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Arlegui H, Mahé E, Richard MA, De Rycke Y, Viguier M, Beylot-Barry M, Dupuy A, Beneton N, Joly P, Jullien D, Bachelez H, Sbidian É, Chosidow O, Paul C, Tubach F. Impact of the first wave of the COVID-19 pandemic on the treatment of psoriasis with systemic therapies in France: Results from the PSOBIOTEQ cohort. Ann Dermatol Venereol 2023:S0151-9638(23)00009-1. [PMID: 36914553 PMCID: PMC9928748 DOI: 10.1016/j.annder.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/18/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND The nature of the COVID-19 pandemic led to concerns among patients and physicians about the potential impact of immunosuppressive treatments for chronic diseases such as psoriasis on the risk of severe COVID-19. OBJECTIVES To describe treatment modifications and determine the incidence of COVID-19 infection among psoriasis patients during the first wave of the pandemic, and identify the factors associated with these events. METHODS Data from PSOBIOTEQ cohort relating to the first COVID-19 wave in France (March to June, 2020), as well as a patient-centred COVID-19 questionnaire, were used to evaluate the impact of lockdown on changes (discontinuations, delays or reductions) in systemic therapies, and to determine the incidence of COVID-19 cases among these patients. Logistic regression models were used to assess associated factors. RESULTS Among the 1751 respondents (89.3%), 282 patients (16.9%) changed their systemic treatment for psoriasis, with 46.0% of these changes being initiated by the patients themselves. Patients were more likely to experience psoriasis flare-ups during the first wave if they changed their treatment during this period (58.7% vs 14.4%; P < 0.0001). Changes to systemic therapies were less frequent among patients with cardiovascular diseases (P < 0.001), and those aged ≥ 65 years (P = 0.02). Overall, 45 patients (2.9%) reported having COVID-19, and eight (17.8%) required hospitalization. Risk factors for COVID-19 infection were close contact with a positive case (P < 0.001) and living in a region with a high incidence of COVID-19 (P < 0.001). Factors associated with a lower risk of COVID-19 were avoiding seeing a physician (P = 0.002), systematically wearing a mask during outings (P = 0.011) and being a current smoker (P = 0.046). CONCLUSIONS Discontinuation of systemic psoriasis treatments during the first COVID-19 wave (16.9%) - mainly decided by patients themselves (46.0%) - was associated with a higher incidence of disease flares (58.7% vs 14.4%). This observation and factors associated with a higher risk of COVID-19 highlight the need to maintain and adapt patient-physician communication during health crises according to patient profiles, with the aim of avoiding unnecessary treatment discontinuations and ensuring that patients are informed about the risk of infection and the importance of complying with hygiene rules.
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Affiliation(s)
- H Arlegui
- AP-HP, Hôpital Pitié-Salpêtrière, Centre de Pharmaco-épidémiologie (Cephépi), INSERM, CIC-1901, Paris, France
| | - E Mahé
- Service de Dermatologie, Hôpital Victor Dupouy, Argenteuil, France
| | - M-A Richard
- Service de Dermatologie, EA 3279: CEReSS - Health Service Research and Quality of Life Centre, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Y De Rycke
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmaco-épidémiologie (Cephépi), CIC-1901, 75013 Paris, France
| | - M Viguier
- Service de Dermatologie-Vénéréologie, Hôpital Robert Debré, Université Reims Champagne Ardenne, 51100 Reims, France
| | - M Beylot-Barry
- Service de Dermatologie, CHU de Bordeaux, Translational Research on Oncodermatology and Rare skin diseases, Bordeaux Institute of Oncology, UMR 1312 INSERM, Université Bordeaux, Bordeaux, France
| | - A Dupuy
- France Univ Rennes, CHU Rennes, 35000 Rennes, France
| | - N Beneton
- REPERES Pharmaco-Epidemiology and Health Services Research, University Rennes and French School of Public Health, Rennes, France
| | - P Joly
- Service de Dermatologie, Hôpital du Mans, Le Mans, France
| | - D Jullien
- Service de Dermatologie, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon F-69003; Lyon-1 University; INSERM U1111 - CIRI, Lyon F-69007, France
| | - H Bachelez
- Service de Dermatologie, Assistance Publique- Hôpitaux de Paris, Hôpital Saint-Louis, Université Paris Cité, Paris, France; INSERM UMR1163, Institut Imagine, Paris, France
| | - É Sbidian
- Service de Dermatologie, Assistance Publique- Hôpitaux de Paris, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Hôpital Henri Mondor, Clinical Investigation Centre, Université Paris-Est Créteil (UPEC), Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Créteil, France
| | - O Chosidow
- Service de Dermatologie, Assistance Publique- Hôpitaux de Paris, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Groupe de recherche Dynamyc, EA7380, Faculté de Santé de Créteil, École nationale vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
| | - C Paul
- Service de Dermatologie, Toulouse University Hospital (CHU), Paul Sabatier University, Toulouse, France
| | - F Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmaco-épidémiologie (Cephépi), CIC-1901, 75013 Paris, France.
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Curmin R, Guillo S, De Rycke Y, Bachelez H, Beylot‐Barry M, Beneton N, Chosidow O, Dupuy A, Joly P, Jullien D, Richard M, Viguier M, Sbidian E, Paul C, Mahé E, Tubach F. Switches between biologics in patients with moderate-to-severe psoriasis: results from the French cohort PSOBIOTEQ. J Eur Acad Dermatol Venereol 2022; 36:2101-2112. [PMID: 35793473 PMCID: PMC9796114 DOI: 10.1111/jdv.18409] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/18/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Biologics are the cornerstone of treatment of patients with moderate-to-severe plaque psoriasis and switches between biologics are frequently needed to maintain clinical improvement over time. OBJECTIVES The main purpose of this study was to describe precisely switches between biologics and how their pattern changed over time with the recent availability of new biologic agents. METHODS We included patients receiving a first biologic agent in the Psobioteq multicenter cohort of adults with moderate-to-severe psoriasis receiving systemic treatment. We described switches between biologics with chronograms, Sankey and Sunburst diagrams, assessed cumulative incidence of first switch by competing risks survival analysis and reasons for switching. We assessed the factors associated with the type of switch (intra-class - i.e. within the same therapeutic class - vs. inter-class) in patients switching from a TNF-alpha inhibitor using multivariate logistic regression. RESULTS A total of 2153 patients was included. The cumulative incidence of switches from first biologic was 34% at 3 years. Adalimumab and ustekinumab were the most prescribed biologic agents as first and second lines of treatment. The main reason for switching was loss of efficacy (72%), followed by adverse events (11%). Patients receiving a TNF-alpha inhibitor before 2016 mostly switched to ustekinumab, whereas those switching in 2016 or after mostly switched to an IL-17 inhibitor. Patients switching from a first-line TNF-alpha inhibitor before 2016 were more likely to switch to another TNF-alpha inhibitor compared with patients switching since 2018. Patients switching from etanercept were more likely to receive another TNF-alpha inhibitor rather than another therapeutic class of bDMARD compared with patients switching from adalimumab. CONCLUSION This study described the switching patterns of biologic treatments and showed how they changed over time, due to the availability of the new biologic agents primarily IL-17 inhibitors.
