:30-39. [PMID: 34052706 DOI: 10.1016/j.lungcan.2021.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVES We aimed to explore the feasibility of 2D and 3D radiomics signature based on the unenhanced computed tomography (CT) images to predict BRCA1-associated protein 1 (BAP1) gene mutation status for malignant pleural mesothelioma (MPM) patients. MATERIALS AND METHODS 74 patients with MPM were retrospectively enrolled (22 mutant BAP1, 52 wild-type BAP1 demonstrated by Sanger sequencing). The radiomic features were extracted respectively from the 2D and 3D segmentation of unenhanced pre-treatment CT images, and the dataset was randomly divided into training (n = 51) and test (n = 23) sets for radiomics model development and internal validation. The synthetic minority over-sampling technique (SMOTE) was used for data balancing in the training set. 2D or 3D features were sequentially selected by ICC > 0.8, correlation analysis (cut-value 0.7), univariate analysis or univariate logistic regression (LR), which were involved into multivariate LR for LR model construction. Following the comparison of the 2D and 3D models by the ROC analysis and Delong test for AUC, the calibration and clinical utility of 2D and 3D models were evaluated. RESULTS 3D radiomic features showed better ICCs compared with 2D in both intra- (P < 0.001) and inter-observer (P < 0.001) analysis. 3D radiomic model based on selected features developed from a balanced training dataset presented a favorable predictive performance with AUC of 0.786 and 0.768 in the training and test sets, respectively. The predictive performance of 3D model was superior to 2D model (1 feature) both in the training (AUC 0.786 vs. 0.683, P = 0.036) and the test (AUC 0.768 vs.0.652, P = 0.441) set. The calibration curve and decision curves also indicate a better BAP1 prediction performance and clinical benefit for 3D model than that of 2D model. CONCLUSION The developed unenhanced CT-based 3D radiomics signature is potential as a noninvasive marker for predicting BAP1 mutation status.
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Affiliation(s)
- Xiao-Jie Xie
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, China
| | - Si-Yun Liu
- Precision Health Institution, GE Healthcare (China), Beijing, 100176, China
| | - Jian-You Chen
- Department of Radiology, Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650106, China
| | - Yi Zhao
- Department of Pathology, the People's Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, Yunnan, 675099, China
| | - Jie Jiang
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, China
| | - Li Wu
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, China
| | - Xing-Wen Zhang
- Department of Radiology, the People's Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, Yunnan, 675099, China
| | - Yi Wu
- Department of Radiology, the People's Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, Yunnan, 675099, China
| | - Hui Duan
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, China
| | - Bing He
- Department of Pathology, the People's Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, Yunnan, 675099, China
| | - Heng Luo
- Office of the Vice President, the People's Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, Yunnan, 675099, China.
| | - Dan Han
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, China.
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3
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Shi J, Lv ZT, Lei Y, Kang H. Maternal occupational exposure to chemicals in the textile factory during pregnancy is associated with a higher risk of polydactyly in the offspring. J Matern Fetal Neonatal Med 2020; 33:3935-3941. [PMID: 30856359 DOI: 10.1080/14767058.2019.1593358] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: The number of children with polydactyly seen in our clinic is increasing. In addition to genetic factors, an influence of environmental effects during pregnancy is becoming increasingly apparent; however, epidemiological data on these effects are lacking.Methods: This hospital-based, case-control study enrolled 143 patients with polydactyly and 286 control patients with no genetic diseases, to evaluate the association between maternal exposure to a textile factory environment during pregnancy and the likelihood of giving birth to a child with polydactyly.Results: Maternal exposure to a textile factory environment during pregnancy was associated with an increased risk of giving birth to a child with polydactyly (exposure to textile factory environment: unadjusted odds ratio (OR) = 3.31, 95% confidence interval (CI) = 1.75-6.27, p = .0002; work seniority of exposed occupation: unadjusted OR 1.28, 95% CI = 1.13-1.47, p = .0002). Covariate screening indicated that certain risk factors (family monthly income per capita, mother's emotional state during pregnancy, colporrhagia, passive smoking, smoking, and history of consanguineous marriage) were potential confounding factors. After adjusting for these variables, the OR of exposure to a textile factory environment remained significant (exposure to textile factory environment: adjusted OR = 3.08, 95% CI = 1.32-7.19, p = .0094; work seniority of exposed occupation: adjusted OR = 1.58, 95% CI = 1.20-2.08, p = .0010). The risk of polydactyly increased with the number of years of employment.Conclusions: Maternal exposure to a textile factory environment appears to be a risk factor for polydactyly in newborns.
