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Margonis GA, Boerner T, Bachet JB, Buettner S, Moretto R, Andreatos N, Sartore-Bianchi A, Wang J, Kamphues C, Gagniere J, Lonardi S, Løes IM, Wagner D, Spallanzani A, Sasaki K, Burkhart R, Pietrantonio F, Pikoulis E, Pawlik TM, Truant S, Orlandi A, Pikouli A, Pella N, Beyer K, Poultsides G, Seeliger H, Aucejo FN, Kornprat P, Kaczirek K, Lønning PE, Kreis ME, Wolfgang CL, Weiss MJ, Cremolini C, Benoist S, D'Angelica M. Demystifying BRAF Mutation Status in Colorectal Liver Metastases : A Multi-institutional, Collaborative Approach to 6 Open Clinical Questions. Ann Surg 2023; 278:e540-e548. [PMID: 36453261 DOI: 10.1097/sla.0000000000005771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To investigate the clinical implications of BRAF -mutated (mut BRAF ) colorectal liver metastases (CRLMs). BACKGROUND The clinical implications of mut BRAF status in CRLMs are largely unknown. METHODS Patients undergoing resection for mut BRAF CRLM were identified from prospectively maintained registries of the collaborating institutions. Overall survival (OS) and recurrence-free survival (RFS) were compared among patients with V600E versus non-V600E mutations, KRAS/BRAF comutation versus mut BRAF alone, microsatellite stability status (Microsatellite Stable (MSS) vs instable (MSI-high)), upfront resectable versus converted tumors, extrahepatic versus liver-limited disease, and intrahepatic recurrence treated with repeat hepatectomy versus nonoperative management. RESULTS A total of 240 patients harboring BRAF -mutated tumors were included. BRAF V600E mutation was associated with shorter OS (30.6 vs 144 mo, P =0.004), but not RFS compared with non-V600E mutations. KRAS/BRAF comutation did not affect outcomes. MSS tumors were associated with shorter RFS (9.1 vs 26 mo, P <0.001) but not OS (33.5 vs 41 mo, P =0.3) compared with MSI-high tumors, whereas patients with resected converted disease had slightly worse RFS (8 vs 11 mo, P =0.01) and similar OS (30 vs 40 mo, P =0.4) compared with those with upfront resectable disease. Patients with extrahepatic disease had worse OS compared with those with liver-limited disease (8.8 vs 40 mo, P <0.001). Repeat hepatectomy after intrahepatic recurrence was associated with improved OS compared with nonoperative management (41 vs 18.7 mo, P =0.004). All results continued to hold true in the multivariable OS analysis. CONCLUSIONS Although surgery may be futile in patients with BRAF -mutated CRLM and concurrent extrahepatic disease, resection of converted disease resulted in encouraging survival in the absence of extrahepatic spread. Importantly, second hepatectomy in select patients with recurrence was associated with improved outcomes. Finally, MSI-high status identifies a better prognostic group, with regard to RFS while patients with non-V600E mutations have excellent prognosis.
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Affiliation(s)
- Georgios A Margonis
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of General and Visceral Surgery, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Thomas Boerner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jean-Baptiste Bachet
- Department of Hepato-Gastroenterology, Hôpital Pitié Salpêtrière, Assistance Publique - Hôpitaux de Paris (AP-HP) and Sorbonne Université, University Pierre and Marie Curie, Paris, France
| | - Stefan Buettner
- Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Roberto Moretto
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Nikolaos Andreatos
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | - Andrea Sartore-Bianchi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Jane Wang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carsten Kamphues
- Department of General and Visceral Surgery, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Johan Gagniere
- Service de Chirurgie Digestive, CHU Clermont-Ferrand, Inserm, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Sara Lonardi
- Oncology Unit 3, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Inger M Løes
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Oncology, Haukeland University, Hospital, Bergen, Norway
| | - Doris Wagner
- Department of General Surgery, Medical University of Graz, Graz, Austria
| | - Andrea Spallanzani
- Medical Oncology Unit, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Kazunari Sasaki
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | - Richard Burkhart
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Oncology and Hemato-oncology Department, University of Milan, Milan, Italy
| | - Emmanouil Pikoulis
- Third Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | | | - Stéphanie Truant
- Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille, France
| | - Armando Orlandi
- Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anastasia Pikouli
- Third Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Nicoletta Pella
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Katharina Beyer
- Department of General and Visceral Surgery, Charité Campus Benjamin Franklin, Berlin, Germany
| | - George Poultsides
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Hendrik Seeliger
- Department of General and Visceral Surgery, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Federico N Aucejo
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | - Peter Kornprat
- Department of General Surgery, Medical University of Graz, Graz, Austria
| | - Klaus Kaczirek
- Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Per E Lønning
- Department of Oncology, Haukeland University, Hospital, Bergen, Norway
| | - Martin E Kreis
- Department of General and Visceral Surgery, Charité Campus Benjamin Franklin, Berlin, Germany
| | | | - Matthew J Weiss
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Surgery, Zucker School of Medicine at Hofstra, Northwell Health Cancer Institute, Lake Success, NY
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Stéphane Benoist
- Department of Digestive Surgery and Surgical Oncology, Bicêtre Hospital, AP-HP, Paris-Sud University, and Paris-Sud University, Le Kremlin Bicêtre, France
| | - Michael D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Zaanan A, Henriques J, Turpin A, Manfredi S, Coriat R, Terrebonne E, Legoux JL, Walter T, Locher C, Dubreuil O, Pernot S, Vernet C, Bouché O, Hautefeuille V, Gagniere J, Lecomte T, Tougeron D, Grainville T, Vernerey D, Afchain P, Aparicio T. Adjuvant chemotherapy benefit according to T and N stage in small bowel adenocarcinoma: a large retrospective multicenter study. JNCI Cancer Spectr 2023; 7:pkad064. [PMID: 37774004 PMCID: PMC10582691 DOI: 10.1093/jncics/pkad064] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/14/2023] [Accepted: 08/24/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Small bowel adenocarcinoma is a rare cancer, and the role of adjuvant chemotherapy for localized disease is still debated. METHODS This retrospective multicenter study included all consecutive patients who underwent curative surgical resection for localized small bowel adenocarcinoma between 1996 and 2019 from 3 French cohort studies. Prognostic and predictive factors of adjuvant chemotherapy efficacy were analyzed for disease-free survival and overall survival. The inverse probability of treatment weighting method was applied in the Cox regression model using the propensity score derived from multivariable logistic regression. RESULTS A total of 354 patients were included: median age, 63.5 years; duodenum location, 53.5%; and tumor stage I, II, and III in 31 (8.7%), 144 (40.7%), and 179 (50.6%) patients, respectively. The adjuvant chemotherapy was administered in 0 (0%), 66 (48.5%), and 143 (80.3%) patients with stage I, II, and III, respectively (P < .0001). In the subgroup analysis by inverse probability of treatment weighting method, a statistically significant disease-free survival and overall survival benefit in favor of adjuvant chemotherapy was observed in high-risk stage II (T4 and/or <8 lymph nodes examined) and III (T4 and/or N2) but not for low-risk stage II (T3 and ≥8 lymph nodes examined) and III (T1-3/N1) tumors (Pinteraction < .05). Furthermore, tumor location in jejunum and ileum was also a statistically significant predictive factor of response to adjuvant chemotherapy in stage II and III tumors (Pinteraction < .05). CONCLUSION In localized small bowel adenocarcinoma, adjuvant chemotherapy seems to provide a statistically significant survival benefit for high-risk stage II and III tumors and for jejunum and ileum tumor locations.
