Unbiased estimates of long-term net survival of solid cancers in France

Overall and net survival of patients with sarcoma between 2005 and 2010: Results from the French Network of Cancer Registries (FRANCIM)

BACKGROUND

Sarcomas are rare, heterogeneous, ubiquitously localized malignancies with many histologic subtypes and genomic patterns. The survival of patients with sarcoma has rarely been described based on this heterogeneity; therefore, the authors' objective was to estimate survival outcomes in patients who had sarcomas using the 2020 version of the World Health Organization classification of soft tissue and bone tumors.

METHODS

Patients older than 15 years who had incident sarcoma diagnosed between 2005 and 2010 were extracted from 14 French population-based cancer registries covering 18% of the French metropolitan population. Vital status for each patient was actively followed up to June 30, 2013. Net survival (NS) was estimated using the unbiased Pohar-Perme method.

RESULTS

Overall, 4202 patients were included. NS declined with increasing age at diagnosis. According to topographic groups, large 5-year NS disparities were observed, ranging from 47% among women with gynecologic sarcomas to 89% among patients with skin sarcomas. Patients with soft tissue, bone, and gastrointestinal sarcomas had 5-year NS rates of 53%, 61%, and 70%, respectively. Similar heterogeneity was observed according to histologic subtypes, with 5-year NS ranging from 19% for patients with angiosarcomas to 96% for patients with dermatofibrosarcomas. Patients with sarcoma who displayed missense mutations had a better 5-year NS (74%); those with MDM2-amplified sarcomas had the worst NS (45%).

CONCLUSIONS

NS rates in patients with sarcoma are presented here for the first time based on the 2020 World Health Organization classification applied to population-based registry data. Large prognostic heterogeneity was observed based on age, topographic and histologic groups, and genomic alteration profiles, constituting a benchmark for future studies and clinical trials.

Value of Adding Dexmedetomidine in Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis for Treatment of Pancreatic Cancer-Associated Pain

BACKGROUND

Abdominal and back pain is present in up to 80% of patients with pancreatic cancer and represents a significant cause of morbidity. Celiac plexus neurolysis (CPN) demonstrated good results in relief of pain of upper abdominal malignancy. Dexmedetomidine is alpha-2 adrenoceptor highly selective agonist approved for procedural sedation use.

PATIENTS AND METHODS

Fifty patients divided in two groups with locally advanced pancreatic cancer-associated abdominal pain underwent endoscopic ultrasound (EUS)-guided CPN using bupivacaine 0.5% alone with alcohol for the first group and bupivacaine 0.5% plus dexmedetomidine in the second. Patients scored their pain according to the Numeric Rating Scale (NRS-11) before, 2, 4, 6, 8, 12, 16, and 24 week after the procedure.

RESULTS

The study has included 50 patient in two groups. There was no significant difference between the two groups as regards medical, laboratory, or tumor characters. The median pain score decreases from 8.32 ± 0.75 before the procedure to 3.75 ± 3.72 24 week after the procedure in group 1 and from 8.08 ± 0.86 before to 1.67 ± 2.3 24 week after the procedure in group 2. However, there was no significant difference between the two groups in the median pain score during the first 4 weeks. There was no statistically significant difference between the two groups as regards the median survival time.

CONCLUSION

The addition of dexmedetomidine to bupivacaine 0.5% in EUS-CPN demonstrated beneficial effects as regards the degree and duration of pain relieve with negligible effect on the patient survival.

Net survival in recurrence-free colon cancer patients

PURPOSE

Conditional net survival in recurrence-free patients (CNS-RF) provides relevant clinical information and has never been assessed yet in a non-selected colon cancer population. We aimed to estimate conditional 5-year net survival in recurrence-free patients with colon cancer in the population-based Digestive Cancer Registry of Burgundy (France).

METHODS

CNS-RF was estimated in the 3736 patients resected for cure for primary colon cancer between 1976 and 2006, using a flexible parametric model of net survival for every additional year survived at diagnosis and from 1 to 5 years thereafter.