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Affiliation(s)
- R. Curmin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé PubliqueParisFrance
| | - S. Guillo
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP‐HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi)Sorbonne UniversitéParisFrance
| | - Y. De Rycke
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP‐HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi)Sorbonne UniversitéParisFrance
| | - H. Bachelez
- Dermatologie, AP‐HP Hôpital Saint LouisParisFrance,Sorbonne Paris Cité Universitaire Paris DiderotParisFrance,UMR INSERM 1163, Institut ImagineParisFrance
| | - M. Beylot‐Barry
- Dermatologie CHU Bordeaux & INSERM U 1053Bordeaux UniversityBordeauxFrance
| | | | - O. Chosidow
- Dermatologie, AP‐HP, Hôpitaux universitaires Henri Mondor, Département de Dermatologie, UPEC, INSERM, Centre d'Investigation Clinique 1430, EA 7379 EpidermEUniversité Paris‐Est Créteil, UPECCréteilFrance
| | - A. Dupuy
- DermatologieCHU PontchaillouRennesFrance
| | - P. Joly
- DermatologieCHU RouenRouenFrance
| | - D. Jullien
- Dermatologie, Hospices Civils de Lyon, Hôpital E. HerriotUniversité Lyon‐1LyonFrance
| | - M.A. Richard
- Dermatologie, EA 3279: CEReSS ‐ Health Service Research and Quality of Life Center, Timone Hospital, Assistance Publique Hôpitaux de MarseilleAix‐Marseille UniversityMarseilleFrance
| | - M. Viguier
- Dermatologie‐VénéréologieHôpital Robert DebréReimsFrance
| | - E. Sbidian
- Dermatologie, AP‐HP, Hôpitaux universitaires Henri Mondor, Département de Dermatologie, UPEC, INSERM, Centre d'Investigation Clinique 1430, EA 7379 EpidermEUniversité Paris‐Est Créteil, UPECCréteilFrance
| | - C. Paul
- DermatologieCHU and Toulouse UniversityToulouseFrance
| | - E. Mahé
- DermatologieHôpital Victor DupouyArgenteuilFrance
| | - F. Tubach
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP‐HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi)Sorbonne UniversitéParisFrance
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Ajrouche A, Estellat C, Lopez-Medina C, Molto A, Ruyssen-Witrand A, Claudepierre P, De Rycke Y, Tubach F, Gossec L, Dougados M. Appariement probabiliste au système national des données de santé (SNDS) d'une cohorte de patients ayant des symptômes évocateurs d'une spondyloarthrite axiale récente, la cohorte DESIR. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.03.087] [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: 11/28/2022] Open
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Curmin R, Guillo S, De Rycke Y, Bachelez H, Beylot-Barry M, Beneton N, Olivier C, Dupuy A, Joly P, Jullien D, Richard M, Viguier M, Sbidian E, Paul C, Mahé E, Tubach F. Switchs de biothérapies chez les patients atteints de psoriasis modéré à sévère dans la cohorte française PSOBIOTEQ. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.03.019] [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] Open
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Lenfant L, Renard-Penna R, De Rycke Y, Roupret M, Baugerie A, Comperat E, Chartier-Kastler E, Mozer PC. Assessment of systematic and combined MRI-targeted biopsy for prostate cancer diagnosis during 10 years of practice at a single institution. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00545-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Aguadé AS, Guillo S, De Rycke Y, Lafourcade A, Chenivesse C, Taillé C, Hejblum G, Tubach F. Evaluation of the ’sophia’ asthma patient management program at two years. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.214] [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: 11/12/2022] Open
Abstract
Abstract
Objectives
To evaluate the impact of a multi-faceted management support program deployed towards asthma patients by the French Health Insurance since February 2015 in 19 (20%) French pilot areas.
Methods
The population is composed of subjects aged 18 to 40 years in 2014, with at least 3 asthma medication deliveries in 2012 as well as in 2013 that were identified and followed-up within the SNDS French claims database. A controlled before-and-after design was used for assessing program impact. Unexposed subjects (i.e. living in non-pilot areas) were matched with exposed subjects (i.e. living in pilot areas) on a propensity score. Adherence to controller treatment (inhaled corticoids), measured by the medication refill adherence MRA, was the primary outcome. Secondary outcomes were medications and heathcare use, sick leaves, exacerbations, costs.
Results
Analysis concerned 29, 746 matched-pairs. With a baseline mean MRA of 40.17% in unexposed subjects, the difference-in-difference was non-significant (0.26%, p = 0.545). However, the program showed a significant impact on the percentage of subjects that moved to a better MRA category or maintained a high adherence (OR = 1.05,p=0.028). The program had no significant impact on the other secondary outcomes. In planned secondary analyses comparing the 11.5% exposed subjects who adhered to the program to their matched-unexposed subjects, the difference-in-difference showed a program impact on specialist consultations, asthma-related and all medication costs, and total asthma-related costs. However, results on this subpopulation must be examined with caution since the matching procedure couldn’t take into account the propensity to adhere.
Conclusions
Although SOPHIA had no impact on the MRA as a continuous variable, more exposed subjects moved to better adherence categories. The program had an impact on asthma-related costs in the adherents to the program, but this result should be considered with caution.
Key messages
Although SOPHIA had no impact on the MRA as a continuous variable, more exposed subjects moved to better adherence categories. The program had an impact on asthma-related costs in the adherents to the program, but this result should be considered with caution.
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Affiliation(s)
| | - S Guillo
- Dpt BIOSPIM/Cephepi, INSERM/IPLESP, Paris, France
| | - Y De Rycke
- Dpt BIOSPIM/Cephepi, INSERM/IPLESP, Paris, France
| | - A Lafourcade
- Dpt BIOSPIM/Cephepi, INSERM/IPLESP, Paris, France
| | | | - C Taillé
- Hôpital Bichat-Claude Bernard, Paris, France
| | - G Hejblum
- Sorbonne University, Paris, France
- INSERM/IPLESP, Paris, France
| | - F Tubach
- Dpt BIOSPIM/Cephepi, INSERM/IPLESP, Paris, France
- Sorbonne University, Paris, France
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Belin L, Tan A, De Rycke Y, Dechartres A. Validation de la survie sans progression en tant que critère de substitution de la survie globale en oncologie : une revue systématique. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.03.005] [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: 11/26/2022] Open
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Ajrouche A, Estellat C, De Rycke Y, Tubach F. Trajectoires d’adhérence à l’aspirine chez la population française âgée de 50 ans et plus : étude sur bases de données médico-administratives françaises. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.01.096] [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: 10/27/2022] Open
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Ajrouche A, De Rycke Y, Dalichampt M, Messika-Zeitoun D, Hulot JS, Estellat C, Tubach F. Utilisation des pseudo-observations dynamiques pour estimer l’effet de l’aspirine sur le risque du cancer : étude à partir des bases de données médico-administratives françaises. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.01.056] [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: 10/27/2022] Open
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Taillé C, Chenivesse C, Guillo S, Lafourcade A, Hejblum G, De Rycke Y, Tubach F. Évaluation du programme de soutien aux asthmatiques SOPHIA-ASTHME dans sa 2e année de déploiement. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.017] [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: 10/27/2022]
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Taillé C, De Rycke Y, Dib F, Raherison C, Lafourcade A, Aguade A, Guillo S, Tubach F. Description de la population des patients adhérents au programme d’accompagnement SOPHIA-asthme. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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Taillé C, Dib F, Raherison C, Guillo S, Lafourcade A, Aguade A, De Rycke Y, Tubach F. Évaluation du programme de soutien aux asthmatiques SOPHIA-ASTHME. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.135] [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: 10/18/2022]
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De Rycke Y, Dib F, Lafourcade A, Guillo S, Tubach F. Évaluation du programme d’accompagnement des patients asthmatiques Sophia asthme. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.04.047] [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: 11/16/2022] Open