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Affiliation(s)
- Aziz Zaanan
- Department of Digestive Oncology, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Cité, Paris Cancer Institute CARPEM, Paris, France
| | - Julie Henriques
- Methodology and Quality of Life Unit in Oncology, centre hospitalier universitaire (CHU) Besançon, Hôpital Jean Minjoz, Besançon, France
- Bourgogne Franche-Comté University, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Anthony Turpin
- Department of Medical Oncology, centre hospitalier universitaire (CHU) Lille—Hôpital Claude Huriez, Lille, France
| | - Sylvain Manfredi
- Department of Hepato-Gastroenterology and Digestive Oncology, Dijon University Hospital, EPICAD LNC UMR 1231, University of Burgundy, Dijon, France
| | - Romain Coriat
- Gastroenterology and Oncology Department, Hôpital Cochin AP-HP, Université Paris Cité, Paris, France
| | - Eric Terrebonne
- Gastroenterology Department, CIC 1401, centre hospitalier universitaire (CHU) Haut Lévèque, Pessac, France
| | - Jean-Louis Legoux
- Department of Hepato-Gastroenterology and Digestive Oncology, Centre Hospitalier Régional d’Orléans, Orléans, France
| | - Thomas Walter
- Department of Medical Oncology, Hospices Civils de Lyon, Lyon, France
| | - Christophe Locher
- Gastroenterology and Digestive Oncology Department, Meaux Hospital, Meaux, France
| | - Olivier Dubreuil
- Department of Digestive Oncology, Groupe hospitalier Diaconesses Croix Saint Simon, Paris, France
| | - Simon Pernot
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Chloé Vernet
- Department of Digestive Oncology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Olivier Bouché
- Department of Digestive Oncology and Gastroenterology, University of Reims Champagne-Ardenne (URCA), centre hospitalier universitaire (CHU) Reims, Reims, France
| | - Vincent Hautefeuille
- Department of Hepato-Gastroenterology and Digestive Oncology, Amiens University Hospital, Amiens, France
| | - Johan Gagniere
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, U1071 INSERM, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Thierry Lecomte
- Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital of Tours, Tours University, U1069 INSERM “Nutrition, Croissance et Cancer”, Tours, France
| | - David Tougeron
- Department of Hepato-Gastroenterology, centre hospitalier universitaire (CHU) de Poitiers, Poitiers, France
| | - Thomas Grainville
- Department of Gastroenterology, Pontchaillou Hospital, Rennes 1 University; INSERM U1242, Rennes, France
| | - Dewi Vernerey
- Methodology and Quality of Life Unit in Oncology, centre hospitalier universitaire (CHU) Besançon, Hôpital Jean Minjoz, Besançon, France
- Bourgogne Franche-Comté University, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Pauline Afchain
- Department of Oncology, Saint Antoine Hospital, Paris, France
| | - Thomas Aparicio
- Gastroenterology and Digestive Oncology Department, Saint Louis Hospital, AP-HP, Université Paris Cité, Paris, France
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Durin T, Marchese U, Sauvanet A, Dokmak S, Cherkaoui Z, Fuks D, Laurent C, André M, Ayav A, Magallon C, Turrini O, Sulpice L, Robin F, Bachellier P, Addeo P, Souche FR, Bardol T, Perinel J, Adham M, Tzedakis S, Birnbaum DJ, Facy O, Gagniere J, Gaujoux S, Tribillon E, Roussel E, Schwarz L, Barbier L, Doussot A, Regenet N, Iannelli A, Regimbeau JM, Piessen G, Lenne X, Truant S, El Amrani M. Defining Benchmark Outcomes for Distal Pancreatectomy: Results of a French Multicentric Study. Ann Surg 2023; 278:103-109. [PMID: 35762617 DOI: 10.1097/sla.0000000000005539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Defining robust and standardized outcome references for distal pancreatectomy (DP) by using Benchmark analysis. BACKGROUND Outcomes after DP are recorded in medium or small-sized studies without standardized analysis. Therefore, the best results remain uncertain. METHODS This multicenter study included all patients undergoing DP for resectable benign or malignant tumors in 21 French expert centers in pancreas surgery from 2014 to 2018. A low-risk cohort defined by no significant comorbidities was analyzed to establish 18 outcome benchmarks for DP. These values were tested in high risk, minimally invasive and benign tumor cohorts. RESULTS A total of 1188 patients were identified and 749 low-risk patients were screened to establish Benchmark cut-offs. Therefore, Benchmark rate for mini-invasive approach was ≥36.8%. Benchmark cut-offs for postoperative mortality, major morbidity grade ≥3a and clinically significant pancreatic fistula rates were 0%, ≤27%, and ≤28%, respectively. The benchmark rate for readmission was ≤16%. For patients with pancreatic adenocarcinoma, cut-offs were ≥75%, ≥69.5%, and ≥66% for free resection margins (R0), 1-year disease-free survival and 3-year overall survival, respectively. The rate of mini-invasive approach in high-risk cohort was lower than the Benchmark cut-off (34.1% vs ≥36.8%). All Benchmark cut-offs were respected for benign tumor group. The proportion of benchmark cases was correlated to outcomes of DP. Centers with a majority of low-risk patients had worse results than those operating complex cases. CONCLUSION This large-scale study is the first benchmark analysis of DP outcomes and provides robust and standardized data. This may allow for comparisons between surgeons, centers, studies, and surgical techniques.
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Affiliation(s)
- Thibault Durin
- Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France
| | - Ugo Marchese
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Teaching Hospital, AP-HP, Université de Paris, Paris, France
| | - Alain Sauvanet
- Department of HBP Surgery, AP-HP, Hôpital Beaujon, University of Paris, Clichy, France
| | - Safi Dokmak
- Department of HBP Surgery, AP-HP, Hôpital Beaujon, University of Paris, Clichy, France
| | - Zineb Cherkaoui
- Department of HBP Surgery, AP-HP, Hôpital Beaujon, University of Paris, Clichy, France
| | - David Fuks
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Teaching Hospital, AP-HP, Université de Paris, Paris, France
| | - Christophe Laurent
- Department of Digestive Surgery, Centre Magellan-CHU Bordeaux, Bordeaux, France
| | - Marie André
- Department of HPB Surgery, Nancy University Hospital, Nancy, France
| | - Ahmet Ayav
- Department of HPB Surgery, Nancy University Hospital, Nancy, France
| | - Cloe Magallon
- Department of Oncological Surgery, Institut Paoli Calmettes, Marseille University, Marseille, France
| | - Olivier Turrini
- Department of Oncological Surgery, Institut Paoli Calmettes, Marseille University, Marseille, France
| | - Laurent Sulpice
- Department of Hepatobiliary and Digestive Surgery, University Hospital, Rennes 1 University, Rennes, France
| | - Fabien Robin
- Department of Hepatobiliary and Digestive Surgery, University Hospital, Rennes 1 University, Rennes, France
| | - Philippe Bachellier
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | - Pietro Addeo
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | | | - Thomas Bardol
- Department of Surgery, Hopital Saint Eloi, Montpellier, France
| | - Julie Perinel
- Department of Digestive Surgery, Hopital Edouard Herriot, Lyon, France
| | - Mustapha Adham
- Department of Digestive Surgery, Hopital Edouard Herriot, Lyon, France
| | - Stylianos Tzedakis
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Teaching Hospital, AP-HP, Université de Paris, Paris, France
| | - David J Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Olivier Facy
- Department of Digestive and Surgical Oncology, University Hospital, Dijon, France
| | - Johan Gagniere
- Department of Digestive and Hepatobiliary Surgery-Liver transplantation, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Sébastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Ecoline Tribillon
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, Paris, France
| | - Edouard Roussel
- Department of Digestive Surgery, Rouen University Hospital and Université de Rouen Normandie, Rouen, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Rouen University Hospital and Université de Rouen Normandie, Rouen, France
| | - Louise Barbier
- Department of Liver Transplant and Surgery, Hopital Trousseau, Tours, France
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology, University Hospital of Besançon, Besançon, France
| | - Nicolas Regenet
- Department of Digestive Surgery, Nantes Hospital, Nantes, France
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, Amiens Cedex, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - Xavier Lenne
- Department of Medical Information, Lille University Hospital, Lille, France
| | - Stéphanie Truant
- Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France
| | - Mehdi El Amrani
- Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France
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Taoum C, Carrier G, Jarlier M, Roche G, Gagniere J, Fiess C, De Forges H, Chevarin C, Colombo PE, Barnich N, Rouanet P, Bonnet M. Determination of biomarkers associated with neoadjuvant treatment response focusing on colibactin-producing Escherichia coli in patients with mid or low rectal cancer: a prospective clinical study protocol (MICARE). BMJ Open 2022; 12:e061527. [PMID: 36460331 PMCID: PMC9723882 DOI: 10.1136/bmjopen-2022-061527] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The management of mid and low rectal cancer is based on neoadjuvant chemoradiotherapy (CRT) followed by standardised surgery. There is no biomarker in rectal cancer to aid clinicians in foreseeing treatment response. The determination of factors associated with treatment response might allow the identification of patients who require tailored strategies (eg, therapeutic de-escalation or intensification). Colibactin-producing Escherichia coli (CoPEC) has been associated with aggressive colorectal cancer and could be a poor prognostic factor. Currently, no study has evaluated the potential association between intestinal microbiota composition and tumour response to CRT in mid and low rectal cancer. The aim of this study is to assess the association between response to neoadjuvant CRT and faecal intestinal microbiota composition and/or CoPEC prevalence in patients with mid or low rectal cancer. METHODS AND ANALYSIS This is a non-randomised bicentric prospective clinical study with a recruitment capacity of 200 patients. Three stool samples will be collected from participants with histological-proven adenocarcinome of mid or low rectum who meet eligibility criteria of the study protocol: one before neoadjuvant treatment start, one in the period between CRT end and surgery and one the day before surgery. In each sample, CoPEC will be detected by culture in special media and molecular (PCR) approaches. The global microbiota composition will be also assessed by the bacterial 16S rRNA gene sequencing. Neoadjuvant CRT response and tumour regression grade will be described using the Dworak system at pathological examination. Clinical data and survival outcomes will also be collected and investigated. ETHICS AND DISSEMINATION MICARE was approved by the local ethics committee (Comité de Protection des Personnes Sud-Est II, 18 December 2019. Reference number 2019-A02493-54 and the institutional review board. Patients will be required to provide written informed consent. Results will be published in a peer reviewed journal. TRIAL REGISTRATION NUMBER NCT04103567.
