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Jaafar E, Gaultier V, Wohrer H, Estevez JP, Gonthier C, Koskas M. Impact of sentinel lymph node mapping on survival in patients with high-risk endometrial cancer in the early stage: A matched cohort study. Int J Gynaecol Obstet 2024; 165:677-684. [PMID: 38226675 DOI: 10.1002/ijgo.15315] [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: 10/30/2023] [Accepted: 12/06/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE The aim of this study was to compare patient survival using sentinel lymph node (SLN) procedure and pelvic lymphadenectomy for stating early-stage high risk endometrial cancer. METHODS Patients who underwent surgery for early-stage high risk endometrial cancer between 2010 and 2017 were extracted from the incidence registry of the SEER program. We identified patients who underwent SLN mapping. Patients who initially underwent pelvic lymphadenectomy were selected as the comparison group. One-to-one matching was performed according to age, ethnicity, histology, extension and grade. The primary outcome was disease-specific survival. The secondary outcome was overall survival. RESULTS A total of 326 patients who underwent SLN mapping and 326 who underwent pelvic lymphadenectomy initially were included in the study. The three-year analysis did not find a significant difference between the SLN and lymphadenectomy groups on disease-specific survival probability (88.2% vs 82.7, P = 0.07) and on overall survival probability (82.7% vs 78.2%, P = 0.57). Patients who underwent SLN mapping had a lower mean number of lymph nodes removed (mean 3 vs 16, P < 0.001) and there was a higher rate of patients with positive pelvic lymph nodes (18% vs 14%, P = 0.04). Following adjustment for confounding factors, disease-specific survival did not vary according to the lymph node intervention performed (P = 0.056), but the SLN group had better overall survival than those in the lymphadenectomy group (P = 0.047). CONCLUSION The SLN technique was not associated with poorer disease-specific survival than pelvic lymphadenectomy even after adjustment. These results suggest that SLN is an acceptable and safe procedure in surgical staging for early-stage high-risk endometrial cancer.
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Affiliation(s)
- Eya Jaafar
- Gynecological Department, Bichat Hospital, Paris Diderot University, Paris, France
| | - Victor Gaultier
- Gynecological Department, Bichat Hospital, Paris Diderot University, Paris, France
- Gynecological Department, University Paris Cité, Paris, France
| | - Henri Wohrer
- Gynecological Department, Bichat Hospital, Paris Diderot University, Paris, France
- Gynecological Department, University Paris Cité, Paris, France
| | - Juan Pablo Estevez
- Gynecological Department, Bichat Hospital, Paris Diderot University, Paris, France
| | - Clementine Gonthier
- Gynecological Department, Bichat Hospital, Paris Diderot University, Paris, France
| | - Martin Koskas
- Gynecological Department, Bichat Hospital, Paris Diderot University, Paris, France
- Gynecological Department, University Paris Cité, Paris, France
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Grenot M, Vandenbroucke T, Bucau M, Koskas M. Quality of information and decision regrets during fertility-sparing management for atypical hyperplasia and endometrial cancer in a prospective cohort study. J Gynecol Obstet Hum Reprod 2024; 53:102722. [PMID: 38185245 DOI: 10.1016/j.jogoh.2024.102722] [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: 09/07/2023] [Revised: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To evaluate satisfaction with information, treatment, and decision regret during management to preserve fertility for atypical hyperplasia (AH) or endometrial cancer (EC). METHODS A cohort study with standardized management using chlormadinone acetate was established through a national referral centre between January 2013 and November 2019. During this period, a questionnaire was given to 136 patients aged 19 to 43 years who were followed for fertility preservation for AH or EC. The questionnaire included the validated EORTC-QLQ-INFO25, as well as questions from the validated EVAPIL questionnaire, the Treatment Satisfaction with Medicines Questionnaire, and the Decision Regret Scales concerning treatment tolerability and general satisfaction. The main outcomes measured were the quality and satisfaction with the information and treatment received and the decision regret. RESULTS 75 patients (55.1 %) responded to the questionnaire. Overall, patients were satisfied with the information received (median 75.0, range: 25-100) and thought it was helpful (median 100.0, range: 25-100). However, 54.7 % wished for more information. Most women (52.0 %) indicated that psychological support should be available. Patients who were less satisfied with the information received or wished to receive more information thought about stopping treatment more frequently. Decision regret was not related to treatment outcome (remission, hysterectomy, live birth), and 47 of the 56 patients who did not obtain a live birth did not regret fertility preservation. None of the nine patients who regretted fertility preservation obtained a live birth. Almost all the patients reported side effects. CONCLUSIONS Dedicated information tools that detail conservative treatment for AH and EC as well as its secondary effects should be provided to improve adherence to treatment and follow-up. Furthermore, psychological support should be systematically proposed.
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Affiliation(s)
- Marie Grenot
- Resident in Gynaecology-Obstetrics, Bichat University Hospital Paris University, 8 rue Georges Boisseau Clichy-La-Garenne, Paris 92110, France.
| | - Tineke Vandenbroucke
- Department of Obstetrics and Gynaecology, and Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Margot Bucau
- Pathology Department, Bichat-Claude Bernard Hospital, Paris, France
| | - Martin Koskas
- Resident in Gynaecology-Obstetrics, Bichat University Hospital Paris University, 8 rue Georges Boisseau Clichy-La-Garenne, Paris 92110, France
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Lavoue V, Raimond E, Ballester M, Carcopino X, Azais H, Kerbage Y, Koskas M, Lecointre L, Huchon C, Touboul C, Ouldamer L. [FRANCOGYN group: A brief history]. Gynecol Obstet Fertil Senol 2024; 52:51-54. [PMID: 37839793 DOI: 10.1016/j.gofs.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES Describing the constitution of the FRANCOGYN group (a national French research group in Oncological and Gynecological Surgery) and present its current and future development. METHODS Literature review using PUBMed database with the keyword "FRANCOGYN". OBJECTIVES Describing the constitution of the FRANCOGYN group (a national French research group in Oncological and Gynecological Surgery) and present its current and future development. RESULTS The FRANCOGYN group was formed in December 2015, bringing together over the years more than 17 gynecological and oncological surgical department in France. The group carries out clinical research on gynecological pelvic cancers by constituting retrospective cohorts. Its legitimacy allows it to lead or co-lead the drafting of recommendations for clinical practice in the field of gynecological cancers. It now offers prospective randomized research funded by national grants. CONCLUSION The FRANCOGYN network allows us to propose a national reflection on the surgical management of pelvic cancers in women, resulting in numerous international reference publications.
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Affiliation(s)
- Vincent Lavoue
- Service de gynécologie, Francen institut de recherche en santé, environnement et travail (Irset) - UMR_S 1085, site Hôpital Sud, CHU de Rennes, université de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France.
| | - Emilie Raimond
- Service de gynécologie, CHU de Reims, université de Reims, Reims, France
| | - Marcos Ballester
- Service de gynécologie, Diaconesses, Croix Saint-Simon, Paris, France
| | - Xavier Carcopino
- Service de gynécologie, université de Marseille, AP-HM, Marseille, France
| | - Henri Azais
- Service de gynécologie, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - Yohan Kerbage
- Service de gynécologie, université de Lille, Lille, France
| | - Martin Koskas
- Service de gynécologie, hôpital Bichat, AP-HP, Paris, France
| | - Lise Lecointre
- Service de gynécologie, CHU de Strasbourg, Strasbourg, France
| | - Cyrille Huchon
- Service de gynécologie, hôpital Lariboisière, AP-HP, Paris, France
| | - Cyril Touboul
- Service de gynécologie, hôpital Tenon (AP-HP.6) Paris, Sorbonne université, UMRS U938 : biologie et thérapie des cancers, Paris, France
| | - Lobna Ouldamer
- Service de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, université François-Rabelais, unité Inserm 1069, 2, boulevard Tonnelle, 37044 Tours, France
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Ouldamer L, Koskas M, Carcopino X. Evaluating the clinical impact of the 2023 FIGO staging for endometrial cancer: Complexities and considerations. Eur J Obstet Gynecol Reprod Biol 2023; 291:59-60. [PMID: 37832479 DOI: 10.1016/j.ejogrb.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023]
Affiliation(s)
- Lobna Ouldamer
- Department of Gynecology. CHRU de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François Rabelais University, Tours, France; INSERM Unit 1069, Tours, France.
| | - Martin Koskas
- Department of Gynecology and Obstetrics, APHP, Hôpital Bichat, Paris, France; Université Paris-Saclay, UVSQ, Unité de Recherche 7285, Risques Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale (RISCQ), Montigny-le-Bretonneux, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397 Marseille, France
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Aissaoui O, Phalippou J, Cordoba A, Azais H, Ouldamer L, Bolze PA, Ballester M, Huchon C, Mimoun C, Akladios C, Lecointre L, Raimond E, Graesslin O, Carcopino X, Lavoué V, Bendifallah S, Touboul C, Dabi Y, Canlorbe G, Koskas M, Chauvet P, Collinet P, Kerbage Y. Brachytherapy and surgery versus surgery alone for IB2 (FIGO 2018) cervical cancers: A FRANCOGYN study. Eur J Obstet Gynecol Reprod Biol 2023; 290:128-134. [PMID: 37788511 DOI: 10.1016/j.ejogrb.2023.09.021] [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: 05/27/2023] [Revised: 09/17/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Evaluation of the management by first brachytherapy followed by radical hysterectomy (Wertheim type) compared to radical hysterectomy alone (Wertheim type) for the treatment of IB2 cervical cancer. METHODS Data from women with histologically proven FIGO stage IB2 cervical cancer treated between April 1996 and December 2016 were retrospectively abstracted from twelve French institutions with prospectively maintained databases. RESULTS Of the 211 patients with FIGO stage IB2 cervical cancer without lymph node involvement included, 136 had surgical treatment only and 75 had pelvic lymph node staging and brachytherapy followed by surgery. The surgery-only group had significantly more adjuvant treatment (29 vs. 3; p = 0.0002). A complete response was identified in 61 patients (81%) in the brachytherapy group. Postoperative complications were comparable (63,2% vs. 72%, p = 0,19) and consisted mainly of urinary (36vs. 27) and digestive (31 vs 22) complications and lymphoceles (4 vs. 1). Brachytherapy had no benefit in terms of progression-free survival (p = 0.14) or overall survival (p = 0.59). However, for tumors of between 20 and 30 mm, preoperative brachytherapy improved recurrence-free survival (p = 0.0095) but not overall survival (p = 0.41). This difference was not observed for larger tumors in terms of either recurrence-free survival (p = 0.55) or overall survival (p = 0.95). CONCLUSION Our study found that preoperative brachytherapy had no benefit for stage IB2 cervical cancers in terms of recurrence-free survival or overall survival. For tumor sizes between 2 and 3 cm, brachytherapy improves progression-free survival mainly by reducing pelvic recurrences without improving overall survival.
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Affiliation(s)
- Othman Aissaoui
- CHU Lille, Service de chirurgie gynécologique, F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France.
| | - Jérôme Phalippou
- CHU Lille, Service de chirurgie gynécologique, F-59000 Lille, France.
| | - Abel Cordoba
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France.
| | - Henri Azais
- AP-HP.CUP, Service de chirurgie cancérologique gynécologique et du sein, Hôpital Européen Georges-Pompidou, Paris, France.
| | - Lobna Ouldamer
- Department of Gynaecology. CHRU de Tours. Hôpital Bretonneau. INSERM Unit, 1069, 2 boulevard Tonnellé 37044 TOURS, France.
| | - Pierre Adrien Bolze
- Department of Gynaecologic and Oncologic Surgery and Obstetrics, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Université Lyon 1, France.
| | - Marcos Ballester
- Department of Gynaecologic and Breast Surgery, Groupe Hospitalier Diaconesses Croix Saint Simon, 125 rue d'Avron, 75020 Paris, France.
| | - Cyrille Huchon
- APHP. Service de gynécologie & obstétrique, GH Saint-Louis Lariboisière-Fernand Widal, Hôpital Lariboisière, Université de Paris, 2, rue Ambroise Paré, 75010 Paris, France.
| | - Camille Mimoun
- APHP. Service de gynécologie & obstétrique, GH Saint-Louis Lariboisière-Fernand Widal, Hôpital Lariboisière, Université de Paris, 2, rue Ambroise Paré, 75010 Paris, France.
| | - Cherif Akladios
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Lise Lecointre
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Alix de Champagne Institute, Centre Hospitalier Universitaire, 45 rue Cognacq-Jay, 51092 Reims, France
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Alix de Champagne Institute, Centre Hospitalier Universitaire, 45 rue Cognacq-Jay, 51092 Reims, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397 Marseille, France.
| | - Vincent Lavoué
- Department of Gynaecology, CHU de Rennes, France; INSERM, 1242, COSS, Rennes, Université de Rennes 1, 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.
| | - Cyril Touboul
- 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.
| | - Yohann Dabi
- 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
| | - Geoffroy Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, Hôpital la Pitié Salpétrière, AP-HP Paris, France.
| | - Martin Koskas
- Department of Gynaecology and Obstetrics, Hôpital Bichat, AP HP, France.
| | - Pauline Chauvet
- Department of Gynaecology and Obstetrics, CHU de Clermont Ferrand, France
| | - Pierre Collinet
- CHU Lille, Service de chirurgie gynécologique, F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France.
| | - Yohan Kerbage
- CHU Lille, Service de chirurgie gynécologique, F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France.
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Wohrer H, Koual M, Bentivegna E, Benoit L, Metairie M, Bolze PA, Kerbage Y, Raimond E, Akladios C, Carcopino X, Canlorbe G, Uzan J, Lavoue V, Mimoun C, Huchon C, Koskas M, Costaz H, Margueritte F, Dabi Y, Touboul C, Bendifallah S, Ouldamer L, Delanoy N, Nguyen-Xuan HT, Bats AS, Azaïs H. Prognostic impact of cytoreductive surgery conducted with primary intent, versus cytoreductive surgery after neoadjuvant chemotherapy, in the management of patients with advanced epithelial ovarian cancers: a multicentre, propensity score-matched study from the FRANCOGYN group. BJOG 2023; 130:1511-1520. [PMID: 37165717 DOI: 10.1111/1471-0528.17524] [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: 02/10/2023] [Revised: 04/05/2023] [Accepted: 04/15/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To compare survival and morbidity rates between primary cytoreductive surgery (pCRS) and interval cytoreductive surgery (iCRS) for epithelial ovarian cancer (EOC), using a propensity score. DESIGN We conducted a propensity score-matched cohort study, using data from the FRANCOGYN cohort. SETTING Retrospective, multicentre study of data from patients followed in 15 French department specialized in the treatment of ovarian cancer. SAMPLE Patients included were those with International Federation of Gynaecology and Obstetrics (FIGO) stage III or IV EOC, with peritoneal carcinomatosis, having undergone CRS. METHODS The propensity score was designed using pre-therapeutic variables associated with both treatment allocation and overall survival (OS). MAIN OUTCOME MEASURES The primary outcome was OS. Secondary outcomes included recurrence-free survival (RFS), quality of CRS and other variables related to surgical morbidity. RESULTS A total of 513 patients were included. Among these, 334 could be matched, forming 167 pairs. No difference in OS was found (hazard ratio, HR = 0.8, p = 0.32). There was also no difference in RFS (median = 26 months in both groups) nor in the rate of CRS leaving no macroscopic residual disease (pCRS 85%, iCRS 81.4%, p = 0.76). The rates of gastrointestinal tract resections, stoma, postoperative complications and hospital stay were significantly higher in the pCRS group. CONCLUSIONS Analysis of groups of patients made comparable by propensity score matching showed no difference in survival, but lower postoperative morbidity in patients treated with iCRS.
