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Cavaller L, Goupille C, Arbion F, Vilde A, Body G, Ouldamer L. Metastatic profiles and survival differences between infiltrating ductal carcinoma and infiltrating lobular carcinoma in invasive breast cancer. J Gynecol Obstet Hum Reprod 2024; 53:102740. [PMID: 38311000 DOI: 10.1016/j.jogoh.2024.102740] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/29/2023] [Accepted: 02/01/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND In this study, we conducted a comprehensive evaluation of metastatic profiles and survival outcomes in patients with infiltrating ductal carcinoma (IDC) and infiltrating lobular carcinoma (ILC) treated at our university hospital center. METHODS We collected and analyzed data from all patients diagnosed with invasive breast cancer at our center between January 1, 2007, and 31 December 2014. We specifically compared three subgroups: patients with IDC, patients with ILC and patients with mixed carcinoma, which is a combination of IDC and ILC. RESULTS Among the 1963 patients treated for invasive breast cancer in our center during the study period, 1435 had IDC, 466 had ILC, and 59 had mixed carcinoma. The incidence of patients with at least one positive axillary lymph node differed significantly: 40 % for IDC, 36 % for ILC, and 45 % for mixed carcinoma (p = 0.001). However, there was no significant difference in the mean number of positive nodes (p = 0.1633). The occurrence of distant metastases was lower in patients with ILC (p = 0.04), particularly in the case of brain metastases (p = 0.01), although there was no difference in bone or visceral metastatic sites. Patients with ILC exhibited a longer mean time to metastasis from the initial diagnosis of invasive breast carcinoma. Overall survival (p = 0.0525) and survival without locoregional recurrence (p = 0.026) were significantly different. Specifically, the 5-year overall survival rates for IDC, ILC, and mixed carcinoma were approximately 95 %. Distance metastatic-free survival at 5 years was 85 % for IDC, 91 % for ILC, and 87 % for mixed carcinoma (p = 0.00506). CONCLUSION Our findings indicate variations in the distribution of distant metastatic sites among patients with IDC, ILC, and mixed carcinoma, as well as differences in survival outcomes. This study sheds light on the unique characteristics and clinical implications associated with these two distinct subtypes of invasive breast cancer.
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Affiliation(s)
- L Cavaller
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, Tours, France
| | - C Goupille
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, Tours, France; INSERM unit, 1069 Tours, France
| | - F Arbion
- Department of Pathology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France
| | - A Vilde
- Department of Radiology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France
| | - G Body
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, Tours, France; INSERM unit, 1069 Tours, France
| | - L Ouldamer
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, Tours, France; INSERM unit, 1069 Tours, France.
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Deberti M, Goupille C, Arbion F, Vilde A, Body G, Ouldamer L. Prognostic value of axillary lymph node metastases in invasive lobular breast carcinoma. J Gynecol Obstet Hum Reprod 2023; 52:102665. [PMID: 37734568 DOI: 10.1016/j.jogoh.2023.102665] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/26/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Axillary lymph node involvement is a well-established prognostic factor for recurrence in breast cancer, specifically the number of nodes affected and the ratio of the number of affected nodes to the number of harvested nodes for non-specific invasive breast cancer (invasive ductal carcinoma). However, there is limited information on the impact of lymph node involvement in the case of invasive lobular carcinoma. OBJECTIVES our study aimed to evaluate the prognostic impact of lymph node involvement on overall survival and distant metastatic-free survival according to the number of nodes affected and the ratio of positive nodes (LNR) for patients managed for invasive lobular carcinoma. METHODS This is a monocentre, comparative, observational study of patients managed for invasive lobular carcinoma at the Gynaecology Department of the University Hospital Center of Tours between January 1, 2007 and December 31, 2018. The LNR cut-off values used were: low risk if LNR ≤ 0.2; intermediate risk if LNR > 0.2 and ≤ 0.65, and high risk for LNR >0.659. RESULTS Our study demonstrated a significant difference in overall survival and distant metastasis free survival (p < 0.0001). The 5-years Overall survival was 94 % for N0 patients, 92.4 % for low-risk patients, 85.6 % for intermediate-risk patients and 58.5 % for high-risk patients. The 5-year distant metastasis-free survival was 98.2 % for N0 patients, 95.9 % for low-risk patients, 80.1 % for intermediate-risk patients, and 60.3 % for high-risk patients. Multivariate analysis identified age, invasive lobular histologic type, presence of clinical inflammation, and intermediate and high risk classes of LNR ratio as independent factors affecting overall survival. For metastatic-free survival, the presence of clinical inflammation, the presence of LVSI and the low, intermediate, or high-risk classes of LNR ratio were identified as independent factors. However, age and invasive lobular histologic type did not appear to be independent factors affecting metastatic-free survival. CONCLUSION Our study highlights the significant prognostic impact of lymph node involvement in patients with invasive lobular carcinoma. The LNR ratio can be used as a reliable predictor of overall survival and metastatic-free survival in these patients.
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Affiliation(s)
- M Deberti
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé 37044 Tours, France; François-Rabelais University, Tours, France
| | - C Goupille
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé 37044 Tours, France; François-Rabelais University, Tours, France; INSERM unit 1069 Tours, France
| | - F Arbion
- Department of Pathology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France
| | - A Vilde
- Department of Radiology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé 37044 Tours, France
| | - G Body
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé 37044 Tours, France; François-Rabelais University, Tours, France; INSERM unit 1069 Tours, France
| | - L Ouldamer
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé 37044 Tours, France; François-Rabelais University, Tours, France; INSERM unit 1069 Tours, France.
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Benbakoura L, Goupille C, Arbion F, Vilde A, Body G, Ouldamer L. The variability of aggressiveness of grade 1 breast cancer. J Gynecol Obstet Hum Reprod 2023; 52:102653. [PMID: 37634700 DOI: 10.1016/j.jogoh.2023.102653] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Grade 1 breast cancer represents the lowest grade of invasive breast cancer and is associated with a low risk of recurrence and distant metastasis. However, when grade 1 breast cancer is associated with lymph node involvement, the prognosis may be worse than that of grade 1 breast cancer without lymph node involvement. METHOD The study population included all patients who were managed in our institution between January 1, 2007 and December 31, 2013 for grade 1 breast cancer . We compared patients who had lymph node involvement to those who had no lymph node involvement. RESULTS During the study period 291 grade 1 carcinomas were included of which 23% had associated positive lymph node involvement. Overall survival did not differ significantly between patients without lymph node involvement and those with lymph node involvement, nor was there a significant difference in the risk of local recurrence free survival. However, a significant difference was found in survival without distant metastasis with a significant level of a p at 0.029. CONCLUSION Our findings confirm that tumor size and LVSI are strong predictors of axillary lymph node involvement, which is a key determinant of distant metastasis-free survival.
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Affiliation(s)
- Leila Benbakoura
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, Tours 37044, France; François-Rabelais University, Tours, France
| | - Caroline Goupille
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, Tours 37044, France; François-Rabelais University, Tours, France; INSERM Unit, Tours 1069, France
| | - Flavie Arbion
- Department of Pathology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, Tours 37044, France
| | - Anne Vilde
- Department of Radiology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, Tours 37044, France
| | - Gilles Body
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, Tours 37044, France; François-Rabelais University, Tours, France; Department of Radiology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, Tours 37044, France
| | - Lobna Ouldamer
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, Tours 37044, France; François-Rabelais University, Tours, France; Department of Radiology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, Tours 37044, France.
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Ozenne A, De Berti M, Body G, Carcopino X, Graesslin O, Kerbage Y, Akladios C, Huchon C, Bricou A, Mimoun C, Raimond E, Ouldamer L. Risk Factors for Recurrence of Borderline Ovarian Tumours after Conservative Surgery and Impact on Fertility: A Multicentre Study by the Francogyn Group. J Clin Med 2022; 11:jcm11133645. [PMID: 35806930 PMCID: PMC9267171 DOI: 10.3390/jcm11133645] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/12/2022] [Accepted: 06/15/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction: Borderline ovarian tumours (BOT) represent 10–20% of epithelial tumours of the ovary. Although their prognosis is excellent, the recurrence rate can be as high as 30%, and recurrence in the infiltrative form accounts for 3% to 5% of recurrences. Affecting, in one third of cases, women of childbearing age, the surgical strategy with ovarian conservation is now recommended despite a significant risk of recurrence. Few studies have focused exclusively on patients who have received ovarian conservative treatment in an attempt to identify factors predictive of recurrence and the impact on fertility. The objective of this study was to identify the risk factors for recurrence of BOT after conservative treatment and the impact on fertility. Material and methods: This was a retrospective, multicentre study of women who received conservative surgery for BOT between February 1997 and September 2020. We divided the patients into two groups, the “R group” with recurrence and the “NR group” without recurrence. Results: Of 175 patients included, 35 had a recurrence (R group, 20%) and 140 had no recurrence (NR group, 80%). With a mean follow-up of 30 months (IQ 8–62.5), the overall recurrence rate was 20%. Recurrence was BOT in 17.7% (31/175) and invasive in 2.3% (4/175). The mean time to recurrence was 29.5 months (IQ 16.5–52.5). Initial complete peritoneal staging (ICPS) was performed in 42.5% of patients (n = 75). In multivariate analysis, age at diagnosis, nulliparity, advanced FIGO stage, the presence of peritoneal implants, and the presence of a micropapillary component for serous tumours were factors influencing the occurrence of recurrence. The post-surgery fertility rate was 67%. Conclusion: This multicentre study is to date one of the largest studies analysing the risk factors for recurrence of BOT after conservative surgery. Five risk factors were found: age at diagnosis, nulliparity, advanced FIGO stage, the presence of implants, and a micropapillary component. Only 25% of the patients with recurrence underwent ICPS. These results reinforce the interest of initial peritoneal staging to avoid ignoring an advanced tumour stage.
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Affiliation(s)
- Adele Ozenne
- Department of Gynecology, Tours University Hospital, 37044 Tours, France; (A.O.); (M.D.B.); (G.B.)
| | - Marion De Berti
- Department of Gynecology, Tours University Hospital, 37044 Tours, France; (A.O.); (M.D.B.); (G.B.)
| | - Gilles Body
- Department of Gynecology, Tours University Hospital, 37044 Tours, France; (A.O.); (M.D.B.); (G.B.)
- INSERM U1069, Université François-Rabelais, 37044 Tours, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397 Marseille, France;
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims Champagne Ardennes University, 51100 Reims, France; (O.G.); (E.R.)
| | - Yohan Kerbage
- Department of Gynecologic Surgery, Jeanne de Flandre Hospital, CHRU LILLE, Rue Eugene Avinée, 59037 Lille, France;
| | - Cherif Akladios
- Department of Surgical Gynecology, Strasbourg University Hospital, 67000 Strasbourg, France;
| | - Cyrille Huchon
- Department of Gynecology, CHI Poissy-St-Germain, EA 7285 Risques Cliniques et Sécurité en Santé des Femmes, Université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France;
| | - Alexandre Bricou
- Department of Gynecology, Bobigny University, AP-HP, Jean-Verdier Hospital, 93140 Bondy, France;
| | - Camille Mimoun
- Department of Gynecology and Obstetrics, Lariboisiere Hospital, 750019 Paris, France;
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims Champagne Ardennes University, 51100 Reims, France; (O.G.); (E.R.)
| | - Lobna Ouldamer
- Department of Gynecology, Tours University Hospital, 37044 Tours, France; (A.O.); (M.D.B.); (G.B.)
- INSERM U1069, Université François-Rabelais, 37044 Tours, France
- Correspondence: ; Tel.: +33-2-47-47-47-41; Fax: +33-2-47-47-92-73
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Ouldamer L, Serre E, Destrieux C, Body G, Ouldamer L. Lymphatic Drainage of Bartholin’s Gland in Fresh Adult Cadavers: Implications in Terms of Groin Surgery in Case of Bartholin’s Gland Carcinoma. J Surg Oncol 2022. [DOI: 10.31487/j.jso.2022.01.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: To investigate the lymphatic drainage of Bartholin’s gland and its therapeutic implications in Bartholin’s gland carcinoma.
Materials and Methods: Data were obtained from the anatomical study of ten fresh female cadavers with groin and pelvic dissections after lymphatic channel and node staining by injection of Lipiodol dye solution into Bartholin’s gland.
Results: We distinguished three different lymphatic pathways: i) the superficial inguinal pathway, identified in 61.5% of cases, ii) the internal pudendal pathway (towards the pararectal fossa), identified in 30.8% of cases, and iii) the pelvic pathway, identified in 15.4% of cases, one after an inguinal pathway and the other following the labiocrural fold. No evidence of stained lymphatic structures was found in 31.6% of cases. The principal pathway was always ipsilateral.
Conclusion: Ipsilateral groin lymphadenectomy offers the most effective ratio between oncological safety and surgery-related complications.
