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Boulahssass R, Gonfrier S, Ferrero JM, Sanchez M, Mari V, Moranne O, Rambaud C, Auben F, Hannoun Levi JM, Bereder JM, Bereder I, Baque P, Turpin JM, Frin AC, Ouvrier D, Borchiellini D, Largillier R, Sacco G, Delotte J, Arlaud C, Benchimol D, Durand M, Evesque L, Mahamat A, Poissonnet G, Mouroux J, Barriere J, Benizri E, Piche T, Guigay J, Francois E, Guerin O. Predicting early death in older adults with cancer. Eur J Cancer 2018; 100:65-74. [PMID: 30014882 DOI: 10.1016/j.ejca.2018.04.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Predicting early death after a comprehensive geriatric assessment (CGA) is very difficult in clinical practice. The aim of this study was to develop a scoring system to estimate risk of death at 100 days in elderly cancer patients to assist the therapeutic decision. METHODS This was a multicentric, prospective cohort study approved by an ethics committee. Elderly cancer patients aged older than 70 years were enrolled before the final therapeutic decision. A standardised CGA was made before the treatment decision at baseline. Within 100 days, event (death), oncologic and geriatric data were collected. Multivariate logistic regression was used to select the risk factors for the overall population. Score points were assigned to each risk factor using the β coefficient. Internal validation was performed by a bootstrap method. Calibration was assessed with the Hosmer-Lemeshow goodness of fit test and accuracy with the mean c-statistic. FINDINGS One thousand fifty patients (mean age: 82 years) joined the study from April 2012 to December 2014. The independent predictors were metastatic cancers (odds ratio [OR] 2.5; 95% confidence interval [CI], [1.7-3.5] p<0 .001); gait speed<0.8 m/s (OR 2.1; 95% CI [1.3-3.3] p=0.001); Mini Nutritional Assessment (MNA) < 17 (OR 8; 95% CI; [3.7-17.3] p<0.001), MNA ≤23.5 and ≥ 17 (OR 4.4; 95% CI, [2.1-9.1) p<0.001); performance status (PS) > 2 (OR 1.7; 95% CI, [1.1-2.6)] p=0.015) and cancers other than breast cancer (OR 4; 95% CI, [2.1-7.9] p<0.001). We attributed 4 points for MNA<17, 3 points for MNA between ≤23.5 and ≥ 17, 2 points for metastatic cancers, 1 point for gait speed <0.8 m/s, 1 point for PS > 2 and 3 points for cancers other than breast cancer. The risk of death at 100 days was 4% for 0 to 6 points, 24% for 7 to 8 points, 39% for 9 to 10 points and 67% for 11 points. INTERPRETATION To our knowledge, this is the first score which estimates early death in elderly cancer patients. The system could assist in the treatment decision for elderly cancer patients.
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Affiliation(s)
- Rabia Boulahssass
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France; FHU ONCOAGE; Nice, France.
| | - Sebastien Gonfrier
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France.
| | - Jean-Marc Ferrero
- University of Nice Sophia Antipolis, France; Department of Medical Oncology, Lacassagne Center; Nice, France.
| | - Marine Sanchez
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France.
| | - Véronique Mari
- Department of Medical Oncology, Lacassagne Center; Nice, France.
| | - Olivier Moranne
- Department of Nephrology, Hopital Caremeau Nimes, France; Institut Universitaire de Recherche Clinique - EA2415 - Epidémiologie, Biostatistiques et Santé Publique/University of Montpellier; Nice, France.
| | - Cyrielle Rambaud
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France.
| | - Francine Auben
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France.
| | - Jean-Michel Hannoun Levi
- University of Nice Sophia Antipolis, France; Department of Medical Oncology, Lacassagne Center; Nice, France.
| | - Jean-Marc Bereder
- Department of Surgical Digestive Oncology, CHU de Nice; Nice, France.
| | | | - Patrick Baque
- University of Nice Sophia Antipolis, France; University of Nice Sophia Antipolis, Emergency Surgery Unit, CHU de Nice; Nice, France.
| | - Jean Michel Turpin
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France.
| | - Anne-Claire Frin
- Unit of Medical Oncology, Department of Gastroenterology, CHU Nice, Nice, France.
| | - Delphine Ouvrier
- Unit of Medical Oncology, Department of Gastroenterology, CHU Nice, Nice, France.
| | | | - Remy Largillier
- Cancer Center: Centre Azuréen de Cancérologie; Mougins, France.