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Affiliation(s)
- Christophe Taoum
- Surgical Oncology, Institut régional du Cancer de Montpellier, Montpellier, France
| | - Guillaume Carrier
- Surgical Oncology, Institut régional du Cancer de Montpellier, Montpellier, France
- Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Clermont Auvergne University, Clermont-Ferrand, France
| | - Marta Jarlier
- Biometrics Unit, Regional Cancer Centre Val d'Aurelle-Paul Lamarque, Montpellier, France
| | - Gwenaelle Roche
- Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Clermont Auvergne University, Clermont-Ferrand, France
| | - Johan Gagniere
- Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Catherine Fiess
- Clinical Research and Innovation Department, Regional Cancer Centre Val d'Aurelle-Paul Lamarque, Montpellier, France
| | - Helene De Forges
- Clinical Research and Innovation Department, Regional Cancer Centre Val d'Aurelle-Paul Lamarque, Montpellier, France
| | - Caroline Chevarin
- Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Clermont Auvergne University, Clermont-Ferrand, France
| | | | - Nicolas Barnich
- Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Clermont Auvergne University, Clermont-Ferrand, France
| | - Philippe Rouanet
- Surgical Oncology, Institut régional du Cancer de Montpellier, Montpellier, France
| | - Mathilde Bonnet
- Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Clermont Auvergne University, Clermont-Ferrand, France
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5
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Bertsimas D, Margonis GA, Sujichantararat S, Boerner T, Ma Y, Wang J, Kamphues C, Sasaki K, Tang S, Gagniere J, Dupré A, Løes IM, Wagner D, Stasinos G, Macher-Beer A, Burkhart R, Morioka D, Imai K, Ardiles V, O'Connor JM, Pawlik TM, Poultsides G, Seeliger H, Beyer K, Kaczirek K, Kornprat P, Aucejo FN, de Santibañes E, Baba H, Endo I, Lønning PE, Kreis ME, Weiss MJ, Wolfgang CL, D'Angelica M. Using Artificial Intelligence to Find the Optimal Margin Width in Hepatectomy for Colorectal Cancer Liver Metastases. JAMA Surg 2022; 157:e221819. [PMID: 35648428 DOI: 10.1001/jamasurg.2022.1819] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance In patients with resectable colorectal cancer liver metastases (CRLM), the choice of surgical technique and resection margin are the only variables that are under the surgeon's direct control and may influence oncologic outcomes. There is currently no consensus on the optimal margin width. Objective To determine the optimal margin width in CRLM by using artificial intelligence-based techniques developed by the Massachusetts Institute of Technology and to assess whether optimal margin width should be individualized based on patient characteristics. Design, Setting, and Participants The internal cohort of the study included patients who underwent curative-intent surgery for KRAS-variant CRLM between January 1, 2000, and December 31, 2017, at Johns Hopkins Hospital, Baltimore, Maryland, Memorial Sloan Kettering Cancer Center, New York, New York, and Charité-University of Berlin, Berlin, Germany. Patients from institutions in France, Norway, the US, Austria, Argentina, and Japan were retrospectively identified from institutional databases and formed the external cohort of the study. Data were analyzed from April 15, 2019, to November 11, 2021. Exposures Hepatectomy. Main Outcomes and Measures Patients with KRAS-variant CRLM who underwent surgery between 2000 and 2017 at 3 tertiary centers formed the internal cohort (training and testing). In the training cohort, an artificial intelligence-based technique called optimal policy trees (OPTs) was used by building on random forest (RF) predictive models to infer the margin width associated with the maximal decrease in death probability for a given patient (ie, optimal margin width). The RF component was validated by calculating its area under the curve (AUC) in the testing cohort, whereas the OPT component was validated by a game theory-based approach called Shapley additive explanations (SHAP). Patients from international institutions formed an external validation cohort, and a new RF model was trained to externally validate the OPT-based optimal margin values. Results This cohort study included a total of 1843 patients (internal cohort, 965; external cohort, 878). The internal cohort included 386 patients (median [IQR] age, 58.3 [49.0-68.7] years; 200 men [51.8%]) with KRAS-variant tumors. The AUC of the RF counterfactual model was 0.76 in both the internal training and testing cohorts, which is the highest ever reported. The recommended optimal margin widths for patient subgroups A, B, C, and D were 6, 7, 12, and 7 mm, respectively. The SHAP analysis largely confirmed this by suggesting 6 to 7 mm for subgroup A, 7 mm for subgroup B, 7 to 8 mm for subgroup C, and 7 mm for subgroup D. The external cohort included 375 patients (median [IQR] age, 61.0 [53.0-70.0] years; 218 men [58.1%]) with KRAS-variant tumors. The new RF model had an AUC of 0.78, which allowed for a reliable external validation of the OPT-based optimal margin. The external validation was successful as it confirmed the association of the optimal margin width of 7 mm with a considerable prolongation of survival in the external cohort. Conclusions and Relevance This cohort study used artificial intelligence-based methodologies to provide a possible resolution to the long-standing debate on optimal margin width in CRLM.
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Affiliation(s)
- Dimitris Bertsimas
- Operations Research Center, Massachusetts Institute of Technology, Cambridge
| | - Georgios Antonios Margonis
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of General and Visceral Surgery, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Suleeporn Sujichantararat
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge
| | - Thomas Boerner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yu Ma
- Operations Research Center, Massachusetts Institute of Technology, Cambridge
| | - Jane Wang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carsten Kamphues
- Department of General and Visceral Surgery, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Kazunari Sasaki
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Seehanah Tang
- Operations Research Center, Massachusetts Institute of Technology, Cambridge
| | - Johan Gagniere
- Service de Chirurgie Digestive, CHU Clermont-Ferrand, Inserm, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Aurelien Dupré
- Service de Chirurgie Digestive, CHU Clermont-Ferrand, Inserm, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Inger Marie Løes
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Doris Wagner
- Department of General Surgery, Medical University of Graz, Graz, Austria
| | | | | | - Richard Burkhart
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daisuke Morioka
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Katsunori Imai
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Victoria Ardiles
- Hepatopancreatobiliary Surgery and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Columbus, Ohio
| | - George Poultsides
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Hendrik Seeliger
- Department of General and Visceral Surgery, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Katharina Beyer
- Department of General and Visceral Surgery, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Klaus Kaczirek
- Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Peter Kornprat
- Department of General Surgery, Medical University of Graz, Graz, Austria
| | - Federico N Aucejo
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eduardo de Santibañes
- Hepatopancreatobiliary Surgery and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Per Eystein Lønning
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Martin E Kreis
- Department of General and Visceral Surgery, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Matthew J Weiss
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Surgery, Zucker School of Medicine at Hofstra, Northwell Health Cancer Institute, Lake Success, New York
| | - Christopher L Wolfgang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Surgery, New York University School of Medicine, New York
| | - Michael D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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6
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Taibi A, Sgarbura O, Hübner M, Bardet SM, Alyami M, Bakrin N, Fontanier SD, Eveno C, Gagniere J, Pache B, Pocard M, Quenet F, Farinha HT, Thibaudeau E, Dumont F, Glehen O. ASO Visual Abstract: Feasibility and Safety of Oxaliplatin-Based Pressurized Intraperitoneal Aerosol Chemotherapy with or Without Intraoperative Intravenous 5-Fluorouracil and Leucovorin for Colorectal Peritoneal Metastases: A Multicenter Comparative Cohort Study. Ann Surg Oncol 2022. [PMID: 35386000 DOI: 10.1245/s10434-022-11675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Abdelkader Taibi
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France. .,CNRS, XLIM, UMR 7252, University Limoges, 87000, Limoges, France.
| | - Olivia Sgarbura
- Department of Surgical Oncology, Cancer Institute Montpellier (ICM), University of Montpellier, Montpellier, France.,IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Institut régional du Cancer de Montpellier, Université de Montpellier, 34298, Montpellier, France
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital (CHUV),, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Sylvia M Bardet
- CNRS, XLIM, UMR 7252, University Limoges, 87000, Limoges, France
| | - Mohammed Alyami
- Department of General Surgery and Surgical Oncology, Lyon Sud University Hospital, Pierre Benite, France.,Department of General Surgery and Surgical Oncology, King Khalid Hospital, Najran, Saudi Arabia
| | - Naoual Bakrin
- Department of General Surgery and Surgical Oncology, Lyon Sud University Hospital, Pierre Benite, France
| | - Sylvaine Durand Fontanier
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France.,CNRS, XLIM, UMR 7252, University Limoges, 87000, Limoges, France
| | - Clarisse Eveno
- Department of General Surgery, University Hospital Lille, Lille, France
| | - Johan Gagniere
- Department of General Surgery, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Basile Pache
- Department of Visceral Surgery, Lausanne University Hospital (CHUV),, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Marc Pocard
- INSERM U1275, CAP Paris-Tech, Carcinomatosis Peritoneum Paris Technology, Lariboisière Hospital, AP-HP, Paris 7-Diderot University, Sorbonne Paris Cité, Paris, France
| | - François Quenet
- Department of Surgical Oncology, Cancer Institute Montpellier (ICM), University of Montpellier, Montpellier, France
| | - Hugo Teixeira Farinha
- Department of Visceral Surgery, Lausanne University Hospital (CHUV),, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Emilie Thibaudeau
- Department of Surgical Oncology, Institut de Cancérologie de l'Ouest, Saint Herblain, France
| | - Frederic Dumont
- Department of Surgical Oncology, Institut de Cancérologie de l'Ouest, Saint Herblain, France
| | - Olivier Glehen
- Department of General Surgery and Surgical Oncology, Lyon Sud University Hospital, Pierre Benite, France
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7
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Taibi A, Sgarbura O, Hübner M, Bardet SM, Alyami M, Bakrin N, Durand Fontanier S, Eveno C, Gagniere J, Pache B, Pocard M, Quenet F, Teixeira Farinha H, Thibaudeau E, Dumont F, Glehen O. Feasibility and Safety of Oxaliplatin-Based Pressurized Intraperitoneal Aerosol Chemotherapy With or Without Intraoperative Intravenous 5-Fluorouracil and Leucovorin for Colorectal Peritoneal Metastases: A Multicenter Comparative Cohort Study. Ann Surg Oncol 2022; 29:5243-5251. [PMID: 35318519 DOI: 10.1245/s10434-022-11577-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 02/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND This retrospective multicenter cohort study compared the feasibility and safety of oxaliplatin-based pressurized intraperitoneal aerosol chemotherapy (PIPAC-Ox) with or without intraoperative intravenous 5-fluorouracil (5-FU) and leucovorin (L). METHODS Our study included consecutive patients with histologically proven unresectable and isolated colorectal peritoneal metastases (cPM) treated with PIPAC-Ox in seven tertiary referral centers between January 2015 and April 2020. Toxicity events and oncological outcomes (histological response, progression-free survival, and overall survival) were compared between patients who received intraoperative intravenous 5-FU/L (PIPAC-Ox + 5-FU/L group) and patients who did not (PIPAC-Ox group). RESULTS In total, 101 patients (263 procedures) were included in the PIPAC-Ox group and 30 patients (80 procedures) were included in the PIPAC-Ox + 5-FU/L group. Common Terminology Criteria for Adverse Events v4.0 grade 2 or higher adverse events occurred in 48 of 101 (47.5%) patients in the PIPAC-Ox group and in 13 of 30 (43.3%) patients in the PIPAC-Ox + 5-FU/L group (p = 0.73). The complete histological response rates according to the peritoneal regression grading score were 27% for the PIPAC-Ox + 5-FU/L group and 18% for the PIPAC-Ox group (p = 0.74). No statistically significant differences were observed in overall or progression-free survival between the two groups. CONCLUSIONS The safety and feasibility of PIPAC-Ox + 5-FU/L appears to be similar to the safety and feasibility of PIPAC-Ox alone in patients with unresectable cPM. Oncological outcomes must be evaluated in larger studies.