RESULTS

The net probability of surviving 5 more years increased from 72% at diagnosis to 92% for recurrence-free patients who survived 5 years after diagnosis. CNS-RF was over 90% 3 years after diagnosis in patients aged 75 and below. CNS-RF was over 95% in patients diagnosed after 2000 who were recurrence-free 3, 4 or 5 years after diagnosis. CNS-RF was similar between patients with stage I and II disease from 2 years after diagnosis and patients with stage III disease from 5 years after diagnosis. The initial differences in net survival related to gross features, clinical presentation, number of harvested nodes in stage II, and number of involved nodes in stage III disappeared after 2 years.

CONCLUSIONS

CNS-RF is a relevant measure of prognosis in patients who have already achieved a period of remission. Providing an updated estimation of prognosis in the years following diagnosis may improve the survivors' quality of life and access to credit or insurance.

Survival of solid cancer patients in France, 1989-2013: a population-based study

This study provides updates of net survival (NS) estimates at 5, 10, and 15 years as well as survival trends for 35 solid cancers in France using data from 19 population-based cancer registries. The study considered all cases of solid cancer diagnosed between 1989 and 2010 in patients older than 15 years of age who were actively followed up until 30 June 2013. NS was estimated using the Pohar-Perme method. The age-standardized NS used the international cancer survival standard weights. The 5-year age-standardized NSs ranged from 4% (pleural mesothelioma) to 93% (prostate) in men and from 10% (pancreas) to 97% (thyroid) in women. The 10-year age-standardized NSs ranged from 2% (pleural mesothelioma) in both sexes to 95% (testis) in men and 91% (thyroid) in women. The most frequent cancers (namely, breast and prostate cancers) had the highest NSs: 87 and 93% at 5 years and 78 and 84% at 10 years, respectively. Several cancers (especially lung, pancreas, and liver cancer) had very poor prognoses (5-year NSs under 20%). Fifteen-year NSs remained high for testis cancer. In most cancers, 5- and 10-year age-standardized NSs increased between 1989 and 2010. Advanced age was associated with a poor prognosis and little improvement in survival. The increases in cancer survival are probably related to earlier diagnosis and therapeutic advances over the last decade. However, poor prognoses are still found in some alcohol-related and tobacco-related cancers and in elderly patients, highlighting the need for more prevention, diagnosis, and treatment efforts.

Survival from cancer in the north region of Portugal: results from the first decade of the millennium

The aim of this study was to evaluate net survival from cancer diagnosed during the period 2001-2010 in the north region of Portugal to identify the tumours that need actions to improve the outcomes. Data were retrieved from the North Region Cancer Registry of Portugal database. The top 20 cancer sites in adults were considered: oesophagus, stomach, colon, rectum, pancreas, liver, larynx, lung, skin melanoma, breast, cervix, corpus uteri, ovary, prostate, kidney, bladder, brain and central nervous system, thyroid, non-Hodgkin lymphoma and multiple myeloma. Net survival was estimated using the Pohar-Perme estimator. The effect of diagnosis period was evaluated using flexible parametric models adjusted for age and sex where appropriate. Thyroid and prostate cancers presented the best 5-year survival (>90%), whereas oesophagus, pancreas, liver and lung cancers the worst 5-year survival (<20%). The largest increase in survival was observed for the larynx. A significant decrease in age-adjusted and sex-adjusted excess mortality was observed for stomach, colon, pancreas, larynx, melanoma, breast, brain and central nervous system, thyroid, non-Hodgkin lymphoma and multiple myeloma. For the other cancer sites, no significant trends were observed. For some of these sites, the downward trend in excess mortality was only observed in the short term. An important picture of population-based cancer survival outcomes for the first decade of the millennium in the north region of Portugal was presented in this study. It has been shown that improvements in survival were not universal for all cancer sites. These results should be used to highlight tumours where intervention is needed the most.

Challenges in the estimation of Net SURvival: The CENSUR working survival group

BACKGROUND

Net survival, the survival probability that would be observed, in a hypothetical world, where the cancer of interest would be the only possible cause of death, is a key indicator in population-based cancer studies. Accounting for mortality due to other causes, it allows cross-country comparisons or trends analysis and provides a useful indicator for public health decision-making. The objective of this study was to show how the creation and formalization of a network comprising established research teams, which already had substantial and complementary experience in both cancer survival analysis and methodological development, make it possible to meet challenges and thus provide more adequate tools, to improve the quality and the comparability of cancer survival data, and to promote methodological transfers in areas of emerging interest.

