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Le Guévelou J, Selleret L, Laas E, Lecuru F, Kissel M. Cervical Cancer Associated with Pregnancy: Current Challenges and Future Strategies. Cancers (Basel) 2024; 16:1341. [PMID: 38611019 PMCID: PMC11011172 DOI: 10.3390/cancers16071341] [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: 02/19/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Cancer during pregnancy is defined as a tumor diagnosed in a pregnant woman or up to 1-year post-partum. While being a rare disease, cervical cancer is probably one of the most challenging medical conditions, with the dual stake of treating the cancer without compromising its chances for cure, while preserving the pregnancy and the health of the fetus and child. To date, guidelines for gynecological cancers are provided through international consensus meetings with expert panels, giving insights on both diagnosis, treatment, and obstetrical care. However, these expert guidelines do not discuss the various approaches than can be found within the literature, such as alternative staging modalities or innovative surgical approaches. Also, the obstetrical care of women diagnosed with cervical cancer during pregnancy requires specific considerations that are not provided within our current standard of care. This systematic review aims to fill the gap on current issues with regards to the management of cervical cancer during pregnancy and provide future directions within this evolving landscape.
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Affiliation(s)
- Jennifer Le Guévelou
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
- Department of Radiation Oncology, Centre Eugène Marquis, 35000 Rennes, France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75005 Paris, France
- Cancer Associé à La Grossesse (CALG), French CALG Network, 75005 Paris, France
| | - Enora Laas
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, 75005 Paris, France
| | - Fabrice Lecuru
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, 75005 Paris, France
- Université de Paris, 75006 Paris, France
| | - Manon Kissel
- Department of Radiation Oncology, Institut Curie, 75005 Paris, France
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Mawet M, Basse C, Barrois M, Gligorov J, Cadranel J, Chabbert-Buffet N, Selleret L. Second-trimester medical abortion after exposure to lorlatinib during early pregnancy, a case report. J Gynecol Obstet Hum Reprod 2023; 52:102673. [PMID: 37777070 DOI: 10.1016/j.jogoh.2023.102673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/08/2023] [Accepted: 09/27/2023] [Indexed: 10/02/2023]
Abstract
Use of Lorlatinib, a third-generation tyrosine kinase inhibitor currently indicated in the treatment of non-small-cell lung cancer (NSCLC) with ALK or ROS1 gene fusion, is formally contra-indicated during pregnancy due to teratogenic effects observed during pre-clinical studies. We report the case of a 38-year-old woman with a ROS1-positive NSCLC, successfully treated with lorlatinib as second line therapy, who became pregnant while on treatment. Due to significant disease progression 12 weeks after lorlatinib stop and the great uncertainty on the pregnancy outcome, she finally decided to interrupt the pregnancy at 22 weeks of gestation. Echography and gross infant examination did not reveal any malformation. Pregnancies occurring under this kind of new oncologic treatment is expected to happen more frequently in the future. It seems therefore important to us to report any information on the topic to increase our level of knowledge and improve decision-making.
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Affiliation(s)
- Marie Mawet
- Department of Gynecology and Obstetrics, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 75020, Paris, France; Department of Gynecology and Obstetrics, Centre Hospitalier Universitaire de Liège, 4000, Liège, Belgique.
| | - Clémence Basse
- Institut du Thorax Curie Montsouris, 75005, Paris, France
| | - Mathilde Barrois
- Department of Gynecology and Obstetrics, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France
| | - Joseph Gligorov
- Department of Oncology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 75020, Paris, France
| | - Jacques Cadranel
- Department of Oncology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 75020, Paris, France
| | - Nathalie Chabbert-Buffet
- Department of Gynecology and Obstetrics, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 75020, Paris, France
| | - Lise Selleret
- Department of Gynecology and Obstetrics, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 75020, Paris, France
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Bachelot G, Dhombres F, Sermondade N, Haj Hamid R, Berthaut I, Frydman V, Prades M, Kolanska K, Selleret L, Mathieu-D'Argent E, Rivet-Danon D, Levy R, Lamazière A, Dupont C. A Machine Learning Approach for the Prediction of Testicular Sperm Extraction in Nonobstructive Azoospermia: Algorithm Development and Validation Study. J Med Internet Res 2023; 25:e44047. [PMID: 37342078 DOI: 10.2196/44047] [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: 11/04/2022] [Revised: 02/19/2023] [Accepted: 04/07/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Testicular sperm extraction (TESE) is an essential therapeutic tool for the management of male infertility. However, it is an invasive procedure with a success rate up to 50%. To date, no model based on clinical and laboratory parameters is sufficiently powerful to accurately predict the success of sperm retrieval in TESE. OBJECTIVE The aim of this study is to compare a wide range of predictive models under similar conditions for TESE outcomes in patients with nonobstructive azoospermia (NOA) to identify the correct mathematical approach to apply, most appropriate study size, and relevance of the input biomarkers. METHODS We analyzed 201 patients who underwent TESE at Tenon Hospital (Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris), distributed in a retrospective training cohort of 175 patients (January 2012 to April 2021) and a prospective testing cohort (May 2021 to December 2021) of 26 patients. Preoperative data (according to the French standard exploration of male infertility, 16 variables) including urogenital history, hormonal data, genetic data, and TESE outcomes (representing the target variable) were collected. A TESE was considered positive if we obtained sufficient spermatozoa for intracytoplasmic sperm injection. After preprocessing the raw data, 8 machine learning (ML) models were trained and optimized on the retrospective training cohort data set: The hyperparameter tuning was performed by random search. Finally, the prospective testing cohort data set was used for the model evaluation. The metrics used to evaluate and compare the models were the following: sensitivity, specificity, area under the receiver operating characteristic curve (AUC-ROC), and accuracy. The importance of each variable in the model was assessed using the permutation feature importance technique, and the optimal number of patients to include in the study was assessed using the learning curve. RESULTS The ensemble models, based on decision trees, showed the best performance, especially the random forest model, which yielded the following results: AUC=0.90, sensitivity=100%, and specificity=69.2%. Furthermore, a study size of 120 patients seemed sufficient to properly exploit the preoperative data in the modeling process, since increasing the number of patients beyond 120 during model training did not bring any performance improvement. Furthermore, inhibin B and a history of varicoceles exhibited the highest predictive capacity. CONCLUSIONS An ML algorithm based on an appropriate approach can predict successful sperm retrieval in men with NOA undergoing TESE, with promising performance. However, although this study is consistent with the first step of this process, a subsequent formal prospective multicentric validation study should be undertaken before any clinical applications. As future work, we consider the use of recent and clinically relevant data sets (including seminal plasma biomarkers, especially noncoding RNAs, as markers of residual spermatogenesis in NOA patients) to improve our results even more.
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Affiliation(s)
- Guillaume Bachelot
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
- Laboratory in Medical Informatics and Knowledge Engineering in e-Health, L'Institut national de la santé et de la recherche médicale, Sorbonne University, Paris, France
| | - Ferdinand Dhombres
- Laboratory in Medical Informatics and Knowledge Engineering in e-Health, L'Institut national de la santé et de la recherche médicale, Sorbonne University, Paris, France
| | - Nathalie Sermondade
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Rahaf Haj Hamid
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Isabelle Berthaut
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Valentine Frydman
- Service d'Urologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Marie Prades
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Kamila Kolanska
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Lise Selleret
- Service d'Urologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Emmanuelle Mathieu-D'Argent
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Diane Rivet-Danon
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Rachel Levy
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Antonin Lamazière
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Département de Métabolomique Clinique, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Charlotte Dupont
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
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Verger E, Selleret L, Nizard J, Bachelot A, Dubreuil S, Ciangura C. Recherche des facteurs associés à l’obtention d’une naissance chez des femmes en situation d’infertilité et d’obésité sévère : expérience du parcours OPIOM. Annales d'Endocrinologie 2022. [DOI: 10.1016/j.ando.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Bachelot G, Haj Hamid R, Sermondade N, Dhombres F, Isabelle B, Frydman V, Borio-Prades M, Kolanska K, Selleret L, Levy R, Lamaziere A, Dupont C. P-057 Machine learning-based prediction of testicular sperm extraction: comparison of different preprocessing and models, required sample size and relevance of input biomarkers. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.053] [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
Study question
Can advanced machine learning applied to the preoperative assessment predict the testicular sperm extraction outcome in azoospermic context and how many patients are required?
Summary answer
Despite encouraging results (AUC = 92.0%, sensitivity = 83.9% and specificity = 84.2%), integrating new biomarkers would probably be more relevant than enrolling additional patients.
What is known already
Testicular sperm extraction (TESE) is an essential therapeutic tool for the male infertility management and is often the “last hope” before gamete donation for these patients. However, it is an invasive procedure and is successful in up to 50%. Until now, no model is sufficiently powerful to accurately predict the success of sperm retrieval in TESE. Among the few models already developed, the findings are highly disparate despite having common input data (preoperative assessment). Moreover, only few types of machine learning models and procedures have been investigated. Performances were mostly capped despite the inclusion sometimes of more than 1000 patients.
Study design, size, duration
Data of 175 patients who underwent TESE between 2012 and 2021 were retrospectively analyzed. The performances of a wide range of preprocessing methods and machine learning models (state-of-the-art methods in machine learning) we explored, evaluated, and compared. The objective was to predict the presence or absence of spermatozoa, using 17 parameters (clinical, hormonal, genetic, history) from the preoperative assessment. The study protocol was approved by a local ethics committee (IRB CER-2021-041).
Participants/materials, setting, methods
After data preprocessing (standardization…), Machine Learning models (Bayesian Naive Classification, logistic regression, k-nearest neighbor classifier, support vector machine, random forests, GradientBoosting and XGBoost) and Deep Learning models were tested. The validation procedure consisted of splitting the dataset into a training set and test set. Beyond the standard metrics (sensitivity, specificity, AUC-ROC), the identification of the most relevant variables and the learning curve to determine the optimal patient number to be included were performed.
Main results and the role of chance
At least one live spermatozoon was found in the testicular tissue of 104 (59.4%) patients (positive TESE) out of 175. The best performing model (Random Forest with appropriate preprocessing) obtained the following results on the test set: AUC = 92.0%, sensitivity = 83.9% and specificity = 84.2%, leading to an efficient tool, which gives additional and more relevant information than the different variables taken separately. Inhibin B, FSH and history of cryptorchidism were the variables with the most discriminating power. However, a plateau in the model performance was observed (beyond 110 patients), whatever the approach or the preprocessing used. A trend curve shows that beyond 110 patients, no improvement can be observed and cast doubt about the power of the traditional preoperative parameters assessed before TESE. The classic preoperative assessment can probably not fully predict the TESE outcomes. Further work is needed to be enhance with new hypothesis and the use of new biomarkers to be integrated into the models.
Limitations, reasons for caution
The main limitation was the monocentric design and the use of retrospective data.
Wider implications of the findings
Machine learning models can provide the basis for an enhanced decision support system tool in the context of azoospermia. Indefinitely increasing the number of participants is not likely to be the solution: further hypotheses and biomarkers integration into the models will probably be necessary to improve performance.
Trial registration number
not applicable
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Affiliation(s)
- G Bachelot
- Sorbonne Université- Saint Antoine Research center, INSERM équipe Lipodystrophies génétiques et acquises , PARIS, France
- Service de Biologie de la reproduction - CECOS Hôpital Tenon, AP-HP Sorbonne Université , Paris, France
| | - R Haj Hamid
- Service de Biologie de la reproduction - CECOS Hôpital Tenon, AP-HP Sorbonne Université , Paris, France
| | - N Sermondade
- Service de Biologie de la reproduction - CECOS Hôpital Tenon, AP-HP Sorbonne Université , Paris, France
| | - F Dhombres
- Médecine foetale - Hôpital Armand-Trousseau, AP-HP Sorbonne Université , Paris, France
| | - B Isabelle
- Service de Biologie de la reproduction - CECOS Hôpital Tenon, AP-HP Sorbonne Université , Paris, France
| | - V Frydman
- Service d'urologie Hôpital Tenon, AP-HP Sorbonne Université , Paris, France
| | - M Borio-Prades
- Service de Biologie de la reproduction - CECOS Hôpital Tenon, AP-HP Sorbonne Université , Paris, France
| | - K Kolanska
- Service de Gynécologie-obstétrique et médecine de la reproduction - Hôpital Tenon, AP-HP Sorbonne Université , Paris, France
| | - L Selleret
- Service de Gynécologie-obstétrique et médecine de la reproduction - Hôpital Tenon, AP-HP Sorbonne Université , Paris, France
| | - R Levy
- Service de Biologie de la reproduction - CECOS Hôpital Tenon, AP-HP Sorbonne Université , Paris, France
| | - A Lamaziere
- Service de Métabolomique - Hôpital Saint-Antoine, AP-HP Sorbonne Université , Paris, France
| | - C Dupont
- Service de Biologie de la reproduction - CECOS Hôpital Tenon, AP-HP Sorbonne Université , Paris, France
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Stout S, Dabi Y, Dupont C, Selleret L, Touboul C, Chabbert-Buffet N, Daraï E, Mathieu d’Argent E, Kolanska K. Stimulation Duration in Patients with Early Oocyte Maturation Triggering Criteria Does Not Impact IVF-ICSI Outcomes. J Clin Med 2022; 11:jcm11092330. [PMID: 35566454 PMCID: PMC9102252 DOI: 10.3390/jcm11092330] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/10/2022] [Accepted: 04/21/2022] [Indexed: 12/04/2022] Open
Abstract
Results from studies reporting the optimal stimulation duration of IVF-ICSI cycles are inconsistent. The aim of this study was to determine whether, in the presence of early ovulation-triggering criteria, prolonged ovarian stimulation modified the chances of a live birth. This cross-sectional study included 312 women presenting triggering criteria beginning from D8 of ovarian stimulation. Among the 312 women included in the study, 135 were triggered for ovulation before D9 (D ≤ nine group) and 177 after D9 (D > nine group). The issues of fresh +/− frozen embryo transfers were taken into consideration. Cumulative clinical pregnancy and live-birth rates after fresh +/− frozen embryo transfers were similar in both groups (37% versus 46.9%, p = 0.10 and 19.3% versus 28.2%, p = 0.09, respectively). No patient characteristics were found to be predictive of a live birth depending on the day of ovulation trigger. Postponing of ovulation trigger did not impact pregnancy or live-birth rates in early responders. A patient’s clinical characteristics should not influence the decision process of ovulation trigger day in early responders. Further prospective studies should be conducted to support these findings.