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Affiliation(s)
- Jia Shi
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng-Tao Lv
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Lei
- Department of Respiratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Kang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Slomovitz B, de Haydu C, Taub M, Coleman RL, Monk BJ. Asbestos and ovarian cancer: examining the historical evidence. Int J Gynecol Cancer 2020; 31:122-128. [PMID: 33037108 DOI: 10.1136/ijgc-2020-001672] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022] Open
Abstract
Asbestos recently returned to the spotlight when Johnson & Johnson halted sales of baby powder due to lawsuits claiming that the talc in baby powder may have been contaminated with asbestos, which has been linked to the risk of ovarian cancer development. Although talc and asbestos have some structural similarities, only asbestos is considered causally associated with ovarian cancer by the WHO's International Agency for Research on Cancer. While it is useful to understand the types and properties of asbestos and its oncologic biology, the history of its association with ovarian cancer is largely based on retrospective observational studies in women working in high asbestos exposure environments. In reviewing the literature, it is critical to understand the distinction between associative risk and causality, and to examine the strength of association in the context of how the diagnosis of ovarian cancer is made and how the disease should be distinguished from a similar appearing but unrelated neoplasm, malignant mesothelioma. Based on contextual misinterpretation of these factors, it is imperative to question the International Agency for Research on Cancer's assertion that asbestos has a clear causal inference to ovarian cancer. This has important clinical implications in the way patients are conceivably counseled and provides motivation to continue research to improve the understanding of the association between asbestos and ovarian cancer.
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Affiliation(s)
- Brian Slomovitz
- Gynecologic Oncology, Broward Health, Fort Lauderdale, Florida, USA .,Obstetrics and Gynecology, Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA
| | - Christopher de Haydu
- Division of Gynecologic Oncology of the Department of Obstetrics, Gynecology, & Reproductive Sciences, No Affiliation, Miami, Florida, USA
| | - Michael Taub
- Stony Brook University, Stony Brook, New York, USA
| | | | - Bradley J Monk
- Gynecologic Oncology, Obstetrics and Gynecology, Arizona Oncology (US Oncology Network), Phoenix, Arizona, USA.,Gynecologic Oncology, Obstetrics and Gynecology, Creighton University School of Medicine Phoenix Regional Campus, Phoenix, Arizona, USA
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Cantini L, Pecci F, Murrone A, Tomasetti M, Copparoni C, Fiordoliva I, Morgese F, Rinaldi S, Mazzanti P, Rubini C, Cimadamore A, Barbisan F, Giampieri R, Scarpelli M, Santarelli L, Berardi R. Questioning the prognostic role of BAP-1 immunohistochemistry in malignant pleural mesothelioma: A single center experience with systematic review and meta-analysis. Lung Cancer 2020; 146:318-326. [PMID: 32622302 DOI: 10.1016/j.lungcan.2020.06.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The prognostic role of BRCA1 associated protein-1 (BAP1) expression in malignant pleural mesothelioma (MPM) is a matter of debate. We aimed to clarify whether MPM patients with loss of BAP1 expression have better overall survival (OS) compared to BAP1 positive patients. METHODS BAP1 immunohistochemical staining of tumor samples from 60 MPM patients treated at our institution with first-line chemotherapy was evaluated. A systematic literature search was also performed. Only cohort studies that investigated BAP1 by immunohistochemistry (IHC) and reported hazard ratio (HR) values for OS obtained through multivariate analysis (or adjusted for histotype) were considered. A dataset comprising 638 MPM patients was added to our cohort and included in the meta-analysis. RESULTS In our cohort, 23 samples (38 %) were BAP1 positive/retained (≥1 %) and 37 samples (62 %) were BAP1 negative/loss. BAP1 loss was associated with epithelioid histotype (p 0.01). Median OS times were 14.8 months (95 % CI: 10.7-29.3) and 18.1 months (95 % CI: 11.2-25.8) for negative and positive BAP1 expression, respectively (p 0.2). At multivariate analysis, again no differences were observed among the two groups (p 0.81). Similarly, the meta-analysis consisting of 698 patients showed no difference in terms of OS according to BAP1 status (HR 1.11; 95 % CI, 0·76-1·61; p 0.60). CONCLUSIONS BAP1 expression is not an independent prognostic factor for MPM patients and it should not be considered without taking into account tumor histotype. Future studies should investigate its predictive role in patients treated with new emerging therapies such as immunotherapy.
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Affiliation(s)
- Luca Cantini
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Federica Pecci
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Alberto Murrone
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Marco Tomasetti
- Department of Clinical and Molecular Sciences, Section of Experimental and Occupational Medicine, Università Politecnica delle Marche, Via Tronto 10/A, 60020, Ancona, Italy
| | - Cecilia Copparoni
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Ilaria Fiordoliva
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Francesca Morgese
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Silvia Rinaldi
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Paola Mazzanti
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Corrado Rubini
- Section of Pathological Anatomy, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Alessia Cimadamore
- Section of Pathological Anatomy, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Francesca Barbisan
- Section of Pathological Anatomy, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Riccardo Giampieri
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Marina Scarpelli
- Section of Pathological Anatomy, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Lory Santarelli
- Department of Clinical and Molecular Sciences, Section of Experimental and Occupational Medicine, Università Politecnica delle Marche, Via Tronto 10/A, 60020, Ancona, Italy
| | - Rossana Berardi
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy.