METHOD

The Challenges in the Estimation of Net SURvival (CENSUR) working survival group is composed of international researchers highly skilled in biostatistics, methodology, and epidemiology, from different research organizations in France, the United Kingdom, Italy, Slovenia, and Canada, and involved in French (FRANCIM) and European (EUROCARE) cancer registry networks.

RESULTS

The expected advantages are an interdisciplinary, international, synergistic network capable of addressing problems in public health, for decision-makers at different levels; tools for those in charge of net survival analyses; a common methodology that makes unbiased cross-national comparisons of cancer survival feasible; transfer of methods for net survival estimations to other specific applications (clinical research, occupational epidemiology); and dissemination of results during an international training course.

CONCLUSION

The formalization of the international CENSUR working survival group was motivated by a need felt by scientists conducting population-based cancer research to discuss, develop, and monitor implementation of a common methodology to analyze net survival in order to provide useful information for cancer control and cancer policy. A "team science" approach is necessary to address new challenges concerning the estimation of net survival.

Are disparities of waiting times for breast cancer care related to socio-economic factors? A regional population-based study (France)

The increasing number of breast cancer cases may induce longer waiting times (WT), which can be a source of anxiety for patients and may play a role in survival. The aim of this study was to examine the factors, in particular socio-economic factors, related to treatment delays. Using French Cancer Registry databases and self-administered questionnaires, we included 1,152 women with invasive non-metastatic breast cancer diagnosed in 2007. Poisson regression analysis was used to identify WTs' influencing factors. For 973 women who had a malignant tissue sampling, the median of overall WT between the first imaging procedure and the first treatment was 44 days (9 days for pathological diagnostic WT and 31 days for treatment WT). The medical factors mostly explained inequalities in WTs. Socio-economic and behavioral factors had a limited impact on WTs except for social support which appeared to be a key point. Better identifying the factors associated with increase in WTs will make it possible to develop further interventional or prospective studies to confirm their causal role in delay and at last reduce disparities in breast cancer management.

Long-term quality of life among localised prostate cancer survivors: QALIPRO population-based study

BACKGROUND

To evaluate quality of life (QoL) 10 years after treatments for localised prostate cancer (LPCa) patients in comparison with aged-matched healthy controls.

METHODS

LPCa patients diagnosed in 2001 were obtained from 11 French cancer registries. Controls were recruited among the general population and were matched to patients on age and geographic area. EORTC Quality of Life Questionnaire - Core 30 items, Expanded Prostate Cancer Index Composite, Hospital Anxiety and Depression Scale and Multidimensional Fatigue Inventory self-reported questionnaires were used to measure QoL, anxiety and fatigue. Patients were classified in three groups according to previous treatments: radical prostatectomy (RP), radiotherapy (RT) and radical prostatectomy and radiotherapy (RP+RT). The differences in QoL between patients and controls and according to treatment groups were evaluated.

RESULTS

There were 287 patients and 287 controls. There was no socio-demographic difference between patients and controls. Treatments were: RP (143), RT (78), PR+RT (33), baseline hormone therapy (49) and hormone therapy at the time of the study (34). Patients had similar levels of global QoL, anxiety, depression and fatigue as controls. They reported more urinary troubles (urinary function and incontinence) (p < 0.0001) and more sexual dysfunctions (p < 0.0001) than controls, whatever the treatment group. Worse bowel dysfunction was reported in patients treated by RT and RP+RT (p < 0.002). According to the treatments, RP groups had the worst urinary function and incontinence (p < 0.01), and reported more bowel bother when the treatment was combined with RT.

CONCLUSIONS

Even though patients reported similar global QoL as control 10 years after treatment, patients reported numerous urinary and sexual dysfunctions. Patients treated with RP+RT reported cumulative sequelae of both treatments.