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Affiliation(s)
- Henri Wohrer
- Department of Gynaecological Oncological and Breast Surgery, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Meriem Koual
- Department of Gynaecological Oncological and Breast Surgery, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
- INSERM UMR-S 1124, University of Paris Cité, Centre Universitaire des Saint-Père, Paris, France
| | - Enrica Bentivegna
- Department of Gynaecological Oncological and Breast Surgery, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Louise Benoit
- Department of Gynaecological Oncological and Breast Surgery, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
- INSERM UMR-S 1124, University of Paris Cité, Centre Universitaire des Saint-Père, Paris, France
| | - Marie Metairie
- Department of Gynaecological Oncological and Breast Surgery, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Pierre-Adrien Bolze
- Department of Gynecologic and Oncologic Surgery and Obstetrics, Lyon Sud University Hospital, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - Yohan Kerbage
- CHU Lille, Service de Chirurgie Gynécologique, Université Lille, Lille, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Cherif Akladios
- Department of Gynaecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, Marseille, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital, Paris, France
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, Paris, France
- University Institute of Cancer, Sorbonne University, Paris, France
| | - Jennifer Uzan
- Department of Obstetrics Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Creteil, France
| | - Vincent Lavoue
- Service de Gynécologie, INSERM 1242, Oncogenesis, Stress and Signaling, CRLC Eugène Marquis, Université de Rennes 1, Hopital Sud, CHU de Rennes, Rennes, France
| | - Camille Mimoun
- Service de Chirurgie Gynécologique - Université de Paris, Hôpital Lariboisière, Paris, France
| | - Cyrille Huchon
- Service de Chirurgie Gynécologique - Université de Paris, Hôpital Lariboisière, Paris, France
| | - Martin Koskas
- Division of Gynaecologic Oncology, Bichat University Hospital, Paris, France
| | - Hélène Costaz
- Department of Surgical Oncology, Georges-Francois Leclerc Centre, Dijon, France
| | - François Margueritte
- Department of Gynaecology, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye Site Hospitalier de Poissy, Poissy, France
| | - Yohann Dabi
- Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Lobna Ouldamer
- Department of Gynaecology, Hôpital Universitaire de Tours, Tours, France
| | - Nicolas Delanoy
- Institut du Cancer Paris CARPEM, Université de Paris Cité, Paris, France
- Department of Medical Oncology, AP-HP Centre, Hopital Européen Georges Pompidou, Paris, France
| | - Huyen-Thu Nguyen-Xuan
- Department of Gynaecological Oncological and Breast Surgery, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Anne-Sophie Bats
- Department of Gynaecological Oncological and Breast Surgery, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
- Institut du Cancer Paris CARPEM, Université de Paris Cité, Paris, France
- INSERM UMR-S 1147, Centre de Recherche des Cordeliers, University of Paris Cité, Paris, France
| | - Henri Azaïs
- Department of Gynaecological Oncological and Breast Surgery, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
- Institut du Cancer Paris CARPEM, Université de Paris Cité, Paris, France
- INSERM UMR-S 1147, Centre de Recherche des Cordeliers, University of Paris Cité, Paris, France
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Ben M’Barek I, Jauvion G, Vitrou J, Holmström E, Koskas M, Ceccaldi PF. DeepCTG® 1.0: an interpretable model to detect fetal hypoxia from cardiotocography data during labor and delivery. Front Pediatr 2023; 11:1190441. [PMID: 37397139 PMCID: PMC10311205 DOI: 10.3389/fped.2023.1190441] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Cardiotocography, which consists in monitoring the fetal heart rate as well as uterine activity, is widely used in clinical practice to assess fetal wellbeing during labor and delivery in order to detect fetal hypoxia and intervene before permanent damage to the fetus. We present DeepCTG® 1.0, a model able to predict fetal acidosis from the cardiotocography signals. Materials and methods DeepCTG® 1.0 is based on a logistic regression model fed with four features extracted from the last available 30 min segment of cardiotocography signals: the minimum and maximum values of the fetal heart rate baseline, and the area covered by accelerations and decelerations. Those four features have been selected among a larger set of 25 features. The model has been trained and evaluated on three datasets: the open CTU-UHB dataset, the SPaM dataset and a dataset built in hospital Beaujon (Clichy, France). Its performance has been compared with other published models and with nine obstetricians who have annotated the CTU-UHB cases. We have also evaluated the impact of two key factors on the performance of the model: the inclusion of cesareans in the datasets and the length of the cardiotocography segment used to compute the features fed to the model. Results The AUC of the model is 0.74 on the CTU-UHB and Beaujon datasets, and between 0.77 and 0.87 on the SPaM dataset. It achieves a much lower false positive rate (12% vs. 25%) than the most frequent annotation among the nine obstetricians for the same sensitivity (45%). The performance of the model is slightly lower on the cesarean cases only (AUC = 0.74 vs. 0.76) and feeding the model with shorter CTG segments leads to a significant decrease in its performance (AUC = 0.68 with 10 min segments). Discussion Although being relatively simple, DeepCTG® 1.0 reaches a good performance: it compares very favorably to clinical practice and performs slightly better than other published models based on similar approaches. It has the important characteristic of being interpretable, as the four features it is based on are known and understood by practitioners. The model could be improved further by integrating maternofetal clinical factors, using more advanced machine learning or deep learning approaches and having a more robust evaluation of the model based on a larger dataset with more pathological cases and covering more maternity centers.
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Affiliation(s)
- Imane Ben M’Barek
- Department of Gynecology Obstetrics, Assistance Publique des Hôpitaux de Paris -Beaujon, Clichy, France
- Health Simulation Department, iLumens, Université Paris Cité, Paris, France
| | | | - Juliette Vitrou
- Department of Gynecology Obstetrics, Assistance Publique des Hôpitaux de Paris -Beaujon, Clichy, France
| | - Emilia Holmström
- Department of Gynecology Obstetrics, Assistance Publique des Hôpitaux de Paris -Beaujon, Clichy, France
| | - Martin Koskas
- Department of Gynecology-Obstetrics and Reproduction, Assistance Publique des Hôpitaux de Paris -Bichat, Paris, France
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Martínez A, Chargari C, Kalbacher E, Gaillard AL, Leary A, Koskas M, Chopin N, Serre AA, Hardy-Bessard AC, Akladios C, Lecuru F. Recommandations pour la pratique clinique Nice/Saint-Paul-de-Vence 2022–2023 : prise en charge du cancer de l'endomètre localisé. Bull Cancer 2023; 110:6S20-6S33. [PMID: 37573036 DOI: 10.1016/s0007-4551(23)00331-4] [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] [Indexed: 08/14/2023]
Abstract
Recommendations for clinical practice, Nice/Saint-Paul-de-Vence 2022-2023: Management of localized endometrial cancer Endometrial cancer is the most frequent gynecological cancers in industrialized countries and its incidence increases. The newmolecularclassification allows determination of the risk of recurrence and helps orienting therapeutic management. Surgery remains the cornerstone of treatment. Minimally invasive approach must be preferred for stages I and II. Surgery includes hysterectomy with bilateral adnexectomy, sentinel lymph node biopsy even in high risk diseases and omentectomy for non-endometrioid tumors (except in case of clear cells tumors). Fertility preservation can be proposed in low grade, stage I tumors without myometrial involvement. In stage III/IV disease, lymph node debulking without totallymphadenectomy is indicated. In case of peritoneal carcinomatosis, first-line cytoreductive surgery is recommended if complete resection can be achieved. Adjuvant therapy is not recommended in low risk tumors. In intermediate risk tumors, curietherapy is indicated. In tumors with high-intermediate risk, curietherapy and external radiotherapy are indicated according to prognostic factors (stage II, lymphovascular invasion); adjuvant chemotherapy can be considered on a case-by-case basis. In high risk tumors, chemotherapy and external radiotherapy are recommended using a concomitant or sequential approach.
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Affiliation(s)
- Alejandra Martínez
- Département de chirurgie oncologique, institut Claudius-Regaud, institut universitaire du cancer Toulouse Oncopole, France; Centre de recherche en cancérologie de Toulouse, UMR 1037 INSERM, France.
| | - Cyrus Chargari
- Département d'oncologie-radiothérapie, hôpital de la Pitié Salpêtrière, France
| | - Elsa Kalbacher
- Département d'oncologie médicale, hôpital de Besançon, France
| | | | - Alexandra Leary
- Département d'oncologie médicale, institut Gustave-Roussy, France
| | - Martin Koskas
- Département de gynécologie-obstétrique, hôpital Bichat, France
| | - Nicolás Chopin
- Département de gynécologie-obstétrique, centre Léon-Bérard, France
| | | | | | - Chérif Akladios
- Département de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, France
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9
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Lombaers MS, Cornel KMC, Visser NCM, Bulten J, Küsters-Vandevelde HVN, Amant F, Boll D, Bronsert P, Colas E, Geomini PMAJ, Gil-Moreno A, van Hamont D, Huvila J, Krakstad C, Kraayenbrink AA, Koskas M, Mancebo G, Matías-Guiu X, Ngo H, Pijlman BM, Vos MC, Weinberger V, Snijders MPLM, van Koeverden SW, Haldorsen IS, Reijnen C, Pijnenborg JMA. Preoperative CA125 Significantly Improves Risk Stratification in High-Grade Endometrial Cancer. Cancers (Basel) 2023; 15:cancers15092605. [PMID: 37174070 PMCID: PMC10177432 DOI: 10.3390/cancers15092605] [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: 02/28/2023] [Revised: 04/03/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Patients with high-grade endometrial carcinoma (EC) have an increased risk of tumor spread and lymph node metastasis (LNM). Preoperative imaging and CA125 can be used in work-up. As data on cancer antigen 125 (CA125) in high-grade EC are limited, we aimed to study primarily the predictive value of CA125, and secondarily the contributive value of computed tomography (CT) for advanced stage and LNM. Patients with high-grade EC (n = 333) and available preoperative CA125 were included retrospectively. The association of CA125 and CT findings with LNM was analyzed by logistic regression. Elevated CA125 ((>35 U/mL), (35.2% (68/193)) was significantly associated with stage III-IV disease (60.3% (41/68)) compared with normal CA125 (20.8% (26/125), [p < 0.001]), and with reduced disease-specific-(DSS) (p < 0.001) and overall survival (OS) (p < 0.001). The overall accuracy of predicting LNM by CT resulted in an area under the curve (AUC) of 0.623 (p < 0.001) independent of CA125. Stratification by CA125 resulted in an AUC of 0.484 (normal), and 0.660 (elevated). In multivariate analysis elevated CA125, non-endometrioid histology, pathological deep myometrial invasion ≥50%, and cervical involvement were significant predictors of LNM, whereas suspected LNM on CT was not. This shows that elevated CA125 is a relevant independent predictor of advanced stage and outcome specifically in high-grade EC.
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Affiliation(s)
- Marike S Lombaers
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Radboud Institute of Health Sciences, 6525 GA Nijmegen, The Netherlands
| | - Karlijn M C Cornel
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Department of Obstetrics and Gynecology, Division Gynecologic Oncology, University of Toronto, Toronto, ON M5G 1E2, Canada
| | - Nicole C M Visser
- Department of Pathology, Eurofins PAMM, 5623 EJ Eindhoven, The Netherlands
| | - Johan Bulten
- Department of Pathology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | | | - Frédéric Amant
- Department of Oncology, KU Leuven, 3000 Leuven, Belgium
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute and Amsterdam University Medical Center, 1066 CX Amsterdam, The Netherlands
| | - Dorry Boll
- Department of Gynecology, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
| | - Peter Bronsert
- Institute of Pathology, University Medical Center, 79104 Freiburg, Germany
| | - Eva Colas
- Biomedical Research Group in Gynecology, Vall Hebron Institute of Research, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red Cáncer, 08193 Barcelona, Spain
| | - Peggy M A J Geomini
- Department of Obstetrics and Gynecology, Maxima Medical Centre, 5631 BM Veldhoven, The Netherlands
| | - Antonio Gil-Moreno
- Biomedical Research Group in Gynecology, Vall Hebron Institute of Research, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red Cáncer, 08193 Barcelona, Spain
- Department of Gynecology, Vall Hebron University Hospital, Centro de Investigación Biomédica en Red Cáncer, 08035 Barcelona, Spain
| | - Dennis van Hamont
- Department of Obstetrics and Gynecology, Amphia Hospital, Breda, 4818 CK Breda, The Netherlands
| | - Jutta Huvila
- Department of Pathology, University of Turku, 20500 Turku, Finland
| | - Camilla Krakstad
- Department of Obstetrics and Gynecology, Haukeland University Hospital, 5021 Bergen, Norway
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, 5020 Bergen, Norway
| | - Arjan A Kraayenbrink
- Department of Obstetrics and Gynaecology, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands
| | - Martin Koskas
- Department of Obstetrics and Gynecology, Bichat-Claude Bernard Hospital, 75018 Paris, France
| | - Gemma Mancebo
- Department of Obstetrics and Gynecology, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain
| | - Xavier Matías-Guiu
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, Centro de Investigación Biomédica en Red Cáncer, 25003 Lleida, Spain
| | - Huy Ngo
- Department of Obstetrics and Gynecology, Elkerliek Hospital, 5751 CB Helmond, The Netherlands
| | - Brenda M Pijlman
- Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, 5223 GZ 's-Hertogenbosch, The Netherlands
| | - Maria Caroline Vos
- Department of Obstetrics and Gynecology, Elisabeth-TweeSteden Hospital, 5000 LC Tilburg, The Netherlands
| | - Vit Weinberger
- Department of Gynecology and Obstetrics, University Hospital Brno, Faculty of Medicine, Masaryk University, 601 77 Brno, Czech Republic
| | - Marc P L M Snijders
- Department of Obstetrics and Gynecology, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
| | - Sebastiaan W van Koeverden
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Ingfrid S Haldorsen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, 5021 Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, 5021 Bergen, Norway
| | - Casper Reijnen
- Department of Radiation Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Johanna M A Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Radboud Institute of Health Sciences, 6525 GA Nijmegen, The Netherlands
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10
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Huchon C, Drioueche H, Koskas M, Agostini A, Bauville E, Bourdel N, Fernandez H, Fritel X, Graesslin O, Legendre G, Lucot JP, Panel P, Raiffort C, Giraudet G, Bussières L, Fauconnier A. Operative Hysteroscopy vs Vacuum Aspiration for Incomplete Spontaneous Abortion: A Randomized Clinical Trial. JAMA 2023; 329:1197-1205. [PMID: 37039805 PMCID: PMC10091175 DOI: 10.1001/jama.2023.3415] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/22/2023] [Indexed: 04/12/2023]
Abstract
Importance Vacuum aspiration is commonly used to remove retained products of conception in patients with incomplete spontaneous abortion. Scarring of the uterine cavity may occur, potentially impairing future fertility. A procedural alternative, operative hysteroscopy, has gained popularity with a presumption of better future fertility. Objective To assess the superiority of hysteroscopy to vacuum aspiration for subsequent pregnancy in patients with incomplete spontaneous abortion who intend to have future pregnancy. Design, Setting, and Participants The HY-PER randomized, controlled, single-blind trial included 574 patients between November 6, 2014, and May 3, 2017, with a 2-year duration of follow-up. This multicenter trial recruited patients in 15 French hospitals. Individuals aged 18 to 44 years and planned for surgery for an incomplete spontaneous abortion with plans to subsequently conceive were randomized in a 1:1 ratio. Interventions Surgical treatment by hysteroscopy (n = 288) or vacuum aspiration (n = 286). Main Outcomes and Measures The primary outcome was a pregnancy of at least 22 weeks' duration during 2-year follow-up. Results The intention-to-treat analyses included 563 women (mean [SD] age, 32.6 [5.4] years). All aspiration procedures were completed. The hysteroscopic procedure could not be completed for 19 patients (7%), 18 of which were converted to vacuum aspiration (8 with inability to completely resect, 7 with insufficient visualization, 2 with anesthetic complications that required a shortened procedure, 1 with equipment failure). One hysteroscopy failed due to a false passage during cervical dilatation. During the 2-year follow-up, 177 patients (62.8%) in the hysteroscopy group and 190 (67.6%) in the vacuum aspiration (control) group achieved the primary outcome (difference, -4.8% [95% CI, -13% to 3.0%]; P = .23). The time-to-event analyses showed no statistically significant difference between groups for the primary outcome (hazard ratio, 0.87 [95% CI, 0.71 to 1.07]). Duration of surgery and hospitalization were significantly longer for hysteroscopy. Rates of new miscarriages, ectopic pregnancies, Clavien-Dindo surgical complications of grade 3 or above (requiring surgical, endoscopic, or radiological intervention or life-threatening event or death), and reinterventions to remove remaining products of conception did not differ between groups. Conclusions and Relevance Surgical management by hysteroscopy of incomplete spontaneous abortions in patients intending to conceive again was not associated with more subsequent births or a better safety profile than vacuum aspiration. Moreover, operative hysteroscopy was not feasible in all cases. Trial Registration ClinicalTrials.gov Identifier: NCT02201732.