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Consonni D, Mensi C. Comment on the paper 'Boffetta et al. Validation of the diagnosis of mesothelioma and BAP1 protein expression in a cohort of asbestos textile workers from Northern Italy. Ann Oncol 2018; 29(2): 484-489'. Ann Oncol 2019; 30:340-341. [PMID: 30475941 DOI: 10.1093/annonc/mdy521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - C Mensi
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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7
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Abstract
One of the most attractive cancer-related genes under investigation is BAP1. Reasons of this growing interest are related to the wide spectrum of pathways directly or indirectly modulated by this gene and shared by several solid tumors. Programmed cell-death, cell metabolisms, immune cells development, ferroptosis and defects in DNA damage response are only some of the multitude of processes depending on BAP1. Loss of this gene seems to occur in different times of tumor history. Moreover, times of BAP1 loss strongly diverge among primary tumors suggesting the presence of several and different triggering factors. Regardless of when it happens, BAP1 loss usually results in prognosis worsening and in the acquisition of more aggressive clinical features by cancer cells.
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Affiliation(s)
| | - Giorgio Frega
- Oncology Unit, Department of Experimental, Diagnostic & Specialty Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Matteo Santoni
- Department of Oncology, Macerata Hospital, Macerata, Italy
| | - Lidia Gatto
- Oncology Unit, Department of Experimental, Diagnostic & Specialty Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Michelangelo Fiorentino
- Pathology Service, Addarii Institute of Oncology, S-Orsola-Malpighi Hospital, Bologna, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | | | - Giovanni Brandi
- Oncology Unit, Department of Experimental, Diagnostic & Specialty Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Boffetta P, Donato F, Pira E, Luu HN, La Vecchia C. Risk of mesothelioma after cessation of asbestos exposure: a systematic review and meta-regression. Int Arch Occup Environ Health 2019; 92:949-957. [PMID: 30993422 DOI: 10.1007/s00420-019-01433-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 04/10/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE A 'risk reversal' has been observed for several human carcinogens following cessation of exposure, but it is unclear whether it also exists for asbestos-related mesothelioma. METHODS We conducted a systematic review of the literature and identified nine studies that reported information on risk of mesothelioma after cessation of asbestos exposure, and performed a meta-regression based on random effects models. As comparison we analyzed results on lung cancer risk from four of these studies. RESULTS A total of six risk estimates from five studies were included in the meta-analysis. The summary relative risk (RR) of mesothelioma for 10-year interval since cessation of exposure was 1.02 [95% confidence interval (CI) 0.87-1.19; p-heterogeneity 0.01]. The corresponding RR of lung cancer was 0.91 (95% CI 0.84-0.98). CONCLUSIONS This analysis provides evidence that the risk of mesothelioma does not decrease after cessation of asbestos exposure, while lung cancer risk does.
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Affiliation(s)
- Paolo Boffetta
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1130, New York, NY, 10029, USA. .,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Francesca Donato
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Enrico Pira
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Hung N Luu
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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9
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Boffetta P, Righi L, Ciocan C, Pelucchi C, La Vecchia C, Romano C, Papotti M, Pira E. Reply to letters to the editor by Brentisci et al. and Consonni and Mensi. Ann Oncol 2019; 30:341. [PMID: 30534997 DOI: 10.1093/annonc/mdy523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- P Boffetta
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - L Righi
- Department of Oncology, University of Turin, Turin, Italy
| | - C Ciocan
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - C Pelucchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - C La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - C Romano
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - M Papotti
- Department of Oncology, University of Turin, Turin, Italy
| | - E Pira
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
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10
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Brentisci C, Gangemi M, Migliore E, Mirabelli D, Stura A. Comment on 'Validation of the diagnosis of mesothelioma and BAP1 protein expression in a cohort of asbestos textile workers from Northern Italy'. Ann Oncol 2018; 29:2395-2396. [PMID: 30321262 DOI: 10.1093/annonc/mdy463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Brentisci
- Cancer Epidemiology, CPO-Piemonte and University of Turin, Turin, Italy
| | - M Gangemi
- Cancer Epidemiology, CPO-Piemonte and University of Turin, Turin, Italy
| | - E Migliore
- Cancer Epidemiology, CPO-Piemonte and University of Turin, Turin, Italy
| | - D Mirabelli
- Cancer Epidemiology, CPO-Piemonte and University of Turin, Turin, Italy.
| | - A Stura
- Cancer Epidemiology, CPO-Piemonte and University of Turin, Turin, Italy
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