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Affiliation(s)
- Sophie Stout
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 Rue de la Chine, 75020 Paris, France; (S.S.); (Y.D.); (L.S.); (C.T.); (N.C.-B.); (E.D.); (E.M.d.)
| | - Yohann Dabi
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 Rue de la Chine, 75020 Paris, France; (S.S.); (Y.D.); (L.S.); (C.T.); (N.C.-B.); (E.D.); (E.M.d.)
| | - Charlotte Dupont
- INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 Rue Chaligny, CEDEX 12, 75571 Paris, France;
- Service de Biologie de la Reproduction-CECOS, Hôpital Tenon, AP-HP, Sorbonne Université, 4 Rue de la Chine, 75020 Paris, France
| | - Lise Selleret
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 Rue de la Chine, 75020 Paris, France; (S.S.); (Y.D.); (L.S.); (C.T.); (N.C.-B.); (E.D.); (E.M.d.)
| | - Cyril Touboul
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 Rue de la Chine, 75020 Paris, France; (S.S.); (Y.D.); (L.S.); (C.T.); (N.C.-B.); (E.D.); (E.M.d.)
- INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 Rue Chaligny, CEDEX 12, 75571 Paris, France;
| | - Nathalie Chabbert-Buffet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 Rue de la Chine, 75020 Paris, France; (S.S.); (Y.D.); (L.S.); (C.T.); (N.C.-B.); (E.D.); (E.M.d.)
- INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 Rue Chaligny, CEDEX 12, 75571 Paris, France;
| | - Emile Daraï
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 Rue de la Chine, 75020 Paris, France; (S.S.); (Y.D.); (L.S.); (C.T.); (N.C.-B.); (E.D.); (E.M.d.)
- INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 Rue Chaligny, CEDEX 12, 75571 Paris, France;
| | - Emmanuelle Mathieu d’Argent
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 Rue de la Chine, 75020 Paris, France; (S.S.); (Y.D.); (L.S.); (C.T.); (N.C.-B.); (E.D.); (E.M.d.)
| | - Kamila Kolanska
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 Rue de la Chine, 75020 Paris, France; (S.S.); (Y.D.); (L.S.); (C.T.); (N.C.-B.); (E.D.); (E.M.d.)
- INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 Rue Chaligny, CEDEX 12, 75571 Paris, France;
- Correspondence:
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Despierres M, Boudy AS, Selleret L, Gligorov J, Richard S, Thomassin I, Dabi Y, Zilberman S, Touboul C, Montravers F, Khaldoun K, Darai E. Feasibility, Safety and Impact of (18F)-FDG PET/CT in patients with pregnancy-associated cancer: experience of the French CALG (Cancer Associé à La Grossesse) network. Acta Oncol 2022; 61:302-308. [PMID: 34779355 DOI: 10.1080/0284186x.2021.2004323] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The incidence of pregnancy-associated cancers has been increasing for decades. (18F)-FDG Positron Emission Tomography (PET)/Computed Tomography (CT) imaging has become a golden standard in the staging of many malignant diseases. The aims of the current study were to evaluate the feasibility, safety and impact of (18F)-FDG PET/CT performed during pregnancy. MATERIAL AND METHODS A retrospective analysis from the prospective database of the Cancer Associé à La Grossesse (CALG) network (Tenon Hospital, France) including patients who underwent (18F)-FDG PET/CT during their pregnancy between 2015 and 2020. RESULTS Of the 536 patients for whom advice from the CALG network was requested during the study period, 359 were diagnosed with cancer during pregnancy. Study population was composed of 63 (17.5%) patients who underwent (18F)-FDG PET/CT. Most cancers were diagnosed during the second trimester. Seventy-five percent were diagnosed with breast cancer, mostly locally advanced invasive ductal carcinomas. Median term of pregnancy at PET/CT was 24.8 weeks of gestation. Twelve (19%), 24 (38.1%) and 22 (34.9%) patients underwent the exam during the 1st, 2nd and 3rd trimester, respectively. (18F)-FDG PET/CT resulted in stage modification for 38 (60.3%) of the patients (28 with more extensive lymph node involvement and 10 with metastatic disease) with subsequently/accordingly modified first-line medical treatment. Fifty patients gave birth to healthy newborns. Two patients had a medical termination of pregnancy, five had a medical abortion, one neonatal death occurred in a patient with severe preeclampsia (unrelated to (18F)-FDG PET/CT). The data of 46 children were available at 6 months, 29 at 12 months, and 15 at 24 months. No cases of mental retardation, childhood cancer, or malformation were reported within 2 years. CONCLUSION (18F)-FDG PET/CT has a major impact on the management of pregnancy-associated cancers and does not appear to cause fetal side effects suggesting that the exam is feasible during pregnancy as maternal benefits outweigh fetal risks.
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Affiliation(s)
- Marie Despierres
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Anne-Sophie Boudy
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
- Cancer Associé à La Grossesse (CALG), French CALG Network, Paris, France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
- Cancer Associé à La Grossesse (CALG), French CALG Network, Paris, France
| | - Joseph Gligorov
- Department of Oncology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
- UMRS-938 4. Faculté de Médecine Sorbonne Université, Paris, France
| | - Sandrine Richard
- Department of Oncology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Isabelle Thomassin
- UMRS-938 4. Faculté de Médecine Sorbonne Université, Paris, France
- Department of Radiology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Yohann Dabi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
- Cancer Associé à La Grossesse (CALG), French CALG Network, Paris, France
| | - Sonia Zilberman
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
- Cancer Associé à La Grossesse (CALG), French CALG Network, Paris, France
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
- Cancer Associé à La Grossesse (CALG), French CALG Network, Paris, France
- UMRS-938 4. Faculté de Médecine Sorbonne Université, Paris, France
| | - Françoise Montravers
- UMRS-938 4. Faculté de Médecine Sorbonne Université, Paris, France
- Department of Nuclear Medicine, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Kerrou Khaldoun
- UMRS-938 4. Faculté de Médecine Sorbonne Université, Paris, France
- Department of Nuclear Medicine, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
- Cancer Associé à La Grossesse (CALG), French CALG Network, Paris, France
- UMRS-938 4. Faculté de Médecine Sorbonne Université, Paris, France
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Verger E, Selleret L, Nizard J, Bachelot A, Dubreuil S, Ciangura C. Recherche des facteurs associés à l’obtention d’une naissance chez des femmes en situation d’infertilité et d’obésité sévère : expérience du parcours OPIOM. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.12.177] [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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Puchar A, Despierres M, Boudy AS, Selleret L, Gligorov J, Richard S, Zilberman S, Ferrier C, Dabi Y, Varlas V, Thomassin-Naggara I, Bendifallah S, Touboul C, Darai E. Prognosis of triple-negative breast cancer associated with pregnancy: A propensity score-matched analysis from the French CALG (Cancer Associé à la Grossesse) network. Breast 2022; 61:168-174. [PMID: 35042133 PMCID: PMC8777280 DOI: 10.1016/j.breast.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Triple-negative (TN) breast cancer represents one third of pregnancy-associated breast cancers (PABC). The aims of the current study were to describe oncological and obstetrical outcomes of patients with TN-PABC and to compare their prognosis with TN-non-PABC patients using a propensity score. Materials and methods Between January 2005 and December 2020, data of patients with histologically proven TN-PABC were collected and compared with data of TN-non-PABC patients under the age of 46 years diagnosed during the same period using a propensity score (PS). Results After PS matching (tumor size and lymph node involvement),there were 59 patients in each group. The median follow-up was 14 months (IQR 4.8–40.1) for the TN-PABC group and 60 months (IQR 30.7–101.4) for the TN-non-PABC group. Eight recurrences occurred in the TN-PABC group and 10 in the TN-non-PABC group (adjusted OR (AOR) = 0.60 (0.21–1.60), HR (Cox adjusted model- AHR) = 1.25 (0.53–2.94)). Two patients died in the TN-PABC group, and six in the TN-non-PABC group with an AOR = 0.23 (0.03–1.01) and an AHR = 0.58 (0.12–2.69). All the patients diagnosed during the second (n = 17) and third trimesters (n = 28) continued their pregnancies, with a median term at delivery of 38 WG (IQR 36–39). All patients gave birth to healthy newborns. Conclusion Although the TN subtype is associated with poor prognosis in pregnant patients due to advanced stage at diagnosis and high lymph node involvement, our PS-matched case-control study showed that pregnancy per se does not worsen the prognosis in terms of recurrence-free and overall survival. Triple-negative breast cancer are associated with poor prognosis. Breast cancers occurring during pregnancy differ from those occurring in the post-partum period. Pregnancy per se does not worsen the prognosis in triple-negative breast cancer.
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Affiliation(s)
- Anne Puchar
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, France; Cancer Associé à La Grossesse (CALG), French CALG Network, France.
| | - Marie Despierres
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, France
| | - Anne-Sophie Boudy
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, France; Cancer Associé à La Grossesse (CALG), French CALG Network, France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, France; Cancer Associé à La Grossesse (CALG), French CALG Network, France
| | - Joseph Gligorov
- Cancer Associé à La Grossesse (CALG), French CALG Network, France; UMRS-938 4. Faculté́ de Médecine Sorbonne Université́, France; Department of Oncology, Tenon University Hospital, Assistance Publique des Ho^pitaux de Paris (AP-HP), Sorbonne University, France
| | - Sandrine Richard
- Cancer Associé à La Grossesse (CALG), French CALG Network, France; Department of Oncology, Tenon University Hospital, Assistance Publique des Ho^pitaux de Paris (AP-HP), Sorbonne University, France
| | - Sonia Zilberman
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, France; Cancer Associé à La Grossesse (CALG), French CALG Network, France
| | - Clément Ferrier
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, France
| | - Yohann Dabi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, France
| | - Valentin Varlas
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, France
| | - Isabelle Thomassin-Naggara
- Cancer Associé à La Grossesse (CALG), French CALG Network, France; Department of Radiology, Tenon University Hospital, Assistance Publique des Ho^pitaux de Paris (AP-HP), Sorbonne University, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, France; Cancer Associé à La Grossesse (CALG), French CALG Network, France; UMRS-938 4. Faculté́ de Médecine Sorbonne Université́, France
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, France; Cancer Associé à La Grossesse (CALG), French CALG Network, France; UMRS-938 4. Faculté́ de Médecine Sorbonne Université́, France
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, France; Cancer Associé à La Grossesse (CALG), French CALG Network, France; UMRS-938 4. Faculté́ de Médecine Sorbonne Université́, France
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Vianna CA, Dupont C, Selleret L, Canestri A, Levy R, Hamid RH. Comparison of in vitro fertilization cycles in couples with human immunodeficiency virus type 1 infection versus noninfected couples through a retrospective matched case-control study. F S Rep 2021; 2:376-385. [PMID: 34934977 PMCID: PMC8655394 DOI: 10.1016/j.xfre.2021.04.008] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/18/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To compare in vitro fertilization (IVF) outcomes in couples in which at least one partner is human immunodeficiency virus (HIV) positive with that of couples in which neither partner is HIV-positive. Design Retrospective matched case-control study. Setting Fertility center at Tenon Hospital, Paris, France. Patient(s) A total of 179 IVF cycles in couples infected with HIV-1 and 179 IVF cycles in control couples. Intervention(s) Ovarian stimulation, oocytes retrieval, IVF (standard and microinjection), embryo transfer, pregnancy, and live birth follow-up. Main Outcome Measure(s) Live birth rate and IVF outcomes Result(s) The first comparison between HIV and non-HIV couples showed poorer outcomes in the HIV group (higher administered gonadotropin doses and longer stimulation periods, lower cumulative pregnancy and live birth rates, among other things). A subgroup analysis was performed in addition. No differences were found in the “men HIV” group compared with the controls. In contrast, poorer outcomes in the “women HIV” and “women and men HIV” groups were shown in terms of administered doses, duration of stimulation, and number of oocytes retrieved. For the “women HIV” group, lower cumulative clinical pregnancy and live birth rates were found. Conclusion The data suggested that couples with HIV-positive women have poorer medically assisted procreation outcomes than couples with non-HIV-infected women. Therefore, physicians should pay particular attention to couples with HIV-positive women.
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Affiliation(s)
- Caroline Aimone Vianna
- Biologie de la Reproduction - Centre d'Etude et de Conservation des Oeufs et du Sperme humains, Hôpital Tenon, Paris, France
| | - Charlotte Dupont
- Biologie de la Reproduction - Centre d'Etude et de Conservation des Oeufs et du Sperme humains, Hôpital Tenon, Paris, France
| | - Lise Selleret
- Service de Gynécologie Obstétrique - Médecine de la Reproduction, Hôpital Tenon, Paris, France
| | - Ana Canestri
- Service Maladies Infectieuses et Tropicales, Hôpital Tenon, Paris, France
| | - Rachel Levy
- Biologie de la Reproduction - Centre d'Etude et de Conservation des Oeufs et du Sperme humains, Hôpital Tenon, Paris, France
| | - Rahaf Haj Hamid
- Biologie de la Reproduction - Centre d'Etude et de Conservation des Oeufs et du Sperme humains, Hôpital Tenon, Paris, France
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Kolanska K, Uddin J, Dabi Y, Mathieu d'Argent E, Dupont C, Selleret L, Touboul C, Antoine JM, Chabbert-Buffet N, Daraï E. Secondary infertility with a history of vaginal childbirth: Ready to have another one? J Gynecol Obstet Hum Reprod 2021; 51:102271. [PMID: 34785399 DOI: 10.1016/j.jogoh.2021.102271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/07/2021] [Revised: 10/25/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Up to 30% of couples may face secondary infertility. The impact of ectopic pregnancy, spontaneous abortion, pregnancy termination or live birth with caesarean section may impair further fertility in different ways. However, secondary infertility after physiological vaginal life childbirth has been little studied. The aim of this study was to describe the population and the fertility issues and analyze the predictive factors of success in in vitro fertilization in women presenting secondary infertility after a physiological vaginal childbirth. MATERIAL AND METHODS This single-centre retrospective study included women aged 18-43 years consulting between 2013 and 2020 for secondary infertility in a couple having already had previous vaginal life childbirth. Couples' characteristics, management decision after the first consultation and IVF outcomes were analyzed. RESULTS Secondary infertility was found in 286 couples, out of whom 138 had a history of vaginal life childbirth. Population was characterized by an advanced female age and overweight. After the first consultation, IVF was performed in only 40% of couples. No predictive factor of live birth was found. CONCLUSION Our study shows that in couples with secondary infertility after prior physiological delivery cigarette smoking is frequent in male partners, and ovarian reserve markers are altered. However, no statistically significant predictive factor of live birth after IVF treatment has been identified. Further large prospective studies are necessary.