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Affiliation(s)
- Cyrille Huchon
- Department of Gynecology and Obstetrics, APHP, Hopital Lariboisière, University of Paris Cité, Paris, France
- Université Paris-Saclay, UVSQ, Unité de Recherche 7285, Risques Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale (RISCQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, CHI Poissy-St-Germain, Poissy CEDEX, France
| | - Hocine Drioueche
- Department of Clinical Research, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France
| | - Martin Koskas
- Université Paris-Saclay, UVSQ, Unité de Recherche 7285, Risques Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale (RISCQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, APHP, Hôpital Bichat, Paris, France
| | - Aubert Agostini
- Department of Gynecology and Obstetrics, Hôpital La Conception, Marseille CEDEX 5, France
| | - Estelle Bauville
- Department of Gynecology and Obstetrics, Rennes University Hospital, Rennes CEDEX 2, France
| | - Nicolas Bourdel
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand CEDEX 1, Faculty of Medicine, ISIT – Université d’Auvergne, Clermont-Ferrand, France
| | - Hervé Fernandez
- Department of Gynecology and Obstetrics, AP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, 94270, France
- Centre for Epidemiology and Population Health-INSERM U1018, Université Paris Sud, Le Kremlin Bicêtre, France
| | - Xavier Fritel
- Department of Gynecology and Obstetrics, CHU de Poitiers, Université de Poitiers, Faculté de Médecine et Pharmacie, Inserm CIC1402, Poitiers, France
| | - Olivier Graesslin
- Department of Gynecology and Obstetrics, Hôpital Alix de Champagne, CHU de Reims, Reims, France
| | - Guillaume Legendre
- Department of Gynecology and Obstetrics, CHU d’Angers, Angers CEDEX 01, France
| | - Jean-Philippe Lucot
- Department of Gynecology and Obstetrics, Hôpital Jeanne-de-Flandre, CHRU de Lille, Lille, France
| | - Pierre Panel
- Department of Gynecology and Obstetrics, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Cyril Raiffort
- Department of Gynecology and Obstetrics, APHP, Hôpital Louis Mourier, Département Hospitalier Universitaire Risque et Grossesse, Colombes, University of Paris Cité, Paris, France
| | - Géraldine Giraudet
- Department of Gynecology and Obstetrics, Hôpital Jeanne-de-Flandre, CHRU de Lille, Lille, France
| | - Laurence Bussières
- Clinical Unit Research/Clinic Investigation Center, Paris Descartes, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Arnaud Fauconnier
- Université Paris-Saclay, UVSQ, Unité de Recherche 7285, Risques Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale (RISCQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, CHI Poissy-St-Germain, Poissy CEDEX, France
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11
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Métairie M, Benoit L, Koual M, Bentivegna E, Wohrer H, Bolze PA, Kerbage Y, Raimond E, Akladios C, Carcopino X, Canlorbe G, Uzan J, Lavoué V, Mimoun C, Huchon C, Koskas M, Costaz H, Margueritte F, Dabi Y, Touboul C, Bendifallah S, Ouldamer L, Delanoy N, Nguyen-Xuan HT, Bats AS, Azaïs H. A Suggested Modification to FIGO Stage IV Epithelial Ovarian Cancer. Cancers (Basel) 2023; 15:706. [PMID: 36765667 PMCID: PMC9913138 DOI: 10.3390/cancers15030706] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
International Federation of Gynecology and Obstetrics (FIGO) staging classification for stage IV epithelial ovarian cancer (EOC) separates stages IVA (pleural effusion) and IVB (parenchymal and/or extra-abdominal lymph node metastases). We aimed to evaluate its prognostic impact and to compare survival according to the initial metastatic location. We conducted a multicenter study between 2000 and 2020, including patients with a FIGO stage IV EOC. Primary endpoint was overall survival (OS). The secondary endpoints were progression-free survival (PFS) and recurrence rates. We included 307 patients: 98 (32%) had FIGO stage IVA and 209 (68%) had FIGO stage IVB. The median OS and PFS of stage IVA patients were significantly lower than those of stage IVB patients (31 versus 45 months (p = 0.02) and 18 versus 25 months (p = 0.01), respectively). Recurrence rate was higher in stage IVA than IVB patients (65% versus 47% (p = 0.004)). Initial pleural involvement was a poor prognostic factor with a median OS of 35 months versus 49 months for patients without initial pleural involvement (p = 0.024). Patients with FIGO stage IVA had a worse prognosis than patients with FIGO stage IVB EOC. Pleural involvement appears to be relevant for predicting survival. We suggest a modification of the current FIGO staging classification.
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Affiliation(s)
- Marie Métairie
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological Oncological and Breast Surgery, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Louise Benoit
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological Oncological and Breast Surgery, Hôpital Européen Georges-Pompidou, 75015 Paris, France
- INSERM UMR-S 1124, University of Paris Cité, Centre Universitaire des Saints-Pères, 75006 Paris, France
| | - Meriem Koual
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological Oncological and Breast Surgery, Hôpital Européen Georges-Pompidou, 75015 Paris, France
- INSERM UMR-S 1124, University of Paris Cité, Centre Universitaire des Saints-Pères, 75006 Paris, France
| | - Enrica Bentivegna
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological Oncological and Breast Surgery, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Henri Wohrer
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological Oncological and Breast Surgery, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Pierre-Adrien Bolze
- Department of Gynaecologic and Oncologic Surgery and Obstetrics, Lyon Sud University Hospital, Hospices Civils de Lyon, Université Lyon 1, 69002 Lyon, France
| | - Yohan Kerbage
- CHU Lille, Department of Gynaecologic Surgery, University Lille, 59000 Lille, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, 51100 Reims, France
| | - Cherif Akladios
- Department of Gynaecology, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), University Avignon, CNRS, IRD, IMBE, UMR 7263, 13397 Marseille, France
| | - Geoffroy Canlorbe
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological and Breast Surgery and Oncology, Pitié-Salpêtrière, 75013 Paris, France
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France
- University Institute of Cancer, Sorbonne University, 75013 Paris, France
| | - Jennifer Uzan
- Department of Obstetrics Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France
| | - Vincent Lavoué
- Department of Gynaecological Surgery, INSERM U1085, équipe 8, CRLC Eugène Marquis, Université de Rennes 1, Hôpital Sud, CHU de Rennes, 35000 Rennes, France
| | - Camille Mimoun
- Department of Gynaecological Oncological and Breast Surgery—Université de Paris, Hôpital Lariboisière, 75010 Paris, France
| | - Cyrille Huchon
- Department of Gynaecological Oncological and Breast Surgery—Université de Paris, Hôpital Lariboisière, 75010 Paris, France
| | - Martin Koskas
- AP-HP (Assistance Publique des Hôpitaux de Paris), Division of Gynaecologic Oncology, Bichat University Hospital, 75018 Paris, France
| | - Hélène Costaz
- Department of Surgical Oncology, Georges-François Leclerc Centre, 21000 Dijon, France
| | - François Margueritte
- Department of Gynaecology, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-laye, Site Hospitalier de Poissy, 78498 Poissy, France
| | - Yohann Dabi
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecology ans Obstetrics, Hôpital Tenon, 75020 Paris, France
| | - Cyril Touboul
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecology ans Obstetrics, Hôpital Tenon, 75020 Paris, France
| | - Sofiane Bendifallah
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecology ans Obstetrics, Hôpital Tenon, 75020 Paris, France
| | - Lobna Ouldamer
- Department of Gynaecology, Hôpital Universitaire de Tours, 37000 Tours, France
| | - Nicolas Delanoy
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Medical Oncology, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Huyen-Thu Nguyen-Xuan
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological Oncological and Breast Surgery, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Anne-Sophie Bats
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological Oncological and Breast Surgery, Hôpital Européen Georges-Pompidou, 75015 Paris, France
- INSERM UMR-S 1147, University of Paris Cité, Centre de Recherche des Cordeliers, 75006 Paris, France
- Institut du Cancer Paris CARPEM, 75006 Paris, France
| | - Henri Azaïs
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological Oncological and Breast Surgery, Hôpital Européen Georges-Pompidou, 75015 Paris, France
- INSERM UMR-S 1147, University of Paris Cité, Centre de Recherche des Cordeliers, 75006 Paris, France
- Institut du Cancer Paris CARPEM, 75006 Paris, France
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12
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Martin FA, Dion L, Nyangoh Timoh K, Dupré PF, Azaïs H, Bendifallah S, Touboul C, Dabi Y, Graesslin O, Raimond E, Costaz H, Kerbage Y, Huchon C, Mimoun C, Koskas M, Akladios C, Lecointre L, Canlorbe G, Chauvet P, Ouldamer L, Levêque J, Lavoué V. Endometrial cancer of the very elderly: Management and survival in the Francogyn population. Eur J Surg Oncol 2023; 49:1023-1030. [PMID: 36707344 DOI: 10.1016/j.ejso.2023.01.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/14/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
INTRODUCTION We aimed to describe management and survival of patients with endometrial cancer (EC) ≥80 years to identify poor prognosis criteria. METHODS We collected clinical, histologic, surgical and follow-up data for patients with EC ≥ 80 years included in a multicenter French cohort (FRANCOGYN) who underwent primary surgical treatment from 1999 to 2019. The outcomes were overall survival (OS) and disease-free survival (DFS). We performed a descriptive analysis then a survival time analysis and comparison using the Kaplan Meier method and log-rank test. RESULTS Of the 1647 patients with EC who received treatment during the study period, 184 (11.17%) were ≥80 years. The mean age was 84 years (±3.34). Thirty-three patients (25.4%) died during the follow-up period and 26 relapsed (18.4%). Forty-nine patients were lost to follow-up (27.37%). The median follow-up time was 15.3 months (4.9-28.8). The median OS and DFS was 16.4 months (6.3-24.9) and 13.6 months (4.5-26.6), respectively. Eighty-three patients received adjuvant therapy (45.11%), out of 95 who had a formal or relative indication. Four patients received adjuvant chemotherapy (2.6%), out of 61 who had a formal or relative indication. Inappropriate or underuse of chemotherapy was significantly associated with a lower median OS of 12.6 months [3.73-24] versus 17.3 months [7.93-41.77] when performed appropriately (HR = 4.14, CI 95% [1.62-10.56]), and a lower median DFS of 10.83 months [3.73-24] versus 17.3 months [7.93-28.5] (HR = 9.04, CI 95% [2.04-40.12]). CONCLUSION Our results suggest that very elderly patients with EC should receive adjuvant chemotherapy according to the standard care guidelines.
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Affiliation(s)
| | - Ludivine Dion
- Gynecology Department of Rennes Teaching Hospital, France
| | | | | | - Henri Azaïs
- Gynecology Department of Georges Pompidou European Teaching Hospital, AP-HP, France
| | - Sofiane Bendifallah
- Sorbonne University, Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Paris, France; Clinical Research Group (GRC) Paris 6: Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France
| | - Cyril Touboul
- Sorbonne University, Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Paris, France; Clinical Research Group (GRC) Paris 6: Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France
| | - Yohann Dabi
- Sorbonne University, Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Paris, France; Clinical Research Group (GRC) Paris 6: Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France
| | | | - Emilie Raimond
- Gynecology Department of Reims Teaching Hospital, AP-HP, France
| | - Hélène Costaz
- Department of Surgical Oncology, Centre Georges François Leclerc, Comprehensive Cancer Center of Dijon, France
| | - Yohan Kerbage
- Gynecology Department of Lille Teaching Hospital, France
| | - Cyrille Huchon
- Gynecology Department of Lariboisiere Teaching Hospital, AP-HP, France
| | - Camille Mimoun
- Gynecology Department of Lariboisiere Teaching Hospital, AP-HP, France
| | - Martin Koskas
- Gynecology Department of Bichat Teaching Hospital, AP-HP, France
| | - Cherif Akladios
- Gynecology Department of Strasbourg Teaching Hospital, France
| | - Lise Lecointre
- Gynecology Department of Strasbourg Teaching Hospital, France
| | - Geoffroy Canlorbe
- Gynecology Department of La Pitié Salpétrière Teaching Hospital, AP-HP, France
| | - Pauline Chauvet
- Gynecology Department of Clermont Ferrand Teaching Hospital, AP-HP, France
| | - Lobna Ouldamer
- Gynecology Department of Tours Teaching Hospital, AP-HP, France
| | - Jean Levêque
- Gynecology Department of Rennes Teaching Hospital, France
| | - Vincent Lavoué
- Gynecology Department of Rennes Teaching Hospital, France.
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13
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Vrede SW, Hulsman AMC, Reijnen C, Van de Vijver K, Colas E, Mancebo G, Moiola CP, Gil-Moreno A, Huvila J, Koskas M, Weinberger V, Minar L, Jandakova E, Santacana M, Matias-Guiu X, Amant F, Snijders MPLM, Küsters-Vandevelde HVN, Bulten J, Pijnenborg JMA. The amount of preoperative endometrial tissue surface in relation to final endometrial cancer classification. Gynecol Oncol 2022; 167:196-204. [PMID: 36096975 DOI: 10.1016/j.ygyno.2022.08.016] [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: 03/28/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate whether the amount of preoperative endometrial tissue surface is related to the degree of concordance with final low- and high-grade endometrial cancer (EC). In addition, to determine whether discordance is influenced by sampling method and impacts outcome. METHODS A retrospective cohort study within the European Network for Individualized Treatment of Endometrial Cancer (ENITEC). Surface of preoperative endometrial tissue samples was digitally calculated using ImageJ. Tumor samples were classified into low-grade (grade 1-2 endometrioid EC (EEC)) and high-grade (grade 3 EEC + non-endometroid EC). RESULTS The study cohort included 573 tumor samples. Overall concordance between pre- and postoperative diagnosis was 60.0%, and 88.8% when classified into low- and high-grade EC. Upgrading (preoperative low-grade, postoperative high-grade EC) was found in 7.8% and downgrading (preoperative high-grade, postoperative low-grade EC) in 26.7%. The median endometrial tissue surface was significantly lower in concordant diagnoses when compared to discordant diagnoses, respectively 18.7 mm2 and 23.5 mm2 (P = 0.022). Sampling method did not influence the concordance in tumor classification. Patients with preoperative high-grade and postoperative low-grade showed significant lower DSS compared to patients with concordant low-grade EC (P = 0.039). CONCLUSION The amount of preoperative endometrial tissue surface was inversely related to the degree of concordance with final tumor low- and high-grade. Obtaining higher amount of preoperative endometrial tissue surface does not increase the concordance between pre- and postoperative low- and high-grade diagnosis in EC. Awareness of clinically relevant down- and upgrading is crucial to reduce subsequent over- or undertreatment with impact on outcome.
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Affiliation(s)
- S W Vrede
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands; Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands.
| | - A M C Hulsman
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
| | - C Reijnen
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, the Netherlands
| | - K Van de Vijver
- Department of Pathology, Ghent University Hospital, Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - E Colas
- Biomedical Research Group in Gynaecology, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
| | - G Mancebo
- Department of Obstetrics and Gynaecology, Hosepital del Mar, PSMAR, Barcelona, Spain
| | - C P Moiola
- Biomedical Research Group in Gynaecology, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
| | - A Gil-Moreno
- Gynaecological Department, Vall d'Hebron University Hospital, CIBERONC, Barcelona, Spain; Pathology Department, Vall d'Hebron University Hospital, CIBERONC, Barcelona, Spain
| | - J Huvila
- Department of Pathology, University of Turku, Turku, Finland
| | - M Koskas
- Obstetrics and Gynaecology Department, Bichat-Claude Bernard Hospital, Paris, France
| | - V Weinberger
- Department of Gynaecology and Obstetrics, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - L Minar
- Department of Gynaecology and Obstetrics, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - E Jandakova
- Institute of Pathology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - M Santacana
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, CIBERONC, Lleida, Spain
| | - X Matias-Guiu
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, CIBERONC, Lleida, Spain
| | - F Amant
- Department of Oncology, KU Leuven, Leuven, Belgium; Department of Gynaecological Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M P L M Snijders
- Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | | | - J Bulten
- Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - J M A Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
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14
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Eid M, Gonthier C, Bucau M, Koskas M. [Conservative treatments for endometrial cancer]. LA REVUE DU PRATICIEN 2022; 72:747-749. [PMID: 36511962] [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] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CONSERVATIVE TREATMENTS FOR ENDOMETRIAL CANCER Treatment for early endometrial cancer remains based on hysterectomy. However, in patients of reproductive age with a pregnancy desire, conservative alternative may be considered in case of atypical hyperplasia or endometrial endometrial adenocarcinoma without myometrial invasion. The conservative treatment consists in proposing a protocol preserving the uterus, based on an antigonadotropic treatment (oral or intrauterine progestin, GnRH agonist) allowing a regression of the endometrial lesion. The pre-therapeutic assessment includes at least a review of initial histological slides, a fertility evaluation and a pelvic MRI. To check the remission and the absence of recurrence, hysteroscopy guided biopsies are performed every 3-4 months. Pregnancy is allowed after at least 3 months of treatment if the remission of lesions is proven histologically. In this circumstance, there is no contraindication to ovulation stimulation. Hysterectomy is finally indicated in case of progression of tumor lesions, non-remission of lesions at 12 months and if pregnancy project is abandoned.
