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Azaïs H, Vignion-Dewalle AS, Carrier M, Augustin J, Da Maïa E, Penel A, Belghiti J, Nikpayam M, Gonthier C, Ziane L, Mordon S, Collinet P, Canlorbe G, Uzan C. Microscopic Peritoneal Residual Disease after Complete Macroscopic Cytoreductive Surgery for Advanced High Grade Serous Ovarian Cancer. J Clin Med 2020; 10:E41. [PMID: 33375564 PMCID: PMC7795826 DOI: 10.3390/jcm10010041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Epithelial ovarian cancers (EOC) are usually diagnosed at an advanced stage and managed by complete macroscopic cytoreductive surgery (CRS) and systemic chemotherapy. Peritoneal recurrence occurs in 60% of patients and may be due to microscopic peritoneal metastases (mPM) which are neither eradicated by surgery nor controlled by systemic chemotherapy. The aim of this study was to assess and quantify the prevalence of residual mPM after complete macroscopic CRS in patients with advanced high-grade serous ovarian cancer (HGSOC). METHODS A prospective study conducted between 1 June 2018 and 10 July 2019 in a single referent center accredited by the European Society of Gynecological Oncology for advanced EOC management. Consecutive patients presenting with advanced HGSOC and eligible for complete macroscopic CRS were included. Up to 13 peritoneal biopsies were taken from macroscopically healthy peritoneum at the end of CRS and examined for the presence of mPM. A mathematical model was designed to determine the probability of presenting at least one mPM after CRS. RESULTS 26 patients were included and 26.9% presented mPM. There were no differences in characteristics between patients with or without identified mPM. After mathematical analysis, the probability that mPM remained after complete macroscopic CRS in patients with EOC was 98.14%. CONCLUSION Microscopic PM is systematically present after complete macroscopic CRS for EOC and could be a relevant therapeutic target. Adjuvant locoregional strategies to conventional surgery may improve survival by achieving microscopic CRS.
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Affiliation(s)
- Henri Azaïs
- Department of Gynecological and Breast Surgery and Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, 75013 Paris, France; (M.C.); (J.B.); (M.N.); (C.G.); (G.C.); (C.U.)
- U1189-ONCO-THAI-Laser Assisted Therapy and Immunotherapies for On-cology, CHU Lille, Université de Lille, INSERM, F-59000 Lille, France; (A.-S.V.-D.); (L.Z.); (S.M.); (P.C.)
| | - Anne-Sophie Vignion-Dewalle
- U1189-ONCO-THAI-Laser Assisted Therapy and Immunotherapies for On-cology, CHU Lille, Université de Lille, INSERM, F-59000 Lille, France; (A.-S.V.-D.); (L.Z.); (S.M.); (P.C.)
| | - Marine Carrier
- Department of Gynecological and Breast Surgery and Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, 75013 Paris, France; (M.C.); (J.B.); (M.N.); (C.G.); (G.C.); (C.U.)
| | - Jeremy Augustin
- AP-HP, Pitié-Salpêtrière Hospital, Department of Pathology, 75013 Paris, France; (J.A.); (E.D.M.)
| | - Elisabeth Da Maïa
- AP-HP, Pitié-Salpêtrière Hospital, Department of Pathology, 75013 Paris, France; (J.A.); (E.D.M.)
| | - Alix Penel
- AP-HP, Pitié-Salpêtrière Hospital, Centre de Pharmaco-épidémiologie de l’APHP (CEPHEPI), 75013 Paris, France;
| | - Jérémie Belghiti
- Department of Gynecological and Breast Surgery and Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, 75013 Paris, France; (M.C.); (J.B.); (M.N.); (C.G.); (G.C.); (C.U.)
| | - Marianne Nikpayam
- Department of Gynecological and Breast Surgery and Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, 75013 Paris, France; (M.C.); (J.B.); (M.N.); (C.G.); (G.C.); (C.U.)
| | - Clémentine Gonthier
- Department of Gynecological and Breast Surgery and Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, 75013 Paris, France; (M.C.); (J.B.); (M.N.); (C.G.); (G.C.); (C.U.)
| | - Laurine Ziane
- U1189-ONCO-THAI-Laser Assisted Therapy and Immunotherapies for On-cology, CHU Lille, Université de Lille, INSERM, F-59000 Lille, France; (A.-S.V.-D.); (L.Z.); (S.M.); (P.C.)
| | - Serge Mordon
- U1189-ONCO-THAI-Laser Assisted Therapy and Immunotherapies for On-cology, CHU Lille, Université de Lille, INSERM, F-59000 Lille, France; (A.-S.V.-D.); (L.Z.); (S.M.); (P.C.)
| | - Pierre Collinet
- U1189-ONCO-THAI-Laser Assisted Therapy and Immunotherapies for On-cology, CHU Lille, Université de Lille, INSERM, F-59000 Lille, France; (A.-S.V.-D.); (L.Z.); (S.M.); (P.C.)
- CHRU Lille, Jeanne de Flandre Hospital, Department of Gynecology, 59000 Lille, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, 75013 Paris, France; (M.C.); (J.B.); (M.N.); (C.G.); (G.C.); (C.U.)
- Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, INSERM UMR_S_938, 75020 Paris, France
- Institut Universitaire de Cancérologie (IUC), Sorbonne University, 75013 Paris, France
| | - Catherine Uzan
- Department of Gynecological and Breast Surgery and Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, 75013 Paris, France; (M.C.); (J.B.); (M.N.); (C.G.); (G.C.); (C.U.)
- Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, INSERM UMR_S_938, 75020 Paris, France
- Institut Universitaire de Cancérologie (IUC), Sorbonne University, 75013 Paris, France
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Abstract
Pierre Janet, in his famous paper (1892) on anterograde amnesia, is concerned with the theme of the disintegration of the human personality. He shows that the weakened personality may lose the power to assimilate memories of current events. After a severe shock, there may supervene not only a retrograde amnesia (a blotting out from memory from some period before the accident), but also a continued or anterograde amnesia, that is to say, an inability to remember events occurring after the accident. Janet details the circumstances of a very interesting case of amnesia resulting from an attack of hysteria, brought on by the shock of bad news. The patient, 'Mrs. D.', had wholly lost all memory of events that occurred during the month and a half before her attack, and since that time she had only been able to remember for a few moments what was going on around her. Janet shows that memories which appear not to be formed are in fact formed; that they exist somewhere in the patient's mind with the full vividness of ordinary recollections, and that they may spontaneously crop up in dreams, or may be called out by hypnotic suggestion, or by other methods.
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