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Affiliation(s)
- Kamila Kolanska
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France; INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 rue Chaligny, 75571 PARIS cedex 12, France.
| | - Jennifer Uddin
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Yohann Dabi
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Emmanuelle Mathieu d'Argent
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Charlotte Dupont
- INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 rue Chaligny, 75571 PARIS cedex 12, France; Service de biologie de la reproduction-CECOS, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Lise Selleret
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Cyril Touboul
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France; INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 rue Chaligny, 75571 PARIS cedex 12, France
| | - Jean-Marie Antoine
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Nathalie Chabbert-Buffet
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France; INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 rue Chaligny, 75571 PARIS cedex 12, France
| | - Emile Daraï
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France; INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 rue Chaligny, 75571 PARIS cedex 12, France
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12
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Boudy AS, Grausz N, Selleret L, Gligorov J, Thomassin-Naggara I, Touboul C, Daraï E, Cadranel J. Use of tyrosine kinase inhibitors during pregnancy for oncogenic-driven advanced non-small cell lung carcinoma. Lung Cancer 2021; 161:68-75. [PMID: 34543940 DOI: 10.1016/j.lungcan.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/16/2021] [Revised: 08/22/2021] [Accepted: 09/06/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Lung cancer associated with pregnancy is rare but on the increase. The use of tyrosine kinase inhibitor (TKI) therapy for advanced oncogenic-driven non-small cell lung carcinoma (NSCLC) has improved overall survival. Oncological and obstetric outcomes of patients diagnosed with NSCLC and treated by TKIs during pregnancy have been poorly evaluated. METHODS Three cases of NSCLC treated by TKIs during pregnancy were collected from the prospective database of the Cancer Associé à La Grossesse (CALG) network (France) in addition to eight cases identified by a systematic review performed between 2000 and 2021. RESULTS Among the eleven reported patients, six received an EGFR- and five an ALK-TKI. All patients were young nonsmokers and four had brain metastases at diagnosis. TKI treatment was initiated during the first trimester for three patients. Premature delivery was induced in 10/11 patients. Anamnios occurred in one patient treated by osimertinib and trastuzumab. Five newborns were hypotrophic. No newborn malformations were observed. Diffusion of the TKIs, confirmed by blood cord sampling, represented about 1/3 (EGFR-TKI) and 1/8 (ALK-TKI) of the maternal concentration. No developmental abnormalities were observed in the children (follow-up 30 months). The anti-tumor efficacy and tolerance of TKIs, when reported, appears similar to that described in the general population. CONCLUSIONS Our results support the rationale for using TKIs during pregnancy, both in terms of maternal NSCLC disease control and the relatively mild effects on the fetus. Our data will serve to better inform patients about the risks associated with TKIs used during pregnancy, contributing to shared decision making.
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Affiliation(s)
- Anne-Sophie Boudy
- Department of Gynaecology and Obstetrics, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France; Cancer Associé à La Grossesse (CALG), French National CALG Network, Sorbonne University, France.
| | - Noémie Grausz
- Department of Gynaecology and Obstetrics, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France; Cancer Associé à La Grossesse (CALG), French National CALG Network, Sorbonne University, France
| | - Joseph Gligorov
- Cancer Associé à La Grossesse (CALG), French National CALG Network, Sorbonne University, France; APHP Tenon, INSERM U938, IUC-UPMC, Sorbonne University, Paris, France
| | - Isabelle Thomassin-Naggara
- Cancer Associé à La Grossesse (CALG), French National CALG Network, Sorbonne University, France; APHP Tenon, INSERM U938, IUC-UPMC, Sorbonne University, Paris, France; Department of Radiology, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France; Cancer Associé à La Grossesse (CALG), French National CALG Network, Sorbonne University, France; APHP Tenon, INSERM U938, IUC-UPMC, Sorbonne University, Paris, France
| | - Emile Daraï
- Department of Gynaecology and Obstetrics, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France; Cancer Associé à La Grossesse (CALG), French National CALG Network, Sorbonne University, France; APHP Tenon, INSERM U938, IUC-UPMC, Sorbonne University, Paris, France
| | - Jacques Cadranel
- Department of Pulmonology and Thoracic Oncology, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Tenon and GRC 04 Theranoscan, Sorbonne Université, Paris 75970, France.
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13
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Dupont C, Didon S, Ciangura C, Selleret L, Bachelot A, Lévy R, Sermondade N. Impact of Bariatric Surgery-Induced Weight Loss on Ovarian Reserve in Women with Obesity: A Systematic Review. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2021.0030] [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: 11/13/2022] Open
Affiliation(s)
- Charlotte Dupont
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
- Sorbonne Université, Centre de Recherche Saint-Antoine, Paris, France
| | - Samia Didon
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
| | - Cécile Ciangura
- Service de Nutrition, Institute of Cardiometabolism and Nutrition, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris, France
| | - Lise Selleret
- Service de Gynécologie, Obstétrique et Médecine de la Reproduction, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
| | - Anne Bachelot
- Service d'Endocrinologie et Médecine de la Reproduction, IE3M, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Maladies Gynécologiques Rares, Institute of Cardiometabolism and Nutrition, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris, France
| | - Rachel Lévy
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
- Sorbonne Université, Centre de Recherche Saint-Antoine, Paris, France
| | - Nathalie Sermondade
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
- Sorbonne Université, Centre de Recherche Saint-Antoine, Paris, France
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Kolanska K, Dabi Y, Dechartres A, Cohen J, Ben Kraiem Y, Selleret L, Mathieu d'Argent E, Placais L, Cheloufi M, Johanet C, Rosefort A, Bornes M, Suner L, Delhommeau F, Ledée N, Chabbert Buffet N, Darai E, Antoine JM, Fain O, Kayem G, Mekinian A. Unexplained recurrent miscarriages: predictive value of immune biomarkers and immunomodulatory therapies for live birth. Am J Reprod Immunol 2021; 86:e13425. [PMID: 33772927 DOI: 10.1111/aji.13425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/02/2021] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Recurrent miscarriages are defined as three or more early miscarriages before 12 weeks of gestation. The aim of this study was to describe a cohort of women with unexplained recurrent miscarriages, evaluate several potential biomarkers of immune origin, and describe the outcome of pregnancies under immunomodulatory therapies. METHODS Women having a history of at least 3 early miscarriages without any etiology were recruited from 3 university hospitals. RESULTS Among 101 women with recurrent miscarriages, overall, 652 pregnancies have been included in the analysis. Women which experienced miscarriages were older (33.3 ± 5.4 versus 31.9 ± 6.7; p = 0.03), with history of more pregnancies (4 (2-6) versus 3.5 (1-5.75); p 0.0008), and less frequently the same partner (406 (74%) versus 79 (86%); p=0.01). There was no difference in the level and frequencies of biomarkers of immune origin (NK, lymphocyte, gamma globulins and blood cytokine levels and endometrial uNK activation status), except the higher rates of positive antinuclear antibodies in women with live birth (12 (13%) versus 36 (7%); p=0.03). Among the 652 pregnancies, 215 (33%) have been treated and received either aspirin/low weighted molecular heparin (LMWH) and/or combined to different lines of immunomodulatory treatment. Patients with pregnancy under treatment had a significantly higher rate of cumulative live birth rate than those with untreated ones (43.0% vs 34.8%; p = 0.04). When compared to patients with untreated pregnancies, patients with steroids during the pregnancy had twice more chances to obtain live birth (OR 2.0, CI95% 1.1 - 3.7, p = 0.02). CONCLUSIONS Unexplained recurrent miscarriages could have improved obstetrical outcome under immunomodulatory therapies and in particular steroids.
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Affiliation(s)
- Kamila Kolanska
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Yohann Dabi
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | | | - Jonathan Cohen
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Yasmine Ben Kraiem
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Lise Selleret
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Emmanuelle Mathieu d'Argent
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Leo Placais
- Sorbonne Université Service de Gynécologie Obstétrique, Hôpital Armand-Trousseau, Paris, France
| | | | - Catherine Johanet
- Sorbonne Université AP-HP, Hôpital Saint Antoine, Service d'Immunologie, Faculté de Médecine Sorbonne Université, Paris, France
| | - Audrey Rosefort
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Marie Bornes
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Ludovic Suner
- Sorbonne Université AP-HP, Hôpital Saint Antoine, Service d'Immunologie, Faculté de Médecine Sorbonne Université, Paris, France
| | - Francois Delhommeau
- Sorbonne Université AP-HP, Hôpital Saint Antoine, Service d'Immunologie, Faculté de Médecine Sorbonne Université, Paris, France
| | | | - Nathalie Chabbert Buffet
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Emile Darai
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Jean Marie Antoine
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Olivier Fain
- Sorbonne Université Service de Gynécologie Obstétrique, Hôpital Armand-Trousseau, Paris, France
| | - Gilles Kayem
- Sorbonne Université AP-HP, Hôpital Saint Antoine, Service de Hématologie biologique, Faculté de Médecine Sorbonne Université, Paris, France
| | - Arsène Mekinian
- Sorbonne Université Service de Gynécologie Obstétrique, Hôpital Armand-Trousseau, Paris, France.,Sorbonne Université AP-HP, Hôpital Saint Antoine, Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DMU I3, Faculté de Médecine Sorbonne Université, Paris, France
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15
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Kolanska K, Bendifallah S, Cohen J, Placais L, Selleret L, Johanet C, Suner L, Delhommeau F, Chabbert-Buffet N, Darai E, Antoine JM, Kayem G, Fain O, Mathieu d'Argent E, Mekinian A. Unexplained recurrent implantation failures: Predictive factors of pregnancy and therapeutic management from a French multicentre study. J Reprod Immunol 2021; 145:103313. [PMID: 33774529 DOI: 10.1016/j.jri.2021.103313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/01/2021] [Accepted: 03/17/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Recurrent implantation failure is defined as the absence of pregnancy after at least three transfers of good-quality embryos after in vitro fecundation/intracytoplasic sperm injection. AIM The aim of this study was to describe a multicentre cohort of women with unexplained RIF, to analyse the factors associated with clinical pregnancy and to evaluate the immunomodulatory therapies efficacy. METHODS Women were consecutively recruited from university departments with unexplained RIF. RESULTS Sixty-four women were enrolled with mean age 36 ± 3 years. The rates of clinical pregnancy in 64 women were compared in untreated and treated cycles and according to therapies used during the last prospectively followed embryo transfer. A clinical pregnancy after the transfer was noted in 56 % pregnancies on intralipids and in 50 % on prednisone, versus 5 % in untreated ones (p < 0.001). The 340 embryo transfers of these 64 women resulted in 68 clinical pregnancies and 18 live births. Clinical pregnancies were significantly more frequent in treated versus untreated embryo transfers (44 % vs 9 %; p < 0.001) with odds ratio at 8.13 (95 % CI 4.49-14.72, p < 0.0001). Cumulative pregnancy rates were higher for steroid-treated transfers than for untreated transfers when considering overall transfers before and after using steroids and also only those under steroids. Cumulative pregnancy rates were not different from steroid- and intralipid-treated embryo transfers CONCLUSIONS: In this multicentre study of women with unexplained RIF, use of immunomodulatory treatments before embryo transfer resulted in higher clinical pregnancy. Randomised, well-designed studies in well-defined population of RIF women are necessary to confirm our preliminary data.
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Affiliation(s)
- Kamila Kolanska
- Sorbonne Université, APHP, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, Faculté de Médecine Sorbonne Université, France
| | - Sofiane Bendifallah
- Sorbonne Université, APHP, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, Faculté de Médecine Sorbonne Université, France
| | - Jonathan Cohen
- Sorbonne Université, APHP, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, Faculté de Médecine Sorbonne Université, France
| | - Leo Placais
- Sorbonne Université, APHP, Service de Médecine Interne, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DMU i3), F-75012, Paris, France
| | - Lise Selleret
- Sorbonne Université, APHP, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, Faculté de Médecine Sorbonne Université, France
| | - Catherine Johanet
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service de Hématologie biologique, Faculté de Médecine Sorbonne Université, F-75012, Paris, France; France AP-HP, Hôpital Saint Antoine, Service d'Immunologie, Faculté de Médecine Sorbonne Université, F-75012, Paris, France
| | - Ludovic Suner
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service de Hématologie biologique, Faculté de Médecine Sorbonne Université, F-75012, Paris, France; France AP-HP, Hôpital Saint Antoine, Service d'Immunologie, Faculté de Médecine Sorbonne Université, F-75012, Paris, France
| | - Francois Delhommeau
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service de Hématologie biologique, Faculté de Médecine Sorbonne Université, F-75012, Paris, France; France AP-HP, Hôpital Saint Antoine, Service d'Immunologie, Faculté de Médecine Sorbonne Université, F-75012, Paris, France
| | - Nathalie Chabbert-Buffet
- Sorbonne Université, APHP, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, Faculté de Médecine Sorbonne Université, France
| | - Emile Darai
- Sorbonne Université, APHP, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, Faculté de Médecine Sorbonne Université, France
| | - Jean-Marie Antoine
- Sorbonne Université, APHP, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, Faculté de Médecine Sorbonne Université, France
| | - Gilles Kayem
- Sorbonne Université, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Trousseau, AP-HP, 26, rue du Docteur-Arnold-Netter, 75012, Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005, Paris, France; Inserm UMR 1153 équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique, Sorbonne Paris cité, 75005, Paris, France
| | - Olivier Fain
- Sorbonne Université, APHP, Service de Médecine Interne, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DMU i3), F-75012, Paris, France
| | - Emmanuelle Mathieu d'Argent
- Sorbonne Université, APHP, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, Faculté de Médecine Sorbonne Université, France
| | - Arsène Mekinian
- Sorbonne Université, APHP, Service de Médecine Interne, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DMU i3), F-75012, Paris, France.