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Affiliation(s)
- Abdelkader Taibi
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France. .,CNRS, XLIM, UMR 7252, University Limoges, Limoges, France.
| | - Olivia Sgarbura
- Department of Surgical Oncology, Cancer Institute Montpellier (ICM), University of Montpellier, Montpellier, France.,IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier, France
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | | | - Mohammed Alyami
- Department of General Surgery and Surgical Oncology, Lyon Sud University Hospital, Pierre Benite, France.,Department of General Surgery and Surgical Oncology, King Khalid Hospital, Najran, Saudi Arabia
| | - Naoual Bakrin
- Department of General Surgery and Surgical Oncology, Lyon Sud University Hospital, Pierre Benite, France
| | - Sylvaine Durand Fontanier
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France.,CNRS, XLIM, UMR 7252, University Limoges, Limoges, France
| | - Clarisse Eveno
- Department of General Surgery, University Hospital Lille, Lille, France
| | - Johan Gagniere
- Department of General Surgery, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Basile Pache
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Marc Pocard
- INSERM U1275, CAP Paris-Tech, Carcinomatosis Peritoneum Paris Technology, Lariboisière Hospital, AP-HP, Paris 7 -Diderot University, Sorbonne Paris Cité, Paris, France.,Hepato-Biliary-Pancreatic Gastrointestinal Surgery and Liver Transplantation Pitié-Salpêtrière Hospital Assistance Publique/Hôpitaux de Paris, 75013, Paris, France
| | - François Quenet
- Department of Surgical Oncology, Cancer Institute Montpellier (ICM), University of Montpellier, Montpellier, France
| | - Hugo Teixeira Farinha
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Emilie Thibaudeau
- Department of Surgical Oncology, Institut de Cancérologie de l'Ouest, Saint Herblain, France
| | - Frederic Dumont
- Department of Surgical Oncology, Institut de Cancérologie de l'Ouest, Saint Herblain, France
| | - Olivier Glehen
- Department of General Surgery and Surgical Oncology, Lyon Sud University Hospital, Pierre Benite, France
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8
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Aparicio T, Svrcek M, Henriques J, Afchain P, Lièvre A, Tougeron D, Gagniere J, Terrebonne E, Piessen G, Legoux JL, Lecaille C, Pocard M, Gornet JM, Zaanan A, Lavau-Denes S, Lecomte T, Deutsch D, Vernerey D, Puig PL. Panel gene profiling of small bowel adenocarcinoma: Results from the NADEGE prospective cohort. Int J Cancer 2021; 148:1731-1742. [PMID: 33186471 DOI: 10.1002/ijc.33392] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 07/10/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/20/2022]
Abstract
Small bowel adenocarcinoma (SBA) is a rare tumour. Large genomic analyses with prognostic assessments are lacking. The NADEGE cohort has enrolled 347 patients with all stage SBA from 2009 to 2012. Next-generation sequencing investigates the presence of 740 hotspot somatic mutations in a panel of 46 genes involved in carcinogenesis. The mismatch repair (MMR) status was assessed by immunochemistry. We have collected 196 tumour samples and 125 had conclusive results for mutation analysis. The number of mutations was 0 in 9.6% of tumours, only 1 in 32.0%, 2 in 26.4% and ≥3 in 32.0%. Overall, at least one genomic alteration was observed in 90.4% of tumour. The most frequent genomic alteration was in KRAS (44.0%), TP53 (38.4%), PIK3CA (20.0%), APC (18.4%), SMAD4 (14.4%) and ERBB2 (7.2%) genes. KRAS mutations were more frequent in synchronous metastatic tumours than in localised tumours (72.7% vs 38.2%, P = .003). There was no significant difference in the mutation rates according to primary location for the most frequently altered gene. ATM, FGFR3 and FGFR1 gene alterations were associated with Lynch syndrome and IDH1 mutations with Crohn disease. dMMR tumours were associated with younger age, localised tumours, less KRAS but more SMARCB1 mutations. No genomic alteration was associated with overall survival. There is a trend for better survival in patient with dMMR tumours. In conclusion, there is a different genomic alteration profile in SBA according to predisposing diseases. No association between genomic alterations and prognoses was observed except for a trend of better prognoses associated with dMMR.
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Affiliation(s)
- Thomas Aparicio
- Department of Gastroenterology and Digestive Oncology, Saint Louis Hospital, APHP, Université de Paris, Paris, France
| | - Magali Svrcek
- Sorbonne Université, Department of Pathology, Saint Antoine Hospital, Paris, France
| | - Julie Henriques
- Methodology and Quality of Life Unit in Oncology, EA 3181, University Hospital, Besançon, France
- Bourgogne Franche-Comté University, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Pauline Afchain
- Department of Oncology, Saint Antoine Hospital, Paris, France
| | - Astrid Lièvre
- Department of Gastroenterology, Pontchaillou Hospital, Rennes 1 University; INSERM U1242, Rennes, France
| | - David Tougeron
- Department of Hepato-Gastroenterology, CHU de Poitiers, Poitiers, France
| | - Johan Gagniere
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, U1071 INSERM, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Eric Terrebonne
- Department of Gastroenterology, CHU Haut-Lévêque, Pessac, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, University Lille, Lille, France
| | - Jean-Louis Legoux
- Department of Hepato-Gastroenterology and Digestive Oncology, CHR La Source, Orléans, France
| | - Cédric Lecaille
- Department of Gastroenterology, Polyclinic Bordeaux Nord, Bordeaux, France
| | - Marc Pocard
- Department of Digestive Surgery, Lariboisière Hospital, Paris, France
| | - Jean-Marc Gornet
- Department of Gastroenterology and Digestive Oncology, Saint Louis Hospital, APHP, Université de Paris, Paris, France
| | - Aziz Zaanan
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou Hospital, APHP, Université de Paris, Paris, France
| | | | - Thierry Lecomte
- Department of Hepato-Gastroenterology and Digestive Oncology, Trousseau Hospital, Tours, France
| | - David Deutsch
- Department of Gastroenterology, Avicenne Hospital, Bobigny, France
| | - Dewi Vernerey
- Methodology and Quality of Life Unit in Oncology, EA 3181, University Hospital, Besançon, France
- Bourgogne Franche-Comté University, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Pierre Laurent Puig
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, Paris, France
- Department of Biology, Georges Pompidou Hospital, APHP, Université de Paris, Paris, France
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9
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Veziant J, Poirot K, Chevarin C, Cassagnes L, Sauvanet P, Chassaing B, Robin F, Godfraind C, Barnich N, Pezet D, Pereira B, Gagniere J, Bonnet M. Prognostic value of a combination of innovative factors (gut microbiota, sarcopenia, obesity, metabolic syndrome) to predict surgical/oncologic outcomes following surgery for sporadic colorectal cancer: a prospective cohort study protocol (METABIOTE). BMJ Open 2020; 10:e031472. [PMID: 31915159 PMCID: PMC6955509 DOI: 10.1136/bmjopen-2019-031472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) is still associated with poor prognosis, especially in patients with advanced disease. Development of new prognostic tools replacing or supplementing those routinely used is definitely needed, with the aim to optimise and personalise treatment strategies. Gut microbiota composition and body composition profile (obesity, sarcopenia and metabolic syndrome) have recently been reported separately as new relevant prognostic factors for postoperative surgical and oncologic outcomes following CRC surgery. However interactions that exist between these factors have been poorly studied. The purpose of this translational prospective cohort study (METABIOTE) is to investigate potential interactions between gut microbiota, body composition profile and postoperative outcomes and recurrence in patients undergoing surgery for non-metastatic sporadic CRC. METHODS AND ANALYSIS This single-centre project aims to prospectively enrol 300 consecutive patients undergoing surgery for non-metastatic sporadic CRC at the University Hospital of Clermont-Ferrand, France for the identification of specific microbial signatures (from tumour, colonic mucosa and stools samples) associated with particular metabolic profiles that could impact postoperative morbidity and oncologic outcomes, using microbiological, molecular and imaging approaches. The primary outcome is the 5-year overall survival (OS). Other outcomes are 5-year CRC-related OS, 5-year disease-free survival, 30-day postoperative morbidity, 90-day postoperative mortality and length of hospital stay. ETHICS AND DISSEMINATION This study protocol was reviewed and approved by an independent French regional review board (n°2018-A00352-53, 'Comité de Protection des Personnes Ile de France VII' on 4 July 2018, declared to the competent French authority ('Agence Nationale de Sécurité du Médicament et des produits de santé', France), and registered on the Clinical Trials web-based platform (NCT03843905). Oral and written informed consent will be obtained from each included patient. Study results will be reported to the scientific community at conferences and in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT03843905..