| | - Guillaume Sacco
- University of Nice Sophia Antipolis, France; Geriatric Department CHU de NICE, France; CoBtek, France.
| | - Jerome Delotte
- University of Nice Sophia Antipolis, France; Department of Obstetrics and Gynecology, Reproduction and Fetal Medicine, CHU de Nice; Nice, France.
| | | | - Daniel Benchimol
- University of Nice Sophia Antipolis, France; Department of Surgical Digestive Oncology, CHU de Nice; Nice, France.
| | - Matthieu Durand
- University of Nice Sophia Antipolis, France; Department of Urology, CHU de Nice, University of Nice Sophia-Antipolis; Nice, France.
| | - Ludovic Evesque
- Department of Medical Oncology, Lacassagne Center; Nice, France.
| | | | | | - Jérôme Mouroux
- University of Nice Sophia Antipolis, France; Department of Thoracic and Cardiovascular Surgery, Hopital Pasteur, CHU Nice, Nice, France.
| | - Jérôme Barriere
- Department of Medical Oncology: Clinic Saint Jean; Cagnes sur Mer France.
| | - Emmanuel Benizri
- University of Nice Sophia Antipolis, France; Geriatric Department CHU de NICE, France.
| | - Thierry Piche
- University of Nice Sophia Antipolis, France; Unit of Medical Oncology, Department of Gastroenterology, CHU Nice, Nice, France.
| | - Joel Guigay
- FHU ONCOAGE; Nice, France; University of Nice Sophia Antipolis, France; Department of Medical Oncology, Lacassagne Center; Nice, France.
| | - Eric Francois
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France; Department of Medical Oncology, Lacassagne Center; Nice, France.
| | - Olivier Guerin
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France; FHU ONCOAGE; Nice, France; University of Nice Sophia Antipolis, France.
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Boyer J, Saint-Paul MC, Dadone B, Patouraux S, Vivinus MH, Ouvrier D, Michiels JF, Piche T, Tulic MK. Inflammatory cell distribution in colon mucosa as a new tool for diagnosis of irritable bowel syndrome: A promising pilot study. Neurogastroenterol Motil 2018; 30. [PMID: 28975689 DOI: 10.1111/nmo.13223] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 09/07/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Currently, there are no histological criteria to diagnose irritable bowel syndrome (IBS). Our aims were (i) to examine the distribution of inflammatory cells in the colon of healthy and IBS subjects and (ii) to find histological diagnosis criteria for IBS. METHODS Colonic biopsies were taken from four distinct regions of the colon from 20 controls (HC) and 11 patients with IBS (4 with constipation (IBS-C) and 7 with diarrhea (IBS-D) and embedded in paraffin. Macrophages, mast cells, eosinophils, and T lymphocytes were immunostained and positive cells counted. KEY RESULTS In both HC and IBS patients, global cellularity decreased from the cecum to the rectum (P < .01) which is attributed to reduced number of macrophages (P < .05) and eosinophils (P < .001) but not T cells. Mast cells were reduced in IBS (P < .05) but not in HC, particularly in IBS-D (P < .05). Results showed higher number of macrophages in the left colon of IBS subjects than HC (P < .05). CONCLUSION & INFERENCES Here we report a decreasing gradient of immune cells from the cecum to the rectum of the human colon. Although global cellularity cannot be used to distinguish between IBS and HC, closer analysis of macrophages and mast cells may be useful markers to confirm IBS histologically and to differentiate between IBS-C and IBS-D when clinical presentation alternates between constipation and diarrhoea. This pilot study remains to be confirmed with greater number of patients.