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Vatel M, Torre A, Paillusson B, Scheffler F, Bergere M, Benkhalifa M, Le Martelot MT, Leperlier F, Mirallié S, Selleret L, Prades-Borio M, Neuraz A, Barraud-Lange V, Boissel N, Fortin A, Poirot C. Efficacy of assisted reproductive technology after ovarian tissue transplantation in a cohort of 11 patients with or without associated infertility factors. J Assist Reprod Genet 2021; 38:503-511. [PMID: 33389379 DOI: 10.1007/s10815-020-02033-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/02/2020] [Accepted: 12/10/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE IVF treatment in women with grafted frozen-thawed ovarian tissue is associated with poor reproductive outcomes. The aim of this study was to evaluate the efficacy of ovarian tissue transplantation (OTT) followed by assisted reproductive technology (ART) in women with or without associated infertility factors. METHODS This is a prospective cohort study with retrospective data collection including eleven women, four of whom having an infertility factor (IF), who had undergone OTT in one university center between 2005 and 2017, followed by ART in six in vitro fertilization (IVF) centers. RESULTS In total, 25 of the 85 cycles initiated (29%) were canceled, resulting in 60 oocyte retrievals. Ninety-five oocytes were retrieved: 36 were abnormal or immature, 29/39 fertilized (74%) after ICSI and 13/20 (65%) after IVF. Thirty-five embryos were transferred in seven patients (5/7 patients without IF and 2/4 patients with IF). After ART, one patient with IF experienced two pregnancies, one resulting in a live birth. For all patients, pregnancy rates and live birth rates were 7.4% and 3.7% per embryo transfer, respectively. Nine pregnancies and four live births occurred after spontaneous conception in five patients without IF, none in the infertility group. CONCLUSION This study confirms that IVF treatment in women with grafted frozen-thawed ovarian tissue is associated with poor outcomes. However, the chances of natural conception are high in women without IF. Patients with IF, without the possibility of spontaneous pregnancy, should be informed of poor reproductive outcomes after OTT followed by ART. TRIAL REGISTRATION NUMBER NCT02184806.
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Affiliation(s)
- M Vatel
- Department of Reproductive Medicine, Clinique de la Muette, 75116, Paris, France
| | - A Torre
- Division of Child Health, Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK
| | - B Paillusson
- Department of Reproductive Medicine, Poissy Saint-Germain-en-Laye Hospital, 78300, Poissy, France
| | - F Scheffler
- Department of Reproductive Medicine, Amiens Hospital, 80054, Amiens, France
| | - M Bergere
- Department of Reproductive Biology, Poissy Saint-Germain-en-Laye Hospital, 78300, Poissy, France
| | - M Benkhalifa
- Medicine and Reproductive Biology, University Hospital and School of Medicine, Picardy Jules Verne University, 80054, Amiens, France.,Peritox-INERIS, UMR-I 01, Joint Research Centre, Picardy Jules Verne University, 80054, Amiens, France
| | - M-T Le Martelot
- Department of Reproductive Medicine, Brest Hospital, 29200, Brest, France
| | - F Leperlier
- Department of Reproductive Medicine and Biology, Nantes Hospital, 44000, Nantes, France
| | - S Mirallié
- Department of Reproductive Medicine and Biology, Nantes Hospital, 44000, Nantes, France
| | - L Selleret
- Department of Gynecology and Obstetrics, Assistance Publique des Hôpitaux de Paris (AP-HP), Tenon Hospital, 75020, Paris, France
| | - M Prades-Borio
- Department of Reproductive Biology, Assistance Publique des Hôpitaux de Paris (AP-HP), Tenon Hospital, 75020, Paris, France
| | - A Neuraz
- Department of Gynecology and Obstetrics, Les Bluets Hospital, 75012, Paris, France
| | - V Barraud-Lange
- Department of Reproductive Biology, Assistance Publique-Hôpitaux de Paris (AP-HP), Cochin Hospital, 75014, Paris, France
| | - N Boissel
- Department of Hematology, Adolescents and Young Adults Unit, Fertility Preservation, Assistance Publique-Hôpitaux de Paris (AP-HP), Saint-Louis Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France.,Paris University, EA3518, 75006, Paris, France
| | - A Fortin
- Department of Obstetrics and Gynecology, Assistance Publique des Hôpitaux de Paris (AP-HP), Pitié-Salpétrière Hospital, 75013, Paris, France
| | - C Poirot
- Department of Hematology, Adolescents and Young Adults Unit, Fertility Preservation, Assistance Publique-Hôpitaux de Paris (AP-HP), Saint-Louis Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France. .,Médecine Sorbonne University, 75005, Paris, France.
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Kolanska K, Alijotas-Reig J, Cohen J, Cheloufi M, Selleret L, d'Argent E, Kayem G, Valverde EE, Fain O, Bornes M, Darai E, Mekinian A. Endometriosis with infertility: A comprehensive review on the role of immune deregulation and immunomodulation therapy. Am J Reprod Immunol 2020; 85:e13384. [PMID: 33278837 DOI: 10.1111/aji.13384] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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: 09/14/2020] [Accepted: 11/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Endometriosis is a multifactorial pathology dependent on intrinsic and extrinsic factors, but the immune deregulation seems to play a pivotal role. In endometriosis-associated infertility, this could raise the benefit of immunomodulatory strategies to improve the results of ART. In this review, we will describe (1) sera and peritoneal fluid cytokines and immune markers; (2) autoantibodies; and (3) immunomodulatory treatments in endometriosis with infertility. METHODS The literature research was conducted in MEDLINE, Embase, and Cochrane Library with the following keywords: "endometriosis", "unexplained miscarriage", "implantation failure", "recurrent implantation failure » and « IVF-ICSI », « biomarkers of autoimmunity", "TNF-α", "TNF-α antagonists", "infliximab", "adalimumab", "etanercept", "immunomodulatory treatment", "steroids", "intralipids", "intravenous immunoglobulins", "G-CSF", "pentoxyfylline". RESULTS Several studies analyzed the levels of pro-inflammatory cytokines in sera and peritoneal fluid of endometriosis-associated infertility, in particular TNF-α. Various autoantibodies have been found in peritoneal fluid and sera of infertile endometriosis women even in the absence of clinically defined autoimmune disease, as antinuclear, anti-SSA, and antiphospholipid autoantibodies. In few uncontrolled studies, steroids and TNF-α antagonists could increase the pregnancy rates in endometriosis-associated infertility, but well-designed trials are lacking. CONCLUSION Endometriosis is characterized by increased levels of cytokines and autoantibodies. This suggests the role of inflammation and immune cell deregulation in infertility associated with endometriosis. The strategies of immunomodulation to regulate these immune deregulations are poorly studied, and well-designed studies are necessary.
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Affiliation(s)
- Kamila Kolanska
- Sorbonne Université, AP-HP, Hôpital Tenon, service de Gynécologie-Obstétrique et Médecine de la Reproduction, Université Paris 06, Paris, France.,GRC-6 Centre Expert En Endométriose (C3E), Sorbonne Université, Paris, France
| | - Jaume Alijotas-Reig
- Department of Internal Medicine, Sant Joan de Deu Hospital, Althaia Healthcare University Network of Manresa, Barcelona, Spain
| | - Jonathan Cohen
- Sorbonne Université, AP-HP, Hôpital Tenon, service de Gynécologie-Obstétrique et Médecine de la Reproduction, Université Paris 06, Paris, France.,GRC-6 Centre Expert En Endométriose (C3E), Sorbonne Université, Paris, France
| | - Meryem Cheloufi
- Sorbonne Université, AP-HP, Hôpital Trousseau, service d'Obstétrique, Université Paris 06, Paris, France
| | - Lise Selleret
- Sorbonne Université, AP-HP, Hôpital Tenon, service de Gynécologie-Obstétrique et Médecine de la Reproduction, Université Paris 06, Paris, France.,GRC-6 Centre Expert En Endométriose (C3E), Sorbonne Université, Paris, France
| | - Emmanuelle d'Argent
- Sorbonne Université, AP-HP, Hôpital Tenon, service de Gynécologie-Obstétrique et Médecine de la Reproduction, Université Paris 06, Paris, France.,GRC-6 Centre Expert En Endométriose (C3E), Sorbonne Université, Paris, France
| | - Gilles Kayem
- Sorbonne Université, AP-HP, Hôpital Trousseau, service d'Obstétrique, Université Paris 06, Paris, France
| | - Enrique E Valverde
- Department of Internal Medicine, Sant Joan de Deu Hospital, Althaia Healthcare University Network of Manresa, Barcelona, Spain
| | - Olivier Fain
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, service de Médecine Interne and Inflammation, Paris, France
| | - Marie Bornes
- Sorbonne Université, AP-HP, Hôpital Tenon, service de Gynécologie-Obstétrique et Médecine de la Reproduction, Université Paris 06, Paris, France.,GRC-6 Centre Expert En Endométriose (C3E), Sorbonne Université, Paris, France
| | - Emile Darai
- Sorbonne Université, AP-HP, Hôpital Tenon, service de Gynécologie-Obstétrique et Médecine de la Reproduction, Université Paris 06, Paris, France.,GRC-6 Centre Expert En Endométriose (C3E), Sorbonne Université, Paris, France
| | - Arsene Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, service de Médecine Interne and Inflammation, Paris, France
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Boudy AS, Ferrier C, Selleret L, Zilberman S, Arfi A, Sussfeld J, Gligorov J, Richard S, Bendifallah S, Chabbert-Buffet N, Touboul C, Daraï E. Prognosis of HER2-positive pregnancy-associated breast cancer: Analysis from the French CALG (Cancer Associé à La Grossesse) network. Breast 2020; 54:311-318. [PMID: 33271423 PMCID: PMC7711283 DOI: 10.1016/j.breast.2020.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 09/10/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The prevalence of pregnancy-associated breast cancer is increasing. HER2-positive breast cancers typically have a poor prognosis. The objective of our study was to compare the prognosis of patients with HER2-positive breast cancer diagnosed during pregnancy (HER2-positive BCP) to young women diagnosed with HER2-positive breast cancer outside of pregnancy (HER2 non-BCP). METHODS Data of patients managed for invasive breast carcinoma between January 2005 and 2020 were retrospectively collected from the database of Tenon University Hospital (Paris, France), part of the "Cancer lié à la Grossesse" network. RESULTS Fifty-one patients with HER2-positive BCP were matched on age at diagnosis with 51 HER2-positive non-BCP patients. Locally advanced disease with axillary lymph node involvement were frequent. Tumors were frequently aggressive with high grade (p = 0.57) and high Ki67 (p = 0.15). Among the HER2-positive BCP patients, the mean term at diagnosis was 19.3 week of gestation (WG). Eighty-four percent of the patients continued their pregnancy with a mean term at delivery of 34.2WG. Chemotherapy modalities differed between the two groups: neoadjuvant chemotherapy was more frequent in the HER2-positive BCP group (p = 0.03) and adjuvant chemotherapy more frequent in the HER2 non-BCP group (p = 0.009). The recurrence rate was 10% (n = 5) and 18% (n = 9) in the HER2-positive BCP and HER2 non-BCP groups, respectively, p = 0.25. Breast cancer-free survival was poorer in the HER2-positive BCP group with earlier recurrence, p = 0.008. No difference in type of recurrence was found between the groups (p = 0.58). CONCLUSION This matched case-control study implies that patients with HER2-positive BCP still have a poorer prognosis than non-pregnant HER-positive patients.
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Affiliation(s)
- Anne-Sophie Boudy
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France.
| | - Clément Ferrier
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Sonia Zilberman
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Alexandra Arfi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Julie Sussfeld
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Joseph Gligorov
- Centre CALG (Cancer Associé à La Grossesse), France; Department of Oncology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; UMRS-938 4, Faculté de Médecine Sorbonne Université, France
| | - Sandrine Richard
- Centre CALG (Cancer Associé à La Grossesse), France; Department of Oncology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; UMRS-938 4, Faculté de Médecine Sorbonne Université, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 4, Faculté de Médecine Sorbonne Université, France
| | - Nathalie Chabbert-Buffet
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 4, Faculté de Médecine Sorbonne Université, France
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 4, Faculté de Médecine Sorbonne Université, France
| | - Emile Daraï
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 4, Faculté de Médecine Sorbonne Université, France
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Boudy AS, Zaccarini F, Selleret L, Arfi A, Guiggi I, Touboul C, Bendifallah S, Darai E. Oncological management of pregnancy-associated cancers: analysis from the French CALG (Cancer Associé à La Grossesse) network. Acta Oncol 2020; 59:1043-1050. [PMID: 32525429 DOI: 10.1080/0284186x.2020.1767300] [Citation(s) in RCA: 6] [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: 12/24/2022]
Abstract
Background: Pregnancy-associated cancers constitute a major medical challenge. The objective of this study was to describe their epidemiological, oncological and obstetrical outcomes from the French CALG (Cancer Associé à La Grossesse) network.Material and methods: Retrospective analysis of patients diagnosed with a cancer associated with pregnancy between January 2015 and December 2018 after advice from the CALG network.Results: Of 218 patients, 197 (90%) were diagnosed with a cancer during pregnancy and 21 the year following delivery. Requests to the CALG network increased from 36 cases in 2015 to 77 cases in 2018. The disease was diagnosed at local and regional stages in 77% of cases. Breast cancer was the most frequent (56%), followed by ovarian (12%) and uterine cervical cancers (10%). Of the 218 patients, 157 (72%) underwent a treatment during pregnancy. Surgery and chemotherapy during pregnancy were performed in 83 patients (83/218, 38%) and 101 patients (46%) at a median term of 17 (IQR 11-24) and 25 (IQR 18-30) WG, respectively. Eighteen (8.5%) of the women had a pregnancy termination, two (1%) an abortion, one (0.5%) a miscarriage, one (0.5%) had a stillbirth and one (0.5%) patient died during pregnancy. The remaining 174 patients (88%) were allowed to continue the pregnancy. Eight recurrences and four deaths were observed with a median follow-up time of 2.6 years (IQR 2.2-3.8).Conclusions: Our data further describe the incidence and management of pregnancy-associated cancers in western Europe allowing comparisons with other regions.