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Louveau B, De Rycke Y, Lafourcade A, Saraux A, Guillemin F, Tubach F, Fautrel B, Hajage D. Modèle prédictif du risque de progression radiologique cinq ans après le diagnostic de polyarthrite rhumatoïde considérant une exposition cumulée aux traitements : analyse de la cohorte ESPOIR. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.03.035] [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: 10/19/2022] Open
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De Rycke Y, Dib F, Lafourcade A, Guillo S, Tubach F. Évaluation du programme d’accompagnement des patients asthmatiques Sophia Asthme. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.03.033] [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] Open
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16
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Hajage D, Chauvet G, Tubach F, De Rycke Y. Estimation de la variance de l’effet du traitement estimé par pondération sur le score de propension. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.03.005] [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: 11/28/2022] Open
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Bazire L, De Rycke Y, Asselain B, Fourquet A, Kirova Y. Risks of second malignancies after breast cancer treatment: Long-term results. Cancer Radiother 2017; 21:10-15. [DOI: 10.1016/j.canrad.2016.07.101] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/30/2016] [Accepted: 07/04/2016] [Indexed: 01/05/2023]
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Genin A, De Rycke Y, Stevens D, Donnadieu A, Langer A, Rouzier R, Lerebours F. Association with pregnancy increases the risk of local recurrence but does not impact overall survival in breast cancer: A case–control study of 87 cases. Breast 2016; 30:222-227. [DOI: 10.1016/j.breast.2015.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/02/2015] [Accepted: 09/12/2015] [Indexed: 10/23/2022] Open
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Belin L, De Rycke Y, Broët P. Comparaison de deux designs de phase II utilisant un critère de jugement censuré dans le cadre d’un suivi réduit. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.03.011] [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: 11/29/2022] Open
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Hajage D, De Rycke Y, Tubach F. Les méthodes de prise en compte des scores pronostiques : une étude de simulation. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.03.034] [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: 11/24/2022] Open
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Pasquet B, Elkrief L, Rautou PE, Tubach F, Moreau R, De Rycke Y, Gault N. Effet de la norfloxacine sur la survie des malades atteints de cirrhose Child-Pugh C : essai contrôlé randomisé avec prise en compte des risques compétitifs. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.03.098] [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: 10/21/2022] Open
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Lafourcade A, De Rycke Y, Tubach F, Hajage D. Modélisation des évènements indésirables associés à deux traitements successifs au cours d’une maladie chronique. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.03.089] [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: 11/25/2022] Open
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Loirat D, Bidard F, Chaltiel L, Berger F, Diéras V, De Rycke Y, Alran S, Kirova Y, Cottu P, Vincent-Salomon A, Sastre-Garau X, Pierga J. Determinants of Central Nervous System (Cns) Metastases in a Cohort of 620 Early Breast Cancer Patients After 11 Years Follow Up: Role of Disseminated Tumor Cell (Dtc) in Bone Marrow (Bm) Detected at Primary Diagnosis. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu329.7] [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: 11/14/2022] Open
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Robin M, Denise S, De Rycke Y, Falcou MC, Noguès C, Brigitte S. Évolution des moyens thérapeutiques mis en œuvre dans le traitement du cancer du sein invasif et utilisation des thérapies ciblées de 1999 à 2010 – Base SEIN, institut Curie. Rev Epidemiol Sante Publique 2014. [DOI: 10.1016/j.respe.2013.12.077] [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: 10/25/2022] Open
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Mariani P, Servois V, De Rycke Y, Bennett SP, Feron JG, Almubarak MM, Reyal F, Baranger B, Pierga JY, Salmon RJ. Liver metastases from breast cancer: Surgical resection or not? A case-matched control study in highly selected patients. Eur J Surg Oncol 2013; 39:1377-83. [PMID: 24126165 DOI: 10.1016/j.ejso.2013.09.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 09/12/2013] [Accepted: 09/17/2013] [Indexed: 02/08/2023] Open
Abstract
AIM To determine whether, in a highly selected patient population, medical treatment combined with surgical resection of liver metastases from breast cancer is associated with improved survival compared with medical treatment alone. PATIENTS AND METHODS Between 1988 and 2007, 100 liver resections for metastatic breast cancer were performed at Institut Curie, 51 of which met the criteria for inclusion in this case-control study. With the exception of bone metastases, patients with other distant metastasis sites were excluded. Surgery was only performed in patients with stable disease or disease responding to medical treatment evaluated by imaging evaluation. Surgical cases were individually matched with 51 patients receiving medical treatment only. All patients had 4 or fewer resectable liver metastases. The study group was matched with the control group for age, year of breast cancer diagnosis, time to metastasis, TNM stage, hormone receptor status and breast cancer tumour pathology. RESULTS Univariate analysis confirmed a survival advantage for patients lacking bone metastases and axillary lymphadenopathy at the time of breast cancer diagnosis and for surgically treated patients. Multivariate analysis indicated that surgery and the absence of bone metastases were associated with a better prognosis. A multivariate Cox model adapted for paired data showed a RR = 3.04 (CI: 1.87-4.92) (p < 0.0001) in favour of surgical treatment. CONCLUSION Surgical resection of liver metastases from primary breast cancer appears to provide a survival benefit for highly selected patients.
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Affiliation(s)
- P Mariani
- Department of Surgical Oncology, Institut Curie, 26 rue d'Ulm, 75248 Paris Cedex, France.
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Kirova Y, De Rycke Y, Campana F, Dendale R, Asselain B, Fourquet A. Second Malignancies After Breast Cancer Treatment and Their Relationship With Adjuvant Radiation Therapy: Long-term Results. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.577] [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: 10/27/2022]
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Ngô C, Mouttet D, De Rycke Y, Reyal F, Fourchotte V, Hugonnet F, Falcou MC, Bidard FC, Vincent-Salomon A, Fourquet A, Alran S. Validation over time of a nomogram including HER2 status to predict the sentinel node positivity in early breast carcinoma. Eur J Surg Oncol 2012; 38:1211-7. [PMID: 22954526 DOI: 10.1016/j.ejso.2012.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 08/03/2012] [Accepted: 08/16/2012] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The molecular subtypes of breast cancer have different axillary status. A nomogram including the interaction covariate between estrogen receptor (ER) and HER2 has been recently published (Reyal et al. PLOS One, May 2011) and allows to identify the patients with a high risk of positive sentinel lymph node (SLN). The purpose of our study was to validate this model on an independent population. METHODS We studied 755 consecutive patients treated at Institut Curie for operable breast cancer with sentinel node biopsies in 2009. The multivariate model, including age, tumor size, lymphovascular invasion and interaction covariate between ER and HER2 status, was used to calculate the theoretical risk of positive sentinel lymph node (SLN) for all patients. The performance of the model on our population was then evaluated in terms of discrimination (area under the curve AUC) and of calibration (Hosmer-Lemeshow HL test). RESULTS our population was significantly different from the training population for the following variables: median tumor size in mm, lymphovascular invasion, positive ER and age. The nomogram showed similar results in our population than in the training population in terms of discrimination (AUC=0.72 [0.68-0.76] versus 0.73 [0.7-0.75] and calibration (HL p=0.4 versus p=0.35). CONCLUSIONS Despite significant differences between the two populations concerning variables which are part of the nomogram, the model was validated in our population. This nomogram is robust over time to predict the likelihood of positive SLN according to molecular subtypes defined by surrogate markers ER and HER2 determined by immunohistochemistry in clinical practice.
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Affiliation(s)
- C Ngô
- Department of Surgical Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.