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Ouldamer L, Giraudeau B, Caille A, Body G. 460 Dead space closure with quilting suture versus conventional closure with drainage in prevention of seroma formation after mastectomy for breast cancer : a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lorenzini J, Deberti M, Body G, Carcopino X, Touboul C, Dabi Y, Collinet P, Coutant C, Akladios C, Lavoué V, Bolze PA, Huchon C, Bricou A, Canlorbe G, Mimoun C, Bendifallah S, Ouldamer L. Lymphovascular space invasion and Estrogen Receptor status in high-grade serous ovarian cancer-a multicenter study by the FRANCOGYN group. J Gynecol Obstet Hum Reprod 2021; 51:102242. [PMID: 34715402 DOI: 10.1016/j.jogoh.2021.102242] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/25/2021] [Accepted: 10/05/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of Lymphovascular Space Invasion (LVSI) on Overall Survival (OS) and Recurrence-Free Survival (RFS) in patients managed for high-grade serous epithelial ovarian cancer (HGSOC). MATERIALS AND METHODS Retrospective multicenter study by the FRANCOGYN research group between January 2001 and December 2018. All patients managed for HGSOC and for whom histological slides for the review of LVSI were available, were included. The characteristics of patients with LVSI (LVSI group) were compared to those without LVSI (No LVSI group). A Cox analysis for OS and RFS analysis was performed in all populations. RESULTS Over the study period, 410 patients were included in the thirteen institutions. Among them, 289 patients had LVSI (33.9%). LVSI was an independent predictive factor for poorer Overall and Recurrence-Free Survival. LVSI affected OS (p<0.001) and RFS (p<0.001), Association of LVSI status and estrogen receptor status (ER) also affected OS and RFS (p=0.04; p=0.04 respectively). CONCLUSION The presence of LVSI in HGSOC has an impact on OS and RFS and should be routinely included in the pathology examination along with ER status.
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Affiliation(s)
- Jerome Lorenzini
- Department of Gynecology, Service de Gynécologie, Tours University Hospital, 2 Boulevard Tonnellé, Tours 37044, France
| | - Marion Deberti
- Department of Gynecology, Service de Gynécologie, Tours University Hospital, 2 Boulevard Tonnellé, Tours 37044, France
| | - Gilles Body
- Department of Gynecology, Service de Gynécologie, Tours University Hospital, 2 Boulevard Tonnellé, Tours 37044, France; INSERM U1069 Université François-Rabelais, Tours, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397, Marseille, France
| | - Cyril Touboul
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Creteil, France
| | - Yohann Dabi
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Creteil, France
| | - Pierre Collinet
- Department of Gynecologic surgery, Jeanne de Flandre Hospital, CHRU LILLE, Rue Eugene Avinée 59037 Lille Cedex, France
| | - Charles Coutant
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Centre, Dijon, France
| | - Cherif Akladios
- Department of Surgical Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Vincent Lavoué
- Department of Gynecology, Rennes University Hospital, France. INSERM 1242, COSS, Rennes. Université de Rennes 1. France
| | - Pierre-Adrien Bolze
- Department of Gynecologic and Oncologic Surgery and Obstetrics, Lyon Sud University Hospital, Hospices Civils de Lyon, Université Lyon 1, France
| | - Cyrille Huchon
- Department of gynecology, CHI Poissy-St-Germain, Université Versailles-Saint-Quentin en Yvelines, EA 7285 Risques cliniques et sécurité en santé des femmes, Université Versailles-Saint-Quentin en Yvelines, Versailles, France
| | - Alexandre Bricou
- Department of Gynecology, Bobigny University, AP-HP, Jean-Verdier Hospital, Bondy, France
| | - Geoffroy Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Pitié-Salpêtrière, University Hospital, Paris, France
| | - Camille Mimoun
- Department of Gynecology and Obstetrics, Lariboisiere Hospital, 750019 Paris, France
| | - Sofiane Bendifallah
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Lobna Ouldamer
- Department of Gynecology, Service de Gynécologie, Tours University Hospital, 2 Boulevard Tonnellé, Tours 37044, France; INSERM U1069 Université François-Rabelais, Tours, France.
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Berti MD, Goupille C, Doucet M, Arbion F, Vilde A, Body G, Ouldamer L. Oncological Safety of Autologous Fat Grafting in Breast Reconstruction after Mastectomy for cancer: A case-control study. J Gynecol Obstet Hum Reprod 2021; 51:102257. [PMID: 34695621 DOI: 10.1016/j.jogoh.2021.102257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The use of autologous fat grafting in the context of breast reconstruction is still a matter of controversy. The objective of this study was to compare the local relapse rate in women who had a fat grafting session in the context of breast reconstruction after breast cancer management, to those who had breast reconstruction without fat grafting. METHODS We performed a retrospective, monocentric, case-control study from January 2007 to December 2017 in our hospital. The cases included women who underwent breast reconstruction with autologous fat grafting and controls, undergoing breast reconstruction without fat grafting. We compared survival and local recurrence between the two groups. RESULTS 412 women were included: 109 (26.5%) in the lipofilling group and 303 women (73.5%) in the "no lipofilling" group. In the overall study population, lipofilling did not appear to be a predictive factor for recurrence, HR = 1.39 [0.63 - 3.06], p = 0.41; or a predictive factor for overall survival, HR = 0.84 [0.23 - 3.02], p = 0.79, or for distant metastases, HR = 1.10 [0.43 - 2.79], p = 0.84. In contrast, in the subgroup of women treated for invasive cancer, the multivariate analysis showed that lipofilling in this context was an independent predictive factor for local recurrence (HR= 5.06 [1.97 - 10.6], p = 0.04). CONCLUSION we found an increased risk of local recurrence after lipofilling in women who were managed for invasive breast cancer. This suggests that special consideration should be given to women who have had invasive breast cancer before lipofilling.
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Affiliation(s)
- M De Berti
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, Tours, France
| | - C Goupille
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, Tours, France; INSERM unit 1069, Tours, France
| | - M Doucet
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, Tours, France
| | - F Arbion
- Department of Pathology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France
| | - A Vilde
- Department of Radiology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France
| | - G Body
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, Tours, France; Department of Radiology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France
| | - L Ouldamer
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, Tours, France; Department of Radiology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France.
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Delvallée J, Etienne C, Arbion F, Vildé A, Body G, Ouldamer L. Negative estrogen receptors and positive progesterone receptors breast cancers. J Gynecol Obstet Hum Reprod 2020; 50:101928. [PMID: 33022450 DOI: 10.1016/j.jogoh.2020.101928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/27/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 12/24/2022]
Abstract
CONTEXT Hormone receptors (estrogen receptor ER and progesterone receptor PR) are prognostic and predictive factors of outcome for invasive breast cancer. Some tumors only express one of these hormone receptors (ER or PR). ER negative/PR positive breast cancer is a rare subtype (1-4 %) and its existence still controversial. The aim of this study was to evaluate characteristics of this group of tumors. METHODS We collected data of all consecutive patients managed in our institution for invasive breast cancer between the 1st January 2007 and 31 December 2013. The aim of the study was to compare data of patients with ER-/PR+tumors with the three other subgroups. RESULTS Of the 2071 patients included during the study period, 1.2 % were ER-/PR+. These patients were younger than those with the two ER+groups (p<0.0001). The ER-/PR+tumors differed from the ER+groups for several histological prognostic factors: greater histological size (p=0.0004), higher histological grade, more HER2 overexpression/amplification, more association with ductal carcinoma in situ, more lymphovascular invasion, more nodal metastasis (p<0.0001). Chemotherapy was more often used as an adjuvant treatment in addition of endocrine therapy. Survival was equivalent for patients with ER-/PR+tumors and ER+tumors and significantly higher than patients with ER-/PR- tumors (p<0.0001). CONCLUSION Women with ER-/PR+breast cancer have worse prognostic factors than women with ER+cancers but have better overall survival than women with ER-/PR- tumors. We may think that the more frequent association of chemotherapy and endocrine therapy is responsible for this better outcome.
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Affiliation(s)
- Julie Delvallée
- Department of Gynecology, CHRU de Tours, Hôpital Bretonneau. 2 boulevard Tonnellé. 37044 Tours. France; François Rabelais University, Tours. France
| | - Claudia Etienne
- Department of Gynecology, CHRU de Tours, Hôpital Bretonneau. 2 boulevard Tonnellé. 37044 Tours. France; François Rabelais University, Tours. France
| | - Flavie Arbion
- Department of Pathology, CHRU de Tours, Hôpital Bretonneau. 2 boulevard Tonnellé. 37044 Tours. France
| | - Anne Vildé
- Department of Radiology, CHRU de Tours, Hôpital Bretonneau. 2 boulevard Tonnellé. 37044 Tours. France
| | - Gilles Body
- Department of Gynecology, CHRU de Tours, Hôpital Bretonneau. 2 boulevard Tonnellé. 37044 Tours. France; François Rabelais University, Tours. France; INSERM Unit 1069, Tours. France
| | - Lobna Ouldamer
- Department of Gynecology, CHRU de Tours, Hôpital Bretonneau. 2 boulevard Tonnellé. 37044 Tours. France; François Rabelais University, Tours. France; INSERM Unit 1069, Tours. France.
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Rossard L, Body G, Ouldamer L. Uterine pseudoaneurysm after abdominal myomectomy: A case report. J Gynecol Obstet Hum Reprod 2020; 50:101877. [PMID: 32717332 DOI: 10.1016/j.jogoh.2020.101877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/10/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
We present the case of a young woman with abnormal vaginal bleeding two weeks after an abdominal myomectomy. The intervention was initially considered uncomplicated. Transvaginal sonography detected a pulsatile cystic area, just above the endometrium in the anterior wall of the lower uterine segment. Color Doppler analysis revealed the communication between an artery and a vein. Although, the ultrasound was completely sufficient for diagnosis, computed tomographic angiography was performed and confirmed the diagnosis of uterine pseudoanevrysm within the uterine myometrium. Selective arterial embolization was performed with complete recovery.
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Affiliation(s)
- Lauranne Rossard
- Department of Gynecology. Centre Hospitalier Régional Universitaire de Tours. Hôpital Bretonneau. 2 Boulevard Tonnellé. 37044 Tours. France; François-Rabelais University, Tours. France
| | - Gilles Body
- Department of Gynecology. Centre Hospitalier Régional Universitaire de Tours. Hôpital Bretonneau. 2 Boulevard Tonnellé. 37044 Tours. France; François-Rabelais University, Tours. France; INSERM Unit 1069, Tours. France
| | - Lobna Ouldamer
- Department of Gynecology. Centre Hospitalier Régional Universitaire de Tours. Hôpital Bretonneau. 2 Boulevard Tonnellé. 37044 Tours. France; François-Rabelais University, Tours. France; INSERM Unit 1069, Tours. France.
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Gest R, Cayet S, Arbion F, Vildé A, Body G, Ouldamer L. Predictive factors of major deviation (>20 mm) between lesion sizes measured by magnetic resonance imaging and histology for invasive lobular breast cancer. Eur J Obstet Gynecol Reprod Biol 2020; 251:14-19. [PMID: 32502770 DOI: 10.1016/j.ejogrb.2020.05.036] [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: 12/14/2019] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To identify factors predictive of high discordance (>20 mm) between lesion sizes measured by magnetic resonance imaging (MRI) and histology for invasive lobular breast cancer. MATERIALS AND METHODS Data for all women with invasive lobular breast cancer (pure or associated with a component of invasive ductal carcinoma) between 1st January 2007 and 31st December 2016 were included in this study. Logistic regression analysis was performed to determine factors predictive of high discordance (underestimation/overestimation by >20 mm) between tumour sizes measured by MRI and histology for invasive lobular breast cancer. RESULTS For overestimation, significant factors on univariate analysis were: menopausal status [odds ratio (OR) 0.27, 95 % confidence interval (CI) 0.10-0.71]; p = 0.01], hormone receptor (HR) status (HR negative, OR 1.64, 95 % CI 0.27-9.89; HR positive, OR 0.64, 95 % CI 0.21-1.88; p = 0.09) and neoadjuvant chemotherapy (OR 10.33, 95 % CI 3.58-29.8; p < 0.001). On multivariate analysis, menopausal status and neoadjuvant chemotherapy were found to be independent predictive factors of overestimation. For underestimation, significant factors on univariate analysis were: histological size (OR 1.05, 95 % CI 1.02-1.08; p < 0.0001) and the presence of an in-situ component (OR 4.66, 95 % CI 1.01-21.5; p = 0.02). These two factors were independent predictive factors of underestimation. CONCLUSION Independent predictive factors of overestimation/underestimation (threshold 20 mm) of tumour sizes measured by MRI compared with histology for invasive lobular breast cancer were identified.
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Affiliation(s)
- Roxane Gest
- Department of Gynaecology, CHRU de Tours, Tours, France; François Rabelais University, Tours, France
| | - Sophie Cayet
- François Rabelais University, Tours, France; Department of Radiology, CHRU de Tours, Tours, France
| | - Flavie Arbion
- Department of Pathology, CHRU de Tours, Tours, France
| | - Anne Vildé
- Department of Radiology, CHRU de Tours, Tours, France
| | - Gilles Body
- Department of Gynaecology, CHRU de Tours, Tours, France; François Rabelais University, Tours, France; INSERM, Tours, France
| | - Lobna Ouldamer
- Department of Gynaecology, CHRU de Tours, Tours, France; François Rabelais University, Tours, France; INSERM, Tours, France.