Impact on Life Expectancy of Withdrawing Thiopurines in Patients with Crohn's Disease in Sustained Clinical Remission: A Lifetime Risk-Benefit Analysis

Objective

Long-term treatment with thiopurines is associated with a decreased risk of Crohn’s disease (CD) flare but an increased risk of various cancers depending on gender, age, and presence of extensive colitis. We evaluated risks and benefits of withdrawing thiopurines in patients with CD in prolonged remission.

Methods

We developed a Markov model assessing risks and benefits of withdrawing thiopurines compared to continuing thiopurines in a lifetime horizon. The model was stratified by age (35 and 65 years old at thiopurine withdrawal), gender and presence of extensive colitis. Parameter estimates were taken from French cohorts and hospital databases, cancer and death national registries and published literature. Life expectancy, rates of relapse, serious adverse events, and causes-of-death were evaluated.

Results

In patients without extensive colitis, continuing thiopurines increased life expectancy up to 0.03 years for 35 year-old men and women but decreased life expectancy down to 0.07 years for 65 year-old men and women. Withdrawal strategy became the preferred strategy at 40.6 years for men, and 45.7 years for women without extensive colitis. In patients with extensive colitis, continuation strategy was the preferred strategy regardless of age. Risk-benefit analysis was not modified by duration of CD activity.

Conclusions

Factors determining life expectancy associated with withdrawal or continuation of thiopurines in patients with CD and in sustained clinical remission vary substantially according to gender, age and presence of extensive colitis. Individual decisions to continue or withdraw thiopurines in patients with CD in sustained remission should take into account these parameters.

Predictive Factors of the Survival of Women With Invasive Breast Cancer in French Guiana: The Burden of Health Inequalities

BACKGROUND

The prognosis of patients with breast cancer in French Guiana is worse than in France, with 23 deaths per 100 incident cases versus 17 per 100 in metropolitan France. This study aimed to compare the relative survival of patients with invasive breast cancer (IBC) between women from French Guiana and metropolitan France and to determine risk factors influencing breast cancer survival in French Guiana.

MATERIALS AND METHODS

Data were collected from the Cancer Registry of French Guiana. We compared the relative survival of women with IBC between French Guiana and metropolitan France. We used the Cox proportional hazard regression to evaluate the effect of prognostic factors on cancer-specific mortality in French Guiana.

RESULTS

We included all 269 cases of IBC in women diagnosed in French Guiana between 2003 and 2009. The overall 5-year relative survival rate of patients with IBC was 79% in French Guiana and 86% in metropolitan France. The place of birth (foreign country vs. French territory), the tumor stage at the time of diagnosis, the mode of diagnosis (symptoms vs. screening), the presence of hormone receptors in the tumor, and the histologic type were the variables associated with survival differences. None of the other study variables were significantly associated with prognosis.

CONCLUSION

Access to care for migrants is challenging, which leads to health inequalities. Early detection through prevention programs is crucial to increase IBC survival, notably for foreign-born patients.

[Thyroid cancers: from epidemiology to molecular biology]

Experts increasingly recognize the hypothesis of "over-diagnosis" as the main factor of the raising incidence of thyroid cancers (TC). The detection of multiple microtumors, mainly of a papillary type, at a sub-clinical stage, with the use of sensitive detection methods supports this hypothesis. However, the intensive management and monitoring of these cancers failed to reduce mortality. Environmental and other risk factors cannot provide a sufficient explanation, as previously thought. In this context, the use of improved tools is needed, and the most promising perspective lies in molecular biology applied to thyroid cancer for diagnosis, evaluation of prognosis and treatment. The next generation sequencing (NGS) has demonstrated its diagnostic performances in recent clinical trials. Its interest in cases with indeterminate cytology is demonstrated and should help better targeting surgical indications. Its promising prognostic and therapeutic applications must be confirmed by additional studies. The integration of NGS in current practice should have a real medical, economic and scientific impact. Indeed, the exponential increase in our knowledge of molecular mechanisms of thyroid tumorigenesis strengthens the will to "reclassify" these cancers into molecular rather than histological subtypes, in order to offer patients more specific and targeted treatment.

