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Meurette J, Daraï E, Tajahmady A, Fouard A, Ducastel A, Collin-Bund V, Jochum F, Lecointre L, Querleu D, Akladios C. [Arguments for centralization of surgical treatment of ovarian cancer in France based on morbidity and mortality data]. Bull Cancer 2024; 111:239-247. [PMID: 36797128 DOI: 10.1016/j.bulcan.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To examine the current state for ovarian cancer surgery in France from 2009 to 2016 and to examine the impact of the volume of activity on morbidity and mortality by institution. MATERIAL AND METHOD National retrospective study analyzing surgical sessions for ovarian cancer from the program of medicalization of information systems (PMSI), from January 2009 to December 2016. Institutions were divided according to the number of annual curative procedures into 3 groups: A<10; B: 10-19; C≥20. A propensity score (PS) and the Kaplan-Meier method were employed for statistical analyses. RESULTS In total, 27,105 patients were included. The 1-month mortality rate in group A, B and C was 1.6; 1 and 0.7 %, respectively (P<0.001). Compared to group C, the Relative Risk (RR) of death within the first month was 2.22 for group A and 1.32 for group B (P<0.01). After MS, the 3- and 5-year survival in group A+B and group C were 71.4 and 60.3% (P<0.05) and 56.6, and 60.3% (P<0.05), respectively. The 1-year recurrence rate was significantly lower in group C (P<0.0001). CONCLUSION An annual volume of activity>20 advanced stage ovarian cancers is associated with a decrease in morbidity, mortality, recurrence rate and improved survival.
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Affiliation(s)
- Jacques Meurette
- Caisse nationale d'assurance maladie, 50, avenue du Pr André-Lemierre, 93170 Paris, France
| | - Emile Daraï
- Hôpital Tenon, service de gynécologie-obstétrique, Paris, France
| | - Ayden Tajahmady
- Caisse nationale d'assurance maladie, 50, avenue du Pr André-Lemierre, 93170 Paris, France
| | - Annie Fouard
- Caisse nationale d'assurance maladie, 50, avenue du Pr André-Lemierre, 93170 Paris, France
| | - Anne Ducastel
- Caisse nationale d'assurance maladie, 50, avenue du Pr André-Lemierre, 93170 Paris, France
| | - Virginie Collin-Bund
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France
| | - Floriane Jochum
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France
| | - Lise Lecointre
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France
| | - Denis Querleu
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France
| | - Chérif Akladios
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France.
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Fauvel C, Raitière O, Belkacem NS, Dominique S, Artaud-Macari E, Viacroze C, Schleifer D, Bauer F. Prognostic importance of Kidney, Heart and Interstitial lung diseases (KHI triad) in PH: A machine learning study. Arch Cardiovasc Dis 2020; 113:630-641. [PMID: 32888873 DOI: 10.1016/j.acvd.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/22/2020] [Accepted: 05/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) is a heterogeneous, severe and progressive disease with an impact on quality of life and life-expectancy despite specific therapies. AIMS (i) to compare prognosis significance of each PH subgroup in a cohort from a referral center, (ii) to identify phenotypically distinct high-risk PH patient using machine learning. METHODS Patients with PH were included from 2002 to 2019 and routinely followed-up. We collected clinical, laboratory, imaging and hemodynamic variables. Four-year survival rate of each subgroups was then compared. Next, phenotypic domains were imputed with 5 eigenvectors for missing values and filtered if the Pearson correlation coefficient was>0.6. Thereafter, agglomerative hierarchical clustering was used for grouping phenotypic variables and patients: a heat map was generated and participants were separated using Penalized Model-Based Clustering. P<0.05 was considered significant. RESULTS 328 patients were prospectively included (mean age 63±18 yo, 46% male). PH secondary to left heart disease (PH-LHD) and lung disease (PH-LD) had a significantly increased mortality compared to pulmonary arterial hypertension (PAH) patients: HR=2.43, 95%CI=(1.24-4.73) and 2.95, 95%CI=(1.43-6.07) respectively. 25 phenotypic domains were pinpointed and 3 phenogroups identified. Phenogroup 3 had a significantly increased mortality (log-rank P=0.046) compared to the others and was remarkable for predominant pulmonary disease in older male, accumulating cardiovascular risk factors, and simultaneous three major comorbidities: coronary artery disease, chronic kidney disease and interstitial lung disease. CONCLUSION PH-LHD and PH-LD has 2-fold and 3-fold increase in mortality, respectively compared with PAH. PH patients with simultaneous kidney-cardiac-pulmonary comorbidities were identified as having high-risk of mortality. Specific targeted therapy in this phenogroup should be prospectively evaluated.
