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

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Aim: 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. Materials and 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). Conclusion: 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. A few areas in the world are so largely exposed to pollutants and contaminants due to illegal dumping of toxic waste that they can be considered potential 'open laboratories' for biomonitoring and epidemiological, genetic and translational cancer research efforts (1). One of these areas spans between the southern Italian provinces of Naples, Salerno and Caserta, affecting the population of 57 townships in the Campania Region where for decades interred or burnt toxic waste have generated dark, malodorous fumes rising from the ground of this agricultural territory, leading to its being named Terra dei Fuochi (TdF), 'Land of Fires'. interesting finding possibly linked to the exposure to dioxins in the TdF is the increased prevalence of hypertension in this group of patients, a phenomenon also observed in the exposed population in Seveso, where increased mortality from nonmalignant cardiovascular diseases was described (22).

Original languageEnglish
Pages (from-to)2119-2124
Number of pages6
JournalAnticancer Research
Issue number5
Publication statusPublished - 2016


  • Lung cancer
  • Pollution
  • Surgery
  • Terra dei Fuochi
  • Waste dumping

ASJC Scopus subject areas

  • Medicine(all)
  • Oncology
  • Cancer Research

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