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Affiliation(s)
- Maha Eid
- Service de gynécologie, hôpital Bichat, université Paris Cité, France
| | | | - Margot Bucau
- Service d'anatomopathologie, hôpital Bichat, université Paris Cité, France
| | - Martin Koskas
- Service de gynécologie, hôpital Bichat, université Paris Cité, France - Centre PREFERE (Préservation de la fertilité et cancer de l'endomètre), hôpital Bichat, Paris, France
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15
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Simon O, Dion L, Nyangoh Timoh K, Dupré PF, Azaïs H, Bendifallah S, Touboul C, Dabi Y, Graesslin O, Raimond E, Costaz H, Kerbage Y, Huchon C, Mimoun C, Koskas M, Akladios C, Lecointre L, Canlorbe G, Chauvet P, Ouldamer L, Levêque J, Lavoué V. Impact of severe obesity in the management of patients with high-risk endometrial cancer: A FRANCOGYN study. J Gynecol Obstet Hum Reprod 2022; 51:102429. [DOI: 10.1016/j.jogoh.2022.102429] [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] [Received: 03/12/2022] [Revised: 05/29/2022] [Accepted: 06/09/2022] [Indexed: 10/18/2022]
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16
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Benoit L, Delangle R, Van NT, Villefranque V, Koskas M, Belghiti J, Uzan C, Canlorbe G. [Feasibility and security of laparoscopic (± robotic) total hysterectomy in outpatient surgery: A French multicenter retrospective study]. Gynecol Obstet Fertil Senol 2022; 50:374-381. [PMID: 34979303 DOI: 10.1016/j.gofs.2021.12.011] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the feasibility and safety of total hysterectomy by laparoscopic approach (± robot assisted) in ambulatory. MATERIALS AND METHODS French three-center retrospective study including 165 patients who had laparoscopic (± robot assisted) total hysterectomy scheduled as outpatients from January 2016 to December 2020. Clinical and perioperative data were collected. Factors associated with outpatient failure and rehospitalization were evaluated. RESULTS The outpatient success rate was 92.7%. Factors associated with outpatient failure were incision time>13:00, large volume of blood loss, intraoperative complications with Oslo score≥2, uterine weight≥250g, indication for benign pathology, and robot-assisted approach. Among patients managed as outpatients, 7.2% were rehospitalized at a mean of 10 days from surgery. The factors associated with rehospitalization were the use of an effective antiaggregant or anticoagulant treatment and the use of intraoperative adhesiolysis. Four patients (2.6%) underwent revision surgery. CONCLUSION Minimally invasive hysterectomy can be performed as an outpatient procedure even in cases of malignant pathology. Age and body mass index are not associated with an increased risk of failure or re-hospitalization within one month.
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Affiliation(s)
- L Benoit
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - R Delangle
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - N T Van
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - V Villefranque
- Service de gynécologie obstétrique, Hôpital Simone-Veil, 95600 Eaubonne, France
| | - M Koskas
- Service de gynécologie obstétrique, Bichat, université de Paris, AP-HP, 75018 Paris, France
| | - J Belghiti
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - C Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Inserm UMR_S_938, Cancer Biology and Therapeutics, centre de recherche Saint-Antoine (CRSA), Sorbonne Université, 75012 Paris, France
| | - G Canlorbe
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Inserm UMR_S_938, Cancer Biology and Therapeutics, centre de recherche Saint-Antoine (CRSA), Sorbonne Université, 75012 Paris, France.
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17
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Parpex G, Bucau M, Estevez JP, Raimond E, Ouldamer L, Carcopino X, Touboul C, Bendifallah S, Graesslin O, Lavoue V, Bolze PA, Koskas M. Impact of vulvar reconstruction on the accuracy of a nomogram for predicting local recurrence after surgery for vulvar cancer. Gynecol Oncol 2022; 165:143-148. [PMID: 35177278 DOI: 10.1016/j.ygyno.2022.02.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/17/2022] [Accepted: 02/06/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND DATA Vulvar carcinoma is a rare disease accounting for 3%-5% of all gynaecological cancers. Although surgery is the standard treatment at an early stage, the outcomes are highly correlated with clear resection margins. Therefore, surgical defects can be important and require reconstruction. The aim of this study was to evaluate vulvar reconstructions using a previously validated nomogram predicting the risk of local recurrence at 2 years. METHODS Patients who underwent surgery for vulvar cancer between 1998 and 2017 were extracted from eight FRANCOGYN centres. We estimated the probability of local recurrence at 2 years using a previously validated nomogram and compared it with actual relapse in patients with or without vulvar reconstruction. Patients were clustered into tiertiles according to their nomogram score: low-, intermediate-, and high-risk for local relapse probability. RESULTS We reviewed 254 patients, of whom 49 underwent immediate vulvar reconstruction. The predicted and actual probability of two-year local relapse were 20.1% and 15.7%, respectively, with a concordance index of 0.75. In the low- and intermediate-risk groups, the difference between predicted and observed recurrence was less than 10% in patients with or without vulvar reconstruction. For the high-risk group, the difference reached 25% and observed recurrence probability was lower in patients who underwent vulvar plasty compared with those who did not (20.0% vs. 36.2%, respectively). Local recurrence-free survival rates following vulvar reconstruction were comparable at two years (82.1% vs. 84.8%, respectively, p = 0.26). CONCLUSION Vulvar reconstruction after surgical resection for vulvar cancer is safe. Vulvar reconstruction should be considered in aggressive cases to decrease local recurrence.
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Affiliation(s)
- Guillaume Parpex
- Department of Gynaecology and Obstetrics, Bichat University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), France; Paris University, Paris, France.
| | - Margot Bucau
- Department of Pathology, Bichat University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), France
| | - Juan Pablo Estevez
- Department of Gynaecology and Obstetrics, Bichat University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne, Universitary Hospital of Reims, University of Reims Champagne Ardenne (URCA), 51092 Reims Cedex, France
| | - Lobna Ouldamer
- Department of Obstetrics and Gynaecology, Centre, Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, Tours, France
| | - Xavier Carcopino
- Hôpital Nord (APHM), Department of Obstetrics and Gynecology, Aix-Marseille Université (AMU), CNRS, IRD, IMBE, Marseille, France
| | - Cyril Touboul
- Paris University, Paris, France; Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), France
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne, Universitary Hospital of Reims, University of Reims Champagne Ardenne (URCA), 51092 Reims Cedex, France
| | - Vincent Lavoue
- Department de Gynaecology, Obstetrics and Reproductive Medicine, University Hospital of Rennes, Rennes, France; Faculty of Medicine, University of Rennes 1, Rennes, France
| | - Pierre-Adrien Bolze
- Université Lyon 1, Faculté de Médecine Lyon Sud, Hospices Civils de Lyon, Department of Gynaecologic Surgery and Oncology, Obstetrics, Hôpital Lyon Sud, Pierre Bénite, France
| | - Martin Koskas
- Department of Gynaecology and Obstetrics, Bichat University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), France; Paris University, Paris, France
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18
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Marcellin L, Goffinet F, Azria E, Thomin A, Garabedian C, Sibiude J, Verspyck E, Koskas M, Santulli P, Rousseau J, Ancel PY, Chapron C. Association Between Endometriosis Phenotype and Preterm Birth in France. JAMA Netw Open 2022; 5:e2147788. [PMID: 35133433 PMCID: PMC8826171 DOI: 10.1001/jamanetworkopen.2021.47788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Endometriosis is an inflammatory disease with a heterogeneous presentation that affects women of childbearing age. Given the limitations of previous retrospective studies, it is still unclear whether endometriosis has adverse implications for pregnancy outcomes. OBJECTIVE To evaluate the association between the presence of endometriosis and preterm birth and whether the risk varied according to the disease phenotype. DESIGN, SETTING, AND PARTICIPANTS This cohort study with exposed and unexposed groups was conducted in 7 maternity units in France from February 4, 2016, to June 28, 2018. Participants included women with singleton pregnancies who were followed up before 22 weeks' gestation along with their newborns delivered at or after 22 weeks' gestation. The final follow-up occurred in July 2019. Data were analyzed from October 7, 2020, to February 7, 2021. EXPOSURES Women in the endometriosis group had a documented history of endometriosis and were classified according to 3 endometriosis phenotypes: isolated superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA; potentially associated with SUP), and deep endometriosis (DE; potentially associated with SUP and OMA). Women in the control group did not have a history of clinical symptoms of endometriosis before their current pregnancy. MAIN OUTCOMES AND MEASURES The primary outcome was preterm birth between 22 weeks and 36 weeks 6 days of gestation. Association between endometriosis and the primary outcome was assessed through univariate and multivariate logistic regression analyses and was adjusted for the following risk factors associated with preterm birth: maternal age, body mass index (calculated as weight in kilograms divided by height in meters squared) before pregnancy, country of birth, parity, previous cesarean delivery, history of myomectomy and hysteroscopy, and preterm birth. The same analysis was performed according to the 3 endometriosis phenotypes (SUP, OMA, and DE). RESULTS Of the 1351 study participants (mean [SD] age, 32.9 [5.0] years) who had a singleton delivery after 22 weeks of gestation, 470 were assigned to the endometriosis group (48 had SUP [10.2%], 83 had OMA [17.7%], and 339 had DE [72.1%]) and 881 were assigned to the control group. No difference was observed in the rate of preterm deliveries before 37 weeks 0 days of gestation between the endometriosis and control groups (34 of 470 [7.2%] vs 53 of 881 [6.0%]; P = .38). After adjusting for confounding factors, endometriosis was not associated with preterm birth before 37 weeks' gestation (adjusted odds ratio, 1.07; 95% CI, 0.64-1.77). The results were comparable for the different disease phenotypes (SUP: 6.2% [3 of 48]; OMA: 7.2% [6 of 83]; and DE: 7.4% [25 of 339]; P = .84). CONCLUSIONS AND RELEVANCE This cohort study found no association between endometriosis and preterm birth, and the disease phenotype did not appear to alter the result. Monitoring the pregnancy beyond the normal protocols or changing management strategies for women with endometriosis may not be warranted to prevent preterm birth.
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Affiliation(s)
- Louis Marcellin
- Université de Paris, Paris, France
- Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU) Cochin, Hôpital Universitaire Paris Centre (HUPC), Paris, France
| | - Francois Goffinet
- Université de Paris, Paris, France
- Port-Royal Maternity, AP-HP, Centre-University of Paris, Federation Hospitalo-Universitaire for Prematurity, Paris, France
| | - Elie Azria
- Maternité Notre-Dame-de-Bon-Secours, Groupe Hospitalier Paris-Saint-Joseph, Paris, France
| | - Anne Thomin
- Sorbonne Université, Paris, France
- Trousseau Hospital, AP-HP, Paris, France
| | - Charles Garabedian
- University Lille, Unité Lilloise de Recherche 2694, Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- CHU Lille, Department of Obstetrics, Lille, France
| | - Jeanne Sibiude
- Université de Paris, Paris, France
- Service de Gynécologie-Obstétrique, AP-HP Hôpital Louis Mourier, Colombes, France
| | - Eric Verspyck
- Service de Gynécologie et Obstétrique, CHU de Rouen, Rouen, France
| | - Martin Koskas
- Université de Paris, Paris, France
- Department of Gynecology, Hôpital Bichat, AP-HP, Paris, France
| | - Pietro Santulli
- Université de Paris, Paris, France
- Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU) Cochin, Hôpital Universitaire Paris Centre (HUPC), Paris, France
| | - Jessica Rousseau
- Université de Paris, Paris, France
- Clinical Research Unit, Center for Clinical Investigation P1419, AP-HP, Paris, France
- Centre de Recherche Épidémiologiques et Bio Statistiques de Sorbonne Paris Cité, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Paris, France
| | - Pierre-Yves Ancel
- Université de Paris, Paris, France
- Clinical Research Unit, Center for Clinical Investigation P1419, AP-HP, Paris, France
- Centre de Recherche Épidémiologiques et Bio Statistiques de Sorbonne Paris Cité, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Paris, France
| | - Charles Chapron
- Université de Paris, Paris, France
- Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU) Cochin, Hôpital Universitaire Paris Centre (HUPC), Paris, France
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19
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Abstract
Endometrial cancer is the most common gynecological malignancy in high‐ and middle‐income countries. Although the overall prognosis is relatively good, high‐grade endometrial cancers have a tendency to recur. Recurrence needs to be prevented since the prognosis for recurrent endometrial cancer is dismal. Treatment tailored to tumor biology is the optimal strategy to balance treatment efficacy against toxicity. Since The Cancer Genome Atlas defined four molecular subgroups of endometrial cancers, the molecular factors are increasingly used to define prognosis and treatment. Standard treatment consists of hysterectomy and bilateral salpingo‐oophorectomy. Lymphadenectomy (and increasingly sentinel node biopsy) enables identification of lymph node‐positive patients who need adjuvant treatment, including radiotherapy and chemotherapy. Adjuvant therapy is used for Stage I–II patients with high‐risk factors and Stage III patients; chemotherapy is especially used in non‐endometrioid cancers and those in the copy‐number high molecular group characterized by TP53 mutation. In advanced disease, a combination of surgery to no residual disease and chemotherapy with or without radiotherapy results in the best outcome. Surgery for recurrent disease is only advocated in patients with a good performance status with a relatively long disease‐free interval. The latest state‐of‐the‐art treatment for endometrial cancer is described, incorporating the most recent new data that influence its clinical management.
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Affiliation(s)
- Martin Koskas
- Division of Gynecologic Oncology, Bichat University Hospital, Paris, France
| | - Frédéric Amant
- Department of Gynecologic Oncology, KU Leuven, Leuven, Belgium.,Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Center for Gynecologic Oncology Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
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20
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Kolanska K, Sbeih M, Canlorbe G, Mekinian A, Varinot J, Capmas P, Koskas M, Aractingi S, Daraï E, Chabbert-Buffet N. Ulipristal Acetate Modifies miRNA Expression in Both Superficial and Basal Layers of the Human Endometrium. J Clin Med 2021; 10:jcm10194442. [PMID: 34640460 PMCID: PMC8509688 DOI: 10.3390/jcm10194442] [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: 09/04/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/05/2022] Open
Abstract
(1) Background: Ulipristal acetate (UPA) is a selective progesterone receptor modulator (SPRM) widely used for emergency contraception and mid- to long-term leiomyoma treatment. The aim of this study was to identify modifications of miRNA expression in superficial and basal layers of the human endometrium at the end of the UPA treatment for at least 3 months. (2) Methods: Microarray miRNA analysis of formalin-fixed, paraffin-embedded hysterectomy tissue samples was conducted, followed by an Ingenuity Pathway Analysis. Samples were divided into three groups: women having had 3 months of UPA treatment (n = 7); and two control groups of UPA-naïve women in the proliferative (n = 8) or secretory (n = 6) phase. (3) Results: The UPA modified the expression of 59 miRNAs involved in the processes of cell cycle, carcinogenesis, and inflammation. Their expression profiles were different in the basal and superficial layers. Most of the processes influenced by the UPA in the basal layer were connected to the cell cycle and immune regulation. (4) Conclusion: Specific changes were observed in both layers of the endometrium in the UPA group. However, the miRNA expression in the basal layer was not consistent with that in the superficial layer. Other large studies analysing the long-term impact of SPRM on endometrial miRNA expression are necessary.
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Affiliation(s)
- Kamila Kolanska
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
- Service de Gynécologie Sestertius et Médecine de la Reproduction, AP-HP Sorbonne Université Site Tenon, 4 rue de la Chine, 75020 Paris, France
- Correspondence:
| | - Maria Sbeih
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
| | - Geoffroy Canlorbe
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75013 Paris, France
| | - Arsène Mekinian
- Service de Médecine Interne, AP-HP Sorbonne Université Site St Antoine, 184 rue du Faubourg Saint Antoine, 75012 Paris, France;
| | - Justine Varinot
- Service d’Anatomopathologie, AP HP Sorbonne Université Site Tenon, 4 rue de la Chine, 75020 Paris, France;
| | - Perrine Capmas
- Department of Gynecology and Obstetrics, University Paris Saclay, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France;
- Inserm, Centre of Research in Epidemiology and Population Health (CESP), U1018, 94276 Le Kremlin-Bicêtre, France
| | - Martin Koskas
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
- Department of Obstetrics and Gynecology, AP-HP Bichat University Hospital, 75018 Paris, France
- Institut de Recherche en Santé de la Femme, Equipe d’accueil 7285, Universite de Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France
| | - Selim Aractingi
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
| | - Emile Daraï
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
- Service de Gynécologie Sestertius et Médecine de la Reproduction, AP-HP Sorbonne Université Site Tenon, 4 rue de la Chine, 75020 Paris, France
| | - Nathalie Chabbert-Buffet
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
- Service de Gynécologie Sestertius et Médecine de la Reproduction, AP-HP Sorbonne Université Site Tenon, 4 rue de la Chine, 75020 Paris, France
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Ouasti S, Bucau M, Larouzee E, Clement De Givry S, Chabbert-Buffet N, Koskas M. Prospective study of fertility-sparing treatment with chlormadinone acetate for endometrial carcinoma and atypical hyperplasia in young women. Int J Gynaecol Obstet 2021; 157:452-457. [PMID: 34558063 DOI: 10.1002/ijgo.13941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/03/2021] [Revised: 07/30/2021] [Accepted: 08/11/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To confirm that the efficiency of the use of chlormadinone acetate for 6 months to obtain remission of atypical hyperplasia or endometrial carcinoma is comparable to that of the use of other fertility-sparing treatments. METHOD The present study is based on the PREFERE prospective registry. All the patients received 3 or 6 months of chlormadinone acetate and were evaluated by hysteroscopic resection and pipelle sampling every 3 months. RESULTS Ninety-four patients were included. Seventy-nine patients achieved complete remission at 6 months (84%). No patients stopped treatment because of a lack of tolerance. Twenty-four per cent of the patients achieved a live birth. CONCLUSION Chlormadinone acetate is an effective and well-tolerated fertility-sparing treatment. Its benefits over other progestins are its tolerability, and its absence of contraindications, which make it a good choice for patients with thromboembolism and high vascular risk.