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Affiliation(s)
- Charles Fauvel
- Department of cardiology, CHU de Rouen, FHU REMOD-VHF, 76000 Rouen, France.
| | - Olivier Raitière
- Department of cardiology, CHU de Rouen, FHU REMOD-VHF, 76000 Rouen, France
| | | | | | | | | | | | - Fabrice Bauer
- INSERM U1096, Normandie université, UNIROUEN, pulmonary hypertension referral centre 27/76, department of cardiac surgery, CHU de Rouen, FHU REMOD-VHF, 76000 Rouen, France
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Owen C, Bendifallah S, Jayot A, Ilenko A, Arfi A, Boudy AS, Richard S, Varinot J, Thomassin-Naggara I, Bazot M, Daraï É. [Lymph node management in endometrial cancer]. Bull Cancer 2019; 107:686-695. [PMID: 31648773 DOI: 10.1016/j.bulcan.2019.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/16/2019] [Indexed: 01/03/2023]
Abstract
In 2018, around 382,100 new cases of endometrial cancer (EC) were reported worldwide, accounting for about 4.4% of all new cases of cancer in women. In France, in 2018, the EC is the first gynecological cancer in incidence and the fourth cancer in women. The rationale for the therapeutic management of EC is based on the estimation of a theoretical risk of recurrence and lymph node metastasis using MRI and preoperative biopsy criteria. However, lymph node status remains the determining factor of adjuvant treatment. In order to reduce the morbidity of lymphadenectomy, the concept of sentinel lymph node biopsy (SLN) has been developed. The SLN technique has evolved in recent years, thanks to the advent of robotics and the creation of fluorescence detection cameras. It has been shown that detection of SLN with Indocyanine Green (ICG) allows for more frequent bilateral migration of 88 to 100% and better detection of pelvic GS in 97% of cases with a decrease in morbidity. Recently, in view of the absence of a therapeutic role of lymph node staging, the operational risks and the delay of adjuvant treatments, in case of pelvic lymph node metastasis on definitive histological examination, the question of secondarily performing paraaortic lymphadenectomy arises. The SLN procedure, extended to all early-stage endometrial cancers, should lead to a major reduction in the use of secondary staging and better adaptation of adjuvant therapy.
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Affiliation(s)
- Clémentine Owen
- AP-HP, université Sorbonne, hôpital Tenon, service de gynécologie obstétrique et médecine de la reproduction humaine, 4, rue de La Chine, 75020 Paris, France.
| | - Sofiane Bendifallah
- AP-HP, université Sorbonne, hôpital Tenon, service de gynécologie obstétrique et médecine de la reproduction humaine, 4, rue de La Chine, 75020 Paris, France; Université Sorbonne, GRC 6 -UPMC : Centre expert en endométriose (C3E), 75005 Paris, France; Faculté de Médecine Sorbonne Université, Site Saint-Antoine, 27, rue Chaligny, 75571 Paris cedex 12, France
| | - Aude Jayot
- AP-HP, université Sorbonne, hôpital Tenon, service de gynécologie obstétrique et médecine de la reproduction humaine, 4, rue de La Chine, 75020 Paris, France
| | - Anna Ilenko
- AP-HP, université Sorbonne, hôpital Tenon, service de gynécologie obstétrique et médecine de la reproduction humaine, 4, rue de La Chine, 75020 Paris, France
| | - Alexandra Arfi
- AP-HP, université Sorbonne, hôpital Tenon, service de gynécologie obstétrique et médecine de la reproduction humaine, 4, rue de La Chine, 75020 Paris, France
| | - Anne Sophie Boudy
- AP-HP, université Sorbonne, hôpital Tenon, service de gynécologie obstétrique et médecine de la reproduction humaine, 4, rue de La Chine, 75020 Paris, France
| | - Sandrine Richard
- AP-HP, université Sorbonne, Alliance pour la recherche en cancérologie (APREC), service d'oncologie médicale, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Justine Varinot
- AP-HP, université Sorbonne, service d'anatomopathologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Isabelle Thomassin-Naggara
- AP-HP, université Sorbonne, service d'anatomopathologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Marc Bazot
- AP-HP, université Sorbonne, UPMC université Paris 6, institut universitaire de cancérologie, hôpital Tenon, service d'imagerie, 4, rue de la Chine, 75020 Paris, France
| | - Émile Daraï
- AP-HP, université Sorbonne, hôpital Tenon, service de gynécologie obstétrique et médecine de la reproduction humaine, 4, rue de La Chine, 75020 Paris, France; Université Sorbonne, GRC 6 -UPMC : Centre expert en endométriose (C3E), 75005 Paris, France; Faculté de Médecine Sorbonne Université, Site Saint-Antoine, 27, rue Chaligny, 75571 Paris cedex 12, France