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Affiliation(s)
- Anne-Sophie Boudy
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France
- Centre CALG (Cancer Associé à La Grossesse), Paris, France
| | - François Zaccarini
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France
- Centre CALG (Cancer Associé à La Grossesse), Paris, France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France
- Centre CALG (Cancer Associé à La Grossesse), Paris, France
| | - Alexandra Arfi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France
- Centre CALG (Cancer Associé à La Grossesse), Paris, France
| | - Ilaria Guiggi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France
- Centre CALG (Cancer Associé à La Grossesse), Paris, France
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France
- Centre CALG (Cancer Associé à La Grossesse), Paris, France
- UMRS-938 4, Faculté de Médecine Sorbonne Université, Paris, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France
- Centre CALG (Cancer Associé à La Grossesse), Paris, France
- UMRS-938 4, Faculté de Médecine Sorbonne Université, Paris, France
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France
- Centre CALG (Cancer Associé à La Grossesse), Paris, France
- UMRS-938 4, Faculté de Médecine Sorbonne Université, Paris, France
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Plaçais L, Kolanska K, Kraiem YB, Cohen J, Suner L, Bornes M, Sedille L, Rosefort A, D'Argent EM, Selleret L, Abisror N, Johanet C, Buffet NC, Darai E, Antoine JM, Fain O, Kayem G, Mekinian A. Intralipid therapy for unexplained recurrent miscarriage and implantation failure: Case-series and literature review. Eur J Obstet Gynecol Reprod Biol 2020; 252:100-104. [PMID: 32592916 DOI: 10.1016/j.ejogrb.2020.06.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 05/09/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In retrospective cohort study of women with unexplained recurrent implantation failure (RIF) and miscarriage (RM), we analyzed the efficacy and safety of intralipid therapy to obtain a live birth. PATIENTS AND METHODS Women with unexplained RM and/or RIF were included from 2015 to 2018 from three French university hospitals. RESULTS Among 187 women treated for unexplained recurrent miscarriages and implantation failures, 26 women with median age of 36 years (29-43) received intralipid therapy. Among these 26 women, 10 women with a median age of 33 years (31-40) had a history of spontaneous recurrent miscarriages, with a median of 5 (4-8) previous miscarriages. Live births occurred in 7 (70 %) pregnancies under intralipids and were significantly more frequent than in women with recurrent miscarriages who did not receive intralipid therapy (n = 20, p = 0.02). Age, number of previous miscarriages, and additional therapies did not significantly differ between the two groups. Among the 26 included women, 16 had a history of recurrent implantation failures, with median age of 37 years (29-43) and median 9.5 (3-19) embryo transfers. Clinical pregnancy occurred in 9 (56 %) women receiving intralipids after embryo transfers under intralipids among which 5 (55 %) resulted in a live birth. Comparing successful pregnancies under intralipids with those with fetal loss, no significant differences have been noted. CONCLUSION Intralipids could be an effective and safe therapy in women with unexplained recurrent miscarriages and infertility.
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Affiliation(s)
- Léo Plaçais
- AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Faculté de Médecine Sorbonne Université, F-75012, Paris, France; Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France
| | - Kamilla Kolanska
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Tenon, service de gynécologie, obstétrique et PMA, Faculté de Médecine Sorbonne Université, F-75020, Paris, France
| | - Yasmine Ben Kraiem
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Tenon, service de gynécologie, obstétrique et PMA, Faculté de Médecine Sorbonne Université, F-75020, Paris, France
| | - Jonathan Cohen
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Tenon, service de gynécologie, obstétrique et PMA, Faculté de Médecine Sorbonne Université, F-75020, Paris, France
| | - Ludovic Suner
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Saint Antoine, service d'hématologie biologique, Faculté de Médecine Sorbonne Université, F-75012, Paris, France
| | - Marie Bornes
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Tenon, service de gynécologie, obstétrique et PMA, Faculté de Médecine Sorbonne Université, F-75020, Paris, France
| | - Lucie Sedille
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Trousseau, service de gynécologie, obstétrique, Faculté de Médecine Sorbonne Université, F-75012, Paris, France
| | - Audrey Rosefort
- AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Faculté de Médecine Sorbonne Université, F-75012, Paris, France
| | - Emmanuel Mathieu D'Argent
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Tenon, service de gynécologie, obstétrique et PMA, Faculté de Médecine Sorbonne Université, F-75020, Paris, France
| | - Lise Selleret
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Tenon, service de gynécologie, obstétrique et PMA, Faculté de Médecine Sorbonne Université, F-75020, Paris, France
| | - Noémie Abisror
- AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Faculté de Médecine Sorbonne Université, F-75012, Paris, France; Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France
| | - Catherine Johanet
- AP-HP, Hôpital Trousseau, service de gynécologie, obstétrique, Faculté de Médecine Sorbonne Université, F-75012, Paris, France
| | - Nathalie Chabbert Buffet
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Tenon, service de gynécologie, obstétrique et PMA, Faculté de Médecine Sorbonne Université, F-75020, Paris, France
| | - Emile Darai
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Tenon, service de gynécologie, obstétrique et PMA, Faculté de Médecine Sorbonne Université, F-75020, Paris, France
| | - Jean Marie Antoine
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Tenon, service de gynécologie, obstétrique et PMA, Faculté de Médecine Sorbonne Université, F-75020, Paris, France
| | - Olivier Fain
- AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Faculté de Médecine Sorbonne Université, F-75012, Paris, France; Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France
| | - Gilles Kayem
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Trousseau, service de gynécologie, obstétrique, Faculté de Médecine Sorbonne Université, F-75012, Paris, France
| | - Arsène Mekinian
- AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Faculté de Médecine Sorbonne Université, F-75012, Paris, France; Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France.
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21
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Dupont C, Aegerter P, Foucaut AM, Reyre A, Lhuissier FJ, Bourgain M, Chabbert-Buffet N, Cédrin-Durnerin I, Selleret L, Cosson E, Lévy R. Effectiveness of a therapeutic multiple-lifestyle intervention taking into account the periconceptional environment in the management of infertile couples: study design of a randomized controlled trial - the PEPCI study. BMC Pregnancy Childbirth 2020; 20:322. [PMID: 32456614 PMCID: PMC7251692 DOI: 10.1186/s12884-020-2855-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/24/2019] [Accepted: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infertility is defined as the inability to conceive after 12 months of unprotected intercourse. It affects approximately one in six couples seeking pregnancy in France or western countries. Many lifestyle factors of the couples' pre and peri-conceptional environment (weight, diet, alcohol, tobacco, coffee, drugs, physical activity, stress, sleep…) have been identified as risk factors for infertility in both males and females. The high prevalence rates of unhealthy diets and lifestyles in the reproductive population of industrialized countries are worrisome. Nevertheless, adoption of a healthy lifestyle may improve fertility but lifestyle changes are difficult to achieve and to maintain due notably to behavioral factors. METHODS Consequently, we decided to propose an interventional study aimed at improving the quality of life of infertile couples before the start of assisted reproductive technology treatment. It is a randomized controlled multicentre trial. Both members of the couples are involved in an integrated global care program (PEPCI for "Parcours Environnement PériConceptionnel en Infertilité") vs. usual care. This global intervention not only considers diet and/or physical activity but follows a holistic approach, including a multidisciplinary assessment to address complete physical, psychological and social well-being. According to patient needs, this includes interventions on weight, exercise, diet, alcohol and drugs, mental and social health. DISCUSSION The main objective of trial is to demonstrate that periconceptional multidisciplinary care has a positive impact on reproductive functions. We will also focus on feasibility, acceptance, compliance and conditions of success of a multifaceted lifestyle intervention. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov, Identifier: NCT02961907 on November 11, 2016.
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Affiliation(s)
- Charlotte Dupont
- Saint Antoine Research Center, INSERM équipe Lipodystrophies génétiques et acquises, Service de biologie de la reproduction-CECOS, AP-HP, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, F-75020, Paris, France.
| | - Philippe Aegerter
- Unité de Recherche Clinique et Département de Santé Publique, Assistance Publique - Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne, France.,UVSQ, UMR-S 1168 Université de Versailles Saint Quentin Paris Saclay, INSERM VIMA Aging and Chronic diseases, Epidemiological and Public Health approaches, Paris, France
| | - Aude-Marie Foucaut
- Université Sorbonne Paris Nord, Laboratoire Educations et Pratiques de Santé, LEPS, UR 3412, F-93017, Bobigny, France.,Département STAPS, Université Sorbonne Paris Nord, Bobigny, France
| | - Aymeric Reyre
- Department of Addiction Medicine and Psychiatry, APHP Avicenne University Hospital, Bobigny, France.,CESP-INSERM U1178, Villejuif, France
| | - François J Lhuissier
- Université Sorbonne Paris Nord, UMR INSERM 1272 Hypoxie et poumon, Bobigny, France.,Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Jean Verdier, Médecine de l'exercice et du sport, Bondy, France
| | - Marie Bourgain
- Department of Addiction Medicine and Psychiatry, APHP Avicenne University Hospital, Bobigny, France
| | - Nathalie Chabbert-Buffet
- Service de Gynécologie-Obstétrique et Médecine de La Reproduction, APHP Hôpital Tenon, 4 Rue de La Chine, 75020, Paris, France
| | - Isabelle Cédrin-Durnerin
- APHP Hôpital Jean verdier Service de médecine de la reproduction et préservation de la fertilité, avenue du 14-Juillet, 93143, Bondy, France
| | - Lise Selleret
- Service de Gynécologie-Obstétrique et Médecine de La Reproduction, APHP Hôpital Tenon, 4 Rue de La Chine, 75020, Paris, France
| | - Emmanuel Cosson
- Paris 13 University, Sorbonne Paris Cité, Assistance Publique - Hôpitaux de Paris, Avicenne Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France.,Paris 13 University, Sorbonne Paris Cité, UMR U557 INSERM/U11125 INRA/CNAM/Université Paris13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
| | - Rachel Lévy
- Saint Antoine Research Center, INSERM équipe Lipodystrophies génétiques et acquises, Service de biologie de la reproduction-CECOS, AP-HP, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, F-75020, Paris, France
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22
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Larouzee E, Allegre L, Boudy AS, Ilenko A, Selleret L, Zilberman S, Owen C, Gligorov J, Richard S, Thomassin-Naggara I, Chabbert-Buffet N, Darai E, Bendifallah S. Predicting the likelihood of recurrence of pregnancy-associated breast cancer: Nomogram based on analysis of the French cancer network: Cancer Associé à La Grossesse. J Gynecol Obstet Hum Reprod 2020; 50:101766. [PMID: 32325267 DOI: 10.1016/j.jogoh.2020.101766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/25/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Pregnancy associated breast cancer (PABC) are defined as breast cancer diagnosed during pregnancy and during the year following delivery. The prediction of poor prognosis events (PPE) such as recurrence is a major medical challenge of management for women with PABC. The aim of this study was to build a nomogram based on selected clinical and histological variables to predict recurrence. STUDY DESIGN This retrospective study included 96 patients with PABC from January 2002 to January 2018. A multivariate Cox analysis of selected risk factors was performed and a nomogram to predict recurrence was built. The nomogram was internally validated. RESULTS The overall recurrence rate was 22% (21/95) and the 3-years recurrence rate was 13% (12/95). Age at diagnosis, histological type, immuno-histological class, tumor stage (TNM), node stage (TNM) were associated with PPE in univariate analysis, and were included in the final Cox model to develop the nomogram. The predictive model had a concordance index of 0.83 (95% Confidence Interval (CI), 0.81-0.85) and 0.78 (95% CI, 0.76-0.80) before and after the 200 repetitions of bootstrap sample corrections, respectively, and showed a good calibration. CONCLUSION Our results support the use of the present nomogram based on 5 clinical and pathological characteristics to predict PPE in PABC with a high concordance. External validation is required to recommend this nomogram in routine practice.
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Affiliation(s)
- Elise Larouzee
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France.
| | - Lucie Allegre
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Anne-Sophie Boudy
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Anna Ilenko
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Sonia Zilberman
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Clémentine Owen
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Joseph Gligorov
- Centre CALG (Cancer Associé à La Grossesse), France; Department of Oncology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Sandrine Richard
- Centre CALG (Cancer Associé à La Grossesse), France; Department of Oncology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Nathalie Chabbert-Buffet
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 Sorbonne University, Paris, France
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 Sorbonne University, Paris, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 Sorbonne University, Paris, France
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23
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Puchar A, Boudy AS, Selleret L, Arfi A, Owen C, Bendifallah S, Darai E. Invasive and in situ cervical cancer associated with pregnancy: analysis from the French cancer network (CALG: Cancer Associé à La Grossesse). Clin Transl Oncol 2020; 22:2002-2008. [PMID: 32240504 DOI: 10.1007/s12094-020-02343-5] [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: 12/28/2019] [Accepted: 03/16/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the oncologic and obstetric outcomes of patients diagnosed with invasive cervical cancer (ICC) and in situ adenocarcinoma (ISA) during pregnancy or during the year following delivery. METHODS This retrospective observational study involved a cohort of 28 patients diagnosed with invasive cervical cancer (20 patients) or in situ adenocarcinoma (eight patients) during pregnancy or during the year following delivery who received expert opinion from physicians of the Cancer Associé à La Grossesse (CALG) network between 2005 and 2018. Descriptive results were expressed in median, range and interquartile range (IQR). RESULTS Between 2005 and 2018, 20 patients with ICC and eight with ISA received expert opinion from physicians of the CALG network. Both ICC and ISA were mostly diagnosed during pregnancy with a median term at diagnosis of 23.3 weeks of gestation (WG) for ICC and 7.3 WG for ISA. Overall, the median age at diagnosis for both ICC and ISA was 33 years. Most ICCs (n = 9) had FIGO stage ≥ IB2 and five underwent neoadjuvant chemotherapy at a median term of 22.5 WG. Seventeen patients with ICC underwent surgery. Three patients had medical termination of the pregnancy. Two patients experienced recurrence and three died. Median time of follow-up was 59.3 months (IQR 30.5-129.2). CONCLUSION Management of cervical cancer during pregnancy is challenging especially in terms of maternal outcomes with a relative poor prognosis requiring a multidisciplinary expert advice.