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Affiliation(s)
- Julie Veziant
- Department of Digestive and Hepatobiliary Surgery, University Hospital, Clermont-Ferrand, France
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Karine Poirot
- Department of Digestive and Hepatobiliary Surgery, University Hospital, Clermont-Ferrand, France
| | - Caroline Chevarin
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Lucie Cassagnes
- Department of Radiology, Universitary Hospital, Clermont Ferrand, France
| | - Pierre Sauvanet
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
| | | | - Frederic Robin
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Catherine Godfraind
- Department of Anatomopathology, Universitary Hospital, Clermont Ferrand, France
| | - Nicolas Barnich
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Denis Pezet
- Department of Digestive and Hepatobiliary Surgery, University Hospital, Clermont-Ferrand, France
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Bruno Pereira
- Department of Clinical research and Innovation (DRCI), Universitary Hospital, Clermont Ferrand, France
| | - Johan Gagniere
- Department of Digestive and Hepatobiliary Surgery, University Hospital, Clermont-Ferrand, France
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Mathilde Bonnet
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
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10
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Golia Pernicka JS, Gagniere J, Chakraborty J, Yamashita R, Nardo L, Creasy JM, Petkovska I, Do RRK, Bates DDB, Paroder V, Gonen M, Weiser MR, Simpson AL, Gollub MJ. Radiomics-based prediction of microsatellite instability in colorectal cancer at initial computed tomography evaluation. Abdom Radiol (NY) 2019; 44:3755-3763. [PMID: 31250180 PMCID: PMC6824954 DOI: 10.1007/s00261-019-02117-w] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To predict microsatellite instability (MSI) status of colon cancer on preoperative CT imaging using radiomic analysis. METHODS This retrospective study involved radiomic analysis of preoperative CT imaging of patients who underwent resection of stage II-III colon cancer from 2004 to 2012. A radiologist blinded to MSI status manually segmented the tumor region on CT images. 254 Intensity-based radiomic features were extracted from the tumor region. Three prediction models were developed with (1) only clinical features, (2) only radiomic features, and (3) "combined" clinical and radiomic features. Patients were randomly separated into training (n = 139) and test (n = 59) sets. The model was constructed from training data only; the test set was reserved for validation only. Model performance was evaluated using AUC, sensitivity, specificity, PPV, and NPV. RESULTS Of the total 198 patients, 134 (68%) patients had microsatellite stable tumors and 64 (32%) patients had MSI tumors. The combined model performed slightly better than the other models, predicting MSI with an AUC of 0.80 for the training set and 0.79 for the test set (specificity = 96.8% and 92.5%, respectively), whereas the model with only clinical features achieved an AUC of 0.74 and the model with only radiomic features achieved an AUC of 0.76. The model with clinical features alone had the lowest specificity (70%) compared with the model with radiomic features alone (95%) and the combined model (92.5%). CONCLUSIONS Preoperative prediction of MSI status via radiomic analysis of preoperative CT adds specificity to clinical assessment and could contribute to personalized treatment selection.
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Affiliation(s)
- Jennifer S Golia Pernicka
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA.
| | - Johan Gagniere
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Digestive and Hepatobiliary Surgery, U1071 INSERM / Clermont-Auvergne University, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Jayasree Chakraborty
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rikiya Yamashita
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
| | - Lorenzo Nardo
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
- Department of Radiology, University of California Davis, Sacramento, CA, USA
| | - John M Creasy
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Iva Petkovska
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
| | - Richard R K Do
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
| | - David D B Bates
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
| | - Viktoriya Paroder
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
| | - Mithat Gonen
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amber L Simpson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc J Gollub
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
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11
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Aparicio T, Svrcek M, Henriques J, Afchain P, Lièvre A, Tougeron D, Gagniere J, Terrebonne E, Piessen G, Legoux JL, Lecaille C, Pocard M, Gornet JM, Zaanan A, Lavau-Denès S, Lecomte T, Benallaoua M, Helfen S, Vernerey D, Laurent-Puig P. BIONADEGE: Genomic profiling of small bowel adenocarcinoma from the NADEGE prospective cohort. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.4140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4140 Background: Small bowel adenocarcinoma (SBA) is a rare tumour. Large genomic analyses with prognostic assessments are lacking. Methods: BIONADEGE is an ancillary study of the NADEGE cohort that enrolled 347 patients (pts) with SBA from 2009 to 2012. Next generation sequencing investigates the presence of 740 hot spot somatic mutations in 46 genes involved in carcinogenesis. The MSI (MicroSatellite Instable) status was assessed using 5 microsatellites. The MMR (MisMatch Repair) status was assessed by immunochemistry (4 antibodies). Results: A total of 196 tumour samples were collected and 125 pts had conclusive results for mutation analysis. The clinical and tumours characteristics were comparable in the NADEGE and BIONADEGE cohort except for metastatic stage at diagnostic underrepresented in the BIONADEGE cohort (17.7%) due to missing tumour sample. A predisposing disease was reported in 25 (20.0%) cases (among them 14 Lynch syndromes and 7 Crohn diseases). The number of mutation observed was 0 in 9.6% pts, only 1 in 32.0%, 2 in 26.4% and ≥3 in 32.0%. The most frequent genomic alteration were KRAS (44.0%), TP53 (38.4%), PIK3CA (20.0%), APC (18.4%), SMAD4 (14.4%) and ERBB2 (7.2%). Altogether, a genomic alteration was observed in 90.3% of tumour. KRAS mutation were more frequent in synchronous metastatic tumour than in localized tumour (72.7% vs 38.2%, p = 0.003). There was no significant difference of mutation rate according to primary location for the most frequently altered gene. With caution to small sample, IDH1 mutation is more frequent and APC mutation never seen in Crohn disease. The rate of dMMR tumor was 38.6% in localized tumour and 0% in synchronous metastatic tumour. After a median follow-up of 55 months (95%CI [44-63]), M0 stage, pN0, pT1-2 were associate with better survival in univariate analysis. No significant prognostic value of genomic alteration was associated with OS. dMMR status was associate with a better prognosis for OS in pts with MMR status determined by immunohistochemistry (HR = 0.55 [0.29-1.01], p = 0.055). Conclusions: A high frequency of targetable alteration is observed in SBA. There is several specificities according to predisposing disease. No association between genomic alteration and prognostic was observed except a trend for a better prognosis associate with dMMR.
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Affiliation(s)
- Thomas Aparicio
- Department of Gastroenterology, Saint Louis Hospital, Paris, France
| | | | - Julie Henriques
- Methodology and Quality of Life Unit, Department of Oncology University Hospital, Besançon, France
| | | | | | | | | | - Eric Terrebonne
- Pôle Appareil Digestif, Endocrinologie et Nutrition CHU de Bordeaux, Bordeaux, France
| | - Guillaume Piessen
- Department of Surgical Oncology, University Hospital of Lille, Lille, France
| | | | - Cedric Lecaille
- Department of Gastroenterology, Polyclinique Nord Aquitaine, Bordeaux, France
| | - Marc Pocard
- Hopital Lariboisiere AP-HP, Service de Chirurgie Digestie et Cancérologie, Paris, France
| | - Jean-Marc Gornet
- Department of Hepato-Gastroenterology, Saint-Louis Hospital, Paris, France
| | - Aziz Zaanan
- Hopital Européen Georges Pompidou, Paris, France
| | | | | | | | | | - Dewi Vernerey
- Methodology and Quality of Life in Oncology Unit, Besançon University Hospital, Besançon, France
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Courtot L, Le Roy B, Memeo R, Voron T, de Angelis N, Tabchouri N, Brunetti F, Berger A, Mutter D, Gagniere J, Salamé E, Pezet D, Ouaïssi M. Risk factors for postoperative ileus following elective laparoscopic right colectomy: a retrospective multicentric study. Int J Colorectal Dis 2018; 33:1373-1382. [PMID: 29732465 DOI: 10.1007/s00384-018-3070-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Accepted: 04/29/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Postoperative ileus (POI) is associated with an elevated risk of other complications and increases the economic impact on healthcare services. The aim of this study was to identify pre-, intra- and postoperative risk factors associated with the development of POI following elective laparoscopic right colectomy. METHODS Between 2004 and 2016, 637 laparoscopic right colectomies were performed. Data were analysed retrospectively thanks to the CLIHMET database. Potential contributing factors were analysed by logistic regression. RESULTS Patients with POI (n = 113, 17.7%) were compared to those without postoperative ileus (WPOI) (n = 524, 82.3%). In the POI group, there were more men (62 vs 49%; p = 0.012), more use of epidural anaesthesia (19 vs 9%; p = 0.004), more intraoperative blood transfusion requirements (7 vs 3%; p = 0.018) and greater perioperative intravenous fluid administration (2000 vs 1750 mL; p < 0.001). POIs were more frequent when extracorporeal vascular section (20 vs 12%; p = 0.049) and transversal incision for extraction site (34 vs 23%; p = 0.044) were performed. Overall surgical complications in the POI group were significantly greater than in the control group WPOI (31.9 vs 12.0%; p < 0.0001). Multivariate analysis found the following independent POI risk factors: male gender (HR = 2.316, 1.102-4.866), epidural anaesthesia (HR = 2.958, 1.250-6.988) and postoperative blood transfusion requirement (HR = 6.994, 1.550-31.560). CONCLUSIONS This study is one of the first to explore the CLIHMET database and the first to use it for investigating risk factors for POI development. Modifiable risk factors such as epidural anaesthesia and intraoperative blood transfusion should be used with caution in order to decrease POI rates.
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Affiliation(s)
- Lise Courtot
- Department of Digestive, Oncological, Endocrine and Hepatic Surgery and Hepatic Transplantation, Colorectal Surgery Unit, Trousseau Hospital, Avenue de la République, Chambray les Tours, Tours, France
| | - Bertrand Le Roy
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - Ricardo Memeo
- Hepato-Biliary and Pancreatic Surgical Unit, IRCAD-IHU, University of Strasbourg, Strasbourg, France
| | - Thibault Voron
- Department of Digestive Surgery, George Pompidou European Hospital, Paris, France
| | - Nicolas de Angelis
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri-Mondor Hospital, AP-HP, Créteil, Paris, France
| | - Nicolas Tabchouri
- Department of Digestive, Oncological, Endocrine and Hepatic Surgery and Hepatic Transplantation, Colorectal Surgery Unit, Trousseau Hospital, Avenue de la République, Chambray les Tours, Tours, France
| | - Francesco Brunetti
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri-Mondor Hospital, AP-HP, Créteil, Paris, France
| | - Anne Berger
- Department of Digestive Surgery, George Pompidou European Hospital, Paris, France
| | - Didier Mutter
- Hepato-Biliary and Pancreatic Surgical Unit, IRCAD-IHU, University of Strasbourg, Strasbourg, France
| | - Johan Gagniere
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - Ephrem Salamé
- Department of Digestive, Oncological, Endocrine and Hepatic Surgery and Hepatic Transplantation, Colorectal Surgery Unit, Trousseau Hospital, Avenue de la République, Chambray les Tours, Tours, France
| | - Denis Pezet
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - Mehdi Ouaïssi
- Department of Digestive, Oncological, Endocrine and Hepatic Surgery and Hepatic Transplantation, Colorectal Surgery Unit, Trousseau Hospital, Avenue de la République, Chambray les Tours, Tours, France.