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12
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Lebreton M, Carton I, Brousse S, Lavoué V, Body G, Levêque J, Nyangoh-Timoh K. Vulvar intraepithelial neoplasia: Classification, epidemiology, diagnosis, and management. J Gynecol Obstet Hum Reprod 2020; 49:101801. [PMID: 32417455 DOI: 10.1016/j.jogoh.2020.101801] [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] [Received: 12/31/2019] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 11/26/2022]
Abstract
Vulvar intraepithelial neoplasia (VIN) is classified into two entities: differentiated (dVIN) and vulvar high-grade squamous intraepithelial lesions (vH-SIL). dVIN is a premalignant lesion that develops on an existing vulvar lesion such as lichen sclerosus, while vH-SIL is associated with HPV infection. The two entities differ in terms of pathophysiology, background, prognosis, and management. The incidence of VIN in young women is rising and recurrence is common, even after radical surgery, which can cause significant disfigurement. Alternative strategies include topical treatments, ablation, and a watch-and-wait approach. There is currently no consensus on how these lesions should be managed. We review the literature in this field.
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Affiliation(s)
- M Lebreton
- Département de Gynécologie Obstétrique et Reproduction Humaine, CHU Anne de Bretagne, 16 Bd de Bulgarie BP 90347, F-35 203, Rennes Cedex 2, France
| | - I Carton
- Département de Gynécologie Obstétrique et Reproduction Humaine, CHU Anne de Bretagne, 16 Bd de Bulgarie BP 90347, F-35 203, Rennes Cedex 2, France
| | - S Brousse
- Département de Gynécologie Obstétrique et Reproduction Humaine, CHU Anne de Bretagne, 16 Bd de Bulgarie BP 90347, F-35 203, Rennes Cedex 2, France
| | - V Lavoué
- Département de Gynécologie Obstétrique et Reproduction Humaine, CHU Anne de Bretagne, 16 Bd de Bulgarie BP 90347, F-35 203, Rennes Cedex 2, France
| | - G Body
- Service de gynécologie obstétrique et médecine fœtale, université François Rabelais, CHRU de Tours, 2, boulevard Tonnelle, 37044, Tours Cedex 9, France
| | - J Levêque
- Département de Gynécologie Obstétrique et Reproduction Humaine, CHU Anne de Bretagne, 16 Bd de Bulgarie BP 90347, F-35 203, Rennes Cedex 2, France.
| | - K Nyangoh-Timoh
- Département de Gynécologie Obstétrique et Reproduction Humaine, CHU Anne de Bretagne, 16 Bd de Bulgarie BP 90347, F-35 203, Rennes Cedex 2, France
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Serre E, Raimond E, Diguisto C, Bendifallah S, Body G, Touboul C, Graesslin O, Carcopino X, Daraï E, Ouldamer L. Inguino-femoral radiotherapy in vulvar squamous cell carcinoma: clues to revised indications in patients with only one intracapsular lymph node metastasis. Acta Oncol 2020; 59:518-524. [PMID: 31718368 DOI: 10.1080/0284186x.2019.1687934] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and objectives: The aim was to review the clinical impact of groin metastatic nodal disease in women with vulvar squamous cell carcinoma (VSCC) and to evaluate the impact of adjuvant radiotherapy on women with single intracapsular lymph node metastasis (SILNM).Methods: Cohort study of women with vulvar squamous cell carcinoma (VSCC) managed between January 2005 and December 2015 in five institutions in France with prospectively maintained databases (French multicentre tertiary care centres). We evaluated Impact of SILNM on outcome.Results: A total of 176 women (34.6%) had at least one positive lymph node (LN). There were no significant differences for the 5-year overall survival rates between women with one extracapsular LN metastasis and women with one intracapsular LN metastasis, or with two node metastases (p = .62, p = .63 respectively). In women with a SILNM: (1) lymphovascular invasion (LVSI) was an independent negative predictive factor recurrence-free survival (RFS) (HR = 0.10 (95%CI, 0.01-0.90), p = .04) and (2) Adjuvant inguino-femoral radiotherapy was a positive independent factor associated with RFS (HR = 5.87 (95%CI 1.21-28.5), p = .02).Conclusion: A potential positive effect of adjuvant radiotherapy in node positive VSCC, irrespective of the number of affected LN, should be considered especially in the case of LVSI.
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Affiliation(s)
- Emilie Serre
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France
- INSERM U1069; Université François-Rabelais, Tours, France
| | - Emilie Raimond
- Department of Obstetrics and Gynecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Caroline Diguisto
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Sofiane Bendifallah
- Department of Obstetrics and Gynecology, Hôpital Tenon, Assistance Publique Des Hôpitaux de Paris, GRC-6 UPMC, Université Pierre et Marie Curie, France
- UMR S 707, Epidemiology, Information Systems, Modeling, Université Pierre et Marie Curie, Paris, France
| | - Gilles Body
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France
- INSERM U1069; Université François-Rabelais, Tours, France
| | - Cyril Touboul
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Olivier Graesslin
- Department of Obstetrics and Gynecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Xavier Carcopino
- Department of Gynecological Surgery, Assistance Publique Des Hôpitaux de Marseille, Marseille, France
| | - Emile Daraï
- Department of Obstetrics and Gynecology, Hôpital Tenon, Assistance Publique Des Hôpitaux de Paris, GRC-6 UPMC, Université Pierre et Marie Curie, France
- Inserm Umr S 938, Université Pierre et Marie Curie, Paris, France
| | - Lobna Ouldamer
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France
- INSERM U1069; Université François-Rabelais, Tours, France
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Serre E, Diguisto C, Body G, Raimond E, Bendifallah S, Touboul C, Graesslin O, Carcopino X, Ballester M, Daraï E, Ouldamer L. [Prognostic significance of groin lymph node ratio in vulvar squamous cell carcinoma]. ACTA ACUST UNITED AC 2020; 48:729-735. [PMID: 32339764 DOI: 10.1016/j.gofs.2020.04.011] [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: 06/10/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim was to review the clinical impact of lymph node ratio (LNR) of groin metastatic nodal disease in women with vulvar squamous cell carcinoma. MATERIAL AND METHODS Cohort study of women with vulvar squamous cell carcinoma, managed between January 2005 and December 2015, in five institutions in France with prospectively maintained databases (French multicenter tertiary care centers). POPULATION In total, 636 women managed for VSCC of whom 508 (79.9%) underwent surgical groin nodal staging. MAIN OUTCOME MEASURES Comparison of overall and recurrence free survival between women according to LNR. RESULTS In total, 176 women (34.6%) had at least one positive lymph node (LN). There was a significant differences for the 5-year overall survival and recurrence free survival rates between women with LNR>0.2 and women with LNR<0.2. CONCLUSION LNR seems to be a significant prognostic factor in women with vulvar squamous cell carcinoma.
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Affiliation(s)
- E Serre
- Department of Gynecology, CHU de Tours, Tours, France; Inserm U1069, Université François-Rabelais, Tours, France
| | - C Diguisto
- Department of Gynecology, CHU de Tours, Tours, France
| | - G Body
- Department of Gynecology, CHU de Tours, Tours, France; Inserm U1069, Université François-Rabelais, Tours, France
| | - E Raimond
- Department of Obstetrics and Gynecology, Institute Alix-de-Champagne, University Hospital, Reims, France
| | - S Bendifallah
- Department of Obstetrics and Gynecology, GRC-6 UPMC, Hôpital Tenon, Université Pierre et Marie-Curie, AP-HP, Paris 6, France; UMR S 707, Epidemiology, Information Systems, Modeling, Université Pierre et Marie-Curie, Paris, France
| | - C Touboul
- Department of Obstetrics and Gynecology, centre hospitalier intercommunal, Créteil, France
| | - O Graesslin
- Department of Obstetrics and Gynecology, Institute Alix-de-Champagne, University Hospital, Reims, France
| | - X Carcopino
- Department of Gynecological surgery, AP-HP, Marseille, France
| | - M Ballester
- Department of Obstetrics and Gynecology, Institute Alix-de-Champagne, University Hospital, Reims, France; Inserm UMR S 938, Université Pierre et Marie-Curie, Paris, France
| | - E Daraï
- Department of Obstetrics and Gynecology, GRC-6 UPMC, Hôpital Tenon, Université Pierre et Marie-Curie, AP-HP, Paris 6, France; Inserm UMR S 938, Université Pierre et Marie-Curie, Paris, France
| | - L Ouldamer
- Department of Gynecology, CHU de Tours, Tours, France; Inserm U1069, Université François-Rabelais, Tours, France.
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De Wit A, Arbion F, Desille-Gbaguidi H, Avigdor S, Body G, Ouldamer L. Role of surgery in patients with synchronous metastatic breast cancer: Is there a need for axillary lymph node removal? J Gynecol Obstet Hum Reprod 2020; 50:101771. [PMID: 32335350 DOI: 10.1016/j.jogoh.2020.101771] [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: 11/11/2019] [Revised: 04/12/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION About 6% of women with breast cancer present with synchronous metastases. Treatment remains palliative in international recommendations but the impact of loco-regional surgery remains controversial. OBJECTIVE We conducted a multicentre, cohort study to evaluate the impact of axillary lymph node (ALN) surgery on overall survival in stage IV breast cancer at diagnosis. METHODS Patients presenting with breast cancer and synchronous metastases between 2005 and 2014 were included. Follow up was conducted up to 1st June 2018. The only exclusion criterion was a history of previous malignancies. Breast surgery was defined as lumpectomy or mastectomy. Axillary surgery included full ALN dissection, and sentinel lymph node biopsy (SLNB). If the SLN was invaded on the frozen section, full axillary dissection was performed. RESULTS 152 patients were included. 71 women had no surgery, 81 had primary site surgery of which 64 (79%) had breast and axillary surgery and 17 (21%) breast surgery only. 5-year overall survival was 59.8% (95% CI=[49.5; 69.5]) for women with breast and axillary surgery, 23.5% (95% CI=[15.6; 33]) for women with breast surgery only and 9.8% (95% CI=[4.7; 17.5]) for women without any surgery, p < 0.001. Combined with breast surgery, axillary surgery significantly added a mean of 33 months to patient overall survival. CONCLUSION ALN surgery combined with breast surgery in metastatic breast cancer significantly increased overall survival. Thus surgical indications should not differ from those in women with breast cancer without metastases.
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Affiliation(s)
- A De Wit
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 Boulevard Tonnelé, 37044 Tours, France; François-Rabelais University, Tours, France
| | - F Arbion
- Department of Pathology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 Boulevard Tonnelé, 37044 Tours, France
| | - H Desille-Gbaguidi
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 Boulevard Tonnelé, 37044 Tours, France; François-Rabelais University, Tours, France
| | - S Avigdor
- Department of Gynaecology and Obstetrics, Centre Hospitalier Régional de Orléans, Orléans, France
| | - G Body
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 Boulevard Tonnelé, 37044 Tours, France; François-Rabelais University, Tours, France; INSERM unit 1069, Tours, France
| | - L Ouldamer
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 Boulevard Tonnelé, 37044 Tours, France; François-Rabelais University, Tours, France; INSERM unit 1069, Tours, France.
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Ouldamer L, Body G, Daraï E, Bendifallah S. [Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Epidemiological Aspects and Risk Factors]. ACTA ACUST UNITED AC 2020; 48:239-247. [PMID: 32004787 DOI: 10.1016/j.gofs.2020.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The incidence (rate/100,000) of BOT gradually increases with age from 15-19 years of age and peaks at nearly 4.5 cases/100,000 for the 55-59 year age group (NP3). In the presence of a benign ovarian mass, the standardized risk ratio of serous and mucinous BOT is 1.69, (95% CI 1.39-2.03) and 1.75, (95% CI 1.45-2.10), respectively (NP2). At diagnosis, a median age of diagnosis of OFA is 46 years, unilateral forms (79.7% of cases) are predominant compared to cancers (45.3%) (<0.001) and FIGO I stages represent nearly 63.7% of cases (NP3). The 5-year survival rates for FIGO I, II, III, IV stages are: 99.7% (95% CI: 96.2-100%), 99.6% (95% CI: 92.6-100%), 95.3% (95% CI: 91.8-97.4%), 77.1% (95% CI: 58.0-88.3%), respectively (NP3). Survivors at 5 years for serous and mucinous tumours are 99.7% (95% CI: 99.2-99.9%), 98.5% (95% CI: 96.9-99.3%), respectively (NP3). An epidemiological association exists between personal BOT risk and: (1) a familial history of BOT/certain cancers (pancreas, lung, bone, leukemia) (NP3), (2) a personal history of benign ovarian cyst (NP2), (3) a personal history of pelvic inflammatory disease (IGH), (4) the use of intrauterine device levonorgestrel (NP3), (5) the use of oral contraceptive pills (NP3), (6) multiparity (NP3), (7) hormone replacement therapy (NP3), (8) high consumption of coumestrol (NP4), (9) medical treatment of infertility with progesterone (NP3), (10) non-steroidal anti-inflammatory drug (NSAID). An epidemiological association exists between previous/actual tabacco consumption and the risk of mucinous ovarian BOT (NP2). Relative risk (RR) varies between 2.2 and 2.7, however the relationship is not necessarily a causal one. An epidemiological association exists between overweight/obesity and the risk of serous BOT (NP2). RR varies between 1.2 to 1.8. The high Vitamin D was inversely associated to the risk of serous BOT (NP4). The risk of mucinous BOT was lowered with paracetamol use (OR=0.77; 95% CI: 0.60-0.98) (NP3). However, the relationship between these factors and BOT is not necessarily a causal one and no screening modality can be proposed in the general population (gradeC).