Therapeutic role of endoscopic ultrasound in pancreaticobiliary disease: A comprehensive review

With the development of technology and accessories, the role of endoscopic ultrasound (EUS) has evolved from diagnostics to therapeutics. In order to characterise the therapeutic role of EUS, we searched Web of Knowledge database and reviewed articles associated with therapeutic EUS. There are two modalities for the therapeutic purpose: drainage and fine-needle injection. EUS-guided drainage is a promising procedure for the treatment of peripancreatic fluid collection and biliary obstruction; EUS-guided fine-needle injections such as celiac plexus neurolysis, for the purpose of pain relief for pancreatic cancer and chronic pancreatitis, has emerged as a promising procedure. The aim of the study was to perform a comprehensive and conscientious review on the techniques, complications and clinical outcomes of those EUS-based procedures.

A multimodal, one-session endoscopic approach for management of patients with advanced pancreatic cancer

BACKGROUND

A number of patients with inoperable pancreatic cancer may concurrently complain of pain, biliary obstruction, and duodenal stenosis. Endoscopic palliative treatments and opioid therapy are generally performed in these patients. The study aimed to assess the efficacy and safety of a multimodal 'one-Session Three Endoscopic Procedures' (one-STEP) to simultaneously treat cholestasis, restore duodenal transit, and achieve pain relief in selected patients with advanced pancreatic cancer.

METHODS

Selected patients diagnosed with an advanced pancreatic cancer presenting with biliary obstruction, duodenal stenosis, and severe pain treated with the one-STEP were considered. The one-STEP endoscopic approach included biliary and duodenal stenting, and EUS-guided celiac plexus neurolysis. The technical success rate, complications, pain relief, and opioid use at follow-up were assessed.

RESULTS

A total of 15 patients were treated. The one-STEP was successful in 13 (87 %) cases, while it failed in two patients due to the impossibility of dilating the neoplastic mass for creating a fistula. No endoscopy-related complications occurred. The median of pain intensity was 8 (range 7-10) at entry and significantly decreased to 2 (range 2-4) 72 h following celiac plexus neurolysis. At follow-up (median survival 4 months; range 3-8), only 3 (20 %) needed of narcotic treatment in the last period.

CONCLUSIONS

The multimodal one-STEP is an effective and safe endoscopic approach for palliative treatment of biliary and duodenal stenosis, and for relieving chronic pain in patients with advanced pancreatic cancer.

Conditional net survival: Relevant prognostic information for colorectal cancer survivors. A French population-based study

BACKGROUND

Traditionally, survival estimates have been reported as survival from the time of diagnosis. A patient's probability of survival changes according to time elapsed since the diagnosis and this is known as conditional survival. The aim was to estimate 5-year net conditional survival in patients with colorectal cancer in a well-defined French population at yearly intervals up to 5 years.

METHODS

Our study included 18,300 colorectal cancers diagnosed between 1976 and 2008 and registered in the population-based digestive cancer registry of Burgundy (France). We calculated conditional 5-year net survival, using the Pohar Perme estimator, for every additional year survived after diagnosis from 1 to 5 years.

RESULTS

The initial 5-year net survival estimates varied between 89% for stage I and 9% for advanced stage cancer. The corresponding 5-year net survival for patients alive after 5 years was 95% and 75%. Stage II and III patients who survived 5 years had a similar probability of surviving 5 more years, respectively 87% and 84%. For survivors after the first year following diagnosis, five-year conditional net survival was similar regardless of age class and period of diagnosis.

CONCLUSIONS

For colorectal cancer survivors, conditional net survival provides relevant and complementary prognostic information for patients and clinicians.

Total and partial cancer prevalence in the adult French population in 2008

BACKGROUND

To provide estimations of partial and total prevalence of 24 cancer sites in France in 2008. The estimations of partial prevalence were compared with the previous estimations for 2002.

METHODS

Nationwide estimations of incidence and survival data from cancer registries were used for partial prevalence. Nationwide incidence and mortality data were used to estimate total prevalence.