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Ngô C, De Rycke Y, Mouttet D, Reyal F, Fourchotte V, Hugonnet F, Falcou MC, Bidard FC, Vincent-Salomon A, Fourquet A, Sigal-Zafrani B, Alran S. PD02-08: Validation over Time of a Nomogram Predicting the Sentinel Node Positivity in Early Breast Carcinoma According to the Molecular Subtypes Classification. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-pd02-08] [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: 11/16/2022]
Abstract
Abstract
Background: The molecular subtypes of breast cancer have different axillary status. A new nomogram including the interaction covariate between estrogen receptor (ER) and HER2 status has been recently published (Reyal et al. PLOSone, may 2011) and allows to identify before surgery the patients with a high risk of positive sentinel lymph node (SLN). The purpose of our study was to validate this model on an independent population.
Patients and methods: We studied 755 consecutive patients treated for operable breast cancer with sentinel node biopsies in 2009, from the Institut Curie breast cancer prospective database. Baseline characteristics were compared between our population and the population used to build the model, using Chi-square test for categorical variables and Kruskal-Wallis test for continuous variables. The multivariate model, including age, tumor size, lymphovascular invasion and interaction covariate between ER and HER2 status, was used to calculate the theoretical risk of positive sentinel lymph node (SLN) for all patients. The performance of the model on our population was then evaluated in terms of discrimination (area under the curve AUC) and of calibration (Hosmer-Lemeshow HL test).
Results: Characteristics of our population were significantly different from the training population for the following variables: tumor size (median 12mm [1-60] versus 13mm [1-100] p=0.005), lymphovascular invasion (18.6% versus 23.7% p=0.006), positive ER (91.4% versus 87% p=0.002) and age as followed: 56.7% of patients ≤ 60 versus 63.1%, 17.5% of patients between 60 and 65 versus 14.1% and 25.8% of patients above 65 versus 22.8% p=0.01. The nomogram showed similar results in our population than in the training population in terms of discrimination (AUC= 0.72 [0.68−0.76] versus 0.73 [0.7−0.75] and calibration (HL p= 0.4 versus p=0.35).
Conclusions: Despite significant differences between the two populations concerning variables which are part of the nomogram, the model was validated in our population. Our study shows that this nomogram is efficient and robust over time to predict the likelihood of positive SLN according to molecular subtypes defined by surrogate markers ER and HER2 determined by immunohistochemistry in clinical practice.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD02-08.
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Affiliation(s)
- C Ngô
- 1Institut Curie, Paris, France
| | | | | | - F Reyal
- 1Institut Curie, Paris, France
| | | | | | | | | | | | | | | | - S Alran
- 1Institut Curie, Paris, France
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Yassa M, Saliou M, De Rycke Y, Hemery C, Henni M, Bachaud J, Thiounn N, Cosset J, Giraud P. Male pattern baldness and the risk of prostate cancer. Ann Oncol 2011; 22:1824-7. [DOI: 10.1093/annonc/mdq695] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Elie C, De Rycke Y, Jais J, Landais P. Appraising relative and excess mortality in population-based studies of chronic diseases such as end-stage renal disease. Clin Epidemiol 2011; 3:157-69. [PMID: 21607017 PMCID: PMC3096516 DOI: 10.2147/clep.s17349] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Indexed: 11/23/2022] Open
Abstract
Purpose: Modeling excess and relative mortality represents two ways of considering general population mortality rates (ie, background mortality) in cohort studies. Excess mortality is obtained by subtracting the expected mortality from the observed mortality (additive hazard model). Relative mortality is obtained by dividing the observed mortality by the expected mortality (multiplicative hazard model). Our first objective was to compare the results of these two models in a population-based cohort including 5115 dialyzed patients older than 70 years (mean age 79 years, range 70–97 years). Our second objective was to explore an alternative model combining both excess and relative mortality. Patients and methods: Effects of covariates on excess mortality and relative mortality were assessed using a generalized linear model and a Cox model, respectively. The model, combining both excess and relative mortality, is derived from the Aalen model. Results: The effect of age and sex was different according to the additive or multiplicative model used, whereas the effect of the first modality of dialysis or the primary nephropathy was similar. Because there was no evidence of lack of fit, the choice of one of these two models was not obvious. The combined model showed that the two components, additive and multiplicative, had to be kept. In this case, the combined model led to results similar to the pure additive and multiplicative univariate models, except for the method of dialysis, which did not exert an effect on both excess and relative mortality. Conclusion: We underlined the complementary interest of modeling excess and relative mortality in looking for factors associated with mortality related to end-stage renal disease. The combined model appeared attractive in offering the possibility of reducing the model to the most appropriate one. When both components have to be retained, it better describes the effect of covariates on excess and relative mortality.
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Affiliation(s)
- Caroline Elie
- Université Paris Descartes, Faculté de Médecine, Hôpital Necker-Enfants Malades, Service de Biostatistique et d'Informatique Médicale, Paris, France
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Toupet A, Alran S, De Rycke Y, Pierga J, Bollet M, Fourchotte V, Falcou M, Vincent-Salomon A, Sigal-Zafrani B, Salmon R. 4N Disease-free survival in breast cancer patients with minimal lymph node involvement: results in 241 isolated tumour cells or micrometastases in the sentinel lymph node with negative complementary axillary dissection. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70031-8] [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] Open
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Alran S, Toupet A, De Rycke Y, Pierga J, Fourchotte V, Falcou M, Sigal-Zafrani B, Salmon R. Distant Metastasis Free Survival (DMFS) in Breast Cancer Patients with Micrometastases (pN1mi) in the Sentinel Lymph Node (SLN): Results in 582 Positive-SLN Patients in a Single Institution. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-308] [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: 11/16/2022]
Abstract
Abstract
Background:The risk of developing distant metastases (DM) in pN1mi and isolated tumor cells (pN0i+) patients remains under question. Does occult axillary node metastases is an additional factor for using an adjuvant systemic therapy (AST) in early breast cancer ?Patients and Methods:Among 2695 patients operated on from 2000 to 2006 for SLN, 582 patients had a positive SNB: 307 were pN1, 154 pN1mi and 121 pN0i+ (6th AJCC-classification). All patients underwent an immediate or delayed Axillary Lymph Node Dissection (ALND). We report the results for DMFS [median follow-up of 56 months (2-105)].We used Kaplan-Meier method and Cox regression for multivariate analysis.Results:ALND were positive in pN1, pN1mi and pN0i+ patients respectively in 127 (41,3%), 20 (13%) and 14 (11.6%) of these patients. On univariate and multivariate analysis, positive ALND, mitotic index, pathologic tumor size were significantly related to the DMFS; on multivariate analysis, the type of axillary lymph node metastases was an additional significative factor. There was not relationship between pN0i+ and the development of DM. Surprisingly, patients with pN1mi had a 2.8 higher risk for developing DM than pN1 patients. pN1 patients receive more AST than pN1mi (75% and 22%), however AST was not prognostic (p=0.49).Conclusion:In our series, patients with pN1mi were associated with a worse prognosis related to DMFS compared to pN1. Use of AST and/or biological primary tumor characteristics could explain this paradoxical result. Longer follow-up and larger series are needed to determine the prognostic significance of axillary occult metastases.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 308.