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Affiliation(s)
- L Ouldamer
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 37044 Tours, France; Unité Inserm 1069, 10, boulevard Tonnellé, 37044 Tours, France
| | - G Body
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 37044 Tours, France; Unité Inserm 1069, 10, boulevard Tonnellé, 37044 Tours, France
| | - E Daraï
- Département de gynécologie et d'obstétrique et médecine de la reproduction, Sorbonne université, hôpital universitaire Tenon, Assistance publique-hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; UMR_S938, centre de recherche de Saint-Antoine, université Sorbonne, 75006 Paris, France
| | - S Bendifallah
- Département de gynécologie et d'obstétrique et médecine de la reproduction, Sorbonne université, hôpital universitaire Tenon, Assistance publique-hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; UMR_S938, centre de recherche de Saint-Antoine, université Sorbonne, 75006 Paris, France.
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Fleurier C, De Wit A, Pilloy J, Boivin L, Jourdan ML, Arbion F, Body G, Ouldamer L. Outcome of patients with breast cancer in the oldest old (≥80 years). Eur J Obstet Gynecol Reprod Biol 2019; 244:66-70. [PMID: 31760264 DOI: 10.1016/j.ejogrb.2019.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE In the present study, we present a large institutional study to determine the influence of age≥ 80 years on breast cancer presentation and prognosis. METHODS The study is a retrospective analysis of our prospectively maintained breast cancer database study using data from of women managed from January 2007 through December 2013. Clinicopathologic characteristics were correlated with outcomes according to age (<80 years and ≥ 80 years). RESULTS During the study period, 2083 women with invasive breast cancer were included of which 160 women aged ≥ 80 years (7.7 %). Overall survival was lower in the oldest old than in younger counterparts (p < 0.0001) as was distant metastasis free survival (p = 0.004). Differences in management included more radical surgeries and less chemotherapy and radiotherapy in case of age≥ 80 years. By multivariate analysis, age ≥ 80 years was an independent predictive factor of poor overall survival. CONCLUSION In the present study, age ≥ 80 years was an independent predictive factor of poor overall survival.
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Affiliation(s)
- Claire Fleurier
- Gynecology Department, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François Rabelais University, Faculté de Médecine de Tours, 10 boulevard Tonnellé, 37044 Tours, France
| | - Adeline De Wit
- Gynecology Department, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François Rabelais University, Faculté de Médecine de Tours, 10 boulevard Tonnellé, 37044 Tours, France
| | - Joseph Pilloy
- Gynecology Department, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François Rabelais University, Faculté de Médecine de Tours, 10 boulevard Tonnellé, 37044 Tours, France
| | - Laura Boivin
- Gynecology Department, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François Rabelais University, Faculté de Médecine de Tours, 10 boulevard Tonnellé, 37044 Tours, France
| | - Marie-Lise Jourdan
- INSERM UMR1069, 10 boulevard Tonnellé, 37044 Tours, France; Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France
| | - Flavie Arbion
- Histology Department, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France
| | - Gilles Body
- Gynecology Department, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François Rabelais University, Faculté de Médecine de Tours, 10 boulevard Tonnellé, 37044 Tours, France; INSERM UMR1069, 10 boulevard Tonnellé, 37044 Tours, France
| | - Lobna Ouldamer
- Gynecology Department, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François Rabelais University, Faculté de Médecine de Tours, 10 boulevard Tonnellé, 37044 Tours, France; INSERM UMR1069, 10 boulevard Tonnellé, 37044 Tours, France.
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Lorphelin H, Rossard L, Rua C, Arbion F, Bougnoux P, Body G, Ouldamer L. Evolution of characteristics of women with endometrial cancer during a 40 years study period. J Gynecol Obstet Hum Reprod 2019; 48:489-494. [DOI: 10.1016/j.jogoh.2019.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/07/2019] [Accepted: 04/09/2019] [Indexed: 01/08/2023]
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Ouldamer L, Bendifallah S, Pilloy J, Arbion F, Body G, Brisson C, Lavoué V, Lévêque J, Daraï E. Risk scoring system for predicting breast conservation after neoadjuvant chemotherapy. Breast J 2019; 25:696-701. [PMID: 31066151 DOI: 10.1111/tbj.13303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/10/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 11/29/2022]
Abstract
We developed a risk scoring system (RSS) for predicting breast conservative surgery (BCS) in women receiving neoadjuvant chemotherapy(NAC) for breast cancer. BCS rate in the training set was 32.6%, associated with five variables: age < 50years, primary radiological tumor diameter < 60mm, absence of multifocality, absence of breast inflammation and hormone receptor status. These variables were assigned scores ranging from 0 to 9. The discrimination of the RSS was 0.78(95%CI 0.69-0.86) in the training set. The area under the curve of the receiver operating characteristics for predicting BCS after internal and external validation was 0.77(95%CI 0.68-0.85) and 0.75(95%CI 0.66-0.84), respectively.
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Affiliation(s)
- Lobna Ouldamer
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France.,INSERM U1069, Université François-Rabelais, Tours, France
| | - Sofiane Bendifallah
- Department of Gynaecology, Hôpital Tenon, Paris, France.,INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
| | - Joseph Pilloy
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Flavie Arbion
- Department of Pathology, Centre Hospitalier Universitaire de Tours, France
| | - Gilles Body
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France.,INSERM U1069, Université François-Rabelais, Tours, France
| | - Caroline Brisson
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France.,INSERM U1069, Université François-Rabelais, Tours, France
| | - Vincent Lavoué
- Department of Gynaecology, CHU Anne de Bretagne, Rennes, France
| | - Jean Lévêque
- Department of Gynaecology, CHU Anne de Bretagne, Rennes, France
| | - Emile Daraï
- Department of Gynaecology, Hôpital Tenon, Paris, France
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Weymuller V, Caille A, Diguisto C, Chas M, Jourdan ML, Arbion F, Body G, Ouldamer L. [Influence of hormonal factors on triple-negative breast cancer prognosis]. ACTA ACUST UNITED AC 2019; 47:471-477. [PMID: 30872189 DOI: 10.1016/j.gofs.2019.03.006] [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: 07/02/2017] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Triples negative breast cancer defined by the absence of expression of the hormone receptors and HER2 protein, are considered as aggressive tumours with bad outcome in comparison to the hormone sensitive tumours. The aim of the study was to evaluate the link between hormone factors and prognostic factors of triple-negative tumours. METHODS All patients managed for a triple-negative breast cancer between January, 2009 and December, 2013 were included. For every patient, collected data were the clinical, histological, adjuvant or neoadjuvant treatments, as well as survival data. RESULTS AND CONCLUSION During the study period, 1682 patients were operated for a breast cancer, among which 1444 presented at least an invasive tumour. One hundred and fifty-five women (10.7%) had a negative triple tumour. The average age of diagnosis was 56.4years, is significantly younger than for patients with other types of tumours, P=0.0001. For women with a triple-negative tumour, the parity was the only hormonal factor identified as an independent factor for axillary lymph node involvement (OR=1.53; 95% CI [1.10-2.25] P=0.02) and previous hormone replacement therapy as an independent factor of locoregional recurrence (OR=0.13 [0.005-0.64] P=0.001). We did not find any hormonal factor predictive of distant metastasis. We did not find any difference in overall survival according to the parity (P=0.72), the Body mass index (P=0.62) or the use of HRT (P=0.49). CONCLUSION Hormone factors seem to have a prognostic implication for triple-negative despite the absence of hormone receptors expression.
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Affiliation(s)
- V Weymuller
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - A Caille
- Inserm, SPHERE U1246, CIC 1415, université de Tours, CHRU, 37044 Tours, France
| | - C Diguisto
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - M Chas
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - M L Jourdan
- Unité Inserm 1069, 10, boulevard Tonnellé, 37044 Tours, France
| | - F Arbion
- Département de pathologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - G Body
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France; Unité Inserm 1069, 10, boulevard Tonnellé, 37044 Tours, France
| | - L Ouldamer
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France; Unité Inserm 1069, 10, boulevard Tonnellé, 37044 Tours, France.
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Lesage M, Pilloy J, Fleurier C, Cirier J, Jourdan ML, Arbion F, Body G, Ouldamer L. [Prognosis impact of breast cancer adjuvant radiotherapy delay]. ACTA ACUST UNITED AC 2019; 47:516-521. [PMID: 30851415 DOI: 10.1016/j.gofs.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/14/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate delay to access to adjuvant radiotherapy for women with breast cancer and to study impact on prognosis. METHODS A restrospective descriptive study in the teaching hospital of Tours between 1st January 2007 and 31th December 2013. All women managed for an invasive breast cancer during this period were included with exclusion of women with indication of chemotherapy (neoadjuvant/adjuvant). Delay between surgery and radiotherapy were recorded. Overall survival and recurrence free survival were used to evaluate the impact of delays on prognosis. RESULTS Of the 1855 women with an invasive breast cancer, 904 (48.7%) had an adjuvant radiotherapy without chemotherapy. In the whole population, a delay surgery-radiotherapy>90 days was found as an independent factor negatively impacting recurrence free survival (HR=2.12 [1.03-4.36] p=0.04). In the group of patient with a breast conservative surgery, a delay surgery-radiotherapy>65 days was found as an independent factor negatively impacting recurrence free survival with HR=2.29 [1.16-4.54], p=0.02. A delay surgery-radiotherapy>70 days was found as an independent factor negatively impacting Overall survival and HR=3.41 [1.005-11.62], p=0.04. CONCLUSION Delay to access to adjuvant radiotherapy is an independent factor impacting patient's survival, especially in the case of breast conservative therapy.
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Affiliation(s)
- M Lesage
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - J Pilloy
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - C Fleurier
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - J Cirier
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - M L Jourdan
- Unité Inserm 1069, 10, boulevard Tonnellé, 37044 Tours, France
| | - F Arbion
- Département de pathologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France
| | - G Body
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France; Département de pathologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France
| | - L Ouldamer
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France; Unité Inserm 1069, 10, boulevard Tonnellé, 37044 Tours, France.
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Bendifallah S, Body G, Daraï E, Ouldamer L. [Diagnostic and prognostic value of tumor markers, scores (clinical and biological) algorithms, in front of an ovarian mass suspected of an epithelial ovarian cancer: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. ACTA ACUST UNITED AC 2019; 47:134-154. [PMID: 30733191 DOI: 10.1016/j.gofs.2018.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/25/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the diagnostic value of serum/urinary biomarkers and the operability diagnosis strategy to make management recommendations. METHODS Bibliographical search in French and English languages by consultation of Pubmed, Cochrane and Embase databases. RESULTS For the diagnosis of a suspicious adnexal mass on imaging: Serum CA125 antigen is recommended (grade A). Serum CAE is not recommended (grade C). The low evidence in literature concerning diagnostic value of CA19.9 does not allow any recommendation concerning its use. Serum Human epididymis protein 4 (HE4) is recommended (grade A). Comparison of data concerning diagnosis value of CA125 and HE4 show similar results for the prediction of malignancy in case of a suspicious adnexal mass on imaging (NP1). Urinary HE4 is not recommended (grade A). The use of circulating tumor DNA is not recommended (grade A). Tumor associated antigen-antibodies (AAbs) is not recommended (grade B). The use of ROMA score (Risk of Ovarian Malignancy Algorithm) is recommended (grade A). The use of Copenhagen index (CPH-I), R-OPS score, OVA500 is not recommended (grade C). For the prediction of resectability of an ovarian cancer with peritoneal carcinomatosis in the context of a primary debulking surgery: It is not recommendend to use serum CA125 (grade A). The low evidence in literature concerning diagnostic value of HE4 does not allow any recommendation concerning its use in this context. No recommendation can be given concerning CA19.9 and CAE. For the prediction of resectability of an ovarian cancer with peritoneal carcinomatosis in the context of surgery after neoadjuvant chemotherapy: the low evidence in literature concerning diagnostic value of serum markers in this context does not allow any recommendation concerning their use in this context. Place of laparoscopy for the prediction of resectability in case of upfront surgery of an ovarian cancer with peritoneal carcinomatosis robust data shows that the use of laparoscopy significantly reduce futile laparotomies (LE1). Laparoscopy is recommended in this context (grade A). Fagotti score is a reproducible tool (LE1) permitting the evaluation of feasibility of an optimal upfront debulking (NP4), its use is recommended (grade C). A Fagotti score≥8 is correlated to a low probability of complete or optimal debulking surgery (LE4) (grade C). There is no sufficient evidence to recommend the use of the modified Fagotti score or any other laparoscopic score (LE4). In case of laparotomy for an ovarian cancer with peritoneal carcinomatosis, the use of Peritoneal Cancer Index (PCI) is recommended (grade C). For the prediction of overall survival, disease free survival and the prediction of postoperative complications, the clinical and statistical of actually available tools do not allow any recommendation.
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Affiliation(s)
- S Bendifallah
- Département de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; UMR_S938, université de Sorbonne, 75000 Paris, France
| | - G Body
- Département de gynécologie, centre hospitalier universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Inserm U1069, université François-Rabelais, 37044 Tours, France
| | - E Daraï
- Département de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; Inserm UMR S 938, université Pierre-et-Marie-Curie, 75000 Paris, France
| | - L Ouldamer
- Département de gynécologie, centre hospitalier universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Inserm U1069, université François-Rabelais, 37044 Tours, France.