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Massoullié G, Wintzer-Wehekind J, Chenaf C, Mulliez A, Pereira B, Authier N, Eschalier A, Clerfond G, Souteyrand G, Tabassome S, Danchin N, Citron B, Lusson JR, Puymirat É, Motreff P, Eschalier R. Prognosis and management of myocardial infarction: Comparisons between the French FAST-MI 2010 registry and the French public health database. Arch Cardiovasc Dis 2016; 109:303-10. [PMID: 27107986 DOI: 10.1016/j.acvd.2016.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 12/01/2015] [Accepted: 01/15/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multicentre registries of myocardial infarction management show a steady improvement in prognosis and greater access to myocardial revascularization in a more timely manner. While French registries are the standard references, the question arises: are data stemming solely from the activity of French cardiac intensive care units (ICUs) a true reflection of the entire French population with ST-segment elevation myocardial infarction (STEMI)? AIM To compare data on patients hospitalized for STEMI from two French registries: the French registry of acute ST-elevation or non-ST-elevation myocardial infarction (FAST-MI) and the Échantillon généraliste des bénéficiaires (EGB) database. METHODS We compared patients treated for STEMI listed in the FAST-MI 2010 registry (n=1716) with those listed in the EGB database, which comprises a sample of 1/97th of the French population, also from 2010 (n=403). RESULTS Compared with the FAST-MI 2010 registry, the EGB database population were older (67.2±15.3 vs 63.3±14.5 years; P<0.001), had a higher percentage of women (36.0% vs 24.7%; P<0.001), were less likely to undergo emergency coronary angiography (75.2% vs 96.3%; P<0.001) and were less often treated in university hospitals (27.1% vs 37.0%; P=0.001). There were no significant differences between the two registries in terms of cardiovascular risk factors, comorbidities and drug treatment at admission. Thirty-day mortality was higher in the EGB database (10.2% vs 4.4%; P<0.001). CONCLUSIONS Registries such as FAST-MI are indispensable, not only for assessing epidemiological changes over time, but also for evaluating the prognostic effect of modern STEMI management. Meanwhile, exploitation of data from general databases, such as EGB, provides additional relevant information, as they include a broader population not routinely admitted to cardiac ICUs.
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Affiliation(s)
- Grégoire Massoullié
- UMR 6284, cardiovascular interventional therapy and imaging (CaVITI), image science for interventional techniques (ISIT), université de Clermont, université d'Auvergne, 63000 Clermont-Ferrand, France; Cardiology department, Clermont university hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - Jérome Wintzer-Wehekind
- UMR 6284, cardiovascular interventional therapy and imaging (CaVITI), image science for interventional techniques (ISIT), université de Clermont, université d'Auvergne, 63000 Clermont-Ferrand, France; Cardiology department, Clermont university hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - Chouki Chenaf
- Pharmacology department, CHU of Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Aurélien Mulliez
- Biostatistics unit, clinical research and innovation delegation, CHU of Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics unit, clinical research and innovation delegation, CHU of Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Nicolas Authier
- Pharmacology department, CHU of Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Alain Eschalier
- Pharmacology department, CHU of Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Guillaume Clerfond
- UMR 6284, cardiovascular interventional therapy and imaging (CaVITI), image science for interventional techniques (ISIT), université de Clermont, université d'Auvergne, 63000 Clermont-Ferrand, France; Cardiology department, Clermont university hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - Géraud Souteyrand
- UMR 6284, cardiovascular interventional therapy and imaging (CaVITI), image science for interventional techniques (ISIT), université de Clermont, université d'Auvergne, 63000 Clermont-Ferrand, France; Cardiology department, Clermont university hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - Simon Tabassome
- Inserm, U-698, UPMC-Paris 6, clinical research unit (URC)-Est, hospital Saint-Antoine, AP-HP, 75012 Paris, France
| | - Nicolas Danchin
- Inserm U-970, department of cardiology, European hospital of Georges-Pompidou, university Paris Descartes, AP-HP, 75015 Paris, France
| | - Bernard Citron
- UMR 6284, cardiovascular interventional therapy and imaging (CaVITI), image science for interventional techniques (ISIT), université de Clermont, université d'Auvergne, 63000 Clermont-Ferrand, France; Cardiology department, Clermont university hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - Jean-René Lusson
- UMR 6284, cardiovascular interventional therapy and imaging (CaVITI), image science for interventional techniques (ISIT), université de Clermont, université d'Auvergne, 63000 Clermont-Ferrand, France; Cardiology department, Clermont university hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - Étienne Puymirat
- Inserm U-970, department of cardiology, European hospital of Georges-Pompidou, university Paris Descartes, AP-HP, 75015 Paris, France
| | - Pascal Motreff
- UMR 6284, cardiovascular interventional therapy and imaging (CaVITI), image science for interventional techniques (ISIT), université de Clermont, université d'Auvergne, 63000 Clermont-Ferrand, France; Cardiology department, Clermont university hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - Romain Eschalier
- UMR 6284, cardiovascular interventional therapy and imaging (CaVITI), image science for interventional techniques (ISIT), université de Clermont, université d'Auvergne, 63000 Clermont-Ferrand, France; Cardiology department, Clermont university hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
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