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Affiliation(s)
- A Puchar
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France. .,Centre CALG (Cancer Associé à La Grossesse), Paris, France.
| | - A S Boudy
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France.,Centre CALG (Cancer Associé à La Grossesse), Paris, France
| | - L Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France.,Centre CALG (Cancer Associé à La Grossesse), Paris, France
| | - A Arfi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France.,Centre CALG (Cancer Associé à La Grossesse), Paris, France
| | - C Owen
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France.,Centre CALG (Cancer Associé à La Grossesse), Paris, France
| | - S Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France.,Centre CALG (Cancer Associé à La Grossesse), Paris, France.,UMRS-938 4, Faculté de Médecine Sorbonne Université, Paris, France
| | - E Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France.,Centre CALG (Cancer Associé à La Grossesse), Paris, France.,UMRS-938 4, Faculté de Médecine Sorbonne Université, Paris, France
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24
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Le Guevelou J, Lebars S, Kammerer E, de Gabory L, Vergez S, Janot F, Baujat B, Righini C, Jegoux F, Dufour X, Merol JC, Mauvais O, Lasne-Cardon A, Selleret L, Thariat J. Head and neck cancer during pregnancy. Head Neck 2019; 41:3719-3732. [PMID: 31329334 DOI: 10.1002/hed.25877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/14/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The incidence of cancer during pregnancy is low but is slightly increasing. Data on incidence and etiology of head and neck (HN) cancers in pregnant women are rare. We evaluated the frequency, tumor type, associated factors, and specific biomarkers in HN cancers occurring in pregnant (and peripartum) women. METHODS A systematic literature search was performed on PubMed, for any HN tumor site occurring in pregnant women. RESULTS Sixty cases of HN cancers occurring during pregnancy were identified. Most of them were oral cavity cancers. Relationships with oncogenic viruses, hormonal disturbance, and shift in maternal immunity profile were identified. CONCLUSION Carcinogenesis of HN cancers in pregnant women may be led by different cancer type-specific hallmarks. Relevance of these etiological factors with respect to treatments and birth control recommendations is being investigated by the REFCOR in an ambispective study.
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Affiliation(s)
| | | | | | - Ludovic de Gabory
- Service de Chirurgie ORL, Centre Hospitalier Universitaire Pellegrin, Bordeaux, France
| | - Sebastien Vergez
- Service de Chirurgie ORL, Centre Hospitalier Universitaire Rangueil-Larrey, Toulouse, France
| | - François Janot
- Service de Chirurgie ORL, Centre Gustave Roussy, Villejuif, France
| | - Bertrand Baujat
- Service de Chirurgie ORL, Hopital Tenon, Université Paris-Est, Paris, France
| | - Christian Righini
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Franck Jegoux
- Service de Chirurgie ORL, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - Xavier Dufour
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Jean-Claude Merol
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Olivier Mauvais
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Audrey Lasne-Cardon
- Service de Chirurgie ORL Centre François Baclesse, Normandie Université-Unicaen, Caen, France
| | - Lise Selleret
- Service de Gynécologie Obstetrique, Hopital Tenon, Paris, France
| | - Juliette Thariat
- Service de Radiothérapie, Centre François Baclesse, Caen, France
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25
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Rousset-Jablonski C, Selle F, Adda-Herzog E, Planchamp F, Selleret L, Pomel C, Daraï E, Chabbert-Buffet N, Pautier P, Trémollières F, Guyon F, Rouzier R, Laurence V, Chopin N, Faure-Conter C, Bentivegna E, Vacher-Lavenu MC, Lhomme C, Floquet A, Treilleux I, Lecuru F, Gouy S, Kalbacher E, Genestie C, Thibault DLMR, Ferron G, Devouassoux M, Kurtz JE, Provansal M, Namer M, Joly F, Pujade-Lauraine E, Grynberg M, Querleu D, Morice P, Gompel A, Ray-Coquard I. Fertility preservation, contraception and menopause hormone therapy in women treated for rare ovarian tumours: guidelines from the French national network dedicated to rare gynaecological cancers. Eur J Cancer 2019; 116:35-44. [DOI: 10.1016/j.ejca.2019.04.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/04/2019] [Accepted: 04/10/2019] [Indexed: 12/14/2022]
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26
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De Garnier J, Boudy AS, Selleret L, Gligorov J, Chabbert-Buffet N, Bendifallah S, Darai E. [Expert centre Cancer du sein et Grossesse (CALG): Concordance between the proposed therapeutics and those finally received]. ACTA ACUST UNITED AC 2018; 47:36-43. [PMID: 30563785 DOI: 10.1016/j.gofs.2018.10.001] [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: 08/06/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Breast cancer associated with pregnancy (CSAG) is a rare condition whose management justifies the use of expert center. The Pregnancy-Associated Cancer Network (CALG) was created in France to optimize therapeutic management. The objective of our study was to evaluate its impact on the therapeutic management of CSAGs and the discrepancy rate between the CALG proposal and the treatment performed. METHOD A retrospective study including 58 CSAGs for which the opinion of the CALG network was solicited between January 2015 and November 2017. A questionnaire was addressed to the practitioner requesting the network. These practitioners were contacted to know the treatments received by the patient to assess the discrepancy rate. RESULTS In 70% of the cases, the CALG network was solicited before any therapeutic treatment. When the opinion was requested after initiation of therapy, the discrepancy rate between the CALG proposal and the one practiced was 47%. Of the 46 physicians contacted, the response rate was 62.5% (30/46). In 90% of cases, the therapy proposed by the CALG network was the one received by the patient. CONCLUSION This study emphasizes the need to refer to an expert center before treatment of a CSAG and the need for the contribution of doctors requesting the expert center to inform them of the follow-up of patients and children.
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Affiliation(s)
- J De Garnier
- Service de gynécologie obstétrique, centre Cancer associé à la grossesse (CALG), hôpital Tenon, université Pierre-et-Marie-Curie Paris VI, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A S Boudy
- Service de gynécologie obstétrique, centre Cancer associé à la grossesse (CALG), hôpital Tenon, université Pierre-et-Marie-Curie Paris VI, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - L Selleret
- Service de gynécologie obstétrique, centre Cancer associé à la grossesse (CALG), hôpital Tenon, université Pierre-et-Marie-Curie Paris VI, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - J Gligorov
- Service d'oncologie médicale, hôpital Tenon, université Pierre-et-Marie-Curie Paris VI, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - N Chabbert-Buffet
- Service de gynécologie obstétrique, centre Cancer associé à la grossesse (CALG), hôpital Tenon, université Pierre-et-Marie-Curie Paris VI, AP-HP, 4, rue de la Chine, 75020 Paris, France; UMRS-938, faculté de médecine Pierre-et-Marie-Curie, site Saint-Antoine, 27, rue Chaligny, 75571 Paris cedex 12, France
| | - S Bendifallah
- Service de gynécologie obstétrique, centre Cancer associé à la grossesse (CALG), hôpital Tenon, université Pierre-et-Marie-Curie Paris VI, AP-HP, 4, rue de la Chine, 75020 Paris, France; UMRS-938, faculté de médecine Pierre-et-Marie-Curie, site Saint-Antoine, 27, rue Chaligny, 75571 Paris cedex 12, France
| | - E Darai
- Service de gynécologie obstétrique, centre Cancer associé à la grossesse (CALG), hôpital Tenon, université Pierre-et-Marie-Curie Paris VI, AP-HP, 4, rue de la Chine, 75020 Paris, France; UMRS-938, faculté de médecine Pierre-et-Marie-Curie, site Saint-Antoine, 27, rue Chaligny, 75571 Paris cedex 12, France
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Kolanska K, Suner L, Cohen J, Ben Kraiem Y, Placais L, Fain O, Mathieu D’argent E, Daraï E, Chabbert-Buffet N, Antoine J, Kayem G, Mekinian A, Rosefort A, Bornes M, Selleret L, Delhommeau F, Féger F, Sédille L. Lymphocytes cytotoxiques Natural Killers et grands lymphocytes granuleux T sanguins dans les fausses couches et des échecs d’implantation à répétition inexpliquées. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.367] [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: 11/15/2022]
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Kolanska K, Dechartres A, Cohen J, Ben Kraiem Y, Selleret L, Mathieu D’argent E, Suner L, François D, Antoine J, Fain O, Kayem G, Mekinian A, Placais L, Rosefort A, Sedille L. Fausses couches ou/et échecs d’implantation répétés inexpliqués : étude prospective multicentrique. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.366] [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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Berveiller P, Mir O, Degrelle SA, Tsatsaris V, Selleret L, Guibourdenche J, Evain-Brion D, Fournier T, Gil S. Chemotherapy in pregnancy: exploratory study of the effects of paclitaxel on the expression of placental drug transporters. Invest New Drugs 2018; 37:1075-1085. [PMID: 30367323 DOI: 10.1007/s10637-018-0677-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 10/02/2018] [Indexed: 12/19/2022]
Abstract
Introduction The use of paclitaxel in pregnant cancer patients is feasible in terms of fetal safety, but little is known about the effects of paclitaxel on the placenta. Using three experimental models, we aimed to assess the effects of paclitaxel on the expression of placental drug transporters. Methods In the in vitro model (human primary trophoblast culture), trophoblasts were isolated from normal term placentas and subsequently exposed to paclitaxel. The transcriptional regulation of 84 genes encoding for drug transporters, and the protein expression of ABCB1/P-gp and ABCG2/BCRP were assessed. In the in vivo model, placental tissues isolated from pregnant cancer patients treated with paclitaxel were analyzed to assess the protein expression of ABCB1/P-gp and ABCG2/BCRP. The same parameters were assessed in extracts from human placental cotyledons perfused ex vivo with paclitaxel. Results In the in vitro model, the expression of twelve drug-transporters genes was found to be significantly down-regulated after exposure to paclitaxel, including ABCC10, SLC28A3, SLC29A2, and ATP7B (involved in the transport of taxanes, antimetabolites, and cisplatin, respectively). The protein expression of ABCB1/P-gp increased by 1.3-fold after paclitaxel administration. Finally, the protein expression of ABCB1/P-gp and ABCG2/BCRP was higher in cotyledons from mothers treated with multiple doses of paclitaxel during pregnancy than in cotyledons perfused with a single dose of paclitaxel. Discussion Paclitaxel modulates the expression of placental drug transporters involved in the disposition of various anticancer agents. Further studies will be needed to assess the impact of repeated or prolonged exposure to paclitaxel on the expression and function of placental drug transporters.
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Affiliation(s)
- Paul Berveiller
- INSERM, UMR-S1139, Paris, France.
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy Saint Germain, 10, rue du champ Gaillard, F78300, Poissy, France.
| | - Olivier Mir
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Séverine A Degrelle
- INSERM, UMR-S1139, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Vassilis Tsatsaris
- INSERM, UMR-S1139, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department of Obstetrics, Port-Royal Maternity, Cochin Teaching Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- PremUp Foundation, Paris, France
| | - Lise Selleret
- Department of Obstetrics and Gynecology, Tenon Teaching Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Jean Guibourdenche
- Department of Hormonal Biology, Cochin Teaching Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Danièle Evain-Brion
- INSERM, UMR-S1139, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- PremUp Foundation, Paris, France
| | - Thierry Fournier
- INSERM, UMR-S1139, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- PremUp Foundation, Paris, France
| | - Sophie Gil
- INSERM, UMR-S1139, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- PremUp Foundation, Paris, France
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Boudy AS, Naoura I, Selleret L, Zilberman S, Gligorov J, Richard S, Thomassin-Naggara I, Chabbert-Buffet N, Ballester M, Bendifallah S, Darai E. Propensity score to evaluate prognosis in pregnancy-associated breast cancer: Analysis from a French cancer network. Breast 2018; 40:10-15. [PMID: 29665447 DOI: 10.1016/j.breast.2018.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 01/31/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To compare the prognosis of pregnancy associated breast cancer occurring during pregnancy (BCP) to non-pregnancy associated breast cancers (non-BCP) in young women managed at a national expert center. METHODS Retrospective cohort study of a prospective database using propensity score matching (PSM) analysis with known prognostic factors. RESULTS We analyzed data of 49 patients with BCP and 104 with non-BCP diagnosed between 2002 and 2017 at Tenon University Hospital (Paris, France). The BCP tumors were often locally advanced (lymph node metastases in 59%), of high grade (55%) and highly proliferative (67% with Ki67 ≥ 20%). After PSM, breast cancer-free survival (p = 0.45) and breast cancer specific survival (p = 0.81) were similar in the two groups. The recurrence rate was 12% vs 18% (p = 0.45) and the death rate was 6% vs 8% (p = 0.74) for the BCP and non-BCP groups, respectively. No difference in recurrence type was observed between the groups (p = 0.60). CONCLUSIONS After PSM for known prognostic factors, the prognosis of BCP patients did not differ from that of young patients with non-BCP.