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Affiliation(s)
- J Boyer
- Laboratoire d'anatomopathologie (LCAP) CHU de Nice Hôpital Pasteur, Nice, France
| | - M-C Saint-Paul
- Laboratoire d'anatomopathologie (LCAP) CHU de Nice Hôpital Pasteur, Nice, France
| | - B Dadone
- Laboratoire d'anatomopathologie (LCAP) CHU de Nice Hôpital Pasteur, Nice, France
| | - S Patouraux
- Laboratoire d'anatomopathologie (LCAP) CHU de Nice Hôpital Pasteur, Nice, France
| | - M-H Vivinus
- Laboratoire d'Immunologie CHU de Nice Hôpital de l'Archet 1, Nice, France
| | - D Ouvrier
- Service de Gastroentérologie, CHU de Nice, Hôpital de l'Archet 2, Nice, France
| | - J-F Michiels
- Laboratoire d'anatomopathologie (LCAP) CHU de Nice Hôpital Pasteur, Nice, France
| | - T Piche
- Service de Gastroentérologie, CHU de Nice, Hôpital de l'Archet 2, Nice, France
| | - M K Tulic
- Centre Méditerranéen de Médecine Moléculaire (C3M Team 12), INSERM U1065, Nice, France.,International Inflammation Network (in-FLAME) of the World Universities Network
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Nguyen S, Ouvrier D, Massalou D, Viau P, Chevallier A, Patouraux S, Passeron T, Lacour JP, Montaudié H. [Lymphedema of the lower limbs: Initial manifestation of gastric linitis plastica]. Ann Dermatol Venereol 2017. [PMID: 28647380 DOI: 10.1016/j.annder.2017.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Primary lymphedemas are constitutional abnormalities of the lymphatic system. Secondary lymphedemas occur after damage to the lymphatic system, mainly after cancer treatments or tumour mass compression. There are many other causes, including filariasis, which is nonetheless very rare in France. PATIENTS AND METHODS A 52-year-old man presented with a two-month history of increased size of the left leg. He was asymptomatic and in good general condition. Clinical examination revealed non-pitting lymphedema and ipsilateral hydrocele without loco-regional compressive lymph node. Initial extensive explorations were unremarkable. Lymphoscintigraphy revealed low tracer fixation in the left leg. The symptoms continued to worsen, with exacerbation and bilateralization of the lymphedema. Two months later, axillary lymph nodes appeared corresponding to metastasis from a signet-ring cell carcinoma. Despite two lines of chemotherapy, the patient died 8 months later due to multiple metastatic disease. DISCUSSION Our case is remarkable because the lymphedema was not related to extrinsic compression and was the first symptom of gastric cancer. In the absence of compression, endo-lymphatic micro-metastases could constitute the causative process. Acquired lymphedema of the lower limbs must be recognized as a potential early symptom of gastric carcinoma and should therefore prompt further investigations.
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Affiliation(s)
- S Nguyen
- Service de dermatologie, hôpital Archet 2, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - D Ouvrier
- Service d'oncologie digestive, CHU de Nice, Archet 2, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - D Massalou
- Chirurgie générale d'urgence, Pasteur 2, université de Nice, CHU de Nice, 30, voie Romaine, 06000 Nice, France; UMRT24, IFSTTAR, laboratoire de biomécanique appliquée, Aix-Marseille université, boulevard Pierre-Dramard, 13005 Marseille, France
| | - P Viau
- Service de médecine nucléaire, Archet 1, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - A Chevallier
- Laboratoire central d'anatomie et cytologie pathologiques, Archet 2, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - S Patouraux
- Laboratoire central d'anatomie et cytologie pathologiques, Pasteur 1, CHU de Nice, 30, voie Romaine, 06001 Nice, France
| | - T Passeron
- Service de dermatologie, hôpital Archet 2, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - J-P Lacour
- Service de dermatologie, hôpital Archet 2, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - H Montaudié
- Service de dermatologie, hôpital Archet 2, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France.
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Nguyen S, Ouvrier D, Passeron T, Lacour JP, Montaudié H. Lymphœdème acquis du membre inférieur révélateur d’une linite gastrique. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.405] [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]
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Boulahssass R, Gonfrier S, Ferrero JM, Marine S, Saja D, Mari V, Piche T, Bereder JM, Delotte J, Turpin JM, Ouvrier D, Barrière J, Largillier R, Rambaud C, Benchimol D, Follana P, Otto J, Guigay J, Francois E, Guerin O. A clinical score to predict the early death at 100 days after a comprehensive geriatric assessment (CGA) in elderly metastatic cancers , analysis from a prospective cohort study with 1048 patients. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e21532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
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Galmiche M, Besnard I, Palomba K, Eyraud E, Frin AC, Ouvrier D, Piche T, Schneider S, Hebuterne X. P262: Évaluation du caractère prédictif de l’échelle visuelle analogique (EVA) pour la détermination des ingesta des malades atteints d’un cancer. NUTR CLIN METAB 2014. [DOI: 10.1016/s0985-0562(14)70904-5] [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: 10/24/2022]
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Martis N, Ouvrier D, Liguori S, Fiandino M, Marcq L, Quinsat D. Syndrome hyperéosinophilique avec un réarrangement FIP1L1-PDGFRA1 et rémission moléculaire sous mésylate d’imatinib : quelle stratégie thérapeutique ? Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.234] [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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