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Alran S, Charles C, De Rycke Y, Berry M, Sigal B, Salmon R. Do isolated cells (pN0i+) in the sentinel lymph node change the post-operative treatment in breast cancer? Eur J Surg Oncol 2009. [DOI: 10.1016/j.ejso.2009.07.166] [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: 10/20/2022] Open
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Brisse HJ, Brenot J, Pierrat N, Gaboriaud G, Savignoni A, De Rycke Y, Neuenschwander S, Aubert B, Rosenwald JC. The relevance of image quality indices for dose optimization in abdominal multi-detector row CT in children: experimental assessment with pediatric phantoms. Phys Med Biol 2009; 54:1871-92. [PMID: 19265204 DOI: 10.1088/0031-9155/54/7/002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study assessed and compared various image quality indices in order to manage the dose of pediatric abdominal MDCT protocols and to provide guidance on dose reduction. PMMA phantoms representing average body diameters at birth, 1 year, 5 years, 10 years and 15 years of age were scanned in a four-channel MDCT with a standard pediatric abdominal CT protocol. Image noise (SD, standard deviation of CT number), noise derivative (ND, derivative of the function of noise with respect to dose) and contrast-to-noise ratio (CNR) were measured. The 'relative' low-contrast detectability (rLCD) was introduced as a new quantity to adjust LCD to the various phantom diameters on the basis of the LCD(1%) assessed in a Catphan phantom and a constant central absorbed dose. The required variations of CTDIvol(16) with respect to phantom size were analyzed in order to maintain each image quality index constant. The use of a fixed SD or CNR level leads to major dose ratios between extreme patient sizes (factor 22.7 to 44 for SD, 31.7 to 51.5 for CNR(2.8%)), whereas fixed ND and rLCD result in acceptable dose ratios ranging between factors of 2.9 and 3.9 between extreme phantom diameters. For a 5-9 mm rLCD1(%), adjusted ND values range between -0.84 and -0.11 HU mGy(-1). Our data provide guidance on dose reduction on the basis of patient dimensions and the required rLCD (e.g., to get a constant 7 mm rLCD(1%) for abdominal diameters of 10, 13, 16, 20 and 25 cm, tube current-time product should be adjusted in order to obtain CTDIvol(16) values of 6.2, 7.2, 8.8, 11.6 and 17.7 mGy, respectively).
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Affiliation(s)
- H J Brisse
- Imaging Department, Institut Curie, 26 rue d'Ulm 75005 Paris, France.
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Bidard F, Kirova Y, Vincent-Salomon A, Alran S, De Rycke Y, Sigal-Zafrani B, Sastre-Garau X, Mignot L, Fourquet A, Pierga J. Bone marrow disseminated tumor cells, loco-regional and adjuvant treatment are prognostic factors for loco-regional relapses in early breast cancers. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-307] [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: 11/16/2022]
Abstract
Abstract
Abstract #307
Purpose: To study in early breast cancer (BC) patients (pts) if bone marrow (BM) disseminated tumor cells (DTC) are associated with a specific loco-regional dissemination of cancer cells, according to the radiotherapy fields and to the pattern of loco-regional relapses.
 Patient and methods: BM aspirates were prospectively screened for cytokeratin positive (CK+) cells at primary treatment in stage I-III BC pts. Local recurrence (LR) was defined as recurrence of the breast or chest wall; Regional recurrence (RR) was defined as lymph node recurrence after loco-regional treatment. Irradiation fields, BM DTC status, clinical and pathological variables of the pts were correlated with loco-regional relapse-free survival (LRRFS).
 Results: BM DTC were detected in 94 out of 621 pts (15%) and were not associated with the axillary lymph node status and other prognostic factors. After a median follow-up of 56 months, 18 pts (2,9%) experienced loco-regional relapses: 15 LR occurred in the RT fields whereas 2 LR and 1 RR were out. 8 of the 18 relapsing pts (44%) were DTC positive (8 LR in the RT fields). BM DTC detection was the only prognostic factor for LRRFS (p=0.0005, OR=5.2 [2.0-13.1]) in multivariate analysis. In BM DTC positive patients, longer LRRFS were observed in those who were given adjuvant hormonal therapy (p=0.03) and RT on supra-clavicular (SCN) and internal mammary (IMN) nodes (p=0.055) (multivariate analysis).
 Conclusions: BM DTC strongly influence loco-regional relapse in early BC patients. Our data support the hypothesis of a different lymphatic spread of BM DTC positive BC and of a possible re-seeding of BM DTC to the breast. Survival analyses suggest that BM DTC positive patients take advantage of adjuvant hormone therapy but also of adjuvant SCN and IMN irradiation. This observation could be one explanation of the influence of systemic treatment on locoregional relapse and of radiotherapy on distant metastatic dissemination.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 307.
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Affiliation(s)
- F Bidard
- 1 Medical Oncology Department, Institut Curie, Paris, France
| | - Y Kirova
- 2 Radiotherapy Department, Institut Curie, Paris, France
| | | | - S Alran
- 4 Surgery Department, Institut Curie, Paris, France
| | - Y De Rycke
- 5 Biostatistics Department, Institut Curie, Paris, France
| | | | | | - L Mignot
- 1 Medical Oncology Department, Institut Curie, Paris, France
| | - A Fourquet
- 2 Radiotherapy Department, Institut Curie, Paris, France
| | - J Pierga
- 1 Medical Oncology Department, Institut Curie, Paris, France
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Charles C, Alran S, De Rycke Y, Malka I, Fourchotte V, Falcou M, Berry M, Benamor M, Kirova Y, Pierga J, Sastre X, Sigal-Zafrani B, Salmon RJ. Do isolated cells (pN0i+) in the sentinel lymph node change the post-operative management in breast cancer? Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-206] [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: 11/16/2022]
Abstract
Abstract
Abstract #206
Background: immunohistochemical (IHC) analysis of the sentinel lymph node (SLN) allows detection of occult metastases not routinely diagnosed by conventional techniques. There is, however, no consensus concerning the post-operative management of those patients with IHC-positive (pN0i+) nodes: should one re-operate, change the medical treatment or alter the irradiation fields?
 Patients and methods: 2692 patients with early invasive breast cancer underwent conservative treatment with SLN biopsy between 2000 and 2006. SLN were evaluated with frozen section followed by serial-section HES and IHC if HES showed no tumour cells. Lymph node staging followed the accepted pTNM classification: pN0, pN0i+ (≤ 0.2mm, IHC+), pNmi (0.2-2mm) and pN1a (> 2mm). In 1506 patients with T1pN0 tumours : 143 were pN0i+, that is 10%. We compared the post-operative management of pN0 patients, who had no completion axillary dissection (CAD), to those pN0i+ who did. All positive SLNs underwent CAD according to our institutional protocol.
 Results: 15 of 143 (10.5%) pN0i+ patients showed metastases in their CAD; a single node in 10 cases, 2-3 in 4 and > 3 in one patient. Univariate analysis showed chemo- and hormono-therapy to be more frequently administered in pN0i+ (24.5% vs. 77.6%) compared to pN0 (9.1% vs. 55.8%) patients; p < 0.0001. Irrespective of the result of CAD, pN0i+ patients had significant modifications in their fields of lymphatic irradiation at the internal mammary (43.6% vs. 23.5%), supra-clavicular (40.9% vs. 21.5%) and sub-clavicular (13.5% vs. 3.7%) areas; p < 0.0001. Other predictive factors showed a similar pattern including age < 50 years (31.5% vs. 18.6%), tumour size bigger (1.51cm vs. 1.16 cm) and lymphovascular invasion (27.5% vs. 11.6%); p < 0,0001. After multivariate analysis, the sole decisive factor for chemotherapy between the two groups was the presence of nodal metastasis in CAD. The duration of this study is, however, insufficient to comment on the long-term implications for pN0i+ patients.