RESULTS

At the end of 2008, in France, nearly 3 million people still alive had received a diagnosis of cancer. Of all prevalent cases, 36% were diagnosed 0 to 5 years earlier and 43% diagnosed 6 to 10 years earlier. The cancer sites with the highest prevalence were the prostate, the breast, and the colon-rectum. The changes in partial prevalence over 5 years (2002 to 2008) were considerable (+244,000 cases) and deemed to be highly related to changes in incidence.

CONCLUSION

The present estimations update the French prevalence data and highlight the burden of cancer in the population, especially in the elderly. The methods of this study had the advantage of using recent incidence and survival data, which is necessary to show sudden changes in incidence trends and changes in survival that impact prevalence.

Net survival after exposure to polychlorinated biphenyls and dioxins: the Yusho study

BACKGROUND

Net survival is an important measure of the overall outcome of disease management. This net survival is the most appropriate for international comparisons of disease impact between countries or time periods with different patterns of all-cause mortality because it is not influenced by other causes of death. However, little information is available on net survival among Yusho patients, who were accidentally exposed to PCBs and other dioxin-related compounds.

METHODS

We estimated the net survival of 1664 Yusho patients (860 males, 804 females) as Yusho cohort subjects using the unbiased Pohar-Perme method.

RESULTS

Among males, 1-, 5-, 10-, and 15-year net survival were 99.5% (95% confidence interval (CI): 97.9, 99.9), 99.1% (CI: 95.0, 99.9), 97.4% (CI: 86.5, 99.5), and 97.4% (CI: 84.2, 99.6), respectively. Among females, net survival remained almost constant. 1-, 5-, 10-, and 15-year net survival were generally higher in females than in males.

CONCLUSIONS

This study provides the first unbiased estimations of net survival among Yusho patients. We confirmed that older male Yusho patients have experienced a significant decrease in net survival. Our results suggest that the excess hazard of PCBs and dioxins must be taken into account when evaluating unbiased estimates of net survival.

Celiac plexus neurolysis in pancreatic cancer: the endoscopic ultrasound approach

Pain in pancreatic cancer is often a major problem of treatment. Administration of opioids is frequently limited by side effects or insufficient analgesia. Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) represents an alternative for the palliative treatment of visceral pain in patients with pancreatic cancer. This review focuses on the indications, technique, outcomes of EUS-CPN and predictors of pain relief. EUS-CPN should be considered as the adjunct method to standard pain management. It moderately reduces pain in pancreatic cancer, without eliminating it. Nearly all patients need to continue opioid use, often at a constant dose. The effect on quality of life is controversial and survival is not influenced. The approach could be done in the central position of the celiac axis, which is easy to perform, or in the bilateral position of the celiac axis, with similar results in terms of pain alleviation. The EUS-CPN with multiple intraganglia injection approach seems to have better results, although extended studies are still needed. Further trials are required to enable more confident conclusions regarding timing, quantity of alcohol injected and the method of choice. Severe complications have rarely been reported, and great care should be taken in choosing the site of alcohol injection.

Long-term net survival in patients with colorectal cancer in France: an informative contribution of recent methodology

BACKGROUND

Net survival, the survival that might occur if cancer was the only cause of death, is a major epidemiological indicator. Recent findings have shown that the classical methods used for the estimation of net survival from cancer registry data, referred as to "relative-survival methods," provided biased estimates.

OBJECTIVES

The aim of this study was to provide, for the first time, long-term net survival rates for colorectal cancer by using a population-based digestive cancer registry.

DESIGN

This study is a population-based cancer registry analysis. The recently proposed unbiased nonparametric Pohar-Perme estimator was used.

PATIENTS

Overall, 14,715 colorectal cancers diagnosed between 1976 and 2005 and registered in the population-based digestive cancer registry of Burgundy (France) were included.

MAIN OUTCOME MEASURES

The primary outcome measured was cancer net survival, ie, the survival that might occur if all risks of dying of other causes than cancer were removed

RESULTS

: Ten-year net survival increased from 31% during the 1976 to 1985 period to 47% during the 1986 to 1995 period and then leveled out (48% during the 1996-2005 period). There was a major improvement in 10-year net survival after resection for cure and for stage I to III. It was striking for stage III cancers, for which 10-year net survival increased from 21% (1976-1985) to 49% (1996-2005). The corresponding net survivals were 70% and 87% for stage I and 49% and 65% for stage II. These trends can be related to the decrease in operative mortality, the increase in the proportion of patients resected for cure, and the improvement in stage at diagnosis. They were mainly seen between 1976 and 1995, explaining why survival leveled out after 1995.