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Affiliation(s)
- Anne-Sophie Boudy
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France.
| | - Iptissem Naoura
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Sonia Zilberman
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Joseph Gligorov
- Centre CALG (Cancer Associé à La Grossesse), France; Department of Oncology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Sandrine Richard
- Centre CALG (Cancer Associé à La Grossesse), France; Department of Oncology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Nathalie Chabbert-Buffet
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 4. Faculté de Médecine Sorbonne Université, France
| | - Marcos Ballester
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 4. Faculté de Médecine Sorbonne Université, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 4. Faculté de Médecine Sorbonne Université, France
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Rousset-Jablonski C, Selle F, Adda-Herzog E, Planchamp F, Selleret L, Pomel C, Chabbert-Buffet N, Daraï E, Pautier P, Trémollières F, Guyon F, Rouzier R, Laurence V, Chopin N, Faure-Conter C, Bentivegna E, Vacher-Lavenu MC, Lhomme C, Floquet A, Treilleux I, Lecuru F, Gouy S, Kalbacher E, Genestie C, de la Motte Rouge T, Ferron G, Devouassoux-Shisheboran M, Kurtz JE, Namer M, Joly F, Pujade-Lauraine E, Grynberg M, Querleu D, Morice P, Gompel A, Ray-Coquard I. Préservation de la fertilité, contraception et traitement hormonal de la ménopause chez les femmes traitées pour tumeurs malignes rares de l’ovaire : recommandations du réseau national dédié aux cancers gynécologiques rares (TMRG/GINECO). Bull Cancer 2018; 105:299-314. [DOI: 10.1016/j.bulcan.2017.10.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/19/2017] [Accepted: 10/25/2017] [Indexed: 12/17/2022]
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Cohen J, Mathieu d’Argent E, Selleret L, Antoine JM, Chabbert-Buffet N, Bendifallah S, Ballester M, Darai E. Endométriose profonde et fertilité. Presse Med 2017; 46:1184-1191. [DOI: 10.1016/j.lpm.2017.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 11/25/2022] Open
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Kolanska K, Cohen J, Bendifallah S, Selleret L, Antoine JM, Chabbert-Buffet N, Darai E, d'Argent EM. Pregnancy outcomes after controlled ovarian hyperstimulation in women with endometriosis-associated infertility: GnRH-agonist versus GnRH-antagonist. J Gynecol Obstet Hum Reprod 2017; 46:681-686. [PMID: 28970135 DOI: 10.1016/j.jogoh.2017.09.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 03/12/2017] [Revised: 09/19/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND OR OBJECTIVE Endometriosis is common in women referred for infertility. In vitro fertilization provides good results but the choice of the best-controlled ovarian hyperstimulation protocol remains a subject of debate. The objective of this retrospective study was to compare pregnancy outcomes in women with endometriosis-associated infertility after COH with a long agonist protocol or a six-week oral contraception-antagonist protocol. MATERIAL AND METHODS Retrospective analysis of a prospective database identified 284 COH cycles - 165 with GnRH-agonist protocol (GnRH-agonist group) and 119 with GnRH-antagonist protocol (GnRH-antagonist group) - in 218 women, with endometriosis from January 2013 to October 2015. RESULTS No difference in the epidemiological characteristics was found between the groups. Per started cycle, pregnancy and live-birth rates after fresh embryo transfer were higher with the GnRH-agonist protocol (25% vs. 13%, P=0.02 and 18% vs. 8%, P=0.04, respectively). Considering analysis per cycle with embryo transfer, the pregnancy rate was similar in both groups while the live-birth rate was higher in the GnRH-agonist group (29% vs. 17%, P=0.053 and 22% vs. 10%, P=0.02, respectively). No difference was observed between the groups with freeze-thaw embryo transfer. Subgroup analysis (endometrioma alone, deep infiltrating endometriosis with and without endometrioma, endometriosis with and without adenomyosis) revealed no difference between the groups for either pregnancy or live-birth rates. CONCLUSION A GnRH-agonist protocol appears to result in higher pregnancy and live-birth rates after fresh embryo transfer in women with endometriosis-associated infertility, suggesting that a GnRH-antagonist protocol might negatively impact endometrial receptivity.
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Affiliation(s)
- K Kolanska
- Department of Gynecology and Obstetrics, Tenon Hospital, Assistance publique-Hôpitaux de Paris, Pierre-et-Marie-Curie University (UMPC)-Paris 6, 75020 Paris, France; UMRS-938, Pierre-et-Marie-Curie University-Paris 6, 75020 Paris, France; Clinical Research Group (GRC-6 UPMC): Centre expert en endométriose (C3E), Tenon Hospital, Pierre-et Marie-Curie-University (UMPC)-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - J Cohen
- Department of Gynecology and Obstetrics, Tenon Hospital, Assistance publique-Hôpitaux de Paris, Pierre-et-Marie-Curie University (UMPC)-Paris 6, 75020 Paris, France; UMRS-938, Pierre-et-Marie-Curie University-Paris 6, 75020 Paris, France; Clinical Research Group (GRC-6 UPMC): Centre expert en endométriose (C3E), Tenon Hospital, Pierre-et Marie-Curie-University (UMPC)-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France.
| | - S Bendifallah
- Department of Gynecology and Obstetrics, Tenon Hospital, Assistance publique-Hôpitaux de Paris, Pierre-et-Marie-Curie University (UMPC)-Paris 6, 75020 Paris, France; Clinical Research Group (GRC-6 UPMC): Centre expert en endométriose (C3E), Tenon Hospital, Pierre-et Marie-Curie-University (UMPC)-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - L Selleret
- Department of Gynecology and Obstetrics, Tenon Hospital, Assistance publique-Hôpitaux de Paris, Pierre-et-Marie-Curie University (UMPC)-Paris 6, 75020 Paris, France; Clinical Research Group (GRC-6 UPMC): Centre expert en endométriose (C3E), Tenon Hospital, Pierre-et Marie-Curie-University (UMPC)-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - J-M Antoine
- Department of Gynecology and Obstetrics, Tenon Hospital, Assistance publique-Hôpitaux de Paris, Pierre-et-Marie-Curie University (UMPC)-Paris 6, 75020 Paris, France; Clinical Research Group (GRC-6 UPMC): Centre expert en endométriose (C3E), Tenon Hospital, Pierre-et Marie-Curie-University (UMPC)-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - N Chabbert-Buffet
- Department of Gynecology and Obstetrics, Tenon Hospital, Assistance publique-Hôpitaux de Paris, Pierre-et-Marie-Curie University (UMPC)-Paris 6, 75020 Paris, France; UMRS-938, Pierre-et-Marie-Curie University-Paris 6, 75020 Paris, France; Clinical Research Group (GRC-6 UPMC): Centre expert en endométriose (C3E), Tenon Hospital, Pierre-et Marie-Curie-University (UMPC)-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - E Darai
- Department of Gynecology and Obstetrics, Tenon Hospital, Assistance publique-Hôpitaux de Paris, Pierre-et-Marie-Curie University (UMPC)-Paris 6, 75020 Paris, France; UMRS-938, Pierre-et-Marie-Curie University-Paris 6, 75020 Paris, France; Clinical Research Group (GRC-6 UPMC): Centre expert en endométriose (C3E), Tenon Hospital, Pierre-et Marie-Curie-University (UMPC)-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - E-M d'Argent
- Department of Gynecology and Obstetrics, Tenon Hospital, Assistance publique-Hôpitaux de Paris, Pierre-et-Marie-Curie University (UMPC)-Paris 6, 75020 Paris, France; Clinical Research Group (GRC-6 UPMC): Centre expert en endométriose (C3E), Tenon Hospital, Pierre-et Marie-Curie-University (UMPC)-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
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Boudy AS, Naoura I, Zilberman S, Gligorov J, Chabbert-Buffet N, Ballester M, Selleret L, Darai E. Arguments pour différencier les cancers du sein associés à la grossesse de ceux diagnostiqués dans le post-partum : expérience monocentrique du réseau cancer associé à la grossesse (CALG). Bull Cancer 2017; 104:574-584. [DOI: 10.1016/j.bulcan.2017.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/26/2017] [Accepted: 03/10/2017] [Indexed: 12/21/2022]
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Haddad S, Selleret L, Fedida B, Benjoar M, Beldjord S, Thomassin-Naggara I, Bazot M. Masses annexielles et grossesse : quelle imagerie et quels diagnostics ? Imagerie de la Femme 2017. [DOI: 10.1016/j.femme.2017.03.009] [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: 11/27/2022]
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Mounsambote L, Cohen J, Bendifallah S, d'Argent EM, Selleret L, Chabbert-Buffet N, Ballester M, Antoine JM, Daraï E. [Deep infiltrative endometriosis without digestive involvement, what is the impact of surgery on in vitro fertilization outcomes? A retrospective study]. ACTA ACUST UNITED AC 2017; 45:15-21. [PMID: 28238309 DOI: 10.1016/j.gofs.2016.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 09/02/2016] [Accepted: 11/18/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the impact of complete removal of endometriosis in case of deep infiltrative endometriosis without digestive involvement, on in vitro fertilization outcomes. METHODS Retrospective monocentric study. We included infertile women with deep infiltrative endometriosis without colorectal involvement that underwent IVF. Women were divided in two groups, following their history: "surgery" when they underwent complete endometriosis resection before IVF and "without surgery" when they underwent IVF without endometriosis removal. We analysed IVF outcomes considering pregnancy rates per cycle and cumulative pregnancy rates per patient. RESULTS We included 72 patients: 35 in the "surgery" group and 37 in the "without surgery" group. Women in the two groups were comparable in terms of baseline characteristics (age, body mass index, anti-Müllerian hormone, antral follicular count), endometriosis localizations and in vitro fertilization parameters. Cumulative pregnancy rates per patient were similar in both groups (40 % in the "surgery" group and 41 % in the "without surgery" group; P=1). Clinical pregnancy rate per cycle were also comparable groups (24 % in the "surgery" group and 28 % in the "without surgery" group; P=0.67). Surgery performed was comparable in women that became pregnant and in women that did not. Age was lower in women that became pregnant (P=0.01) and there were more pregnancy obtained in women under 35 years. CONCLUSION In women with deep infiltrative endometriosis without digestive involvement, in vitro fertilization outcomes were not impacted by surgery. Therapeutic choice between IVF or surgery as first-line treatment remains thus questionable and shall be guided by other influencing factors, such as pain symptomatology, age, tubal permeability, ovarian reserve, partner's sperm characteristics and woman's choice.
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Affiliation(s)
- L Mounsambote
- Department of Obstetrics, Gynecology and Reproductive Medicine, hôpital Tenon, GRC 6-UPMC centre expert en endométriose (C3E), université Pierre-et-Marie-Curie-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - J Cohen
- Department of Obstetrics, Gynecology and Reproductive Medicine, hôpital Tenon, GRC 6-UPMC centre expert en endométriose (C3E), université Pierre-et-Marie-Curie-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France; Inserm UMRS 938, université Pierre-et-Marie-Curie, 75012 Paris, France.
| | - S Bendifallah
- Department of Obstetrics, Gynecology and Reproductive Medicine, hôpital Tenon, GRC 6-UPMC centre expert en endométriose (C3E), université Pierre-et-Marie-Curie-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - E Mathieu d'Argent
- Department of Obstetrics, Gynecology and Reproductive Medicine, hôpital Tenon, GRC 6-UPMC centre expert en endométriose (C3E), université Pierre-et-Marie-Curie-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - L Selleret
- Department of Obstetrics, Gynecology and Reproductive Medicine, hôpital Tenon, GRC 6-UPMC centre expert en endométriose (C3E), université Pierre-et-Marie-Curie-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - N Chabbert-Buffet
- Department of Obstetrics, Gynecology and Reproductive Medicine, hôpital Tenon, GRC 6-UPMC centre expert en endométriose (C3E), université Pierre-et-Marie-Curie-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France; Inserm UMRS 938, université Pierre-et-Marie-Curie, 75012 Paris, France
| | - M Ballester
- Department of Obstetrics, Gynecology and Reproductive Medicine, hôpital Tenon, GRC 6-UPMC centre expert en endométriose (C3E), université Pierre-et-Marie-Curie-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France; Inserm UMRS 938, université Pierre-et-Marie-Curie, 75012 Paris, France
| | - J M Antoine
- Department of Obstetrics, Gynecology and Reproductive Medicine, hôpital Tenon, GRC 6-UPMC centre expert en endométriose (C3E), université Pierre-et-Marie-Curie-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - E Daraï
- Department of Obstetrics, Gynecology and Reproductive Medicine, hôpital Tenon, GRC 6-UPMC centre expert en endométriose (C3E), université Pierre-et-Marie-Curie-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France; Inserm UMRS 938, université Pierre-et-Marie-Curie, 75012 Paris, France
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Cohen J, Mounsambote L, Prier P, Mathieu d'ARGENT E, Selleret L, Chabbert-Buffet N, Delarouziere V, Levy R, Darai E, Antoine JM. Outcomes of first IVF/ICSI in young women with diminished ovarian reserve. Minerva Obstet Gynecol 2016; 69:315-321. [PMID: 28001021 DOI: 10.23736/s0026-4784.16.04003-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is no consensual definition of diminished ovarian reserve and the best therapeutic strategy has not yet been demonstrated. METHODS We performed a retrospective study to evaluate outcomes following a first in-vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) cycle in young women with diminished ovarian reserve. Women with tubal factor, endometriosis or previous stimulation cycle were excluded. We defined diminished ovarian reserve as women ≤38 years with an AMH ≤1.1 ng/mL or antral follicular count ≤7. RESULTS Among 59 IVF/ICSI cycles (40% IVF/60% ICSI), the pregnancy rate was 17% (10/59) and live birth rate 8.5% (5/59). Miscarriage rate was 50%. Baseline characteristics and IVF outcomes of the pregnant and not pregnant women were compared. No differences in age, antral follicular count, AMH, protocol used or number of harvested oocytes were found between the groups. A higher gonadotropin starting dose in the pregnancy group (397.5±87 IU vs. 314.8±103 IU; P=0.02) and a trend to a higher total dose received (4720±1349 IU vs. 3871±1367 IU; P=0.07) were noted. CONCLUSIONS The present study confirms that women with diminished ovarian reserve have low live birth rates after a first IVF-ICSI cycle and that a higher gonadotropin starting dose might be associated with better outcomes.