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Affiliation(s)
- Samia Ouasti
- Department of Obstetrics and Gynecologic Surgery, Hôpital Bichat Claude Bernard, Paris, France
| | - Margot Bucau
- Department of Anatomopathology, Hôpital Bichat Claude Bernard, Paris, France
| | - Elise Larouzee
- Department of Obstetrics and Gynecologic Surgery, Hôpital Bichat Claude Bernard, Paris, France
| | | | - Nathalie Chabbert-Buffet
- Department Obstetrics, Gynecology and Reproductive Medicine, APHP Sorbonne University Hôpital Tenon, Paris, France
| | - Martin Koskas
- Department of Obstetrics and Gynecologic Surgery, Hôpital Bichat Claude Bernard, Paris, France
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Touboul C, Legendre G, Agostini A, Akladios C, Bendifallah S, Bolze PA, Bouet PE, Chauvet P, Collinet P, Dabi Y, Delotte J, Deffieux X, Dion L, Gauthier T, Kerbage Y, Koskas M, Millet P, Narducci F, Ouldamer L, Ploteau S, Santulli P, Golfier F. [Guidelines for Clinical Practice of the French College of Obstetricians and Gynecologists 2021: Prophylactic procedures associated with gynecologic surgery]. ACTA ACUST UNITED AC 2021; 49:805-815. [PMID: 34520857 DOI: 10.1016/j.gofs.2021.09.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To draw up recommendations on the use of prophylactic gynecologic procedures during surgery for other indications. DESIGN A consensus panel of 19 experts was convened. A formal conflict of interest policy was established at the onset of the process and applied throughout. The entire study was performed independently without funding from pharmaceutical companies or medical device manufacturers. The panel applied the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system to evaluate the quality of evidence on which the recommendations were based. The authors were advised against making strong recommendations in the presence of low-quality evidence. Some recommendations were ungraded. METHODS The panel studied 22 key questions on seven prophylactic procedures: 1) salpingectomy, 2) fimbriectomy, 3) salpingo-oophorectomy, 4) ablation of peritoneal endometriosis, 5) adhesiolysis, 6) endometrial excision or ablation, and 7) cervical ablation. RESULTS The literature search and application of the GRADE system resulted in 34 recommendations. Six were supported by high-quality evidence (GRADE 1+/-) and 28 by low-quality evidence (GRADE 2+/-). Recommendations on two questions were left ungraded due to a lack of evidence in the literature. CONCLUSIONS A high level of consensus was achieved among the experts regarding the use of prophylactic gynecologic procedures. The ensuing recommendations should result in improved current practice.
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Affiliation(s)
- C Touboul
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Tenon (AP-HP), Sorbonne Université, 4, rue de la Chine, 75020 Paris, France.
| | - G Legendre
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU Anger, 4, rue Larrey, 49933 Angers cedex 9, France
| | - A Agostini
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital de la Conception (AP-HM), Marseille, France
| | - C Akladios
- Service de Gynécologie Obstétrique et Médecine de la Reproduction des hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - S Bendifallah
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Tenon (AP-HP), Sorbonne Université, 4, rue de la Chine, 75020 Paris, France
| | - P A Bolze
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - P E Bouet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU Anger, 4, rue Larrey, 49933 Angers cedex 9, France
| | - P Chauvet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU Estaing, 1, place Lucie-Aubrac, 63000 Clermont-Ferrand, France
| | - P Collinet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59000 Lille, France
| | - Y Dabi
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Tenon (AP-HP), Sorbonne Université, 4, rue de la Chine, 75020 Paris, France
| | - J Delotte
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital de l'Archet 2, 151, route de Saint-Antoine, 06200 Nice, France
| | - X Deffieux
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'hôpital A.-Béclêre (AP-HP), 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - L Dion
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du Centre Hospitalier Universitaire de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - T Gauthier
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - Y Kerbage
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59000 Lille, France
| | - M Koskas
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de de l'hôpital Bichat (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
| | - P Millet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital de l'Archet 2, 151, route de Saint-Antoine, 06200 Nice, France
| | - F Narducci
- Département de Cancérologie Gynécologique, Centre de Lutte Contre le Cancer Oscar-Lambret, Lille, France
| | - L Ouldamer
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU de Tours, 2, boulevard Tonnellé, 37000 Tours, France
| | - S Ploteau
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU de Nantes, 38 bd Jean-Monnet, 44093 Nantes cedex 1, France
| | - P Santulli
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Cochin (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - F Golfier
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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Dion L, Agostini A, Golfier F, Legendre G, Touboul C, Koskas M. In which cases should endometrial destruction be performed during an operative hysteroscopy? Clinical practice guidelines from the French College of Gynaecologists and Obstetricians (CNGOF). J Gynecol Obstet Hum Reprod 2021; 50:102188. [PMID: 34166864 DOI: 10.1016/j.jogoh.2021.102188] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To provide guidelines from the French College of Obstetricians and Gynaecologists (CNGOF), based on the best evidence available, concerning the impact of endometrial destruction on bleeding and endometrial cancer risk reduction in patients candidates for operative hysteroscopy. METHODS Recommendations were made according to AGREE II and the GRADE® (Grading of Recommendations Assessment, Development and Evaluation) systems to determine separately the quality of evidence (QE) and in the level of recommendation. RESULTS In a retrospective study comparing the incidence of endometrial cancer in 4776 patients with menorrhagia treated with endometrial destruction vs 229 945 patients with a medical treatment. There was a non-significant reduced risk of developing endometrial cancer (HR, 0.45; 95% CI, 0.15-1.40; p = .17). In premenopausal women, five studies compared the incidence of endometrial cancer in patients treated with endometrial ablation/destruction (EA/D) to the incidence of endometrial cancer in a comparable population of women from national registers, all of which show reduced risk of endometrial cancer after endometrectomy. In case of menopausal metrorrhagia, the prevalence of endometrial cancer is 9%, by analogy with the results found in premenopausal patients, the combination of endometrial ablation during operative hysteroscopy seems justified. In a retrospective cohort of 177 non-menopausal patients treated with myomectomy for metrorrhagia and/or menorrhagia, a significantly better control of bleeding at 12 months was found when myomectomy was combined with endometrectomy using roller-ball (OR: 0.18 [95% Cl 0.05-0.63]; p = 0.003). CONCLUSION In premenopausal women with heavy menstrual bleeding, when an operative hysteroscopy is performed, it is recommended to propose an endometrial ablation/destruction in order to prevent the risk of endometrial cancer, (QE3) and to prevent recurrence of bleeding (QE2). In menopausal women, it is probably recommended to also perform an endometrial ablation/destruction in case of operative hysteroscopy in order to prevent the risk of endometrial cancer (QE1).
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Affiliation(s)
- L Dion
- Department of Gynaecology, Rennes University Hospital, 16 Bd de Bulgarie, 35000 Rennes, France.
| | - A Agostini
- Department of Obstetrics and Gynaecology, APHM, 147 Bd Baille, 13005 Marseille, France
| | - F Golfier
- Department of Obstetrics and Gynaecology, CHU Lyon, 69000 Lyon, France
| | - G Legendre
- Department of Obstetrics and Gynaecology, CHU Angers, 49000 Angers, France
| | - C Touboul
- Department of Obstetrics and Gynaecology, APHP.6 Sorbonne Université, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - M Koskas
- Department of Obstetrics and Gynaecology, APHP, Hôpital Bichat - Claude-Bernard, 46 rue Henri-Huchard, 75018 Paris, France
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Vaugon M, Peigné M, Phelippeau J, Gonthier C, Koskas M. IVF impact on the risk of recurrence of endometrial adenocarcinoma after fertility-sparing management. Reprod Biomed Online 2021; 43:495-502. [PMID: 34315696 DOI: 10.1016/j.rbmo.2021.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 03/10/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
RESEARCH QUESTION Do IVF treatments after conservative management of endometrial atypical hyperplasia or grade 1 endometrial adenocarcinoma (AH/EC) increase the risk of disease recurrence? DESIGN This is a prospective cohort study from a national registry from January 2008 to July 2019. Sixty patients had an AH/EC and received progestin treatment using chlormadinone acetate for at least 3 months. After remission, 31 patients underwent IVF and 29 did not. The primary outcome was the recurrence rate at 24 months according to the use of IVF. The secondary outcome was the identification of risk factors for recurrence. RESULTS The probability of 2-year recurrence was 37.7% (SD 10.41%) in the IVF group and 55.7% (SD 14.02%) in the no IVF group (P = 0.13). Obesity, nulliparity, polycystic ovary syndrome, age and tumoural characteristics were not associated with recurrence. Pregnancy was a protective factor for recurrence, with 2-year recurrence probabilities of 20.5% and 62.0% in the pregnancy and no pregnancy groups, respectively (P = 0.002, 95% CI 0.06-0.61). In contrast, the number of cycles, maximum serum oestradiol concentration during ovarian stimulation, ovarian stimulation protocol, total dose of gonadotrophin administered and thickness of the endometrium showed no significant differences in terms of the risk of recurrence in the IVF subgroup. CONCLUSION IVF treatment after fertility-sparing management of AH/EC does not increase the risk of recurrence. Therefore, it is an acceptable strategy to decrease the time to pregnancy. Overall, the recurrence rate is high enough to justify close monitoring once remission occurs.
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Affiliation(s)
- Maïlys Vaugon
- AP-HP, Department of Obstetrics and Gynecology, Hôpital Bichat-Claude Bernard, Paris, France; Université de Paris, Paris, France.
| | - Maëliss Peigné
- AP-HP, Department of Reproductive Medicine and Fertility Preservation, Hôpital Jean Verdier, Bondy, France; Université Sorbonne Paris Nord, Paris, France
| | - Juliette Phelippeau
- AP-HP, Department of Obstetrics and Gynecology, Hôpital Bichat-Claude Bernard, Paris, France; Université de Paris, Paris, France
| | - Clémentine Gonthier
- AP-HP, Department of Obstetrics and Gynecology, Hôpital Bichat-Claude Bernard, Paris, France; Université de Paris, Paris, France; Groupe PREFERE (Préservation de la fertilité et cancer de l'endomètre) Hôpital Bichat-Claude Bernard, Paris, France
| | - Martin Koskas
- AP-HP, Department of Obstetrics and Gynecology, Hôpital Bichat-Claude Bernard, Paris, France; Université de Paris, Paris, France; Groupe PREFERE (Préservation de la fertilité et cancer de l'endomètre) Hôpital Bichat-Claude Bernard, Paris, France
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25
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Lecointre L, Bund V, Sangnier E, Ouldamer L, Bendifallah S, Koskas M, Bolze PA, Collinet P, Canlorbe G, Touboul C, Huchon C, Coutant C, Faller E, Boisramé T, Gantzer J, Demarchi M, Lavoué V, Akladios C. Status of Surgical Management of Borderline Ovarian Tumors in France: are Recommendations Being Followed? Multicentric French Study by the FRANCOGYN Group. Ann Surg Oncol 2021; 28:7616-7623. [PMID: 33904003 PMCID: PMC8521578 DOI: 10.1245/s10434-021-09852-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/23/2021] [Indexed: 11/22/2022]
Abstract
Background Borderline ovarian tumors (BOTs) are tumors with a favorable prognosis but whose management by consensus is essential to limit the risk of invasive recurrence. This study aimed to conduct an inventory of surgical practices for BOT in France and to evaluate the conformity of the treatment according to the current French guidelines. Methods This retrospective, multicenter cohort study included nine referral centers of France between January 2001 and December 2018. It analyzed all patients with serous and mucinous BOT who had undergone surgery. A peritoneal staging in accordance with the recommendations was defined by performance of a peritoneal cytology, an omentectomy, and at least one peritoneal biopsy. Results The study included 332 patients. A laparoscopy was performed in 79.5% of the cases. Treatment was conservative in 31.9% of the cases. The recurrence rate was significantly increased after conservative treatment (17.3% vs 3.1%; p < 0.001). Peritoneal cytology was performed for 95.5%, omentectomy for 83.1%, and at least one biopsy for 82.2% of the patients. The overall recurrence rate was 7.8%, and the recurrence was invasive in 1.2% of the cases. No link was found between the recurrence rate and the conformity of peritoneal staging. The overall rate of staging noncompliance was 22.9%. Conclusion The current standards for BOT management seem to be well applied.
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Affiliation(s)
- Lise Lecointre
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,I-Cube UMR 7357-Laboratoire des Sciences de L'ingénieur, de L'informatique et de L'imagerie, Université de Strasbourg, Strasbourg, France.,Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France
| | - Virginie Bund
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. .,Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 1109, Institut thématique interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
| | - Eva Sangnier
- Department of Gynecology, Hôpitaux Universitaires de Reims, Reims, France
| | - Lobna Ouldamer
- Department of Gynecology, Hôpital Universitaire de Tours, Tours, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Hôpital Tenon, AP-HP, Paris, France
| | - Martin Koskas
- Department of Gynecology, Hôpital Bichat, AP-HP, Paris, France
| | | | - Pierre Collinet
- Department of Gynecological Surgery, Hôpital Jeanne De Flandre, CHRU, Lille, France
| | - Geoffroy Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, Hôpital la Pitié Salpétrière, AP-HP, Paris, France
| | - Cyril Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Cyrille Huchon
- Department of Gynecology, Centre Hospitalier de Poissy, Poissy, France
| | - Charles Coutant
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, Dijon, France
| | - Emilie Faller
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Boisramé
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Justine Gantzer
- Department of Medical Oncology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Martin Demarchi
- Medical Oncology Department, Centre Paul Strauss, Strasbourg, France
| | - Vincent Lavoué
- Department of Gynecologic Surgery, Hôpital Universitaire de Rennes, Rennes, France
| | - Chérif Akladios
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Vrede SW, van Weelden WJ, Visser NCM, Bulten J, van der Putten LJM, van de Vijver K, Santacana M, Colas E, Gil-Moreno A, Moiola CP, Mancebo G, Krakstad C, Trovik J, Haldorsen IS, Huvila J, Koskas M, Weinberger V, Bednarikova M, Hausnerova J, van der Wurff AA, Matias-Guiu X, Amant F, Snijders MPLM, Küsters-Vandevelde HVN, Reijnen C, Pijnenborg JMA. Immunohistochemical biomarkers are prognostic relevant in addition to the ESMO-ESGO-ESTRO risk classification in endometrial cancer. Gynecol Oncol 2021; 161:787-794. [PMID: 33858677 DOI: 10.1016/j.ygyno.2021.03.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/20/2021] [Accepted: 03/30/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Pre-operative immunohistochemical (IHC) biomarkers are not incorporated in endometrial cancer (EC) risk classification. We aim to investigate the added prognostic relevance of IHC biomarkers to the ESMO-ESGO-ESTRO risk classification and lymph node (LN) status in EC. METHODS Retrospective multicenter study within the European Network for Individualized Treatment of Endometrial Cancer (ENITEC), analyzing pre-operative IHC expression of p53, L1 cell-adhesion molecule (L1CAM), estrogen receptor (ER) and progesterone receptor (PR), and relate to ESMO-ESGO-ESTRO risk groups, LN status and outcome. RESULTS A total of 763 EC patients were included with a median follow-up of 5.5-years. Abnormal IHC expression was present for p53 in 112 (14.7%), L1CAM in 79 (10.4%), ER- in 76 (10.0%), and PR- in 138 (18.1%) patients. Abnormal expression of p53/L1CAM/ER/PR was significantly related with higher risk classification groups, and combined associated with the worst outcome within the 'high and advanced/metastatic' risk group. In multivariate analysis p53-abn, ER/PR- and ESMO-ESGO-ESTRO 'high and advanced/metastatic' were independently associated with reduced disease-specific survival (DSS). Patients with abnormal IHC expression and lymph node metastasis (LNM) had the worst outcome. Patients with LNM and normal IHC expression had comparable outcome with patients without LNM and abnormal IHC expression. CONCLUSION The use of pre-operative IHC biomarkers has important prognostic relevance in addition to the ESMO-ESGO-ESTRO risk classification and in addition to LN status. For daily clinical practice, p53/L1CAM/ER/PR expression could serve as indicator for surgical staging and refine selective adjuvant treatment by incorporation into the ESMO-ESGO-ESTRO risk classification.