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13
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Zaanan A, Bouché O, Benhaim L, Buecher B, Chapelle N, Dubreuil O, Fares N, Granger V, Lefort C, Gagniere J, Meilleroux J, Baumann AS, Vendrely V, Ducreux M, Michel P. Gastric cancer: French intergroup clinical practice guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO). Dig Liver Dis 2018; 50:768-779. [PMID: 29886081 DOI: 10.1016/j.dld.2018.04.025] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION This document is a summary of the French Intergroup guidelines regarding the management of gastric cancer published in October 2016, available on the website of the French Society of Gastroenterology (SNFGE) (www.tncd.org), updated in October 2017. METHODS This collaborative work was realized under the auspices of several French medical societies involved in management of gastric cancer. Recommendations are graded in three categories (A-C), according to the amount of evidence found in the literature until July 2017. RESULTS There are several known risk factors for gastric cancer, including Helicobacter pylori and genetic predispositions, both requiring a specific screening for patients and their relatives. The diagnosis and staging evaluation are essentially based on gastroscopy plus biopsies and computed tomography scan. The endoscopic ultrasonography can be used for superficial tumors in case of discussion for endoscopic resection (T1N0). For local disease (N+ and/or T > T1), the strategic therapy is based on surgery associated with perioperative chemotherapy. In the absence of preoperative treatment (for any raison), the postoperative chemoradiotherapy (or chemotherapy) should be discussed for patients with stage II or III tumor. For metastatic disease, the treatment is based on "palliative" chemotherapy consisting in a doublet or triplet regimens depending of age, performance status and HER2 tumor status. For patients with limited metastatic disease, surgical resection could be discussed in multidisciplinary meeting in case of stable disease after chemotherapy. CONCLUSION These guidelines in gastric cancer are done to help decision for daily clinical practice. These recommendations are permanently being reviewed. Each individual case must be discussed within a multidisciplinary team.
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Affiliation(s)
- Aziz Zaanan
- Department of Gastroenterology and Digestive Oncology, European Georges Pompidou Hospital, APHP, Paris, France.
| | - Olivier Bouché
- Department of Gastroenterology and Digestive Oncology, CHU Reims, Reims, France
| | - Leonor Benhaim
- Department of Surgical Oncology, Gustave Roussy Cancer Center, UNICANCER, Villejuif, France
| | - Bruno Buecher
- Departments of Genetics and Medical Oncology, Curie Institute, UNICANCER, Paris, France
| | - Nicolas Chapelle
- Department of Hepato-Gastroenterology and Digestive Oncology, Institute for Diseases of the Digestive System, CHU Nantes, France
| | - Olivier Dubreuil
- Department of Gastroenterology and Digestive Oncology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Nadim Fares
- Department of Digestive Oncology, CHU Toulouse, Toulouse, France
| | - Victoire Granger
- Department of Hepato-Gastroenterology and Digestive Oncology, CHU Grenoble, Grenoble, France
| | - Christine Lefort
- Department of Gastroenterology and Endoscopy, Private Hospital Jean Mermoz, Lyon, France
| | - Johan Gagniere
- Department of Digestive and Hepatobiliary Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Anne-Sophie Baumann
- Department of Radiotherapy, Lorraine Institute of Oncology, UNICANCER, Vandœuvre-lès-Nancy, France
| | | | - Michel Ducreux
- Department of Medical Oncology, Gustave Roussy Cancer Center, UNICANCER, Villejuif, France
| | - Pierre Michel
- Department of Hepato-gastroenterology and Digestive Oncology, CHU Rouen, Rouen, France
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Scalabre A, Philippe-Chomette P, Passot G, Orbach D, Elias D, Corradini N, Brugières L, Msika S, Leclair MD, Joseph S, Brigand C, Becmeur F, Soler C, Pezet D, Gagniere J, Glehen O, Sarnacki S. Cytoreductive surgery and hyperthermic intraperitoneal perfusion with chemotherapy in children with peritoneal tumor spread: A French nationwide study over 14 years. Pediatr Blood Cancer 2018; 65. [PMID: 29286576 DOI: 10.1002/pbc.26934] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 10/02/2017] [Revised: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Efficacy and role of cytoreductive surgery (CRS) and hyperthermic peritoneal perfusion with chemotherapy (HIPEC) remain poorly documented in pediatric tumors. METHODS This retrospective national study analyzed all pediatric patients with peritoneal tumor spread treated by CRS and HIPEC as part of a multimodal therapy in France from 2001 to 2015. RESULTS Twenty-two patients (nine males and 13 females) were selected. The median age at diagnosis was 14.8 years (4.2-17.6). Seven had peritoneal mesotheliomas; seven, desmoplastic small round cells tumors (DSRCT); and eight, other histologic types. A complete macroscopic resection (CC-0, where CC is completeness of cytoreduction) was achieved in 16 (73%) cases. Incomplete resections were classified as CC-1 in four (18%) cases and CC-2 in two (9%) cases. Fourteen (64%) patients had complications within 30 days from HIPEC, requiring an urgent laparotomy in eight (36%) cases. Thirteen (59%) patients received adjuvant chemotherapy and four (18%) received total abdominal radiotherapy after surgery. Sixteen (72%) patients had relapse after a median time of 9.6 months (1.4-86.4) and nine (41%) eventually died after a median time of 5.3 months (0.1-36.1) from relapse. Six (27%) patients (four mesotheliomas, one pseudopapillary pancreatic tumor, and one DSRCT) were alive and in complete remission after a median follow-up of 25.0 months (5.3-78.2). The mean overall survival (OS) and disease-free survival (DFS) were 57.5 months (95% CI [38.59-76.32]) and 30.9 months (95% CI [14.96-46.77]). Patients with a peritoneal mesothelioma had a significantly better OS (p = 0.015) and DFS (p = 0.028) than other histologic type. CONCLUSIONS In this national series, outcomes of HIPEC are encouraging for the treatment of peritoneal mesothelioma in children.
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Affiliation(s)
- Aurélien Scalabre
- Department of Pediatric Surgery, University Hospital of Saint-Etienne, Faculty of Medicine Jacques Lisfranc, PRES Lyon 42023, Jean Monnet University, Saint-Etienne, France
| | - Pascale Philippe-Chomette
- Department of Pediatric Surgery, University Paris 7 Denis Diderot, Hôpital, Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Passot
- Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.,EMR 37-38, Lyon 1 University, Lyon, France
| | - Daniel Orbach
- Department of Pediatric, Adolescent and Young Adult Oncology, Institut Curie, Paris, France
| | - Dominique Elias
- Department of Oncologic Surgery, Gustave Roussy, Cancer Center, Grand Paris, France
| | - Nadège Corradini
- Departments of Oncology and Clinical Research, Centre Léon Berard and Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - Laurence Brugières
- Department of Oncology for Child and Adolescents, Gustave Roussy, Cancer Center, Paris, France
| | - Simon Msika
- Department of Digestive Surgery, University Paris 7 Denis Diderot, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France
| | - Marc-David Leclair
- Paediatric Surgery and Urology Department, Children University Hospital, Nantes, France
| | - Solène Joseph
- Paediatric Surgery and Urology Department, Children University Hospital, Nantes, France
| | - Cécile Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - François Becmeur
- Department of Pediatric Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Christine Soler
- Pediatric Hematology-Oncology Department, Hôpital l'Archet, CHU de Nice, Nice, France
| | - Denis Pezet
- Digestive Surgery and Oncological Department, Hospital Estaing, Clermont-Ferrand, France
| | - Johan Gagniere
- Digestive Surgery and Oncological Department, Hospital Estaing, Clermont-Ferrand, France
| | - Olivier Glehen
- Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Paris Descartes University, Hôpital Necker Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
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15
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Alyami M, Gagniere J, Sgarbura O, Cabelguenne D, Villeneuve L, Pezet D, Quenet F, Glehen O, Bakrin N, Passot G. Multicentric initial experience with the use of the pressurized intraperitoneal aerosol chemotherapy (PIPAC) in the management of unresectable peritoneal carcinomatosis. Eur J Surg Oncol 2017; 43:2178-2183. [PMID: 28964609 DOI: 10.1016/j.ejso.2017.09.010] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [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: 06/05/2017] [Revised: 08/17/2017] [Accepted: 09/06/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND PIPAC is a recent approach for intraperitoneal chemotherapy with promising results for patients with peritoneal carcinomatosis (PC). We aimed to evaluate the postoperative outcome of PIPAC in patients with non-resectable PC during our initial experience of the technique. METHODS All patients who underwent PIPAC for non-resectable PC in three centers were analyzed regarding postoperative outcomes. RESULTS Seventy-three patients underwent 164 PIPAC. PC was from colorectal, gastric, ovarian, malignant mesothelioma, pseudomyxoma peritonei or other origins in 20, 26, 13, 8, 1 and 5 patients respectively. Forty-five (62%), 31 (42%), 8 (11%), 6 (8%), 1 (1%) patients underwent a second, third, fourth, fifth, and sixth PIPAC respectively. At the time of the first PIPAC, the median PCI was 17 (1-39), 57 patients presented with symptomatic PC (pain: 33; ascites: 35; transit disorder like diarrhea and constipation: 11). PCI improved in 64.5% of patients, 63.5% of patients presented with complete disappearance of symptoms. Major complications occurred as the outcome of 16 PIPAC (9.7%) and 5 (6.8%) patients died within 30 days of the PIPAC procedure. Rate of mortality and major complications 40% and 62% respectively occurred in first 20 treated patients. For 64 (88%) patients, systemic chemotherapy was associated with PIPAC and could be administered after PIPAC with a median delay of 14 days (2-28). CONCLUSIONS Implementing a PIPAC program in association with systemic chemotherapy is feasible and is associated with a risk of postoperative morbidity, even in teams highly experienced in PC management and requires a learning curve in patient selection.