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Ouldamer L, Bendifallah S, Body G, Touboul C, Graesslin O, Raimond E, Collinet P, Coutant C, Bricou A, Lavoué V, Lévêque J, Daraï E, Ballester M. Incidence, patterns and prognosis of first distant recurrence after surgically treated early stage endometrial cancer: Results from the multicentre FRANCOGYN study group. Eur J Surg Oncol 2019; 45:672-678. [PMID: 30722948 DOI: 10.1016/j.ejso.2019.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 10/17/2018] [Revised: 12/28/2018] [Accepted: 01/09/2019] [Indexed: 01/28/2023] Open
Abstract
Patterns of distant metastatic failure of endometrial cancer (EC) by specific anatomic site are not well described in the literature. In this manuscript, we evaluated the metastatic patterns of EC cancer and analysed the potential distribution of metastatic disease in this malignancy. METHODS A total of 1444 women with EC were identified. Of which we extracted women with locoregional and distant recurrence or with distant recurrence alone. Women were scored based on first site of metastasis: multiple versus one site: bone, brain, lung, liver or sus diaphragmatic lymph nodes. RESULTS 110 women developed distant metastatic disease with (n = 37(33.6%)) or without (n = 73(66.4%)) locoregional recurrence, including 39 women with exclusive first site of metastatic disease and 34 women with multiple sites of metastatic disease. When considering all women, the most common exclusive first site of metastasis was lung (42.8%). The median time to develop distant metastases was shorter after the completion of treatment for exclusive brain metastatic disease compared with other sites of metastatic- disease (7 months vs, 9 for lung, 10 for liver, 19 for bone and 27 months for sus-diaphragmatic LN; P = 0.004). The rate of 3-year overall survival was higher in the sus-diaphragmatic LN metastase group (83.3% vs 50.6% for lung, 37.3% for bone, 16.7% for brain and 0% for liver; P = 0.0059). CONCLUSION The present study has demonstrated the site-specific patterns of metastases. These data support current clinical practice of screening for site-specific metastatic disease after initial treatment of early stage EC based on concerning women-specific signs or symptoms.
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Affiliation(s)
- Lobna Ouldamer
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France; INSERM U1069 Université François-Rabelais, Tours, France.
| | - Sofiane Bendifallah
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France; UMR_S938 Sorbonne University, Paris, France
| | - Gilles Body
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France; INSERM U1069 Université François-Rabelais, Tours, France
| | - Cyril Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Pierre Collinet
- Department of Gynecological Surgery, Jeanne de Flandre University Hospital, Lille, France
| | - Charles Coutant
- Centre de lutte contre le cancer Georges François Leclerc, Dijon, France
| | - Alexandre Bricou
- Department of Gynaecology, Bobigny University, AP-HP, Hôpital Jean-Verdier, Bondy, France
| | - Vincent Lavoué
- Department of Gynecological Surgery, Rennes University Hospital, Rennes, France
| | - Jean Lévêque
- Department of Gynecological Surgery, Rennes University Hospital, Rennes, France
| | - Emile Daraï
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France; INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
| | - Marcos Ballester
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France; INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
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Ouldamer L, Bendifallah S, Body G, Canlorbe G, Touboul C, Graesslin O, Raimond E, Collinet P, Coutant C, Lavoué V, Lévêque J, Bricou A, Huchon C, Daraï E, Ballester M. Change in hazard rates of recurrence over time following diagnosis of endometrial cancer: An age stratified multicentre study from the FRANCOGYN group. Eur J Surg Oncol 2018; 44:1914-1920. [DOI: 10.1016/j.ejso.2018.07.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/17/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022] Open
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Desille-Gbaguidi H, Avigdor S, Body G, Ouldamer L. Survival impact of primary site surgery on metastatic breast cancer patients at diagnosis. J Gynecol Obstet Hum Reprod 2018; 48:171-177. [PMID: 30352310 DOI: 10.1016/j.jogoh.2018.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 09/08/2018] [Revised: 10/13/2018] [Accepted: 10/17/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stage IV breast cancer was considered to be an incurable disease. Primary site surgery used to be reserved to control local complications. In the present study, we compared the survival of women who received therapeutic breast surgery for stage IV breast cancer at initial diagnosis to the survival of those who did not. METHODS Two French hospitals databases were retrospectively screened from 2005 to 2012. We identified all women with metastatic breast cancer at diagnosis. Patients' data were obtained by a review of their medical history. Data were analyzed according the four breast cancer subtypes (luminal A, luminal B, her 2 and triple negative). RESULTS One hundred thirty nine women were included, of whom 69 had primary site surgery. TNM stage and phenotypes of breast cancer were comparable in the two groups but operated women were younger than women who did not (p<0.0001). Average follow-up was 31±23.3 months [1-97]. Through logistic regression, we observed that tumor resection decreased death hazard ratio vs no surgery: HR 0.33, 95% CI [0.16-0.66] p=0.001. In the surgery group, there was no survival difference if women received chemotherapy (p=0.23). There were more patients with only one metastatic site in the surgery group (p=0.002) and they had been more treated with systemic therapy. When we compared tumor phenotypes individually, surgery increased survival on luminal A breast cancer patients (p<.0001). CONCLUSION Women with luminal A breast cancer and synchronous metastasis seemed to benefit from surgery. The development of a national reporting system or registers for outcomes would facilitate the investigation of the disease across a multitude of aspects of stage IV breast cancer.
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Affiliation(s)
- H Desille-Gbaguidi
- Department of Gynecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnelé, 37044 Tours, France; François-Rabelais University, Tours, France
| | - S Avigdor
- Department of Gynecology and Obstetric, Madeleine Hospital, Orléans, France
| | - G Body
- Department of Gynecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnelé, 37044 Tours, France; François-Rabelais University, Tours, France
| | - L Ouldamer
- Department of Gynecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnelé, 37044 Tours, France; François-Rabelais University, Tours, France; INSERM Unit 1069, Tours, France.
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Benoist P, Mureau A, Joueidi Y, Arbion F, Vilde A, Body G, Michenet P, Leveque J, Ouldamer L. Management and prognosis of pure primary squamous cell carcinoma of the breast. J Gynecol Obstet Hum Reprod 2018; 47:275-280. [PMID: 29959086 DOI: 10.1016/j.jogoh.2018.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 06/16/2018] [Accepted: 06/21/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of the study was to investigate the management and prognosis of Pure primary squamous cell carcinoma (PPSCC) of the breast. MATERIALS AND METHODS This study is a multicentre retrospective cohort from three French tertiary referral hospitals (Rennes, Orléans and Tours) including all women treated for a PPSCC of the breast defined by squamous cells that could contain a minority of sarcomatoid component. We excluded carcinomas with a ductual component. Clinicopathologic, radiological and therapeutic patterns were described. Demographic, histological and therapeutic characteristics were compared to a population of women with triple negative invasive breast carcinomas. RESULTS Twelve patients were included, with a mean age of 71.6 years. All lesions were unifocal, with a cystic complex ultrasound mass in 50% of cases. Mean tumor size was 43mm, with axillary lymph node metastasis in 25% of patients. The comparison with a population of women with triple negative breast carcinomas revealed that women with PPSCC were older (71 versus 57 years, p=0.003), tumor size was larger (43mm versus 25mm, p=0.032) and local recurrence occurred earlier (three months versus 38 months, p=0.014). CONCLUSION PPSCC is a rare entity with a worse prognosis in comparison with triple negative invasive carcinoma.
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Affiliation(s)
- P Benoist
- Department of Gynecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, Tours, France
| | - A Mureau
- François-Rabelais University, Tours, France; Department of Radiology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France
| | - Y Joueidi
- Department of Gynecology, Centre Hospitalier Régional Universitaire de Rennes, Anne de Bretagne, 16, boulevard de Bulgarie, 35203 Rennes, France; Department of Surgical Oncology, Eugene Marquis Comprehensive Cancer Center, avenue de la bataille flandres dunkerque, 35042 Rennes, France
| | - F Arbion
- Department of Pathology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France
| | - A Vilde
- Department of Radiology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France
| | - G Body
- Department of Gynecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, Tours, France; INSERM unit 1069, Tours, France
| | - P Michenet
- Department of Pathology, Centre Hospitalier Régional d'Orléans, Hôpital de la Source, 14, avenue de l'hôpital, 45067 Orléans, France
| | - J Leveque
- Department of Gynecology, Centre Hospitalier Régional Universitaire de Rennes, Anne de Bretagne, 16, boulevard de Bulgarie, 35203 Rennes, France; Department of Surgical Oncology, Eugene Marquis Comprehensive Cancer Center, avenue de la bataille flandres dunkerque, 35042 Rennes, France
| | - L Ouldamer
- Department of Gynecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, Tours, France; INSERM unit 1069, Tours, France.
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Ouldamer L, Cayrol M, Vital M, Fièvre C, Druelles M, Arbion F, Body G, Lévêque J, Fritel X. Axillary lymph node metastases from unknown primary: A French multicentre study. Eur J Obstet Gynecol Reprod Biol 2018. [PMID: 29518639 DOI: 10.1016/j.ejogrb.2018.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of the study was to investigate the management and prognosis of axillary cancers from unknown primaries (CUPax). METHODS We included all patients with lesions described as axillary nodal metastases from an unknown primary referred to four French tertiary breast cancer centres between January 1988 and December 2012. The inclusion criteria comprised: no sign of primary breast cancer on clinical examination nor on imaging (mammography, ultrasonography and breast MRI) and no primary tumour identified elsewhere. RESULTS CUPax represented 1.8% of all metastatic axillary lymphadenopathies in our institutions. The overall survival rate was 71%, and 16.7% of patients had secondary inflammatory breast cancer signalling a posteriori that CUPax originated from the breast. Factors that favourably affected survival according to univariate analysis were: histological type of non specific adenocarcinoma (versus other types, p = 0.02), only one lymph node involved (versus several, p = 0.04), a normal CA153 serum-level (p = 0.02), no distant metastasis at initial assessment (p = 0.02), no secondary distant metastasis (p = 0.005) and radiotherapy to the ipsilateral breast/chest wall/lymph nodes (p = 0.04). On multivariate analysis including these factors, a histological type of non-specific adenocarcinoma (p = 0.03) and distant metastases (p = 0.03) were identified as independent factors affecting survival. CONCLUSION We believe that these results will shed light on current investigations and treatment of this rare entity.
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Affiliation(s)
- Lobna Ouldamer
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France; INSERM unit 1069, 10 boulevard Tonnellé, 37044, Tours, France; François Rabelais University, 2 boulevard Tonnellé, 37044, Tours, France.
| | - Marie Cayrol
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France; François Rabelais University, 2 boulevard Tonnellé, 37044, Tours, France
| | | | - Claire Fièvre
- Department of Gynecology, Centre Hospitalier Universitaire de Poitiers, 6 rue de la milétrie, 86021, Poitiers cedex, France
| | - Marion Druelles
- Department of Gynecology, Centre Hospitalier Universitaire Anne de Bretagne, 16 boulevard de Bulgarie, BP 90347, 35203, Rennes Cedex 2, France
| | - Flavie Arbion
- Department of Pathology, Centre Hospitalier Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France
| | - Gilles Body
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France; François Rabelais University, 2 boulevard Tonnellé, 37044, Tours, France
| | - Jean Lévêque
- Department of Gynecology, Centre Hospitalier Universitaire Anne de Bretagne, 16 boulevard de Bulgarie, BP 90347, 35203, Rennes Cedex 2, France
| | - Xavier Fritel
- Department of Gynecology, Centre Hospitalier Universitaire de Poitiers, 6 rue de la milétrie, 86021, Poitiers cedex, France
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Ouldamer L, Chas M, Arbion F, Body G, Cirier J, Ballester M, Bendifallah S, Daraï E. Risk scoring system for predicting axillary response after neoadjuvant chemotherapy in initially node-positive women with breast cancer. Surg Oncol 2018; 27:158-165. [PMID: 29937166 DOI: 10.1016/j.suronc.2018.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 12/24/2016] [Revised: 01/21/2018] [Accepted: 02/04/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND One of the current therapeutic challenges for women with breast cancer receiving neoadjuvant chemotherapy (NAC) is distinguishing women with complete axillary nodal response from those with axillary residual disease to promote a personalized therapeutic strategy including sparing axillary surgery. This study set out to develop a risk scoring system (RSS) for predicting probability of nodal pathological complete response (pCR) in women presenting with cN1 breast cancer who received NAC. METHODS Data of 116 women with cN1 breast cancer who received NAC between January 2009 and December 2013 were abstracted from our prospectively maintained database. A risk model based on factors impacting nodal axillary was developed. RESULTS The overall nodal conversion rate was 36.2% (42/116). Axillary nodal response was associated with three variables: menopausal status [Odds ratio (OR) = 0.23; 95% confidence interval (CI) 0.09-0.60], the radiological % of breast tumour shrinkage ≥50% (OR = 3.71; 95% CI 1.51-9.10), and negative hormone receptors (ER-, PR-) (OR = 2.41; 95% CI 0.99-5.87). These variables were included in the RSS and assigned scores ranging from 0 to 2. The discrimination of the RSS was 0.78 [95% confidence interval (CI) 0.69-0.86]. A total score of 3 points corresponded to the optimal threshold of the RSS. The diagnostic accuracy was 74.1%. CONCLUSIONS This study shows that the probability of axillary nodal pCR after NAC can be accurately predicted so that women at high probability may be spared of axillary surgery.