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Affiliation(s)
- Jonathan Cohen
- Department of Gynecology and Obstetrics, Endometriosis Expert Center, Tenon Hospital, Pierre et Marie Curie University, Paris, France - .,Université Pierre et Marie Curie, Paris, France -
| | - Leonisse Mounsambote
- Department of Gynecology and Obstetrics, Endometriosis Expert Center, Tenon Hospital, Pierre et Marie Curie University, Paris, France
| | - Perrine Prier
- Department of Gynecology and Obstetrics, Endometriosis Expert Center, Tenon Hospital, Pierre et Marie Curie University, Paris, France
| | - Emmanuelle Mathieu d'ARGENT
- Department of Gynecology and Obstetrics, Endometriosis Expert Center, Tenon Hospital, Pierre et Marie Curie University, Paris, France
| | - Lise Selleret
- Department of Gynecology and Obstetrics, Endometriosis Expert Center, Tenon Hospital, Pierre et Marie Curie University, Paris, France
| | - Nathalie Chabbert-Buffet
- Department of Gynecology and Obstetrics, Endometriosis Expert Center, Tenon Hospital, Pierre et Marie Curie University, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Vanina Delarouziere
- Department of Biology of Reproduction, Tenon Hospital, Pierre et Marie Curie University, Paris, France
| | - Rachel Levy
- Department of Biology of Reproduction, Tenon Hospital, Pierre et Marie Curie University, Paris, France
| | - Emile Darai
- Department of Gynecology and Obstetrics, Endometriosis Expert Center, Tenon Hospital, Pierre et Marie Curie University, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Jean-Marie Antoine
- Department of Gynecology and Obstetrics, Endometriosis Expert Center, Tenon Hospital, Pierre et Marie Curie University, Paris, France
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Cohen J, Ballester M, Selleret L, Mathieu D'Argent E, Antoine JM, Chabbert-Buffet N, Darai E. Finding the balance between surgery and medically-assisted reproduction in women with deep infiltrating endometriosis. Minerva Ginecol 2016; 68:642-652. [PMID: 27098393] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Deep infiltrating endometriosis (DIE) affects several anatomical locations including the bladder, torus uterinum, uterosacral ligament, rectovaginal septum and bowel. It is the most debilitating form of endometriosis and causes severe pain, digestive and urinary symptoms as well as infertility. Faced with an infertile woman suffering from DIE, the dilemma is whether to opt for first-line IVF treatment or for surgery. In the absence of high-level of evidence from randomized studies, several factors should be taken into account in the decision-making process. The main criterion is whether the patient wants in-vitro fertilization (IVF) treatment or not. Secondly, while previous reports have demonstrated the positive impact of surgery on pregnancy, they also underline the risk of severe complications requiring management in expert centers. Despite the availability of predictive models or scoring systems, the decision mainly boils down to the couple's characteristics. It seems logical to propose first-line IVF when spontaneous fertility is not possible due to associated male infertility or tubal obstruction; for women aged ≥35 years; or in women with diminished ovarian reserve. Conversely, first-line surgery could be the best option for women without these characteristics. However, this strategy is mainly based on low-level of evidence underlining the requiring of randomized trials.
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Affiliation(s)
- Jonathan Cohen
- Department of Gynecology, Obstetrics and Reproductive Medicine, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Pierre et Marie Curie Paris 6 University, GRC6-UPMC - Specialized Center for Endometriosis (C3E), Paris, France -
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Margulies AL, Selleret L, Zilberman S, Nagarra IT, Chopier J, Gligorov J, Berveiller P, Ballester M, Darai E, Chabbert-Buffet N. [Pregnancy after cancer: for whom and when?]. Bull Cancer 2015; 102:463-9. [PMID: 25917345 DOI: 10.1016/j.bulcan.2015.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/04/2015] [Indexed: 11/18/2022]
Abstract
Planning a pregnancy for patients with a history of cancer, including breast cancer, is a clinical situation that becomes more and more common. Several specific items are to be discussed: decrease of fertility after cancer treatment, fertility preservation options, impact of pregnancy on cancer recurrence risk and appropriate interval between cancer and pregnancy. Programming pregnancy after cancer is doable in a multidisciplinary setting, and begins at cancer diagnosis to anticipate the various specific pitfalls. Favor adequate oncologic care remains the leading rule.
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Affiliation(s)
- Anne Laure Margulies
- AP-HP, hôpital Bichat, département de gynécologie obstétrique médecine de la reproduction, 75018 Paris, France
| | - Lise Selleret
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, département de gynécologie obstétrique médecine de la reproduction, 75020 Paris, France; Réseau INCA cancers associés à La grossesse (CALG), 75020 Paris, France
| | - Sonia Zilberman
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, département de gynécologie obstétrique médecine de la reproduction, 75020 Paris, France; Réseau INCA cancers associés à La grossesse (CALG), 75020 Paris, France
| | | | | | - Joseph Gligorov
- Hôpital Tenon, service d'oncologie médicale, 75020 Paris, France
| | - Paul Berveiller
- Réseau INCA cancers associés à La grossesse (CALG), 75020 Paris, France; AP-HP, hôpital Trousseau, département de gynécologie obstétrique, 75012 Paris, France
| | - Marcos Ballester
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, département de gynécologie obstétrique médecine de la reproduction, 75020 Paris, France; Réseau INCA cancers associés à La grossesse (CALG), 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, UMRS-938, 75005 Paris, France
| | - Emile Darai
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, département de gynécologie obstétrique médecine de la reproduction, 75020 Paris, France; Réseau INCA cancers associés à La grossesse (CALG), 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, UMRS-938, 75005 Paris, France
| | - Nathalie Chabbert-Buffet
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, département de gynécologie obstétrique médecine de la reproduction, 75020 Paris, France; Réseau INCA cancers associés à La grossesse (CALG), 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, UMRS-938, 75005 Paris, France.
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Berveiller P, Selleret L, Mir O. Drug selection and dosing in pregnant cancer patients: insights from clinical pharmacokinetics. Ann Oncol 2014; 25:1869-1870. [DOI: 10.1093/annonc/mdu376] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Rouzier R, Selleret L, Uzan S, Chabbert-Buffet N, Uzan C, Daraï E. Structuration nationale pour la prise en charge des cancers en cours de grossesse: réseau CALG. ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2282-x] [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: 10/26/2022]
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Bonneau C, Maulard A, Vanlemmens L, Selleret L, Rouzier R. Cancers du sein associés à la grossesse. ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2280-z] [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: 10/26/2022]
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Maulard A, Bonneau C, Selleret L, Atallah D, Rouzier R. [Cancer and pregnancy]. Rev Prat 2012; 62:954-959. [PMID: 23236867] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
To diagnose cancer during pregnancy is a terrible event for the patient and her family and a complex situation for physicians. The management of this clinical situation should be as standardized as possible, most similar to management that would be offered without pregnancy. Except in rare cases, termination of pregnancy is not justified by the cancer itself, because it does not improve the prognosis. Hormone therapy, targeted therapy, chemotherapy in the first trimester, and radiotherapy are most of the time contra-indicated. During the 2nd and 3rd trimesters, management will follow the usual recommendations with surgery and chemotherapy. The delivery term depends on the date of discovery of cancer but is beyond 35 weeks of gestation in the majority of cases. It is at best scheduled between the oncologist and obstetrician to minimize fetal or obstetrical risks. A network exists to help physicians and patients: www.cancer-et-grossesse.fr.
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Affiliation(s)
- Amandine Maulard
- Université Pierre-et-Marie-Curie Paris-6, hôpital Tenon, gynécologie-obstétrique et médecine de la reproduction, 75970 Paris Cedex 20, France
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Genin AS, Lesieur B, Gligorov J, Antoine M, Selleret L, Rouzier R. Pregnancy-associated breast cancers: do they differ from other breast cancers in young women? Breast 2012; 21:550-5. [PMID: 22698618 DOI: 10.1016/j.breast.2012.05.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 03/22/2012] [Accepted: 05/06/2012] [Indexed: 11/28/2022] Open
Abstract
The impact of pregnancy in the physiopathology of pregnancy-associated breast cancer (PABC) is still unclear. We compared the characteristics of PABCs and breast cancers not associated with pregnancy (non-PABCs) in terms of their loco-regional invasion and histological phenotype. We conducted a retrospective chart review on women less than 43 years of age treated for breast cancer from January 1, 2004 to December 31, 2010. We compared age at diagnosis, loco-regional invasion and histological data. We recorded 282 breast cancers in 276 patients. Forty-one tumors (14.5%) were PABCs. PABC patients were significantly younger than non-PABC patients. Compared with the non-PABCs, PABCs were twice more frequent advanced tumors (T3-4) and have twice more frequent HER2 over-expression and hormone negative status. The more aggressive histological profile observed in the PABCs, especially in post-partum tumors and women older than 35 years of age, seems to be a direct consequence of the association with pregnancy.
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Affiliation(s)
- Anne-Sophie Genin
- Department of Obstetrics and Gynecology, Tenon University Hospital, 4 rue de Chine, 75020 Paris, France.
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Rouzier R, Werkoff G, Uzan C, Mir O, Gligorov J, Selleret L, Goffinet F, Goldwasser F, Treluyer JM, Uzan S, Delaloge S. Pregnancy-associated breast cancer is as chemosensitive as non-pregnancy-associated breast cancer in the neoadjuvant setting. Ann Oncol 2011; 22:1582-1587. [PMID: 21242588 DOI: 10.1093/annonc/mdq642] [Citation(s) in RCA: 19] [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: 11/15/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the chemosensitivity of pregnancy-associated breast cancer (PABC) in the neoadjuvant setting by comparing the observed pathological complete response (pCR) rate with the rate predicted by a validated nomogram. METHODS Data from 48 PABC patients who received neoadjuvant chemotherapy (NACT) were collected. To predict the response rate to chemotherapy, we used well-calibrated logistic regression-based nomograms to calculate individual probability of pCR. RESULTS Observed rates of pCR were concordant with predictions in the whole sample and in the analyzed subgroups. For the whole sample, the area under the receiver-operated curve (AUC) was 0.77 (95% CI 0.66-0.87). The calibration of predicted and observed probabilities was excellent. In the subgroup analyses (NACT initiated during pregnancy or postpartum, NACT with only anthracycline or both anthracycline and taxanes), discriminations assessed by AUC were significantly above 0.5, except for patients treated with anthracycline only. The interpretation was limited by a lack of power. CONCLUSION Through the use of nomograms, our study demonstrates that PABC is as chemosensitive as non-PABC and suggests that taxanes should be part of the NACT regimen for PABC. Further studies are warranted to increase the power of the presented data.
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Affiliation(s)
- R Rouzier
- CALG (Cancers Associés à La Grossesse) Network; Department of Obstetrics and Gynecology, Hôpital Tenon, Assistance Publique Hôpitaux de Paris; University Pierre et Marie Curie, Paris 6, INSERM-UMR S 938 and ER2- Prediction Unit (Pôle GYNORESP).
| | - G Werkoff
- Department of Obstetrics and Gynecology, Hôpital Tenon, Assistance Publique Hôpitaux de Paris; University Pierre et Marie Curie, Paris 6, INSERM-UMR S 938 and ER2- Prediction Unit (Pôle GYNORESP)
| | - C Uzan
- CALG (Cancers Associés à La Grossesse) Network; Department of Surgical Oncology; Breast Cancer Unit, Institut Gustave Roussy, University Paris 11
| | - O Mir
- CALG (Cancers Associés à La Grossesse) Network; Department of Pharmacology; Department of Medical Oncology, Hôpital Cochin -Saint-Vincent de Paul, Assistance Publique-Hôpitaux de Paris; University Paris Descartes, Paris 5
| | - J Gligorov
- CALG (Cancers Associés à La Grossesse) Network; Medical Oncology, Hôpital Tenon, Assistance Publique Hôpitaux de Paris
| | - L Selleret
- CALG (Cancers Associés à La Grossesse) Network; Department of Obstetrics and Gynecology, Hôpital Tenon, Assistance Publique Hôpitaux de Paris
| | - F Goffinet
- CALG (Cancers Associés à La Grossesse) Network; University Paris Descartes, Paris 5; Obstetrics and Gynecology, Hôpital Cochin -Saint-Vincent de Paul, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - F Goldwasser
- Department of Medical Oncology, Hôpital Cochin -Saint-Vincent de Paul, Assistance Publique-Hôpitaux de Paris; University Paris Descartes, Paris 5
| | - J M Treluyer
- CALG (Cancers Associés à La Grossesse) Network; Department of Pharmacology; University Paris Descartes, Paris 5
| | - S Uzan
- CALG (Cancers Associés à La Grossesse) Network; Department of Obstetrics and Gynecology, Hôpital Tenon, Assistance Publique Hôpitaux de Paris; University Pierre et Marie Curie, Paris 6, INSERM-UMR S 938 and ER2- Prediction Unit (Pôle GYNORESP)
| | - S Delaloge
- CALG (Cancers Associés à La Grossesse) Network; Department of Surgical Oncology; Breast Cancer Unit, Institut Gustave Roussy, University Paris 11
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Bourdet-Tréfoux A, Genin AS, Mir O, Selleret L, Uzan S, Rouzier R. Cancer du sein associé à la grossesse : traitement. Imagerie de la Femme 2010. [DOI: 10.1016/j.femme.2010.07.002] [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]
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Guibaud L, Selleret L, Larroche JC, Buenerd A, Alias F, Gaucherand P, Des Portes V, Pracros JP. Abnormal Sylvian fissure on prenatal cerebral imaging: significance and correlation with neuropathological and postnatal data. Ultrasound Obstet Gynecol 2008; 32:50-60. [PMID: 18570201 DOI: 10.1002/uog.5357] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To illustrate and determine the significance of abnormal Sylvian fissure development (or abnormal operculization) in cases in which prenatal cerebral imaging is suggestive of underlying cortical dysplasia. METHODS This was a retrospective study of 15 fetuses at 24-34 weeks in which abnormal operculization was identified on prenatal cerebral imaging and for which follow-up data were available. The imaging findings were correlated to macro- and microscopic neuropathological data (n = 11) or to postnatal clinical and imaging findings (n = 4). RESULTS On microscopic examination of fetuses from 11 terminated pregnancies, abnormal operculization was associated with cortical dysplasia in four cases and the cortex was normal in seven. Abnormal operculization was associated with cortical dysplasia in only one of the four liveborn infants. Cases of abnormal Sylvian fissure development with normal cortical architecture were classified, according to associated anomalies of the central nervous system, into one of five groups: those with neural tube defects, microcephaly or frontal hypoplasia, glutaric aciduria, other cerebral abnormalities, and extracerebral anomalies. CONCLUSION Abnormal operculization on prenatal imaging does not systematically reflect underlying cortical dysplasia. It may be related to extracortical factors such as abnormal cerebral volume or other developmental anomalies of the central nervous system. An understanding of the significance of abnormal Sylvian fissure development could be useful in integrating its analysis into a more general one of the whole central nervous system.
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Affiliation(s)
- L Guibaud
- Imagerie Pédiatrique et Foetale, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon I, Lyon-Bron, France.
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Selleret L, Mathevet P. Diagnostic et prise en charge des lésions précancéreuses du col utérin pendant la grossesse. ACTA ACUST UNITED AC 2008; 37 Suppl 1:S131-8. [DOI: 10.1016/j.jgyn.2007.11.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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