 Discussion: immunohistochemistry alone plays a decisive role in favour of chemotherapy in N+ supplementary AD in only 10% of pN0i+ (15/143) patients. However, this concerns only 1% (15/1506) of those undergoing IHC so may have significant resource implications and other factors were found to be more influential. Moreover, pN0i+ patients underwent additional lymphatic irradiation, to all 3 fields, more frequently.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 206.
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Affiliation(s)
- C Charles
- 1 Surgery, Institut Curie, Paris, France
| | - S Alran
- 1 Surgery, Institut Curie, Paris, France
| | - Y De Rycke
- 2 Biostatistics, Institut Curie, Paris, France
| | - I Malka
- 1 Surgery, Institut Curie, Paris, France
| | | | - M Falcou
- 2 Biostatistics, Institut Curie, Paris, France
| | - M Berry
- 1 Surgery, Institut Curie, Paris, France
| | - M Benamor
- 3 Nuclear Medecine, Institut Curie, Paris, France
| | - Y Kirova
- 4 Radiotherapy, Institut Curie, Paris, France
| | - J Pierga
- 5 Medical Oncology, Institut Curie, Paris, France
| | - X Sastre
- 6 Pathology, Institut Curie, Paris, France
| | | | - RJ Salmon
- 1 Surgery, Institut Curie, Paris, France
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Garabige V, Giraud P, De Rycke Y, Girod A, Jouffroy T, Jaulerry C, Brunin F, Rodriguez J. Intérêt de la prise en charge nutritionnelle des patients traités par irradiation des voies aérodigestives supérieures: la consultation diététique est-elle utile? Cancer Radiother 2007; 11:111-6. [PMID: 17218137 DOI: 10.1016/j.canrad.2006.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Revised: 11/21/2006] [Accepted: 11/23/2006] [Indexed: 10/23/2022]
Abstract
AIMS The head and neck tumors are most often associated with a precarious nutritional status. Radiotherapy increases the risk of denutrition because of its secondary effects on the secretory and sensorial mucous membranes. The purpose of our retrospectively study was to evaluate the interest of a precocious and regular nutritional therapy on the ability to maintain the nutritional status of the patient during the radiotherapy. PATIENTS AND METHODS The fifty-two patients included in the survey have been classified retrospectively in two different groups based on their observance to the nutritional therapy: group 1 "good observance", group 2 "bad observance". RESULTS The 31 patients of group 1 have lost an average of 1.9 kg by the end of the irradiation, whereas the 21 patients of group 2 have lost an average of 6.1 kg (p<0.001). The almost stability in weight of patients in group 1 was linked to a lower frequency of breaks in the radiotherapy (6 vs 33% p=0.03) and in a decrease in grade of inflammatory mucous membranes (10% of grade 3 in group 1 vs 52% in group 2, p=0.006). The quantity of calories ingested in form of nutritional supplements was greater in group 1 and consequently enabled patients to stabilized their weight (1200 calories in group 1 versus 850 calories in group 2, p<0.005). CONCLUSIONS The given nutritional advice and the prescription of adapted nutritional supplements consequently allowed limiting efficiently the weight lost during the irradiation and the grade of mucositis. The systematization of a precocious nutritional therapy for patients irradiated for head and neck tumors seems absolutely essential.
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Affiliation(s)
- V Garabige
- Service de diététique, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
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Vincent-Salomon A, Sigal-Zafrani B, Caly M, Fréneaux P, Lae M, Merle S, Alran S, Nos C, De Rycke Y, Pierga J, Salmon R, Thiery J, Sastre-Garau X. Extension métastatique minime loco-régionale et ostéo-médullaire dans les cancers du sein : des événements précoces, dissociés l’un de l’autre, indépendants des facteurs histopronostiques classiques, mais associés au phénotype lobulaire. Ann Pathol 2006. [DOI: 10.1016/s0242-6498(06)70785-4] [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: 10/22/2022]
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Alran S, De Rycke Y, Fourchotte V, Charitansky H, Falcou M, Freneaux P, Benamor M, Sigal Zafrany B, Salmon R. 28 ORAL Validation and limitations of use of a Breast Cancer Nomogram predicting the likelihood of non-sentinel node involvement after positive sentinel node biopsy. Eur J Surg Oncol 2006. [DOI: 10.1016/s0748-7983(06)70463-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sigal-Zafrani B, Vincent-Salomon A, Laé M, Fréneaux P, Caly M, Valenty F, Birolini M, De Rycke Y, Alran S, Salmon R, Sastre-Garau X. Dispersion métastatique occulte ganglionnaire régionale : un facteur indépendant de la taille et du grade histo-pronostique des carcinomes mammaires mais dépendant du phénotype tumoral. Ann Pathol 2006. [DOI: 10.1016/s0242-6498(06)78418-8] [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: 10/22/2022]
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Thiery JP, Sastre-Garau X, Vincent-Salomon B, Sigal-Zafrani X, Pierga JY, Decraene C, Meyniel JP, Gravier E, Asselain B, De Rycke Y, Hupe P, Barillot E, Ajaz S, Faraldo M, Deugnier MA, Glukhova M, Medina D. Challenges in the stratification of breast tumors for tailored therapies. Bull Cancer 2006; 93:E81-9. [PMID: 16935776] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Studying the molecular stratification of breast carcinoma is a real challenge considering the extreme heterogeneity of these tumors. Many patients are now treated following recommendation established at several NIH and St Gallen consensus conferences. However a significant fraction of these breast cancer patients do not need adjuvant chemotherapies while other patients receive inefficacious therapies. High density gene expression arrays have been designed to attempt to establish expression profiles that could be used as prognostic indicators or as predictive markers for response to treatment. This review is intended to discuss the potential value of these new indicators, but also the current weaknesses of these new genomic and bioinformatic approaches. The combined analysis of transcriptomic and genomic alteration data from relatively large numbers of well annotated tumor specimens may offer an opportunity to overcome the current difficulties in validating recently published non overlapping gene lists as prognostic or therapeutic indicators. There is also hope for identifying and deciphering signal transduction pathways driving tumor progression with newly developed algorithms and semi quantitative parameters obtained in simplified in vitro or in vivo models for specific transduction pathways.
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MESH Headings
- Animals
- Antineoplastic Agents/therapeutic use
- Breast Neoplasms/classification
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/classification
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/classification
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Female
- Gene Expression Profiling
- Humans
- Mice
- Mice, Transgenic
- Models, Animal
- Mutation/genetics
- Neoplasm Metastasis
- Neoplasm Staging
- Neoplastic Stem Cells/pathology
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Affiliation(s)
- J-P Thiery
- Institut Curie, 26, rue d'Ulm, 75248 Paris Cedex 05.