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Affiliation(s)
- S W Vrede
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands; Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands.
| | - W J van Weelden
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
| | - N C M Visser
- Department of Pathology, Stichting PAMM, Eindhoven, the Netherlands; Department of Pathology, Radboud university medical center, Nijmegen, the Netherlands
| | - J Bulten
- Department of Pathology, Radboud university medical center, Nijmegen, the Netherlands
| | - L J M van der Putten
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
| | - K van de Vijver
- Department of Pathology, Ghent University Hospital, Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - M Santacana
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, CIBERONC, Lleida, Spain
| | - E Colas
- Biomedical Research Group in Gynaecology, Vall Hebron Institute of Research, Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
| | - A Gil-Moreno
- Gynecological Department, Vall Hebron University Hospital, CIBERONC, Barcelona, Spain; Pathology Department, Vall Hebron University Hospital, CIBERONC, Barcelona, Spain
| | - C P Moiola
- Biomedical Research Group in Gynaecology, Vall Hebron Institute of Research, Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
| | - G Mancebo
- Department of Obstetrics and Gynaecology, Hospital del Mar, PSMAR, Barcelona, Spain
| | - C Krakstad
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway; Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - J Trovik
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - I S Haldorsen
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway; Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - J Huvila
- Department of Pathology, University of Turku, Turku, Finland
| | - M Koskas
- Department of Obstetrics and Gynaecology Department, Bichat-Claude Bernard Hospital, Paris, France
| | - V Weinberger
- Department of Obstetrics and Gynaecology, University Hospital in Brno and Masaryk University, Brno, Czech Republic
| | - M Bednarikova
- Department of Internal Medicine, Hematology and Oncology, University Hospital in Brno and Masaryk University, Brno, Czech Republic
| | - J Hausnerova
- Department of Pathology, University Hospital in Brno and Masaryk University, Brno, Czech Republic
| | - A A van der Wurff
- Department of Pathology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - X Matias-Guiu
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, CIBERONC, Lleida, Spain
| | - F Amant
- Department of Oncology, KU Leuven, Leuven, Belgium; Department of Gynaecologic Oncology, Netherlands Cancer Institute and Amsterdam Medical Centers, Amsterdam, the Netherlands
| | | | - M P L M Snijders
- Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | | | - C Reijnen
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, the Netherlands
| | - J M A Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
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van Weelden WJ, Reijnen C, Küsters-Vandevelde HVN, Bulten J, Bult P, Leung S, Visser NCM, Santacana M, Bronsert P, Hirschfeld M, Colas E, Gil-Moreno A, Reques A, Mancebo G, Huvila J, Koskas M, Weinberger V, Bednarikova M, Hausnerova J, Snijders MPLM, Matias-Guiu X, Amant F. The cutoff for estrogen and progesterone receptor expression in endometrial cancer revisited: a European Network for Individualized Treatment of Endometrial Cancer collaboration study. Hum Pathol 2020; 109:80-91. [PMID: 33338506 DOI: 10.1016/j.humpath.2020.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 12/22/2022]
Abstract
There is no consensus on the cutoff for positivity of estrogen receptor (ER) and progesterone receptor (PR) in endometrial cancer (EC). Therefore, we determined the cutoff value for ER and PR expression with the strongest prognostic impact on the outcome. Immunohistochemical expression of ER and PR was scored as a percentage of positive EC cell nuclei. Cutoff values were related to disease-specific survival (DSS) and disease-free survival (DFS) using sensitivity, specificity, and multivariable regression analysis. The results were validated in an independent cohort. The study cohort (n = 527) included 82% of grade 1-2 and 18% of grade 3 EC. Specificity for DSS and DFS was highest for the cutoff values of 1-30%. Sensitivity was highest for the cutoff values of 80-90%. ER and PR expression were independent markers for DSS at cutoff values of 10% and 80%. Consequently, three subgroups with distinct clinical outcomes were identified: 0-10% of ER/PR expression with, unfavorable outcome (5-year DSS = 75.9-83.3%); 20-80% of ER/PR expression with, intermediate outcome (5-year DSS = 93.0-93.9%); and 90-100% of ER/PR expression with, favorable outcome (5-year DSS = 97.8-100%). The association between ER/PR subgroups and outcomes was confirmed in the validation cohort (n = 265). We propose classification of ER and PR expression based on a high-risk (0-10%), intermediate-risk (20-80%), and low-risk (90-100%) group.
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Affiliation(s)
- Willem Jan van Weelden
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, 6525, GA, Nijmegen, the Netherlands.
| | - Casper Reijnen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, 6525, GA, Nijmegen, the Netherlands; Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, 6532, SZ, the Netherlands
| | | | - Johan Bulten
- Department of Pathology, Radboud University Medical Center, Nijmegen, 6525, GA, the Netherlands
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, 6525, GA, the Netherlands
| | - Samuel Leung
- Genetic Pathology Evaluation Center, Vancouver General Hospital, Vancouver, BC V5Z 1M9, British Columbia, Canada
| | - Nicole C M Visser
- Foundation Laboratory for Pathology and Medical Microbiology (PAMM), 5623 EJ, Eindhoven, the Netherlands
| | - Maria Santacana
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, CIBERONC, 25198, Lleida, Spain
| | - Peter Bronsert
- Institute of Pathology, University Medical Center, 79106, Freiburg, Germany
| | - Marc Hirschfeld
- Department of Obstetrics and Gynecology, University Medical Center, 79106, Freiburg, Germany; Institute of Veterinary Medicine, Georg-August-University, 37073, Goettingen, Germany
| | - Eva Colas
- Biomedical Research Group in Gynecology, Vall Hebron Institute of Research, Universitat Autònoma de Barcelona, CIBERONC, 08035, Barcelona, Spain
| | - Antonio Gil-Moreno
- Biomedical Research Group in Gynecology, Vall Hebron Institute of Research, Universitat Autònoma de Barcelona, CIBERONC, 08035, Barcelona, Spain; Gynecological Department, Vall Hebron University Hospital, CIBERONC, 08035, Barcelona, Spain
| | - Armando Reques
- Pathology Department, Vall Hebron University Hospital, CIBERONC, 08035, Barcelona, Spain
| | - Gemma Mancebo
- Department of Obstetrics and Gynecology, Hospital del Mar, PSMAR, 08003, Barcelona, Spain
| | - Jutta Huvila
- Department of Pathology, University of Turku, 20500, Turku, Finland
| | - Martin Koskas
- Obstetrics and Gynecology Department, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Vit Weinberger
- Department of Gynecology and Obstetrics, Faculty of Medicine, Masaryk University, 62500, Brno, Czech Republic
| | - Marketa Bednarikova
- Department of Internal Medicine, Oncology and Hematology, Faculty of Medicine, Masaryk University, 62500, Brno, Czech Republic
| | - Jitka Hausnerova
- Institute of Pathology, Faculty of Medicine, Masaryk University, 62500, Brno, Czech Republic
| | - Marc P L M Snijders
- Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, 6532, SZ, the Netherlands
| | - Xavier Matias-Guiu
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, CIBERONC, 25198, Lleida, Spain
| | - Frédéric Amant
- Department of Oncology, KU Leuven, 3000, Leuven, Belgium; Center for Gynaecologic Oncology, Netherlands Cancer Institute and Amsterdam University Medical Center, 1066, CX, Amsterdam, the Netherlands
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Bourdel N, Huchon C, Abdel Wahab C, Azaïs H, Bendifallah S, Bolze PA, Brun JL, Canlorbe G, Chauvet P, Chereau E, Courbiere B, De La Motte Rouge T, Devouassoux-Shisheboran M, Eymerit-Morin C, Fauvet R, Gauroy E, Gauthier T, Grynberg M, Koskas M, Larouzee E, Lecointre L, Levêque J, Margueritte F, Mathieu D'argent E, Nyangoh-Timoh K, Ouldamer L, Raad J, Raimond E, Ramanah R, Rolland L, Rousset P, Rousset-Jablonski C, Thomassin-Naggara I, Uzan C, Zilliox M, Daraï E. Borderline ovarian tumors: Guidelines from the French national college of obstetricians and gynecologists (CNGOF). Eur J Obstet Gynecol Reprod Biol 2020; 256:492-501. [PMID: 33262005 DOI: 10.1016/j.ejogrb.2020.11.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 10/28/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/28/2022]
Abstract
It is recommended to classify Borderline Ovarian Tumors (BOTs) according to the WHO classification. Transvaginal and suprapubic ultrasonography are recommended for the analysis of an ovarian mass (Grade A). In case of an undetermined ovarian lesion on ultrasonography, it is recommended to perform a pelvic MRI (Grade A) with a score for malignancy (ADNEX MR/O-RADS) (Grade C) included in the report and to formulate a histological hypothesis (Grade C). Pelvic MRI is recommended to characterize a tumor suspected of being BOT (Grade C). It is recommended to evaluate serum levels of HE4 and CA125 and to use the ROMA score for the diagnosis of indeterminate ovarian mass on imaging (grade A). If there is a suspicion of a mucinous BOT on imaging, serum levels of CA 19-9 may be proposed (Grade C). For Early Stages (ES) of BOT, if surgery without risk of tumor rupture is possible, laparoscopy with protected extraction is recommended over laparotomy (Grade C). For treatment of a bilateral serous ES BOT with a strategy to preserve fertility and/or endocrine function, bilateral cystectomy is recommended where possible (Grade B). For mucinous BOTs with a treatment strategy of fertility and/or endocrine function preservation, unilateral salpingo-oophorectomy is recommended (grade C). For mucinous BOTs treated by initial cystectomy, unilateral salpingo-oophorectomy is recommended (grade C). For serous or mucinous ES BOTs, routine hysterectomy is not recommended (Grade C). For ES BOTs, lymphadenectomy is not recommended (Grade C). For ES BOTs, appendectomy is recommended only in case of a macroscopically pathological appendix (Grade C). Restaging surgery is recommended in cases of serous BOTs with micropapillary architecture and an incomplete abdominal cavity inspection during initial surgery (Grade C). Restaging surgery is recommended for mucinous BOTs after initial cystectomy or in cases where the appendix was not examined (Grade C). If restaging surgery is decided for ES BOTs, the following procedures should be performed: peritoneal washing (grade C), omentectomy (grade B), complete exploration of the abdominal cavity with peritoneal biopsies (grade C), visualization of the appendix and appendectomy in case of a pathological macroscopic appearance (grade C) as well as unilateral salpingo-oophorectomy in case of a mucinous BOT initially treated by cystectomy (grade C). In advanced stages (AS) of BOT, it is not recommended to perform a lymphadenectomy as a routine procedure (Grade C). For AS BOT in a patient with a desire to fall pregnant, conservative treatment involving preservation of the uterus and all or part of the ovary may be proposed (Grade C). Restaging surgery aimed at removing all lesions, not performed initially, is recommended for AS BOTs (Grade C). After treatment, follow-up for a duration greater than 5 years is recommended due to the median recurrence time of BOTs (Grade B). It is recommended that a systematic clinical examination be carried out during follow-up of a treated BOT (Grade B). If the determination of tumor markers is normal preoperatively, the routine dosage of tumor markers in BOT follow-up is not recommended (Grade C). In case of an initial elevation in serum CA 125 levels, it is recommended to monitor CA 125 during follow up (Grade B). In case of conservative treatment, it is recommended to use transvaginal and transabdominal ultrasound during follow up of a treated BOT (Grade B). In the event of a BOT recurrence in a woman of childbearing age, a second conservative treatment may be proposed (Grade C). A consultation with a physician specialized in Assisted Reproductive Technique (ART) should be offered in the case of BOTs in women of childbearing age (Grade C). When possible, a conservative surgical strategy is recommended to preserve fertility in women of childbearing age (Grade C). In the case of optimally treated BOT, there is no evidence to contraindicate the use of ART. The use of hormonal contraception after serous or mucinous BOT is not contraindicated (Grade C). After management of mucinous BOT, for women under 45 years, given the benefit of Hormonal Replacement Therapy (HRT) on cardiovascular and bone risks, and the lack of hormone sensitivity of mucinous BOTs, it is recommended to offer HRT (Grade C). Over 45 years of age, HRT can be prescribed in case of a climacteric syndrome after individual benefit to risk assessment (Grade C).
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Affiliation(s)
- N Bourdel
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
| | - C Huchon
- Service de Gynécologie & Obstétrique, Hopital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France; Université de Paris, Paris, France.
| | - C Abdel Wahab
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France; Faculté De Médecine UPMC, Sorbonne Université, France
| | - H Azaïs
- AP-HP, Hôpital Pitié-Salpêtrière, Service De Chirurgie Et Oncologie Gynécologique Et Mammaire, 75013 Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - S Bendifallah
- Service De Gynécologie-Obstétrique Et Médecine De La Reproduction, Hôpital Tenon, Assistance Publique Des Hôpitaux De Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, France
| | - P A Bolze
- Service De Chirurgie Gynécologique Et Oncologique, Obstétrique, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - J L Brun
- Service De Chirurgie Gynécologique, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33076 Bordeaux, Société Française De Gynéco Pathologie, 81 Rue Verte, 76000 Rouen, France
| | - G Canlorbe
- AP-HP, Hôpital Pitié-Salpêtrière, Service De Chirurgie Et Oncologie Gynécologique Et Mammaire, 75013 Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - P Chauvet
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
| | - E Chereau
- Service De Gynécologie Obstétrique, Hopital Saint Joseph, Marseille, France
| | - B Courbiere
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
| | | | - M Devouassoux-Shisheboran
- Institut De Pathologie Multi-Sites Des HOSPICES CIVILS De LYON, Centre Hospitalier Lyon Sud, Centre De Biologie Et Pathologie Sud, 165 Chemin Du Grand Revoyet, 69495 Pierre Bénite. Société Française de Gynéco Pathologie, 81 Rue Verte, 76000 Rouen, France
| | - C Eymerit-Morin
- Service d'Anatomie Et Cytologie Pathologiques, Hôpital Tenon, HUEP, UPMC Paris VI, Sorbonne Universities, 4 rue de la Chine, 75020 Paris, France; Institut de Pathologie de Paris, 35 boulevard Stalingrad, 92240 Malakoff, France
| | - R Fauvet
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Caen, Caen, France
| | - E Gauroy
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - T Gauthier
- Service De Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 Av Dominique Larrey 87042 Limoges, France
| | - M Grynberg
- Service De Médecine De La Reproduction, Hôpital Antoine Béclère, 157 Rue De La Porte De Trivaux, 92140 Clamart, France
| | - M Koskas
- Service De Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - E Larouzee
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - L Lecointre
- Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, CHRU Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France
| | - J Levêque
- Département De Gynécologie Obstétrique Et Reproduction Humaine, 16, Boulevard De Bulgarie, 35000 CHU Anne De Bretagne, UFR Médecine Université de Rennes 1, Rennes, Bretagne, France
| | - F Margueritte
- Service De Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 Av Dominique Larrey, 87042 Limoges, France
| | - E Mathieu D'argent
- Service de Gynécologie-Obstétrique Et Médecine De La Reproduction, Hôpital Tenon, Assistance Publique Des Hôpitaux De Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, France
| | - K Nyangoh-Timoh
- Département De Gynécologie Obstétrique Et Reproduction Humaine, 16, Boulevard De Bulgarie, 35000 CHU Anne De Bretagne, UFR Médecine Université de Rennes 1, Rennes, Bretagne, France
| | - L Ouldamer
- Département De Gynécologie, Centre Hospitalier Universitaire De Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000, Tours, France
| | - J Raad
- Service De Médecine De La Reproduction, Hôpital Antoine Béclère, 157 Rue De La Porte De Trivaux, 92140 Clamart, France
| | - E Raimond
- Département de Gynécologie Obstétrique, Institut Alix De Champagne, CHU Reims, Reims, France
| | - R Ramanah
- Pôle Mère-Femme, CHU Besançon, 3 Boulevard Fleming, 25000 Besançon, France
| | - L Rolland
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
| | - P Rousset
- Service de Radiologie, Centre Hospitalier Lyon Sud, HCL, EMR 3738, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre-Bénite, France; Université Lyon 1, 43 Boulevard Du 11 Novembre 1918, 69100, Villeurbanne, France
| | - C Rousset-Jablonski
- Centre Léon Bérard, 28 Rue Laënnec, 69008, Lyon, France; Centre Hospitalier Lyon Sud, Pierre-Bénite, France; Université Claude Bernard Lyon 1, EA 7425 Hesper, Health Service and Performance Research, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon Cedex 8, France
| | - I Thomassin-Naggara
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - C Uzan
- AP-HP, Hôpital Pitié-Salpêtrière, Service De Chirurgie Et Oncologie Gynécologique Et Mammaire, 75013 Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - M Zilliox
- Centre Hospitalier Universitaire Hautepierre, Hôpital De Hautepierre, CHRU Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France
| | - E Daraï
- Service de Gynécologie-Obstétrique Et Médecine De La Reproduction, Hôpital Tenon, Assistance Publique Des Hôpitaux De Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, France
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Zilliox M, Lecointre L, Azais H, Ballester M, Bendifallah S, Bolze PA, Bourdel N, Bricou A, Canlorbe G, Carcopino X, Chauvet P, Collinet P, Coutant C, Dabi Y, Dion L, Gauthier T, Graesslin O, Huchon C, Koskas M, Lavoue V, Mezzadri M, Mimoun C, Ouldamer L, Raimond E, Touboul C, Lapointe M, Akladios C. Management of borderline ovarian tumours during pregnancy: Results of a French multi-centre study. Eur J Obstet Gynecol Reprod Biol 2020; 256:412-418. [PMID: 33296755 DOI: 10.1016/j.ejogrb.2020.11.033] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 10/05/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the diagnostic and prognostic characteristics of borderline ovarian tumours (BOTs) detected during pregnancy, and to establish an inventory of French practices. MATERIALS AND METHODS A retrospective multi-centre case study of 14 patients treated for BOTs, diagnosed during pregnancy between 2005 and 2017, in five French pelvic cancerology expert centres, including data on clinical characteristics, histological tumour characteristics, surgical procedure, adjuvant treatments, follow-up and fertility. RESULTS The mean age of patients was 29.3 [standard deviation (SD) 6.2] years. Most BOTs were diagnosed on ultrasonography in the first trimester (85.7 %), and most of these cases (78.5 %) also underwent magnetic resonance imaging to confirm the diagnosis (true positives 54.5 %). Most patients underwent surgery during pregnancy (57 %), with complete staging surgery in two cases (14.3 %). Laparoscopy was performed more frequently than other procedures (50 %), and unilateral adnexectomy was more common than cystectomy (57.5 %). Tumour size influenced the surgical approach significantly (mean size 7.5 cm for laparoscopy, 11.9 cm for laparoconversion, 14 cm for primary laparotomy; P = 0.08), but the type of resection did not. Most patients were initially diagnosed with International Federation of Gynecology and Obstetrics stage IA (92.8 %) tumours, but many were upstaged after complete restaging surgery (57.1 %). Most BOTs were serous (50 %), two cases had a micropapillary component (28.5 %), and one case had a micro-invasive implant. BOTs were bilateral in two cases (14.2 %). Mean follow-up was 31.4 (SD 14.8) months. Recurrent lesions occurred in two patients (14.2 %) and no deaths have been recorded to date among the study population. CONCLUSION BOTs remain rare, but this study - despite its small sample size - supports the hypothesis that BOTs during pregnancy have potentially aggressive characteristics.