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Affiliation(s)
- Lobna Ouldamer
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France; INSERM U1069, Université François-Rabelais, Tours, France.
| | - Marie Chas
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Flavie Arbion
- INSERM U1069, Université François-Rabelais, Tours, France; Department of Pathology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Gilles Body
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France; INSERM U1069, Université François-Rabelais, Tours, France
| | - Julien Cirier
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France; INSERM U1069, Université François-Rabelais, Tours, France
| | - Marcos Ballester
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Paris, France; INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
| | - Sofiane Bendifallah
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Paris, France; UMR S 707, Epidemiology, Information Systems, Modeling, Université Pierre et Marie Curie, Paris, France
| | - Emile Daraï
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Paris, France; INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
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Chas M, Boivin L, Arbion F, Jourdan ML, Body G, Ouldamer L. Clinicopathologic predictors of lymph node metastasis in breast cancer patients according to molecular subtype. J Gynecol Obstet Hum Reprod 2018; 47:9-15. [DOI: 10.1016/j.jogoh.2017.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 10/23/2017] [Accepted: 10/30/2017] [Indexed: 01/28/2023]
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Cirier J, Body G, Jourdan ML, Bedouet L, Fleurier C, Pilloy J, Arbion F, Ouldamer L. [Impact of pathological complete response to neoadjuvant chemotherapy in invasive breast cancer according to molecular subtype]. ACTA ACUST UNITED AC 2017; 45:535-544. [PMID: 28939364 DOI: 10.1016/j.gofs.2017.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/27/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of pathological complete response (pCR) on overall survival (OS) and recurrence-free survival (RFS) according to molecular subtypes in women treated for an invasive breast cancer after neoadjuvant chemotherapy (NAC). METHODS All women (n=225) managed with a neoadjuvant chemotherapy for an invasive breast cancer in our institution between January 2007 and December 2013 were included. The characteristics of patients with pCR (pCR-1), breast pCR and axillary pCR were compared to those without pCR (pCR-0) according to the molecular subtypes: luminal A (n=62), luminal B (n=77), Her-2 (n=31) and triple negative (n=55). RESULTS NAC concerned 225 patients of whom 36 (16%) had pCR. Achievement of pCR led to significantly better overall survival in women with Her-2 tumors (35% versus 100%, P=0.035) and also to significantly better locoregional survival in women treated for triple negative tumors (P=0.026). Predictive factors of pCR were a high pathologic grade: OR=2.39, IC 95% (1.19-4.83), P=0.008; Her-2 molecular subtype (P=0.008); positive estrogenic hormonal receptors (P=0.006), a positive Her-2 receptor: OR=2.58, IC 95% (1.20-5.54), P=0.01. CONCLUSION Achievement of pCR is an intermediate marker of survival in women managed with NAC for breast cancer.
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Affiliation(s)
- J Cirier
- Service de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine de Tours, université François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France.
| | - G Body
- Service de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine de Tours, université François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France; Inserm UMR1069, 10, boulevard Tonnellé, 37044 Tours, France
| | - M-L Jourdan
- Inserm UMR1069, 10, boulevard Tonnellé, 37044 Tours, France; Hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - L Bedouet
- Service de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine de Tours, université François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - C Fleurier
- Service de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine de Tours, université François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - J Pilloy
- Service de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine de Tours, université François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - F Arbion
- Service d'anatomie pathologique, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - L Ouldamer
- Service de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine de Tours, université François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France; Inserm UMR1069, 10, boulevard Tonnellé, 37044 Tours, France
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Pilloy J, Fleurier C, Chas M, Bédouet L, Jourdan ML, Arbion F, Body G, Ouldamer L. [Predictive factors of conservative breast surgery after neoadjuvant chemotherapy for breast cancer]. ACTA ACUST UNITED AC 2017; 45:466-471. [PMID: 28869182 DOI: 10.1016/j.gofs.2017.07.003] [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: 03/06/2017] [Accepted: 07/12/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of our study was to evaluate the existence of predictive factors of conservative breast surgery after neoadjuvant chemotherapy (NAC) for breast cancer. METHODS We included all women with invasive breast cancer who received NAC and underwent breast surgery between January 2007 and December 2013 in our institution. Univariable and multivariable analyses were performed to determine the association between clinical and histological factors and conservative breast surgery. RESULTS During the study period, 229 women were included of whom 73 had breast conservative surgery (32%). At univariable analysis, significant predictive factors were age (OR 0.97 [CI 95% 0.95-0.99], P=0.02), radiological size (OR 0.97 [CI 95% 0.96-0.99], P<0.001), multifocality (OR 0.53 [CI 95% 0.27-1.05], P=0.06), breast inflammation (OR 0.15 [CI 95% 0.07-0.32], P<0.001) and the type of hormone receptors (P=0.12). In multivariable analysis, all these factors but age were significant factors and thus considered as independent predictive factors. CONCLUSION This work permitted to identify independent predictive factors of breast conservative surgery after NAC for breast cancer that will be included in a risk scoring system that we aim to evaluate prospectively.
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Affiliation(s)
- J Pilloy
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - C Fleurier
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - M Chas
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - L Bédouet
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - M L Jourdan
- Unité Inserm 1069, 10, boulevard Tonnellé, 37044 Tours, France
| | - F Arbion
- Département de pathologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France
| | - G Body
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France; Département de pathologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France
| | - L Ouldamer
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France; Unité Inserm 1069, 10, boulevard Tonnellé, 37044 Tours, France.
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Ouldamer L, Bendifallah S, Nikpayam M, Body G, Fritel X, Uzan C, Morice P, Daraï E, Ballester M. Improving the clinical management of women with borderline tumours: a recurrence risk scoring system from a French multicentre study. BJOG 2017; 124:937-944. [DOI: 10.1111/1471-0528.14577] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2017] [Indexed: 12/12/2022]
Affiliation(s)
- L Ouldamer
- Department of Gynaecology; Centre Hospitalier Universitaire de Tours; Tours France
- INSERM U1069; Université François-Rabelais; Tours France
| | - S Bendifallah
- Department of Obstetrics and Gynaecology; Hôpital Tenon; Paris France
- UMR S 707; Epidemiology; Information Systems; Modelling; Université Pierre et Marie Curie; Paris France
| | - M Nikpayam
- Department of Obstetrics and Gynaecology; Hôpital Tenon; Paris France
- UMR S 707; Epidemiology; Information Systems; Modelling; Université Pierre et Marie Curie; Paris France
| | - G Body
- Department of Gynaecology; Centre Hospitalier Universitaire de Tours; Tours France
- INSERM U1069; Université François-Rabelais; Tours France
| | - X Fritel
- Department of Obstetrics and Gynaecology; Faculté de Médecine et Pharmacie; CHU de Poitiers; Université de Poitiers; Poitiers France
- INSERM CIC 1402; CHU de Poitiers; Poitiers France
| | - C Uzan
- Department of Gynaecological Surgery; Institut Gustave Roussy; Villejuif France
- INSERM U 10-30; Institut Gustave Roussy; Villejuif France
| | - P Morice
- Department of Gynaecological Surgery; Institut Gustave Roussy; Villejuif France
- INSERM U 10-30; Institut Gustave Roussy; Villejuif France
| | - E Daraï
- Department of Obstetrics and Gynaecology; Hôpital Tenon; Paris France
- INSERM UMR S 938; Université Pierre et Marie Curie; Paris France
| | - M Ballester
- Department of Obstetrics and Gynaecology; Hôpital Tenon; Paris France
- INSERM UMR S 938; Université Pierre et Marie Curie; Paris France
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Ouldamer L, Bendifallah S, Body G, Canlorbe G, Touboul C, Graesslin O, Raimond E, Collinet P, Coutant C, Lavoué V, Lévêque J, Daraï E, Ballester M. Call for Surgical Nodal Staging in Women with ESMO/ESGO/ESTRO High–Intermediate Risk Endometrial Cancer: A Multicentre Cohort Analysis from the FRANCOGYN Study Group. Ann Surg Oncol 2017; 24:1660-1666. [DOI: 10.1245/s10434-016-5731-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Indexed: 01/25/2023]
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Ouldamer L, Bendifallah S, Body G, Touboul C, Graesslin O, Raimond E, Collinet P, Coutant C, Lavoué V, Lévêque J, Daraï E, Ballester M. Predicting poor prognosis recurrence in women with endometrial cancer: a nomogram developed by the FRANCOGYN study group. Br J Cancer 2016; 115:1296-1303. [PMID: 27824810 PMCID: PMC5129824 DOI: 10.1038/bjc.2016.337] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/14/2016] [Accepted: 09/23/2016] [Indexed: 11/09/2022] Open
Abstract
Background: The purpose of this study was to develop a nomogram to predict ‘poor prognosis recurrence' (PPR) in women treated for endometrial cancer (EC). Methods: The data of 861 women who received primary surgical treatment between January 2001 and December 2013 were abstracted from a prospective multicenter database. Data were randomly split into two sets: training and validation with a predefined 2/3 ratio. A Cox proportional hazards multivariate model of selected prognostic features was performed in the training cohort (n=574) to develop a nomogram predicting PPRs. The nomogram was validated in the validation cohort of 287 patients. Results: In the training cohort, 82 (14.3%) developed subsequent PPR. Age, histologic type and grade, lymphovascular space invasion status, FIGO stage, and nodal staging (SLN±pelvic and/or para-aortic lymphadenectomy) were independently associated with subsequent PPR. The nomogram showed an area under the receiver operating characteristic curve (AUC) of 0.82 (95% confidence interval (CI), 0.73–0.89) in the training set. The validation set showed a good discrimination with an AUC of 0.75 (95% CI, 0.65–0.83). Conclusions: We have developed a robust tool that is able to predict subsequent PPRs in women with FIGO I–III EC.
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Affiliation(s)
- Lobna Ouldamer
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France.,INSERM U1069; Université François-Rabelais, 10 Boulevard Tonnellé, 3704 Tours, France
| | - Sofiane Bendifallah
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC-6 UPMC, Université Pierre et Marie Curie, Paris, France.,UMR S 707, Epidemiology, Information Systems, Modeling, Université Pierre et Marie Curie, Paris, France
| | - Gilles Body
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France.,INSERM U1069; Université François-Rabelais, 10 Boulevard Tonnellé, 3704 Tours, France
| | - Cyril Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Pierre Collinet
- Department of Gynecological surgery, Jeanne de Flandre University Hospital, Lille, France
| | - Charles Coutant
- Centre de lutte Contre le Cancer Georges François Leclerc, Dijon, France
| | - Vincent Lavoué
- Departement of Gynecological Surgery, Rennes University Hospital, Rennes, France
| | - Jean Lévêque
- Departement of Gynecological Surgery, Rennes University Hospital, Rennes, France
| | - Emile Daraï
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC-6 UPMC, Université Pierre et Marie Curie, Paris, France.,INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
| | - Marcos Ballester
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC-6 UPMC, Université Pierre et Marie Curie, Paris, France.,INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
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Ouldamer L, Bendifallah S, Chas M, Boivin L, Bedouet L, Body G, Ballester M, Daraï E. Intrinsic and extrinsic flaws of the nomogram predicting bone-only metastasis in women with early breast cancer: An external validation study. Eur J Cancer 2016; 69:102-109. [PMID: 27821312 DOI: 10.1016/j.ejca.2016.09.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/19/2016] [Accepted: 09/26/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The recently developed MDACC nomogram purports to predict the risk of bone-only metastasis in women with early breast carcinoma based on five clinical and pathological characteristics. We set out to externally validate and assess its robustness using a tertiary breast cancer centre database. METHODS All consecutive women treated for early breast cancer in our centre between January 1989 and December 2013 and who had all the nomogram variables documented were eligible for analysis. RESULTS We identified 1255 eligible women for external validation analysis. The median follow-up was 54 months (range: 1-312) and time to initial metastasis 20 months (range: 1-80). The correspondence between the actual bone-only metastasis and the nomogram predictions implied poor calibration of the nomogram in the validation cohort, be it in the whole cohort or when stratified by breast cancer subtype. CONCLUSION This external validation study of the MDACC nomogram showed limitations in its generalizability to a new and independent European patient population.