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Kahan A, Mödder G, Menkes CJ, Verrier P, Devaux JY, Bonmartin A, De Rycke Y, Manil L, Chossat F, Tebib J. 169Erbium-citrate synoviorthesis after failure of local corticosteroid injections to treat rheumatoid arthritis-affected finger joints. Clin Exp Rheumatol 2004; 22:722-6. [PMID: 15638046] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVES Intra-articular injection of 169Erbium-citrate (169Er-citrate; radiosynoviorthesis or radiosynovectomy) is an effective local treatment of rheumatic joint diseases. However, its efficacy in corticosteroid-resistant rheumatoid arthritis-affected joints has not been clearly demonstrated. METHODS A double-blind, randomised, placebo-controlled, international multicentre study was conducted in patients with rheumatoid arthritis with recent (< or = 24 months) ineffective corticosteroid injection(s) into their finger joint(s). Eighty-five finger joints of 44 patients were randomised to receive a single injection of placebo (NaCl 0.9%) or 169Er-citrate. Results of evaluation 6 months later were available for 82 joints (46 metacarpophalangeal and 36 proximal interphalangeal joints) of 42 patients: 39 169Er-citrate-injected joints and 43 placebo-injected joints. Efficacy was assessed using a rating scale for joint pain, swelling and mobility. RESULTS Intent-to-treat analysis of the results of the 82 joints showed a significant effect of 169Er-citrate compared to placebo for the principal criteria decreased pain or swelling (95 vs 79%; p = 0.038) and decreased pain and swelling (79 vs 47%; p = 0.0024) and for the secondary criteria decreased pain (92 vs 72%; p = 0.017), decreased swelling (82 vs 53%; p = 0.0065) and increased mobility (64 vs 42%; p = 0.036). Per-protocol analysis, excluding 18 joints of patients who markedly changed their usual systemic treatment for arthritis, gave similar percentages of improvement but statistical significance was lower owing the reduced power of the statistical tests. CONCLUSION These results confirm the clinical efficacy of 169Er-citrate synoviorthesis of rheumatoid arthritis-diseased finger joints after recent failure of intra-articular corticotherapy.
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Affiliation(s)
- A Kahan
- Paris V University, Rheumatology A Department, Hôpital Cochin, AP-HP, Paris, France.
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Tebib JG, Manil LM, Mödder G, Verrier P, De Rycke Y, Bonmartin A, Devaux JY, Chossat F, Menkes CJ, Kahan A. Better results with rhenium-186 radiosynoviorthesis than with cortivazol in rheumatoid arthritis (RA): a two-year follow-up randomized controlled multicentre study. Clin Exp Rheumatol 2004; 22:609-16. [PMID: 15485015] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE The aim of this international multicentric randomized phase 3 clinical trial was to compare prospectively radiosynoviorthesis (RSO) with rhenium-186-sulfide (186Re) to intra-articular corticotherapy in patients with clinically controlled rheumatoid arthritis (RA), but in whom one or a few medium-sized joints remained painful or swollen. METHODS One hundred and twenty-nine joints in 81 RA patients [stratified into 2 groups: wrists (group 1, n = 78) and all the other joints (group 2, n = 51, including 18 elbows, 21 shoulders and 12 ankles)] were randomized to receive intra-articular injections of either 186Re-sulfide (64 +/- 4 MBq), or cortivazol (Altim) 3.75 mg. Clinical assessment was performed before and then at 3, 6, 12, 18 and 24 months after local therapy, using a 4-step verbal rating scale (VRS) and a 100 mm visual analog scale for pain, a 4-step VRS for joint swelling and mobility and a 2-step VRS for the radiological stage. The Mantel-Haenszel test was used for qualitative variables, analysis of variance (ANOVA) for quantitative pain analysis and Kaplan-Meyer survival test for relapse analysis. RESULTS 186Re was observed to be statistically superior to cortivazol at 18 and 24 months while no statistical difference was seen for any criterion at 3, 6 and 12 months post injection. At 24 months, the difference in favor of 186Re was significant for pain (p = 0.024), joint swelling (p = 0.01), mobility (p = 0.05, non-wrists only), pain and swelling (p = 0.03) and pain or swelling (p = 0.02). "Survival" studies (Kaplan-Meyer) demonstrated a greater relative risk of relapse in corticoid treated joints, but only from the second year of follow-up. No serious side effect was observed in any patient, with only light and transient local pain and/or swelling occurring in 24% of cases, regardless of the treatment used. CONCLUSION 186Re-sulfide and cortivazol had similar efficacy up to 12 months post-injection, but 186Re became clearly more effective at 18 and 24 months, for all criteria monitored and for RA outcome. Therefore, 186Re RSO can be recommended for routine clinical use.
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Affiliation(s)
- J G Tebib
- Department of Rheumatology, Centre Hospitalier Lyon-Sud, France
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Broët P, Tubert-Bitter P, De Rycke Y, Moreau T. A score test for establishing non-inferiority with respect to short-term survival in two-sample comparisons with identical proportions of long-term survivors. Stat Med 2003; 22:931-40. [PMID: 12627410 DOI: 10.1002/sim.1453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 11/06/2022]
Abstract
In recent years randomized trials designed to establish non-inferiority of a new treatment as compared to a standard one have been more widely used. Two-sample statistics have been proposed for this equivalence testing problem. However, they are not suited to situations where a long-term survivor fraction is expected. In this paper we propose a score test designed for establishing non-inferiority for the new treatment as compared to the standard one while assuming identical long-term survivor rates. Simulations results show that the proposed statistic has satisfactory size and power as long as certain restricting conditions are verified. A breast cancer trial is analysed as an example.
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Affiliation(s)
- P Broët
- Faculté de Médecine Paris-Sud and INSERM U472, 16 Avenue P. Vaillant-Couturier, 94807 Villejuif, France
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Giraud P, De Rycke Y, Minet P, Danhier S, Dubray B, Helfre S, Dauphinot C, Rosenwald JC, Cosset JM. [Estimation of the probability of mediastinal involvement: a statistical definition of the clinical target volume for 3-dimensional conformal radiotherapy in non-small-cell lung cancer?]. Cancer Radiother 2001; 5:725-36. [PMID: 11797293 DOI: 10.1016/s1278-3218(01)00135-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [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: 11/30/2022]
Abstract
PURPOSE Conformal irradiation of non-small cell lung carcinoma (NSCLC) is largely based on a precise definition of the nodal clinical target volume (CTVn). The reduction of the number of nodal stations to be irradiated would render tumor dose escalation more achievable. The aim of this work was to design an mathematical tool based on documented data, that would predict the risk of metastatic involvement for each nodal station. METHODS AND MATERIAL From the large surgical series published in the literature we looked at the main pre-treatment parameters that modify the risk of nodal invasion. The probability of involvement for the 17 nodal stations described by the American Thoracic Society (ATS) was computed from all these publications and then weighted according to the French epidemiological data. Starting from the primitive location of the tumour as the main characteristic, we built a probabilistic tree for each nodal station representing the risk distribution as a function of each tumor feature. From the statistical point of view, we used the inversion of probability trees method described by Weinstein and Feinberg. RESULTS Taking into account all the different parameters of the pre-treatment staging relative to each level of the ATS map brings up to 20,000 different combinations. The first chosen parameters in the tree were, depending on the tumour location, the histological classification, the metastatic stage, the nodal stage weighted in function of the sensitivity and specificity of the diagnostic examination used (PET scan, CAT scan) and the tumoral stage. A software is proposed to compute a predicted probability of involvement of each nodal station for any given clinical presentation. CONCLUSION To better define the CTVn in NSCLC 3DRT, we propose a software that evaluates the mediastinal nodal involvement risk from easily accessible individual pre-treatment parameters.
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Affiliation(s)
- P Giraud
- Département d'oncologie-radiothérapie, institut Curie, 26, rue d'Ulm, 75231 Paris, France.