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Affiliation(s)
- Mohammad Alyami
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France; King Salman Scholarship Program, Saudi Arabian Cultural Bureau, Paris, France.
| | - Johan Gagniere
- Department of Digestive and Hepatobiliary Surgery, Centre Hospitalier Univeristaire de Clermont Ferrand, Clermont-Ferrand, France; U1071 INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Olivia Sgarbura
- Department of Surgery, Institut Du Cancer de Montpellier (ICM), 34298, Montpellier, France
| | | | - Laurent Villeneuve
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Denis Pezet
- Department of Digestive and Hepatobiliary Surgery, Centre Hospitalier Univeristaire de Clermont Ferrand, Clermont-Ferrand, France; U1071 INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Francois Quenet
- Department of Surgery, Institut Du Cancer de Montpellier (ICM), 34298, Montpellier, France
| | - Olivier Glehen
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Naoual Bakrin
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Guillaume Passot
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
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Duffaud F, Meeus P, Bertucci F, Delhorme JB, Stoeckle E, Isambert N, Bompas E, Gagniere J, Bouché O, Toulmonde M, Salas S, Blay JY, Bonvalot S. Patterns of care and clinical outcomes in primary oesophageal gastrointestinal stromal tumours (GIST): A retrospective study of the French Sarcoma Group (FSG). Eur J Surg Oncol 2017; 43:1110-1116. [PMID: 28433494 DOI: 10.1016/j.ejso.2017.03.017] [Citation(s) in RCA: 7] [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: 09/15/2016] [Revised: 03/10/2017] [Accepted: 03/23/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Oesophageal GIST (ESOGIST) are very rare tumours requiring special consideration regarding diagnosis, surgical management, and perioperative treatment. METHODS A retrospective study was conducted across 9 centres in the French Sarcoma Group (FSG) to characterize all patients in the years 2000-2014. RESULTS Seventeen patients (pts) with primary localized ESOGIST were identified, with median age 69 years (36-81) and 11 females. Eight tumours (T) occurred in the lower third of the oesophagus, five in the oesophageal gastric junction, two in the superior third, and two in the middle third. All pts underwent oesophagoscopy and/or endoscopic ultrasound (EUS) and CT scan. Fifteen had EUS guided biopsy. Nine pts received Imatinib (IM) as initial treatment resulting in six PR, three SD. Tumours were resected in nine pts (53%) (7 upfront, 2 after IM); via enucleation in four (44%) [median size 4 cm], oesophagectomy in five (56%) [median size 10 cm]. Resections were R0 in three pts (33%), R1 in six (66%). Eight pts (47%) had no tumour resection, and one patient was never treated. Six pts received adjuvant IM. With a median follow-up of 24 months (7-101), 11 pts are alive (64.7%), five died (29.4%), one was lost to follow-up. Two pts of 4 pts relapsed following enucleation. CONCLUSIONS ESOGIST can be reliably identified pre-operatively by EUS-guided biopsy. Surgery for ESOGIST is either enucleation or oesophagectomy depending on tumour size, location, and patient's individual surgical risk. Preoperative IM therapy could improve resectability and should be considered if surgery is contraindicated or would lead to negative impact on the functional status of the patient.
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Affiliation(s)
- F Duffaud
- Service D'Oncologie Médicale, CHU La Timone, Marseille, France; UMR S910 INSERM, Aix-Marseille Université (AMU), Marseille, France.
| | - P Meeus
- Service de Chirurgie, Centre Léon Bérard, Lyon, France
| | - F Bertucci
- Service d' Oncologie Médicale, Institut Paoli Calmettes, Marseille, France
| | - J-B Delhorme
- Service de Chirurgie Générale et Digestive, Hôpital Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - E Stoeckle
- Service de Chirurgie, Institut Bergonié, Bordeaux, France
| | - N Isambert
- Service D'Oncologie Médicale, Centre G Leclerc, Dijon, France
| | - E Bompas
- Service D'Oncologie Médicale, Centre R Gauduchau, Nantes, France
| | - J Gagniere
- Service de Chirurgie Digestive et Hépatobiliaire, CHU Estaing Clermont Ferrand, Université D'Auvergne, France
| | - O Bouché
- Service D'Oncologie Digestive, CHU de Reims, France
| | - M Toulmonde
- Service D'Oncologie Médicale, Institut Bergonié, Bordeaux, France
| | - S Salas
- Service D'Oncologie Médicale, CHU La Timone, Marseille, France; UMR S910 INSERM, Aix-Marseille Université (AMU), Marseille, France
| | - J-Y Blay
- Service D'Oncologie Médicale, Centre L Bérard, Lyon, France
| | - S Bonvalot
- Service de Chirurgie, Institut Curie, Paris, France
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17
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Mariette C, Markar S, Gronnier C, Pasquer A, Duhamel A, Behal H, Thereaux J, Gagniere J, Lebreton G, Brigand C, Meunier B, Collet D. Surgically treated esophageal cancer developed in a radiated field: Impact on peri-operative and long-term outcomes. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
150 Background: The objectives of this study were to compare peri-operative and long-term outcomes from esophageal cancer (EC) (i) that arose in a previously radiated field (ECRF) versus primary (PEC) and among ECRF patients (ii) radiotherapy-induced (RIEC) versus non radiotherapy-induced EC (NRIEC). Methods: Data was collected from 30 European centers from 2000–2010. 2489 EC patients surgically treated were included in the PEC group and 136 in the ECRF group, including 61 in the NRIEC group and 75 in the RIEC group. Propensity score matching analyses were used to compensate for differences in baseline characteristics. Results: Compared to the PEC group, the ECRF group was characterized by less use of neoadjuvant chemoradiotherapy (0% vs. 29.5%; P < 0.001), less pathological stage III/IV (31.6% vs 39.2%, P = 0.036), greater incidence of R1/2 margins (21.3% vs. 10.9%; P < 0.001), increased in-hospital mortality (14.0% vs. 7.1%; P = 0.003) and overall morbidity (68.4% vs. 56.4%, P = 0.006). After matching, 5-year overall (28.8% vs. 50.5%; HR = 1.53, 95% C.I. 1.15-2.04; P = 0.003) and event-free (32.2% vs. 42.5%; HR = 1.56, 95% C.I. 1.18-2.05; P = 0.002) survivals were significantly reduced in the ECRF group. There were no significant differences in incidence or pattern of tumor recurrence. Comparing RIEC and NRIEC groups, there were no significant differences in short- or long-term outcomes before and after matching. Conclusions: ECRF is associated with poorer long-term survival related to a reduced utilization of neoadjuvant chemoradiotherapy and an increased incidence of tumor margin involvement at surgery. Outcomes are dictated by the limitations related to previous radiotherapy administration more than the radiotherapy-induced carcinogenesis.
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Affiliation(s)
| | - Sheraz Markar
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Caroline Gronnier
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | | | - Alain Duhamel
- Department of Biostatistics, University Hospital of Lille, Lille, France
| | | | | | | | | | - Cecile Brigand
- Department of Digestive Surgery, Hautepierre University Hospital, Strasbourg, France
| | - Bernard Meunier
- Department of Digestive Surgery, Pontchaillou University Hospital, Rennes, France
| | - Denis Collet
- Haut-Leveque University Hospital, Bordeaux, France
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Sgarbura O, Alyami M, Passot G, Bakrin N, Gagniere J, Villeneuve L, Quénet F, Glehen O. Pressurized IntraPeritoneal Aerosole Chemotherapy (PIPAC) for unresectable peritoneal carcinomatosis: The French experience. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30292-7] [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: 11/30/2022]
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Boucher AL, Pereira B, Decousus S, Goutte M, Goutorbe F, Dubois A, Gagniere J, Borderon C, Joubert J, Pezet D, Dapoigny M, Déchelotte PJ, Bommelaer G, Buisson A. Endoscopy-based management decreases the risk of postoperative recurrences in Crohn’s disease. World J Gastroenterol 2016; 22:5068-5078. [PMID: 27275099 PMCID: PMC4886382 DOI: 10.3748/wjg.v22.i21.5068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/14/2016] [Accepted: 04/20/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate whether an endoscopy-based management could prevent the long-term risk of postoperative recurrence.
METHODS: From the pathology department database, we retrospectively retrieved the data of all the patients operated on for Crohn’s disease (CD) in our center (1986-2015). Endoscopy-based management was defined as systematic postoperative colonoscopy (median time after surgery = 9.5 mo) in patients with no clinical postoperative recurrence at the time of endoscopy.
RESULTS: From 205 patients who underwent surgery, 161 patients (follow-up > 6 mo) were included. Endoscopic postoperative recurrence occurred in 67.6%, 79.7%, and 95.5% of the patients, respectively 5, 10 and 20 years after surgery. The rate of clinical postoperative recurrence was 61.4%, 75.9%, and 92.5% at 5, 10 and 20 years, respectively. The rate of surgical postoperative recurrence was 19.0%, 38.9% and 64.7%, respectively, 5, 10 and 20 years after surgery. In multivariate analysis, previous intestinal resection, prior exposure to anti-TNF therapy before surgery, and fistulizing phenotype (B3) were postoperative risk factors. Previous perianal abscess/fistula (other perianal lesions excluded), were predictive of only symptomatic recurrence. In multivariate analysis, an endoscopy-based management (n = 49/161) prevented clinical (HR = 0.4, 95%CI: 0.25-0.66, P < 0.001) and surgical postoperative recurrence (HR = 0.30, 95%CI: 0.13-0.70, P = 0.006).