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Affiliation(s)
- Lobna Ouldamer
- Department of Gynaecology, Centre Hospitalier Universitaire de Tours, Tours, France; INSERM U1069, Université François-Rabelais, Tours, France.
| | - Sofiane Bendifallah
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Paris, France; UMR S 707, Epidemiology, Information Systems, Modeling, Université Pierre et Marie Curie, Paris, France
| | - Marie Chas
- Department of Gynaecology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Laura Boivin
- Department of Gynaecology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Lea Bedouet
- Department of Gynaecology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Gilles Body
- Department of Gynaecology, Centre Hospitalier Universitaire de Tours, Tours, France; INSERM U1069, Université François-Rabelais, Tours, France
| | - Marcos Ballester
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Paris, France; INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
| | - Emile Daraï
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Paris, France; INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
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Ouldamer L, Bendifallah S, Naoura I, Body G, Uzan C, Morice P, Ballester M, Daraï E. Nomogram to predict live birth rate after fertility-sparing surgery for borderline ovarian tumours. Hum Reprod 2016; 31:1732-7. [DOI: 10.1093/humrep/dew137] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/19/2016] [Indexed: 12/23/2022] Open
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Ouldamer L, Bonastre J, Brunet-Houdard S, Body G, Giraudeau B, Caille A. Dead space closure with quilting suture versus conventional closure with drainage for the prevention of seroma after mastectomy for breast cancer (QUISERMAS): protocol for a multicentre randomised controlled trial. BMJ Open 2016; 6:e009903. [PMID: 27044574 PMCID: PMC4823448 DOI: 10.1136/bmjopen-2015-009903] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Postoperative wound seroma is common after mastectomy. This complication is associated with significant impact on patient outcomes and healthcare costs. The optimal closure approach for seroma prevention remains unknown but some evidence suggests that quilting suture of the dead space could lower the incidence of seroma. The aim of this trial is to compare seroma formation using quilting suture versus conventional closure with drainage in patients undergoing mastectomy. METHODS AND ANALYSIS This is a multicentre, superiority, randomised controlled trial in women undergoing mastectomy with or without axillary involvement. Exclusion criteria include indication of bilateral mastectomy or immediate reconstruction and any physical or psychiatric condition that could impair patient's ability to cooperate with postoperative data collection or that do not allow an informed consent. 320 participants will be randomised in a 1:1 ratio to receive either quilting suture or conventional wound closure with drain. The primary outcome is seroma requiring either aspiration or surgical intervention within 21 days following mastectomy. Secondary outcomes include seroma regardless of whether or not it requires an intervention, surgical site infection, pain score, cosmetic result, patient's quality of life, costs and cost-effectiveness. The primary analysis will be an intention-to treat analysis performed with a χ(2) test (or Fisher's exact test). ETHICS AND DISSEMINATION Written informed consent will be obtained from all participants. This study was approved by Tours Research ethics committee (CPP TOURS-Region Centre-Ouest 1, 2014-R20, 16 December 2014). Study findings will be published in peer-reviewed journals and presented at relevant national and international breast cancer conferences. TRIAL REGISTRATION NUMBER NCT02263651.
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Affiliation(s)
- Lobna Ouldamer
- Department of Gynecology, CHRU de Tours, Tours, France
- INSERM unit 1069, Tours, France
| | - Julia Bonastre
- Gustave Roussy, Service de Biostatistique et d'Epidemiologie, Villejuif, France
- CESP, Centre for Research in Epidemiology and Population Health, Villejuif, France
| | - Solène Brunet-Houdard
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
- CHRU de Tours, Unité d'Evaluation Médico-Economique, Tours, France
| | - Gilles Body
- Department of Gynecology, CHRU de Tours, Tours, France
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
| | - Bruno Giraudeau
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
- CHRU de Tours, Tours, France
| | - Agnès Caille
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
- CHRU de Tours, Tours, France
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Champagne AL, Brunault P, Huguet G, Suzanne I, Senon JL, Body G, Rusch E, Magnin G, Voyer M, Réveillère C, Camus V. Personality disorders, but not cancer severity or treatment type, are risk factors for later generalised anxiety disorder and major depressive disorder in non metastatic breast cancer patients. Psychiatry Res 2016; 236:64-70. [PMID: 26747215 DOI: 10.1016/j.psychres.2015.12.032] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 10/06/2015] [Accepted: 12/25/2015] [Indexed: 01/06/2023]
Abstract
This study aimed to determine whether personality disorders were associated with later Major Depressive Disorder (MDD) or Generalised Anxiety Disorder (GAD) in breast cancer patients. This longitudinal and multicentric study included 120 French non-metastatic breast cancer patients. After cancer diagnosis (T1) and 7 months after diagnosis (T3), we assessed MDD and GAD (Mini International Neuropsychiatric Interview 5.0). We assessed personality disorders 3 months after diagnosis (VKP). We used multiple logistic regression analysis to determine what were the factors associated with GAD and MDD at T3. At T3, prevalence rate was 10.8% for MDD and 19.2% for GAD. GAD at T3 was significantly and independently associated with GAD at T1 and with existence of a personality disorder, no matter the cluster type. MDD at T3 was significantly and independently associated with MDD at T1 and with the existence of a cluster C personality disorder. Initial cancer severity and the type of treatment used were not associated with GAD or MDD at T3. Breast cancer patients with personality disorders are at higher risk for GAD and MDD at the end of treatment. Patients with GAD should be screened for personality disorders. Specific interventions for patients with personality disorders could prevent psychiatric disorders.
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Affiliation(s)
- Anne-Laure Champagne
- CHRU de Tours, Clinique Psychiatrique Universitaire, 2 Boulevard Tonnellé, 37042 Tours Cedex 9, France
| | - Paul Brunault
- CHRU de Tours, Clinique Psychiatrique Universitaire, 2 Boulevard Tonnellé, 37042 Tours Cedex 9, France; CHRU de Tours, Équipe de Liaison et de Soins en Addictologie, 2 Boulevard Tonnellé, 37042 Tours Cedex 9, France; Université François Rabelais de Tours, Département de Psychologie, EA 2114 « Psychologie des Âges de la Vie », 3 rue des Tanneurs BP 4103, 37041 Tours Cedex 1, France.
| | - Grégoire Huguet
- CHRU de Tours, Clinique Psychiatrique Universitaire, 2 Boulevard Tonnellé, 37042 Tours Cedex 9, France
| | - Isabelle Suzanne
- CHRU de Tours, Clinique Psychiatrique Universitaire, 2 Boulevard Tonnellé, 37042 Tours Cedex 9, France
| | - Jean-Louis Senon
- Centre Hospitalier Henri-Laborit, Service de Psychiatrie, 370 Avenue Jacques Cœur, 86021 Poitiers, France
| | - Gilles Body
- CHRU de Tours, Service de Gynécologie Obstétrique, 2 Boulevard Tonnellé, 37042 Tours Cedex 9, France
| | - Emmanuel Rusch
- CHRU de Tours, Service d'Information Médicale, Epidémiologie et Economie de la Santé, 2 Boulevard Tonnellé, 37042 Tours Cedex 9, France
| | - Guillaume Magnin
- CHU de Poitiers, Service de Gynécologie Obstétrique, 2 rue de la Milétrie, 86021 Poitiers, France
| | - Mélanie Voyer
- Centre Hospitalier Henri-Laborit, Service de Psychiatrie, 370 Avenue Jacques Cœur, 86021 Poitiers, France
| | - Christian Réveillère
- Université François Rabelais de Tours, Département de Psychologie, EA 2114 « Psychologie des Âges de la Vie », 3 rue des Tanneurs BP 4103, 37041 Tours Cedex 1, France
| | - Vincent Camus
- CHRU de Tours, Clinique Psychiatrique Universitaire, 2 Boulevard Tonnellé, 37042 Tours Cedex 9, France; UMR INSERM U930, 2 boulevard Tonnellé, 37044 Tours Cedex, France; Université François Rabelais de Tours, 3 rue des Tanneurs BP 4103, 37041 Tours Cedex 1, France
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Ouldamer L, Nadal-Desbarats L, Chevalier S, Body G, Goupille C, Bougnoux P. NMR-Based Lipidomic Approach To Evaluate Controlled Dietary Intake of Lipids in Adipose Tissue of a Rat Mammary Tumor Model. J Proteome Res 2016; 15:868-78. [DOI: 10.1021/acs.jproteome.5b00788] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Lobna Ouldamer
- INSERM UMR1069, 10 Boulevard Tonnellé, 37044 Tours, France
- François-Rabelais University, 10 Boulevard
Tonnellé, 37044 Tours, France
| | - Lydie Nadal-Desbarats
- François-Rabelais University, 10 Boulevard
Tonnellé, 37044 Tours, France
- INSERM UMR930, 10 Boulevard Tonnellé, 37044 Tours, France
| | - Stephan Chevalier
- INSERM UMR1069, 10 Boulevard Tonnellé, 37044 Tours, France
- François-Rabelais University, 10 Boulevard
Tonnellé, 37044 Tours, France
| | - Gilles Body
- François-Rabelais University, 10 Boulevard
Tonnellé, 37044 Tours, France
| | | | - Philippe Bougnoux
- INSERM UMR1069, 10 Boulevard Tonnellé, 37044 Tours, France
- François-Rabelais University, 10 Boulevard
Tonnellé, 37044 Tours, France
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Ouldamer L, Goupille C, Vildé A, Arbion F, Body G, Chevalier S, Cottier JP, Bougnoux P. N-3 Polyunsaturated Fatty Acids of Marine Origin and Multifocality in Human Breast Cancer. PLoS One 2016; 11:e0147148. [PMID: 26812254 PMCID: PMC4727910 DOI: 10.1371/journal.pone.0147148] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/17/2015] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The microenvironment of breast epithelial tissue may contribute to the clinical expression of breast cancer. Breast epithelial tissue, whether healthy or tumoral, is directly in contact with fat cells, which in turn could influence tumor multifocality. In this pilot study we investigated whether the fatty acid composition of breast adipose tissue differed according to breast cancer focality. METHODS Twenty-three consecutive women presenting with non-metastatic breast cancer underwent breast-imaging procedures including Magnetic Resonance Imaging prior to treatment. Breast adipose tissue specimens were collected during breast surgery. We established a biochemical profile of adipose tissue fatty acids by gas chromatography. We assessed whether there were differences according to breast cancer focality. RESULTS We found that decreased levels in breast adipose tissue of docosahexaenoic and eicosapentaenoic acids, the two main polyunsaturated n-3 fatty acids of marine origin, were associated with multifocality. DISCUSSION These differences in lipid content may contribute to mechanisms through which peritumoral adipose tissue fuels breast cancer multifocality.
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Affiliation(s)
- Lobna Ouldamer
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France
- INSERM UMR1069, 10 boulevard Tonnellé, 37044, Tours, France
- François-Rabelais University, 10 boulevard Tonnellé, 37044, Tours, France
- * E-mail:
| | - Caroline Goupille
- INSERM UMR1069, 10 boulevard Tonnellé, 37044, Tours, France
- François-Rabelais University, 10 boulevard Tonnellé, 37044, Tours, France
| | - Anne Vildé
- Department of Radiology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France
| | - Flavie Arbion
- Department of Pathology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France
| | - Gilles Body
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France
- François-Rabelais University, 10 boulevard Tonnellé, 37044, Tours, France
| | - Stephan Chevalier
- INSERM UMR1069, 10 boulevard Tonnellé, 37044, Tours, France
- François-Rabelais University, 10 boulevard Tonnellé, 37044, Tours, France
| | - Jean Philippe Cottier
- François-Rabelais University, 10 boulevard Tonnellé, 37044, Tours, France
- Department of Radiology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France
- INSERM UMR930, 10 boulevard Tonnellé, 37044, Tours, France
| | - Philippe Bougnoux
- INSERM UMR1069, 10 boulevard Tonnellé, 37044, Tours, France
- François-Rabelais University, 10 boulevard Tonnellé, 37044, Tours, France
- Department of Oncology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France
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Ouldamer L, Lacoste C, Cormier B, Arbion F, Marret H, Jallais L, Fignon A, Body G. Is there a justification for hysterectomy in patients with borderline ovarian tumors? Surg Oncol 2015; 25:1-5. [PMID: 26979634 DOI: 10.1016/j.suronc.2015.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 05/30/2014] [Revised: 10/18/2015] [Accepted: 11/03/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the frequency of uterine involvement in patients with borderline ovarian tumors (BOT) and to evaluate the recurrence risk and survival after hysterectomy. MATERIALS AND METHODS In two French hospitals: A tertiary referral centre (University hospital centre of Tours, France) and the Alliance community hospital of Tours (France), we reviewed data of consecutive women undergoing surgery for presumed stage I BOT between January 1997 and December 2012. Patients were divided into two groups: patients treated with fertility sparing surgery (group 1) and those treated with radical surgery (group 2). RESULTS A total of 135 patients were evaluated. 35 had fertility sparing surgery, 81 had radical surgery with hysterectomy and 19 had previous hysterectomy for other reasons. There were more recurrent borderline ovarian disease and more ovarian invasive disease developed in group 1 (p = 0.02, p = 0.04, respectively). Hysterectomy affected favorably borderline disease-free survival, OR = 0.09 95%CI (0.005-0.69), p = 0.04, but perceived benefits may be related to bilateral salpingo-oophorectomy and not hysterectomy directly.