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Giraud P, De Rycke Y, Dubray B, Helfre S, Voican D, Guo L, Rosenwald JC, Keraudy K, Housset M, Touboul E, Cosset JM. Conformal radiotherapy (CRT) planning for lung cancer: analysis of intrathoracic organ motion during extreme phases of breathing. Int J Radiat Oncol Biol Phys 2001; 51:1081-92. [PMID: 11704333 DOI: 10.1016/s0360-3016(01)01766-7] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.8] [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: 10/18/2022]
Abstract
PURPOSE Conformal radiotherapy beams are defined on the basis of static computed tomography acquisitions by taking into account setup errors and organ/tumor motion during breathing. In the absence of precise data, the size of the margins is estimated arbitrarily. The objective of this study was to evaluate the amplitude of maximum intrathoracic organ motion during breathing. METHODS AND MATERIALS Twenty patients treated for non-small-cell lung cancer were included in the study: 10 patients at the Institut Curie with a personalized alpha cradle immobilization and 10 patients at Tenon Hospital with just the Posirest device below their arms. Three computed tomography acquisitions were performed in the treatment position: the first during free breathing and the other two during deep breath-hold inspiration and expiration. For each acquisition, the displacements of the various intrathoracic structures were measured in three dimensions. RESULTS Patients from the two centers were comparable in terms of age, weight, height, tumor site, and stage. In the overall population, the greatest displacements were observed for the diaphragm, and the smallest displacements were observed for the lung apices and carina. The relative amplitude of motion was comparable between the two centers. The use of a personalized immobilization device reduced lateral thoracic movements (p < 0.02) and lung apex movements (p < 0.02). CONCLUSION Intrathoracic organ movements during extreme phases of breathing are considerable. Quantification of organ motion is necessary for definition of the safety margins. A personalized immobilization device appears to effectively reduce apical and lateral displacement.
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Affiliation(s)
- P Giraud
- Department of Radiation Oncology, Institut Curie, Paris, France.
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Broët P, De Rycke Y, Tubert-Bitter P, Lellouch J, Asselain B, Moreau T. A semiparametric approach for the two-sample comparison of survival times with long-term survivors. Biometrics 2001; 57:844-52. [PMID: 11550936 DOI: 10.1111/j.0006-341x.2001.00844.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [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: 12/01/2022]
Abstract
In the two-sample comparison of survival times with long-term survivors, the overall difference between the two distributions reflects differences occurring in early follow-up for susceptible subjects and in long-term follow-up for nonsusceptible subjects. In this setting, we propose statistics for testing (i) no overall, (ii) no short-term, and (iii) no long-term difference between the two distributions to be compared. The statistics are derived as follows. A semiparametric model is defined that characterizes a short-term effect and a long-term effect. By approximating this model about no difference in early survival, a time-dependent proportional hazards model is obtained. The statistics are obtained from this working model. The asymptotic distributions of the statistics for testing no overall or no short-term effects are ascertained, while that of the statistic for testing no long-term effect is valid only when the short-term effect is small. Simulation studies investigate the power properties of the proposed tests for different configurations. The results show the interesting behavior of the proposed tests for situations where a short-term effect is expected. An example investigating the impact of progesterone receptors status on local tumor relapse for patients with early breast cancer illustrates the use of the proposed tests.
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Affiliation(s)
- P Broët
- National Institute for Health and Medical Research and Department of Public Health, Hopital Paul Brousse, Villejuif , France.
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Zafrani B, Aubriot MH, Mouret E, De Crémoux P, De Rycke Y, Nicolas A, Boudou E, Vincent-Salomon A, Magdelénat H, Sastre-Garau X. High sensitivity and specificity of immunohistochemistry for the detection of hormone receptors in breast carcinoma: comparison with biochemical determination in a prospective study of 793 cases. Histopathology 2000; 37:536-45. [PMID: 11122436 DOI: 10.1046/j.1365-2559.2000.01006.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.5] [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: 11/20/2022]
Abstract
AIMS The hormone receptor (HR) status of breast cancer is an important prognostic factor and predictive parameter of the response to hormone therapy. Enzyme immunoassay (EIA) is currently the standard for determination of HR, but immunohistochemistry (IHC) represents a potentially useful alternative. We used IHC to determine HR status in a large prospective study and compared the results to those obtained by EIA. This study was designed to determine which technique should be used in daily practice in our institution which manages a large number of patients. METHODS AND RESULTS Oestrogen (ER) and progesterone (PgR) receptor status was evaluated in a prospective series of 793 infiltrating breast cancers by IHC in paraffin-embedded tissue sections, using antibodies 6F11 and 1A6, with a rigorous quality control of the methodology. ER were found to be significantly expressed in 81% of cases after IHC analysis and in 78% of cases by EIA. For PgR, the respective rates of positivity were 65% and 69%. The tumour HR level detected by either technique was significantly correlated with the value of tumour size, histological grade and S-phase fraction. A significant link was observed between the percentage of labelled cells after IHC analysis and the amount of protein detected by EIA. Critical analysis of discordance found that, in the group of invasive lobular carcinomas, the rate of HR positivity was higher with IHC (84%) than with EIA (45%) and that, in the overall population, IHC was more specific than EIA, since cases with nonrelevant positivity related to intraductal normal or neoplastic cells expressing HR could be discarded. The cost of IHC analysis was found to be about one-third of that of EIA. CONCLUSIONS IHC is more sensitive, specific and economical than EIA. It should constitute the new standard technique provided that good quality assurance procedures are respected.
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MESH Headings
- Antibodies, Monoclonal
- Breast Neoplasms/chemistry
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/chemistry
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Lobular/chemistry
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/secondary
- Female
- Humans
- Immunoenzyme Techniques
- Lymph Nodes/chemistry
- Lymph Nodes/pathology
- Lymphatic Metastasis
- Prospective Studies
- Receptors, Estrogen/analysis
- Receptors, Progesterone/analysis
- Sensitivity and Specificity
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Affiliation(s)
- B Zafrani
- Departments of Pathology, Institut Curie, Paris, France.
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Giraud P, Antoine M, Larrouy A, Milleron B, Callard P, De Rycke Y, Carette MF, Rosenwald JC, Cosset JM, Housset M, Touboul E. Evaluation of microscopic tumor extension in non-small-cell lung cancer for three-dimensional conformal radiotherapy planning. Int J Radiat Oncol Biol Phys 2000; 48:1015-24. [PMID: 11072158 DOI: 10.1016/s0360-3016(00)00750-1] [Citation(s) in RCA: 354] [Impact Index Per Article: 14.8] [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: 12/19/2022]
Abstract
PURPOSE One of the most difficult steps of the three-dimensional conformal radiotherapy (3DCRT) is to define the clinical target volume (CTV) according to the degree of local microscopic extension (ME). In this study, we tried to quantify this ME in non-small-cell lung cancer (NSCLC). MATERIAL AND METHODS Seventy NSCLC surgical resection specimens for which the border between tumor and adjacent lung parenchyma were examined on routine sections. This border was identified with the naked eye, outlined with a marker pen, and the value of the local ME outside of this border was measured with an eyepiece micrometer. The pattern of histologic spread was also determined. RESULTS A total of 354 slides were examined, corresponding to 176 slides for adenocarcinoma (ADC) and 178 slides for squamous cell carcinoma (SCC). The mean value of ME was 2.69 mm for ADC and 1.48 mm for SCC (p = 0.01). The usual 5-mm margin covers 80% of the ME for ADC and 91% for SCC. To take into account 95% of the ME, a margin of 8 mm and 6 mm must be chosen for ADC and SCC, respectively. Aerogenous dissemination was the most frequent pattern observed for all groups, followed by lymphatic invasion for ADC and interstitial extension for SCC. CONCLUSION The ME was different between ADC and SCC. The usual CTV margin of 5 mm appears inadequate to cover the ME for either group, and it must be increased to 8 mm and 6 mm for ADC and SCC, respectively, to cover 95% of the ME. This approach is obviously integrated into the overall 3DCRT procedure and with other margins.
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Affiliation(s)
- P Giraud
- Department of Radiation Oncology, Hôpital Tenon, Paris, France.
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