LIMITATIONS

The study was limited by its retrospective and population-based nature.

CONCLUSIONS

Further improvements for colorectal cancer management can be expected from more effective treatments and from the implementation of organized cancer screening.

Emergency IVF for embryo freezing to preserve female fertility: a French multicentre cohort study

STUDY QUESTION

What are the outcomes of French emergency IVF procedures involving embryo freezing for fertility preservation before gonadotoxic treatment?

SUMMARY ANSWER

Pregnancy rates after emergency IVF, cryopreservation of embryos, storage, thawing and embryo transfer (embryo transfer), in the specific context of the preservation of female fertility, seem to be similar to those reported for infertile couples undergoing ART.

STUDY DESIGN, SIZE, DURATION

A French retrospective multicentre cohort study initiated by the GRECOT network-the French Study Group for Ovarian and Testicular Cryopreservation. We sent an e-mail survey to the 97 French centres performing the assisted reproduction technique in 2011, asking whether the centre performed emergency IVF and requesting information about the patients' characteristics, indications, IVF cycles and laboratory and follow-up data. The response rate was 53.6% (52/97).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Fourteen French centres reported that they performed emergency IVF (56 cycles in total) before gonadotoxic treatment, between 1999 and July 2011, in 52 patients.

MAIN RESULTS AND THE ROLE OF CHANCE

The patients had a mean age of 28.9 ± 4.3 years, and a median length of relationship of 3 years (1 month-15 years). Emergency IVF was indicated for haematological cancer (42%), brain tumour (23%), sarcoma (3.8%), mesothelioma (n = 1) and bowel cancer (n = 1). Gynaecological problems accounted for 17% of indications. In 7.7% of cases, emergency IVF was performed for autoimmune diseases. Among the 52 patients concerned, 28% (n = 14) had undergone previous courses of chemotherapy before beginning controlled ovarian stimulation (COS). The initiation of gonadotoxic treatment had to be delayed in 34% of the patients (n = 19). In total, 56 cycles were initiated. The mean duration of stimulation was 11.2 ± 2.5 days, with a mean peak estradiol concentration on the day on which ovulation was triggered of 1640 ± 1028 pg/ml. Three cycles were cancelled due to ovarian hyperstimulation syndrome (n = 1), poor response (n = 1) and treatment error (n = 1). A mean of 8.2 ± 4.8 oocytes were retrieved, with 6.1 ± 4.2 mature oocytes and 4.4 ± 3.3 pronuclear-stage embryos per cycle. The mean number of embryos frozen per cycle was 4.2 ± 3.1. During follow-up, three patients died from the consequences of their disease. For the 49 surviving patients, 22.5% of the couples concerned (n = 11) requested embryo replacement. A total of 33 embryos were thawed with a post-thawing survival rate of 76%. Embryo replacement was finally performed for 10 couples with a total of 25 embryos transferred, leading to one biochemical pregnancy, one miscarriage and three live births. Clinical pregnancy rate and live birth per couple who wanted a pregnancy after cancer were, respectively, 36% (95% CI = 10.9-69.2%) and 27% (95% CI = 6.0-61%).

LIMITATIONS, REASONS FOR CAUTION

The overall response rate for clinics was 53.6%. Therefore, it is not only that patients may not have been included, but also that those that were included were biased towards the University sector with a response rate of 83% (25/30) for a small number of patients.

WIDER IMPLICATIONS OF THE FINDINGS

According to literature, malignant disease is a risk factor for a poor response to COS. However, patients having emergency IVF before gonadotoxic treatment have a reasonable chance of pregnancy after embryo replacement. Embryo freezing is a valuable approach that should be included among the strategies used to preserve fertility.

STUDY FUNDING/COMPETING INTEREST(S)

No external funding was sought for this study. None of the authors has any conflict of interest to declare.