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Affiliation(s)
- L Ouldamer
- Department of Gynecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France; INSERM Unit 1069, Tours, France; François-Rabelais University, Tours, France.
| | - C Lacoste
- Department of Gynecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France; François-Rabelais University, Tours, France
| | - B Cormier
- Department of Pathology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France
| | - F Arbion
- Department of Pathology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France
| | - H Marret
- Department of Gynecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France; François-Rabelais University, Tours, France
| | - L Jallais
- Department of Pathology, Clinique de l'Alliance, 1 boulevard Alfred Nobel, 37540, St-Cyr-sur-Loire, France
| | - A Fignon
- Department of Gynecology, Clinique de l'Alliance, 1 boulevard Alfred Nobel, 37540, St-Cyr-sur-Loire, France
| | - G Body
- Department of Gynecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France; François-Rabelais University, Tours, France
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Ouldamer L, Kellal I, Legendre G, Ngô C, Chopier J, Body G. [Management of breast nipple discharge: Recommendations]. ACTA ACUST UNITED AC 2015; 44:927-37. [PMID: 26545854 DOI: 10.1016/j.jgyn.2015.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate diagnostic value of imaging procedures and management strategies of the patients with nipple discharge (ND) to establish management recommendations. METHODS Bibliographical search in French and English languages by consultation of PubMed, Cochrane and Embase databases. RESULTS Although, all ND require an systematic evaluation guided by clinical data, bloody ND could be a predictor of breast cancer risk among different colors of discharge particularly in patients of more than 50 years (LE2). The mammography and breast ultrasography are the imaging procedures to realize in first intention (grade C) but they turn out useful only when they detect radiological abnormalities (LE4). Galactography has only a localizing value of possible ductal abnormalities (when standard imaging procedures is not contributive) (LE4). Thus, in the diagnostic investigation of a suspicious ND, galactography it is not recommended in standard practice (grade C). The breast Magnetic Resonance Imaging (MRI) is recommended when breast standard imaging procedures are not contributive (grade C). The ND cytology is useful only if it is positive (i.e. reveal cancer cells). There is no proof on the diagnostic performance of the cytological analysis of the ND to allow a recommendation on its realization or not. In front of a suspicious ND, when breast-imaging procedures reveals an associated radiological lesion, an adapted percutaneous biopsy is recommended by percutaneous way (grade C). Vacuum-assisted breast biopsies is a diagnostic tool but can also be therapeutic allowing to avoid surgery in case of benign lesion but current literature data do not allow recommendations on the therapeutic aspect of vacuum-assisted breast biopsy (LE4). In the absence of associated radiological signal, and in case of reproducible bloody persistent ND, a pyramidectomy is recommended (grade C).
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Affiliation(s)
- L Ouldamer
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France; Unité Inserm 1069, 37044 Tours, France.
| | - I Kellal
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - G Legendre
- CESP Inserm U1018, service de gynécologie obstétrique, CHU d'Angers, 49000 Angers, France
| | - C Ngô
- Service de chirurgie cancérologique, gynécologique et du sein, hôpital européen Georges-Pompidou, AP-HP, 15, rue Leblanc, 75015 Paris, France; Université Paris-Descartes, Paris, France
| | - J Chopier
- Service de radiologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - G Body
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France
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Brunault P, Champagne AL, Huguet G, Suzanne I, Senon JL, Body G, Rusch E, Magnin G, Voyer M, Réveillère C, Camus V. Major depressive disorder, personality disorders, and coping strategies are independent risk factors for lower quality of life in non-metastatic breast cancer patients. Psychooncology 2015; 25:513-20. [PMID: 26356037 DOI: 10.1002/pon.3947] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 07/31/2015] [Accepted: 07/31/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Our aim was to identify risk factors for lower quality of life (QOL) in non-metastatic breast cancer patients. METHODS Our study included 120 patients from the University Hospital Centers of Tours and Poitiers. This cross-sectional study was conducted 7 months after patients' breast cancer diagnosis and assessed QOL (Quality of Life Questionnaire Core 30 = QLQ-C30), socio-demographic characteristics, coping strategies (Brief-COPE), physiological and biological variables (e.g., initial tumor severity and types of treatment received), the existence of major depressive disorder (Mini International Neuropsychiatric Interview), and pain severity (Questionnaire de Douleur Saint Antoine). We assessed personality disorders 3 months after diagnosis (Vragenlijst voor Kenmerken van de Persoonlijkheid questionnaire). We used multiple linear regression models to determine which factors were associated with physical, emotional, and global QOL. RESULTS Lower physical QOL was associated with major depressive disorder, younger age, a more severe initial tumor stage, and the use of the behavioral disengagement coping. Lower emotional QOL was associated with major depressive disorder, the existence of a personality disorder, a more severe pain level, higher use of self-blame, and lower use of acceptance coping strategies. Lower global QOL was associated with major depressive disorder, the existence of a personality disorder, a more severe pain level, higher use of self-blame, lower use of positive reframing coping strategies, and an absence of hormone therapy. CONCLUSIONS Lower QOL scores were more strongly associated with variables related to the individual's premorbid psychological characteristics and the manner in which this individual copes with the cancer (e.g., depression, personality, and coping) than to cancer-related variables (e.g., treatment types and cancer severity). Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Paul Brunault
- Clinique Psychiatrique Universitaire, CHRU de Tours, Tours, France.,Équipe de Liaison et de Soins en Addictologie, CHRU de Tours, Tours, France.,Département de Psychologie, EA 2114 Psychologie des Âges de la Vie, Université François Rabelais de Tours, Tours, France
| | | | - Grégoire Huguet
- Clinique Psychiatrique Universitaire, CHRU de Tours, Tours, France
| | - Isabelle Suzanne
- Clinique Psychiatrique Universitaire, CHRU de Tours, Tours, France
| | - Jean-Louis Senon
- Centre Hospitalier Henri-Laborit, Service de Psychiatrie, Poitiers, France
| | - Gilles Body
- Service de Gynécologie Obstétrique, CHRU de Tours, Tours, France
| | - Emmanuel Rusch
- Service d'Information Médicale, Épidémiologie et Économie de la Santé, CHRU de Tours, Tours, France
| | - Guillaume Magnin
- Service de Gynécologie Obstétrique, CHU de Poitiers, Poitiers, France
| | - Mélanie Voyer
- Centre Hospitalier Henri-Laborit, Service de Psychiatrie, Poitiers, France
| | - Christian Réveillère
- Département de Psychologie, EA 2114 Psychologie des Âges de la Vie, Université François Rabelais de Tours, Tours, France
| | - Vincent Camus
- Clinique Psychiatrique Universitaire, CHRU de Tours, Tours, France.,UMR INSERM U930 'Imagerie et Cerveau', Tours, France.,Université François Rabelais de Tours, Tours, France
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Lacoste C, Cormier B, Marret H, Body G, Ouldamer L. Primary osteosarcoma of the ovary. ACTA ACUST UNITED AC 2015; 43:555-6. [PMID: 26119474 DOI: 10.1016/j.gyobfe.2015.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/01/2015] [Indexed: 11/29/2022]
Affiliation(s)
- C Lacoste
- Department of Gynecology, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; François Rabelais University, 37044 Tours, France
| | - B Cormier
- Department of Pathology, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France
| | - H Marret
- Department of Gynecology, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; François Rabelais University, 37044 Tours, France
| | - G Body
- Department of Gynecology, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; François Rabelais University, 37044 Tours, France
| | - L Ouldamer
- Department of Gynecology, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France; François Rabelais University, 37044 Tours, France; Inserm unit U1069, 10, boulevard Tonnellé, 37044 Tours, France.
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Paternotte J, Hebert T, Ouldamer L, Marret H, Body G. [Treatment of vulvar intra-epithelial neoplasias with Imiquimod]. ACTA ACUST UNITED AC 2015; 43:528-32. [PMID: 26047969 DOI: 10.1016/j.gyobfe.2015.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 09/18/2014] [Accepted: 04/14/2015] [Indexed: 11/25/2022]
Abstract
The incidence of vulvar intra-epithelial neoplasia (VIN) is increasing in the developed countries especially in young women. There is little consensus regarding the optimal management. Surgery used to be the gold standard. Alternatives to surgery are now needed for the treatment of VIN. Many studies investigated the effectiveness of Imiquimod 5% cream in this pathology. We present a literature review of the results published on the subject.
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Affiliation(s)
- J Paternotte
- Service de gynécologie-obstétrique et médecine fœtale, université François-Rabelais, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.
| | - T Hebert
- Service de gynécologie-obstétrique et médecine fœtale, université François-Rabelais, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - L Ouldamer
- Service de gynécologie-obstétrique et médecine fœtale, UMR Inserm U 1069, université François-Rabelais, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - H Marret
- Service de gynécologie-obstétrique et médecine fœtale, UMR Inserm U 930, université François-Rabelais, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - G Body
- Service de gynécologie-obstétrique et médecine fœtale, université François-Rabelais, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
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Diguisto C, Hébert T, Paternotte J, Kellal I, Marret H, Ouldamer L, Body G. Laparoscopie robot-assistée pour endométriose colorectale : morbidité de la résection digestive et du shaving. ACTA ACUST UNITED AC 2015; 43:266-70. [DOI: 10.1016/j.gyobfe.2015.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 02/18/2015] [Indexed: 11/30/2022]
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Ouldamer L, Caille A, Giraudeau B, Body G. Quilting Suture of Mastectomy Dead Space Compared with Conventional Closure with Drain. Ann Surg Oncol 2015; 22:4233-40. [PMID: 25783681 DOI: 10.1245/s10434-015-4511-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE This study was designed to compare conventional closure with a drain and quilting suture of mastectomy dead space for preventing wound seroma. METHODS Consecutive patients undergoing mastectomy for breast cancer were included in this retrospective observational study. Patients received conventional closure with drainage or quilting suture for wound closure. Propensity score (PS) matching was performed based on potential confounders to minimize selection bias. The primary outcome was the rate of type 2 or 3 wound seroma according to the common terminology criteria for adverse events (CTCAE) definition. RESULTS A total of 119 patients were included (quilting suture n = 59; conventional closure n = 60). Type 2 or 3 seroma was observed in 6.8 % of the quilting suture group and 21.7 % of the conventional closure group (crude odds ratio 0.26; 95 % confidence interval 0.08-0.86; p = 0.03). The overall seroma rate was 15.2 % in the quilting suture group and 51.7 % in the conventional closure group (p < 0.001). Persistent pain at days 15-21 was significantly less frequent in the quilting suture group than in the conventional suture group. PS matched analysis confirmed these findings, in particular the lower rate of type 2 or 3 seroma in the quilting suture group than in the conventional closure group (PS-matched odds ratio 0.16; 95 % confidence interval 0.04-0.72; p = 0.02). CONCLUSIONS Quilting suture of the mastectomy dead space is associated with significantly less frequent seroma than conventional closure with drain.
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Affiliation(s)
- Lobna Ouldamer
- Department of Gynecology, CHRU de Tours, Tours, France. .,INSERM Unit 1069, Tours, France. .,Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France.
| | - Agnès Caille
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France.,INSERM, CIC 1415, Tours, France.,CHRU de Tours, Tours, France
| | - Bruno Giraudeau
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France.,INSERM, CIC 1415, Tours, France.,CHRU de Tours, Tours, France
| | - Gilles Body
- Department of Gynecology, CHRU de Tours, Tours, France.,Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
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Trefoux-Bourdet A, Body G, Jacquet A, Hébert T, Kellal I, Marret H, Ouldamer L. [Quilting suture after mastectomy in prevention of postoperative seroma: a prospective observational study]. ACTA ACUST UNITED AC 2015; 43:205-12. [PMID: 25708845 DOI: 10.1016/j.gyobfe.2015.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/07/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The occurrence of a postoperative seroma is the main complication of mastectomy. In 2011, Ouldamer et al. adapted a quilting technique used in reconstructive surgery in mastectomy closure. The aim of this study is to evaluate the impact of quilting in the prevention of postoperative seroma. PATIENTS AND METHODS This is an observational prospective study to the Centre Hospital-University of Tours. Hundred and forty-four patients who underwent a mastectomy between January 1st, 2011 and October 1st, 2012 were included. Patients were divided into 2 groups, one with a classic wound closure with drainage and the second with quilting suture of skin flaps to the underlying musculature after mastectomy without drainage. RESULTS Quilting suture significantly reduces the postoperative seroma appearance (OR=0.15; CI95% [0.06-0.39]; P<0.001). Operative time is increased by 20minutes in the quilted group (P<0.001). Postoperative pain is not changed by quilting. The duration of hospitalization is significantly shorter (5.09±1.46 days versus 6.49±2.77 days; P<0.001). Quality of the healing and appearance of the scar, rated by patients, are identical in both groups. CONCLUSION Quilting is an effective method not only for prevention of seroma, but also for reducing of hospitalization duration, without increasing of postoperative pain and complications.
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Affiliation(s)
- A Trefoux-Bourdet
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France.
| | - G Body
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - A Jacquet
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - T Hébert
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - I Kellal
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - H Marret
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - L Ouldamer
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France; Unité Inserm 1069, 10, boulevard Tonnellé, 37044 Tours. France
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Tauveron V, Body G, Machet L, Lenain H, Ouldamer L, Lorette G. Prolonged remission of Paget disease of the vulva after chemotherapy for breast carcinoma. Br J Dermatol 2015; 170:1199-200. [PMID: 24404871 DOI: 10.1111/bjd.12825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- V Tauveron
- Department of Dermatology, CHRU de Tours, Tours, France
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Chraïbi Z, Ouldamer L, Body G, Bacq Y. Hyperemesis gravidarum : étude de cohorte rétrospective française (109 patientes). Presse Med 2015; 44:e13-22. [DOI: 10.1016/j.lpm.2014.04.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 04/09/2014] [Accepted: 04/16/2014] [Indexed: 12/27/2022] Open
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