CONCLUSION: Endoscopy-based management should be recommended in all CD patients within the first year after surgery as it highly decreases the long-term risk of clinical recurrence and reoperation.
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Desiderio J, Jiang ZW, Nguyen NT, Zhang S, Reim D, Alimoglu O, Azagra JS, Yu PW, Coburn NG, Qi F, Jackson PG, Zang L, Brower ST, Kurokawa Y, Facy O, Tsujimoto H, Coratti A, Annecchiarico M, Bazzocchi F, Avanzolini A, Gagniere J, Pezet D, Cianchi F, Badii B, Novotny A, Eren T, Leblebici M, Goergen M, Zhang B, Zhao YL, Liu T, Al-Refaie W, Ma J, Takiguchi S, Lequeu JB, Trastulli S, Parisi A. Robotic, laparoscopic and open surgery for gastric cancer compared on surgical, clinical and oncological outcomes: a multi-institutional chart review. A study protocol of the International study group on Minimally Invasive surgery for GASTRIc Cancer-IMIGASTRIC. BMJ Open 2015; 5:e008198. [PMID: 26482769 PMCID: PMC4611863 DOI: 10.1136/bmjopen-2015-008198] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Gastric cancer represents a great challenge for healthcare providers and requires a multidisciplinary treatment approach in which surgery plays a major role. Minimally invasive surgery has been progressively developed, first with the advent of laparoscopy and recently with the spread of robotic surgery, but a number of issues are currently being debated, including the limitations in performing an effective extended lymph node dissection, the real advantages of robotic systems, the role of laparoscopy for Advanced Gastric Cancer, the reproducibility of a total intracorporeal technique and the oncological results achievable during long-term follow-up. METHODS AND ANALYSIS A multi-institutional international database will be established to evaluate the role of robotic, laparoscopic and open approaches in gastric cancer, comprising of information regarding surgical, clinical and oncological features. A chart review will be conducted to enter data of participants with gastric cancer, previously treated at the participating institutions. The database is the first of its kind, through an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centres. ETHICS AND DISSEMINATION This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. A multicentre study with a large number of patients will permit further investigation of the safety and efficacy as well as the long-term outcomes of robotic, laparoscopic and open approaches for the management of gastric cancer. TRIAL REGISTRATION NUMBER NCT02325453; Pre-results.
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Affiliation(s)
- Jacopo Desiderio
- Department of Digestive Surgery, St Mary's Hospital, University of Perugia, Terni, Italy
| | - Zhi-Wei Jiang
- Department of General Surgery, Jinling Hospital, Medical School, Nanjing University, Nanjing, China
| | - Ninh T Nguyen
- Department of Surgery, Division of Gastrointestinal Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Shu Zhang
- Department of General Surgery, Jinling Hospital, Medical School, Nanjing University, Nanjing, China
| | - Daniel Reim
- Chirurgische Klinik und Poliklinik, Klinikum Rechts der Isar der Technischen Universität München, München, Germany
| | - Orhan Alimoglu
- Department of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Juan-Santiago Azagra
- Unité des Maladies de l'Appareil Digestif et Endocrine (UMADE), Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Pei-Wu Yu
- Department of General Surgery, Third Military Medical University Southwest Hospital, Chongqing, China
| | - Natalie G Coburn
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Feng Qi
- Department of Gastrointestinal Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Patrick G Jackson
- Division of General Surgery, Medstar Georgetown University Hospital, Washington DC, USA
| | - Lu Zang
- Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Steven T Brower
- Department of Surgical Oncology and HPB Surgery, Englewood Hospital and Medical Center, Englewood, New Jersey, USA
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Olivier Facy
- Service de chirurgie digestive et cancérologique CHU Bocage. Dijon, France
| | - Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Andrea Coratti
- Division of Oncological and Robotic Surgery, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Mario Annecchiarico
- Division of Oncological and Robotic Surgery, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Francesca Bazzocchi
- Department of General Surgery, Division of General, Gastroenterologic and Minimally Invasive Surgery, GB Morgagni Hospital, Forlì, Italy
| | - Andrea Avanzolini
- Department of General Surgery, Division of General, Gastroenterologic and Minimally Invasive Surgery, GB Morgagni Hospital, Forlì, Italy
| | - Johan Gagniere
- Digestive and Hepatobiliary Surgery Department, University of Auvergne, University Hospital Estaing, Clermont-Ferrand, France
| | - Denis Pezet
- Digestive and Hepatobiliary Surgery Department, University of Auvergne, University Hospital Estaing, Clermont-Ferrand, France
| | - Fabio Cianchi
- Department of Surgery and Translational Medicine, Center of Oncological Minimally Invasive Surgery (COMIS), University of Florence, Florence, Italy
| | - Benedetta Badii
- Department of Surgery and Translational Medicine, Center of Oncological Minimally Invasive Surgery (COMIS), University of Florence, Florence, Italy
| | - Alexander Novotny
- Chirurgische Klinik und Poliklinik, Klinikum Rechts der Isar der Technischen Universität München, München, Germany
| | - Tunc Eren
- Department of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Metin Leblebici
- Department of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Martine Goergen
- Unité des Maladies de l'Appareil Digestif et Endocrine (UMADE), Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Ben Zhang
- Department of General Surgery, Third Military Medical University Southwest Hospital, Chongqing, China
| | - Yong-Liang Zhao
- Department of General Surgery, Third Military Medical University Southwest Hospital, Chongqing, China
| | - Tong Liu
- Department of Gastrointestinal Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Waddah Al-Refaie
- Division of General Surgery, Medstar Georgetown University Hospital, Washington DC, USA
| | - Junjun Ma
- Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Stefano Trastulli
- Department of Digestive Surgery, St Mary's Hospital, University of Perugia, Terni, Italy
| | - Amilcare Parisi
- Department of Digestive Surgery, St Mary's Hospital, University of Perugia, Terni, Italy
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Pasquer A, Gronnier C, Renaud F, Duhamel A, Théreaux J, Carrere N, Gagniere J, Meunier B, Collet D, Mariette C. Impact of Adjuvant Chemotherapy on Patients with Lymph Node-Positive Esophageal Cancer who are primarily Treated with Surgery. Ann Surg Oncol 2015; 22 Suppl 3:S1340-9. [PMID: 26065869 DOI: 10.1245/s10434-015-4658-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Whereas the optimal therapeutic strategy in node positive esophageal cancer primarily treated by surgery remains unknown, the study was designed to evaluate the impact of adjuvant chemotherapy on survival in such population. METHODS Among 2944 consecutive patients operated on for esophageal cancer between 2000 and 2010 in 30 European centers, patients with lymph node metastasis treated by adjuvant treatment (n = 178) were compared to patients who did not received adjuvant treatment (n = 378). Multivariable analyses and propensity score matching were used to compensate for differences in baseline characteristics. RESULTS After matching, patients were comparable between the two groups. When comparing adjuvant treatment and nonadjuvant treatment groups, there was no significant differences in 3-year overall (40.9 vs. 35.8 %, P = 0.560) and disease-free (33.9 vs. 28.5 %, P = 0.190) survivals. Locoregional recurrence was lower in the adjuvant treatment group (14.4 vs. 30.9 %, P = 0.012). In the adjuvant treatment group, 94 patients received chemotherapy and 84 chemoradiotherapy, without significant survival benefit over chemoradiotherapy compared with chemotherapy alone (P = 0.280). Predictive factors of overall survival were age ≥60 years, ASA III-IV score, and pN+ classification. No survival benefit was observed according to histological subtype or occurrence of postoperative complications. CONCLUSIONS Adjuvant chemo(radio)therapy did not offer survival benefit in lymph node-positive esophageal cancer patients primarily treated with surgery.
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Affiliation(s)
- Arnaud Pasquer
- Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - Caroline Gronnier
- Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Regional University Hospital Center, Place de Verdun, Lille Cedex, France.,North of France University, Lille Cedex, France.,Inserm, UMR S-1172, Team 5 "Mucins, Epithelial Differentiation and Carcinogenesis," JPARC, Lille Cedex, France.,SIRIC OncoLille, Lille Cedex, France
| | - Florence Renaud
- SIRIC OncoLille, Lille Cedex, France.,Department of Pathology, Lille University Hospital, Lille Cedex, France
| | - Alain Duhamel
- SIRIC OncoLille, Lille Cedex, France.,Department of Biostatistics, University Hospital, Lille Cedex, France
| | | | | | | | | | - Denis Collet
- Haut-Levêque University Hospital, Bordeaux, France
| | - Christophe Mariette
- Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Regional University Hospital Center, Place de Verdun, Lille Cedex, France. .,North of France University, Lille Cedex, France. .,Inserm, UMR S-1172, Team 5 "Mucins, Epithelial Differentiation and Carcinogenesis," JPARC, Lille Cedex, France. .,SIRIC OncoLille, Lille Cedex, France.
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Duffaud F, Meeus P, Bertucci F, Delhorme JB, Stoeckle E, Isambert N, Bompas E, Gagniere J, Bouche O, Toulmonde M, Salas S, Blay JY, Bonvalot S. Selective indications of surgery in esophageal gastrointestinal stromal tumors: A retrospective study of the French Sarcoma Group (FSG). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.10534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Emmanuelle Bompas
- Department of Medical Oncology, Centre René Gauducheau, Nantes St. Herblain, France
| | | | - Olivier Bouche
- Centre Hospitalier Universitaire Robert Debré, Reims, France
| | - Maud Toulmonde
- Institut Bergonié, Department of Medical Oncology, Bordeaux, France
| | | | - Jean-Yves Blay
- Centre Léon Bérard, Department of Medicine, Lyon, France
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