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Affiliation(s)
- M Zilliox
- Department of Gynaecology, University Hospital of Hautepierre, Strasbourg, France.
| | - L Lecointre
- Department of Gynaecology, University Hospital of Hautepierre, Strasbourg, France; I-Cube UMR 7357 Science Laboratory, Strasbourg, France; IHU: Institute for Minimally Invasive Hybrid Image Guided Surgery, Strasbourg, France
| | - H Azais
- Department of Gynaecology, Pitié Salpetriere Hospital, Paris, France
| | - M Ballester
- Department of Gynaecology, Diaconesses Croix Saint Simon, Paris, France
| | - S Bendifallah
- Department of Gynaecology, Tenon Hospital, Paris, France
| | - P A Bolze
- Department of Gynaecology, University Hospital South Lyon, Pierre-Bénite, France
| | - N Bourdel
- Department of Gynaecology, University Hospital of Clermont Ferrand, Clermont Ferrand, France
| | - A Bricou
- Department of Gynaecology, Diaconesses Croix Saint Simon, Paris, France
| | - G Canlorbe
- Department of Gynaecology, Pitié Salpetriere Hospital, Paris, France
| | - X Carcopino
- Department of Gynaecology, La Timone Hospital, Marseille, France
| | - P Chauvet
- Department of Gynaecology, University Hospital of Clermont Ferrand, Clermont Ferrand, France
| | - P Collinet
- Department of Gynaecology, Jeanne de Flandres Hospital, Lille, France
| | - C Coutant
- Centre de Lutte Contre le Cancer, Dijon, France
| | - Y Dabi
- Department of Gynaecology, Tenon Hospital, Paris, France
| | - L Dion
- Department of Gynaecology, University South Hospital, Rennes, France
| | - T Gauthier
- Department of Gynaecology, University Hospital, Limoges, France
| | - O Graesslin
- Department of Gynaecology, University Hospital, Reims, France
| | - C Huchon
- Department of Gynaecology, Intercommunal Hospital of Poissy, Poissy, France
| | - M Koskas
- Department of Gynaecology, Bichat Hospital, Paris, France
| | - V Lavoue
- Department of Gynaecology, University South Hospital, Rennes, France
| | - M Mezzadri
- Department of Gynaecology, Lariboisière Hospital, Paris, France
| | - C Mimoun
- Department of Gynaecology, Lariboisière Hospital, Paris, France
| | - L Ouldamer
- Department of Gynaecology, University Hospital of Tours, Tours, France
| | - E Raimond
- Department of Gynaecology, University Hospital, Reims, France
| | - C Touboul
- Department of Gynaecology, Tenon Hospital, Paris, France
| | - M Lapointe
- Department of Gynaecology, University Hospital of Hautepierre, Strasbourg, France
| | - C Akladios
- Department of Gynaecology, University Hospital of Hautepierre, Strasbourg, France
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Capmas P, Brun JL, Legendre G, Koskas M, Merviel P, Fernandez H. Ulipristal acetate use in adenomyosis: A randomized controlled trial. J Gynecol Obstet Hum Reprod 2020; 50:101978. [PMID: 33186772 DOI: 10.1016/j.jogoh.2020.101978] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 09/22/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the effect of a 10 mg per day 12 week treatment of ulipristal acetate (UPA) on abnormal uterine bleeding due to adenomyosis. DESIGN A double-blind phase 2 randomized controlled pilot study. SETTING From May 2015 to February 2018 in five teaching hospitals. POPULATION Premenopausal women with abnormal uterine bleeding (with a pictorial blood loss assessment score (PBAC) higher than 100 at inclusion) and a sonographic or MRI diagnosis of adenomyosis. METHODS After random allocation, either UPA 10 mg or placebo were orally administered during 12 weeks. A 3:1 ratio was used. MAIN OUTCOME MEASURES The primary outcome was the rate of women with a PBAC score of less than 75 as evaluated over the 28 days following the 12-week treatment. Secondary outcomes included rate of amenorrhea, evolution of pain, quality of life and tolerance. RESULTS Thirty women were included in the UPA group and 10 in the placebo group. No woman in the placebo group versus 95.24 % of women in the UPA group had a PBAC score under 75 during the 28 day period following the 12-week treatment (p < 0.01). A significant decrease in pain was noticed between inclusion and 13 weeks in the UPA group (p < 0.01). At 6 months, there was no significant difference in PBAC score or pain between groups. No serious adverse event was recorded. CONCLUSION UPA could be an interesting option for treatment of abnormal uterine bleeding related to adenomyosis in women wishing to preserve their fertility.
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Affiliation(s)
- Perrine Capmas
- Gynecology Obstetric Department, Bicetre Hospital, GHU Sud, AP-HP, F-94276, Le Kremlin Bicetre, France; Inserm, Centre of Research in EPIDEMIOLOGY and Population Health (CESP), U1018, F-94276, Le Kremlin Bicetre, France; Medical School, University Paris Sud, F-94276, Le Kremlin Bicêtre, France.
| | - Jean-Luc Brun
- Gynecology Obstetric Department, Centre Aliénor D'aquitaine CHU Bordeaux, F-33076, Bordeaux, France
| | | | - Martin Koskas
- Gynecology Obstetric Department, CHU Bichat, F-75018, Paris, France
| | - Philippe Merviel
- Gynecology Obstetric Department, CHRU Brest, F-29200, Brest, France
| | - Hervé Fernandez
- Gynecology Obstetric Department, Bicetre Hospital, GHU Sud, AP-HP, F-94276, Le Kremlin Bicetre, France; Inserm, Centre of Research in EPIDEMIOLOGY and Population Health (CESP), U1018, F-94276, Le Kremlin Bicetre, France; Medical School, University Paris Sud, F-94276, Le Kremlin Bicêtre, France
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31
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Huchon C, Bourdel N, Abdel Wahab C, Azaïs H, Bendifallah S, Bolze PA, Brun JL, Canlorbe G, Chauvet P, Chereau E, Courbiere B, De La Motte Rouge T, Devouassoux-Shisheboran M, Eymerit-Morin C, Fauvet R, Gauroy E, Gauthier T, Grynberg M, Koskas M, Larouzee E, Lecointre L, Levêque J, Margueritte F, Mathieu D'argent E, Nyangoh-Timoh K, Ouldamer L, Raad J, Raimond E, Ramanah R, Rolland L, Rousset P, Rousset-Jablonski C, Thomassin-Naggara I, Uzan C, Zilliox M, Daraï E. Borderline ovarian tumors: French guidelines from the CNGOF. Part 1. Epidemiology, biopathology, imaging and biomarkers. J Gynecol Obstet Hum Reprod 2020; 50:101965. [PMID: 33160106 DOI: 10.1016/j.jogoh.2020.101965] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The incidence (rate per 100 000) of borderline ovarian tumors (BOTs) increases progressively with age, starting at 15-19 years and peaking at around 4.5 cases per 100 000 at an age of 55-59 years (LE3) with a median age of 46 years. The five year survival for FIGO stages I, II, III and IV is 99.7 % (95 % CI: 96.2-100 %), 99.6 % (95 % CI: 92.6-100 %), 95.3 % (95 % CI: 91.8-97.4 %) and 77.1 % (95 % CI: 58.0-88.3 %), respectively (LE3). An epidemiological association exists between the individual risk of BOT and family history of BOT and certain other cancers (pancreatic, lung, bone, leukemia) (LE3), a personal history of benign ovarian cyst (LE2), a personal history of tubo-ovarian infection (LE3), the use of a levonorgestrel intrauterine device (LE3), oral contraceptive use (LE3), multiparity (LE3), Hormonal replacement therapy (LE3), high consumption of Coumestrol (LE4), medical treatment for infertility with progesterone (LE3) and non-steroidal anti-inflammatory drug use (LE3). Screening for BOTs is not recommended for patients (Grade C). The overall risk of recurrence of BOTs varies between 2% and 24 %, with an overall survival greater than 94 % at 10 years, and the risk of an invasive recurrence of a BOT ranges from 0.5 % to 3.8 %. The use of scores and nomograms can be useful in assessing the risk of recurrence, and providing patients with information (Grade C). The WHO classification is recommended for classifying BOTs. It is recommended that the presence of a microinvasive focus (<5 mm) and microinvasive carcinoma (<5 mm with an atypical nuclei and a desmoplastic stroma reaction) within a BOT be reported. In cases of serous BOT, it is recommended to specify the classic histological subtype or micropapillary / cribriform type (Grade C). When confronted with a BOT, it is recommended that the invasive or non-invasive nature of peritoneal implants can be investigated based solely on the invasion and destruction of underlying adipose or peritoneal tissue which has a desmoplastic stromal reaction where in contact with the invasive clusters (Grade B). For bilateral mucinous BOTs and / or in cases with peritoneal implants or peritoneal pseudomyxoma, it is recommended to also look for a primitive digestive or pancreato-biliary cancer (Grade C). It is recommended to sample ovarian tumors suspected of being BOTs by focusing samples on vegetations and solid components, with at least 1 sample per cm in tumors with a size less than 10 cm and 2 samples per cm in tumors with a size greater than 10 cm (Grade C). In cases of BOTs and in the absence of macroscopic omental involvement after careful macroscopic examination, it is recommended to perform at least 4-6 systematic sampling blocks and to include all peritoneal implants (Grade C). It is recommended to consult an expert pathologist in gynecology when a BOT suspicion requires intraoperative extemporaneous histology (grade C). Endo-vaginal and suprapubic ultrasonography are recommended for the analysis of an ovarian mass (Grade A). In case of an undetermined ovarian lesion on ultrasonography, it is recommended that a pelvic MRI be performed (Grade A). To analyze an adnexal mass with MRI, it is recommended to use an MRI protocol with T2, T1, T1 Fat Sat, dynamic and diffusion sequences as well as gadolinium injection (Grade B). To characterize an adnexal mass with MRI, it is recommended to include a score system for malignancy (ADNEX MR/O-RADS) (Grade C) in the report and to formulate a histological hypothesis (Grade C). Pelvic MRI is recommended to characterize a tumor suspected of being a BOT (Grade C). Macroscopic MRI features should be analyzed to differentiate BOT subtypes (Grade C). Pelvic ultrasound is the first-line examination for the detection and characterization of adnexal masses during pregnancy (Grade C). Pelvic MRI is recommended from 12 weeks of gestation in case of an indeterminate adnexal mass and should provide a diagnostic score (Grade C). Gadolinium injection must be minimized as fetal impairment has been proven (Grade C). It is recommended that serum levels of HE4 and CA125 be evaluated and that the ROMA score for the diagnosis of an indeterminate ovarian mass on imaging be used (grade A). In case of suspicion of a mucinous BOT on imaging, dosage of serum levels of CA 19-9 can be considered (Grade C). If the determination of tumor markers is normal preoperatively, routine dosage of tumor markers in BOT follow-up is not recommended (Grade C). In case of preoperative elevation in tumor markers, the determination of serum CA 125 levels is recommended in the follow-up of BOT (Grade B). When conservative treatment of a BOT has been adopted, the use of endovaginal and transabdominal ultrasonography is recommended during follow-up (Grade B).
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Affiliation(s)
- Cyrille Huchon
- APHP. Service de gynécologie & obstétrique, GH Saint-Louis Lariboisière-Fernand Widal, Hôpital Lariboisière, Université de Paris, 2, rue Ambroise Paré, 75010 Paris, France.
| | - Nicolas Bourdel
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
| | - Cendos Abdel Wahab
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Henri Azaïs
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Sofiane Bendifallah
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Pierre-Adrien Bolze
- Service de chirurgie gynécologique et oncologique, obstétrique, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Jean-Luc Brun
- Service de Chirurgie Gynécologique, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33076 Bordeaux, France; Société Française de Gynéco Pathologie, 81 rue verte, 76000 Rouen, France
| | - Geoffroy Canlorbe
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Pauline Chauvet
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
| | - Elisabeth Chereau
- Service de gynécologie obstétrique, Hopital Saint Joseph, 13005 Marseille, France
| | - Blandine Courbiere
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
| | | | - Mojgan Devouassoux-Shisheboran
- Institut de Pathologie multi-sites des HOSPICES CIVILS de LYON, Centre Hospitalier Lyon Sud, Centre de biologie et pathologie Sud, 165 Chemin du Grand revoyet, 69495 Pierre Bénite, France; Société Française de Gynéco Pathologie, 81 rue verte, 76000 Rouen, France
| | - Caroline Eymerit-Morin
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Tenon, HUEP, 4 rue de la Chine, 75020 Paris, France; UPMC Paris VI, Sorbonne Universities, France; Institut de Pathologie de Paris, 35 boulevard Stalingrad, 92240 Malakoff, France
| | - Raffaele Fauvet
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Caen, 14000 Caen, France
| | - Elodie Gauroy
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018 Paris, France
| | - Tristan Gauthier
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 av Dominique Larrey, 87042 Limoges, France
| | - Michael Grynberg
- Service de Médecine de la Reproduction, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140 Clamart, France
| | - Martin Koskas
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018 Paris, France
| | - Elise Larouzee
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018 Paris, France
| | - Lise Lecointre
- Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, CHRU Strasbourg, 1 avenue Molière, 67000 Strasbourg, France
| | - Jean Levêque
- Département de Gynécologie Obstétrique et Reproduction Humaine, 16, boulevard de Bulgarie, 35000 Rennes, France; CHU Anne de Bretagne, UFR Médecine Université de Rennes 1, 35000 Rennes, Bretagne, France
| | - Francois Margueritte
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 av Dominique Larrey, 87042 Limoges, France
| | - Emmanuelle Mathieu D'argent
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Krystel Nyangoh-Timoh
- Département de Gynécologie Obstétrique et Reproduction Humaine, 16, boulevard de Bulgarie, 35000 Rennes, France; CHU Anne de Bretagne, UFR Médecine Université de Rennes 1, 35000 Rennes, Bretagne, France
| | - Lobna Ouldamer
- Département de Gynécologie, Centre hospitalier universitaire de Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Jade Raad
- Service de Médecine de la Reproduction, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140 Clamart, France
| | - Emilie Raimond
- Département de Gynécologie Obstétrique, Institut Alix de Champagne, CHU Reims, 51000 Reims, France
| | - Rajeev Ramanah
- Pôle Mère-Femme, CHU Besançon, 3 boulevard Fleming, 25000 Besançon, France
| | - Lucie Rolland
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
| | - Pascal Rousset
- Service de Radiologie, Centre Hospitalier Lyon Sud, HCL, EMR 3738, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre-Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Christine Rousset-Jablonski
- Centre Léon Bérard, 28 Rue Laënnec, 69008, Lyon, France; Centre Hospitalier Lyon Sud, Pierre-Bénite, France; Université Claude Bernard Lyon 1, EA 7425 Hesper, Health Service and Performance Research, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon Cedex 8, France
| | - Isabelle Thomassin-Naggara
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Catherine Uzan
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Marie Zilliox
- Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, CHRU Strasbourg, 1 avenue Molière, 67000 Strasbourg, France
| | - Emile Daraï
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
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Bourdel N, Huchon C, Abdel Wahab C, Azaïs H, Bendifallah S, Bolze PA, Brun JL, Canlorbe G, Chauvet P, Chereau E, Courbiere B, De La Motte Rouge T, Devouassoux-Shisheboran M, Eymerit-Morin C, Fauvet R, Gauroy E, Gauthier T, Grynberg M, Koskas M, Larouzee E, Lecointre L, Levêque J, Margueritte F, D'argent Mathieu E, Nyangoh-Timoh K, Ouldamer L, Raad J, Raimond E, Ramanah R, Rolland L, Rousset P, Rousset-Jablonski C, Thomassin-Naggara I, Uzan C, Zilliox M, Daraï E. Borderline ovarian tumors: French guidelines from the CNGOF. Part 2. Surgical management, follow-up, hormone replacement therapy, fertility management and preservation. J Gynecol Obstet Hum Reprod 2020; 50:101966. [PMID: 33144266 DOI: 10.1016/j.jogoh.2020.101966] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In the Early Stages (ES) of Borderline Ovarian Tumor (BOT), if surgery without risk of tumor rupture is possible, then laparoscopy with protected extraction is recommended over laparotomy (Grade C). In case of bilateral serous ES BOT treatment with a strategy to preserve fertility and/or endocrine function, bilateral cystectomy is recommended if possible (Grade B). In case of mucinous BOT treatment with a strategy to preserve fertility and/or endocrine function, unilateral adnexectomy is recommended (grade C). In the case of a mucinous BOT in a patient who has had an initial cystectomy, unilateral adnexectomy is recommended (grade C). In the case of treatment of a serous ES BOT in a patient who has had an initial cystectomy, with a strategy to preserve fertility and/or endocrine function, restaging surgery for adnexectomy is not recommended in the absence of suspicious residual lesions at the time of surgery and/or postoperative imaging (reference ultrasonography or pelvic MRI) (grade C). For serous or mucinous ES BOTs, routine hysterectomy is not recommended (Grade C). In cases of ES BOTs, lymphadenectomy is not recommended (Grade C). For ES BOTs, appendectomy is recommended only if there is a macroscopically pathological aspect to the appendix (Grade C). Restaging surgery is recommended in case of a serous BOT with a micropapillary aspect and an unsatisfactory inspection of the abdominal cavity during initial surgery (Grade C). Restaging surgery is recommended in cases of mucinous BOT if only a cystectomy has been performed or if the appendix has not been evaluated (Grade C). If restaging surgery is decided for an ES BOT, the following procedures should be performed: peritoneal cytology (grade C), omentectomy (there is no data in literature to recommend which type of omentectomy should be performed) (grade B), complete exploration of the abdominal cavity with peritoneal biopsies (grade C), visualization of the appendix +/- appendectomy in case of pathological macroscopic appearance (grade C) and unilateral adnexectomy in case of a mucinous BOT (grade C). In advanced stages of BOT it is not recommended to perform a lymphadenectomy as a routine procedure (Grade C). In cases of an advanced stage BOT, in a patient with a desire to fall pregnant, conservative treatment involving preservation of the uterus and all or part of the ovary may be proposed after a multidisciplinary meeting (Grade C). Second surgery aimed at removing all lesions, if not performed initially, is recommended in cases of advanced stage BOT (Grade C). It is not recommended to perform completion surgery after conservative treatment (preservation of the ovaries and the uterus) and after the achievement of fertility desire for a serous BOT (Grade B). After treatment for a BOT, follow-up beyond 5 years is recommended due to the median time to recurrence (Grade B). It is recommended that a systematic clinical examination be carried out during follow-up of a treated BOT (Grade B). In the particular case of an initial elevation of CA 125 levels, it is recommended to monitor CA 125 during follow up (Grade B). In cases treated conservatively (ovarian and uterine conservation), it is recommended to use endovaginal and transabdominal ultrasonography during the follow up period (Grade B). In the event of a recurrence of a BOT, in a woman of childbearing age, a conservative treatment strategy can again be proposed (Grade C). In the presence of non-invasive BOT implants, conservative treatment may be considered after a first non-invasive recurrence in women who wish to preserve their fertility (Grade C). Pelvic MRI is recommended after 12 weeks of amenorrhea in case of an undetermined adnexal mass and should be concluded with a diagnostic score (Grade C). The injection of gadolinium, in case of pregnancy, should be discussed on a case-by-case basis due to the proven risks for the foetus (Grade C). If feasible, a laparoscopic approach should be preferred during pregnancy (Grade C). A consultation with a specialist reproductive physician should be offered to patients with a BOT and of childbearing age (Grade C). It is recommended that patients be provided with full information on the risk of decreased ovarian reserve following to surgical treatment. It is recommended that the ovarian reserve be evaluated prior to surgical management of a suspected BOT (Grade C). When possible, a conservative surgical strategy is recommended to preserve fertility in women of childbearing age (Grade C). There is no specific data on the management of infertility following to conservative treatment of BOT. In case of durable infertility following to conservative treatment of BOT, a consultation with a specialist reproductive physician is required (Grade C). In the case of optimally treated BOT, there is no evidence in literature to contraindicate the use of Assisted Reproductive Techniques (ART). The use of hormonal contraception after serous or mucinous BOT is not contraindicated (Grade C). After treatment of a mucinous BOT, for women aged under 45 years, given the benefit of hormonal replacement therapy (HRT) on cardiovascular and bone risks, and the lack of hormone-sensitivity of mucinous BOTs, it is recommended to offer HRT (Grade C). After treatment of a mucinous BOT, for women over 45 years of age, there is no argument to contraindicate the use of HRT. HRT can be prescribed in case of a climacteric syndrome, as part of an individual benefit to risk assessment (Grade C).
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Affiliation(s)
- Nicolas Bourdel
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France
| | - Cyrille Huchon
- Service de gynécologie & obstétrique, GH Saint-Louis Lariboisière-Fernand Widal, Hôpital Lariboisière, Université de Paris, 2, rue Ambroise Paré, 75010, Paris, France.
| | - Cendos Abdel Wahab
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Henri Azaïs
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013, Paris, France
| | - Sofiane Bendifallah
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Pierre-Adrien Bolze
- Service de chirurgie gynécologique et oncologique, obstétrique, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Jean-Luc Brun
- Service de Chirurgie Gynécologique, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33076 Bordeaux, Société Française de Gynéco Pathologie, 81 rue verte, 76000, Rouen, France
| | - Geoffroy Canlorbe
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013, Paris, France
| | - Pauline Chauvet
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France
| | - Elizabeth Chereau
- Service de gynécologie obstétrique, Hopital Saint Joseph, 13005, Marseille, France
| | - Blandine Courbiere
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005, Marseille, France
| | | | - Mojgan Devouassoux-Shisheboran
- Institut de Pathologie multi-sites des HOSPICES CIVILS de LYON, Centre Hospitalier Lyon Sud, Centre de biologie et pathologie Sud, 165 Chemin du Grand revoyet, 69495 Pierre Bénite, Société Française de Gynéco Pathologie, 81 rue verte, 76000, Rouen, France
| | - Caroline Eymerit-Morin
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Tenon, HUEP, 4 rue de la Chine, 75020, Paris, UPMC Paris VI, Sorbonne Universities, France; Institut de Pathologie de Paris, 35 boulevard Stalingrad, 92240, Malakoff, France
| | - Raffaele Fauvet
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Caen, 14000, Caen, France
| | - Elodie Gauroy
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018, Paris, France
| | - Tristan Gauthier
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 av Dominique Larrey, 87042, Limoges, France
| | - Michael Grynberg
- Service de Médecine de la Reproduction, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Martin Koskas
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018, Paris, France
| | - Elise Larouzee
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018, Paris, France
| | - Lise Lecointre
- Département de Gynécologie Obstétrique et Reproduction Humaine, 16, boulevard de Bulgarie, CHU Anne de Bretagne, UFR Médecine Université de Rennes 1, 35000, Rennes, France
| | - Jean Levêque
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France; Service de gynécologie obstétrique, Hopital Saint Joseph, 13005, Marseille, France
| | - Francois Margueritte
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 av Dominique Larrey, 87042, Limoges, France
| | - Emmanuelle D'argent Mathieu
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Krystel Nyangoh-Timoh
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France; Service de gynécologie obstétrique, Hopital Saint Joseph, 13005, Marseille, France
| | - Lobna Ouldamer
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France; Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005, Marseille, France
| | - Jade Raad
- Service de Médecine de la Reproduction, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Emilie Raimond
- Département de Gynécologie Obstétrique, Institut Alix de Champagne, CHU Reims, 51100, Reims, France
| | - Rajeev Ramanah
- Département de Gynécologie, Centre hospitalier universitaire de Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Lucie Rolland
- Service de gynécologie obstétrique, Hopital Saint Joseph, 13005, Marseille, France
| | - Pascal Rousset
- Service de Radiologie, Centre Hospitalier Lyon Sud, HCL, EMR 3738, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre-Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Christine Rousset-Jablonski
- Pôle Mère-Femme, CHU Besançon, 3 boulevard Fleming, 25000, Besançon, France; Centre Hospitalier Lyon Sud, Pierre-Bénite, France; Université Claude Bernard Lyon 1, EA 7425 Hesper, Health Service and Performance Research, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon Cedex 8, France
| | - Isabelle Thomassin-Naggara
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Catherine Uzan
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013, Paris, France
| | - Marie Zilliox
- Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, CHRU Strasbourg, 1 avenue Molière, 67000, Strasbourg, France
| | - Emile Daraï
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
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Bund V, Lecointre L, Velten M, Ouldamer L, Bendifallah S, Koskas M, Bolze PA, Collinet P, Canlorbe G, Touboul C, Huchon C, Coutant C, Faller E, Boisramé T, Gantzer J, Demarchi M, Baldauf JJ, Ballester M, Lavoué V, Akladios C. Impact of Lymphadenectomy on Survival of Patients with Serous Advanced Ovarian Cancer After Neoadjuvant Chemotherapy: A French National Multicenter Study (FRANCOGYN). J Clin Med 2020; 9:jcm9082427. [PMID: 32751303 PMCID: PMC7464978 DOI: 10.3390/jcm9082427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/15/2020] [Accepted: 07/23/2020] [Indexed: 11/24/2022] Open
Abstract
Background: The population of interest to this study comprised individuals with advanced-stage ovarian carcinoma who were exposed to neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). Those who had not received systematic lymphadenectomy (SL; Group 1) were compared to those who had received SL (Group 2). Outcome measures included progression-free survival (PFS), overall survival (OS), and surgical complications. Methods: This was a retrospective, multicenter cohort study in nine referral centers of France between January 2000 and June 2017. OS analysis using the multivariate Cox regression model was performed. PFS and surgery-related morbidity were analyzed. Results: Of the 255 patients included, 100 were in Group 1 and 155 in Group 2. Patient majority was, on average, younger and less comorbid, with predominant R0 surgery in Group 2. Dindo–Clavien score was similar between the two groups (p = 0.15). Median OS was 26.8 months in Group 2 and 27.6 months in Group 1. SL was not statistically significant on OS (p = 0.7). Median PFS was 18.3 months in Group 2 and 16.6 months in Group 1. SL had positive impact on PFS (p = 0.005). Conclusions: patients who had received SL (Group 2) had significantly higher PFS regardless of node-positivity status when compared to those who had not received SL (Group 1).
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Affiliation(s)
- Virginie Bund
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
- Department of Public Health, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France;
- Correspondence: ; Tel.: +33-(0)7-8170-2239
| | - Lise Lecointre
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
- I-Cube UMR 7357—Laboratoire des Sciences de L’ingénieur, de L’informatique et de L’imagerie, Université de Strasbourg, 67081 Strasbourg, France
- Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, 67081 Strasbourg, France
| | - Michel Velten
- Department of Public Health, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France;
| | - Lobna Ouldamer
- Department of Gynecology, Hôpital Universitaire de Tours, 37000 Tours, France;
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Hôpital Tenon, AP-HP, 75020 Paris, France;
| | - Martin Koskas
- Department of Gynecology, Hôpital Bichat, AP-HP, 75018 Paris, France;
| | - Pierre-Adrien Bolze
- Gynecological Surgery Service, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France;
| | - Pierre Collinet
- Department of Gynecological Surgery, Hôpital Jeanne De Flandre, CHRU, 59000 Lille, France;
| | - Geoffroy Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, Hôpital la Pitié Salpétrière, AP-HP, 75013 Paris, France;
| | - Cyril Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, 94000 Créteil, France;
| | - Cyrille Huchon
- Department of Gynecology, Centre Hospitalier de Poissy, 78100 Poissy, France;
| | - Charles Coutant
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 21000 Dijon, France;
| | - Emilie Faller
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
| | - Thomas Boisramé
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
| | - Justine Gantzer
- Department of Medical Oncology, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France;
| | - Martin Demarchi
- Medical Oncology Department, Centre Paul Strauss, 67000 Strasbourg, France;
| | - Jean-Jacques Baldauf
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
| | - Marcos Ballester
- Department of Gynecologic and Breast Surgery, Groupe Hospitalier Diaconesses Croix, Saint-Simon, 75020 Paris, France;
| | - Vincent Lavoué
- Department of Gynecologic Surgery, Hôpital Universitaire de Rennes, 35000 Rennes, France;
| | - Chérif Akladios
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
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Gaudet Chardonnet A, Azaïs H, Ballester M, Raimond E, Bendifallah S, Ouldamer L, Coutant C, Graesslin O, Touboul C, Collinet P, Bricou A, Huchon C, Daraï E, Lavoue V, Koskas M, Uzan C, Canlorbe G. Prognostic Value and Risk Factors of Peritoneal Carcinomatosis Recurrence for Patients with Endometrial Cancer: A Multicenter Study from the FRANCOGYN Group. Ann Surg Oncol 2020; 28:212-221. [PMID: 32648177 DOI: 10.1245/s10434-020-08812-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/15/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The prognosis for patients with endometrial cancer (EC) peritoneal carcinomatosis (PC) recurrence has received little study. This study aimed to determine specific risk factors and prognosis of EC with PC recurrence (PCR) versus no PC recurrence (NPCR). METHODS Data of all patients with EC who received primary surgical treatment between January 2000 and February 2017 were abstracted from the French FRANCOGYN Research Group database. Clinical and pathologic variables were compared between the two groups (PCR vs. NPCR). Multivariate analysis was performed to define prognostic factors for peritoneal recurrence. Overall survivals (OS) of patients after recurrence were compared using the Kaplan-Meier method. RESULTS The study analyzed 1466 patients, and 257 of these patients (17.5%) had recurrence. At presentation, 63 of these patients had PC. International Federation of Gynecology and Obstetrics (FIGO) stages 3 and 4 disease were significantly associated with PCR versus NPCR (odds ratio 2.24; 95% confidence interval 1.23-4.07; p = 0.008). The death rate for the patients with PC was 47.6%, with a median survival of 12 months after diagnosis of recurrence. According to the histologic subtype, OS was 29 months (Q1-Q3, 13-NA) for endometrioid carcinomas, 7.5 months (Q1-Q3, 4-15) for serous carcinomas, and 10 months (Q1-Q3, 5-15) for clear cell carcinomas. Chemotherapy for treatment of PCR was associated with improved OS after recurrence (OSAR; p = 0.0025). CONCLUSION An initial advanced stage of EC is a risk factor for PCR. For women with PCR, a diagnosis of type 1 EC recurrence more than 12 months after the initial treatment and management of PCR with chemotherapy is associated with improved OSAR. Prospective studies are needed to determine the precise optimal management required in this clinical situation and to assess the relevance of biomarkers to predict the risk of PCR for EC patients.
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Affiliation(s)
- A Gaudet Chardonnet
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France
| | - H Azaïs
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France
| | - M Ballester
- Service de Chirurgie Gynécologique et Mammaire, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France
| | - E Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - S Bendifallah
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecology and Obstetrics, Tenon University Hospital, Paris, France.,INSERM UMR_S_938, "Cancer Biology and Therapeutics," Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, Paris, France.,Institut Universitaire de Cancérologie (IUC), Sorbonne University, Paris, France
| | - L Ouldamer
- Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - C Coutant
- Center de Lutte Contre le Cancer Georges François Leclerc, Dijon, France
| | - O Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - C Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France
| | - P Collinet
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France.,Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire, Lille, France
| | - A Bricou
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecology and Obstetrics, Jean Verdier University Hospital, Bondy, France
| | - C Huchon
- Department of Gynaecology and Obstetrics, Centre Hospitalier Intercommunal, Poissy, France
| | - E Daraï
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecology and Obstetrics, Tenon University Hospital, Paris, France.,INSERM UMR_S_938, "Cancer Biology and Therapeutics," Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, Paris, France.,Institut Universitaire de Cancérologie (IUC), Sorbonne University, Paris, France
| | - V Lavoue
- Service de Gynécologie, INSERM 1242, Oncogenesis, Stress and Signaling, CRLC Eugène Marquis, Université de Rennes 1, Hopital Sud, CHU de Rennes, Rennes, France
| | - M Koskas
- Service de Chirurgie et Oncologie Gynécologique et Mammaire, APHP, Université Paris Diderot Hôpital Bichat, Paris, France
| | - C Uzan
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France.,INSERM UMR_S_938, "Cancer Biology and Therapeutics," Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, Paris, France.,Institut Universitaire de Cancérologie (IUC), Sorbonne University, Paris, France
| | - G Canlorbe
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France. .,INSERM UMR_S_938, "Cancer Biology and Therapeutics," Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, Paris, France. .,Institut Universitaire de Cancérologie (IUC), Sorbonne University, Paris, France.
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35
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Akladios C, Azais H, Ballester M, Bendifallah S, Bolze PA, Bourdel N, Bricou A, Canlorbe G, Carcopino X, Chauvet P, Collinet P, Coutant C, Dabi Y, Dion L, Gauthier T, Graesslin O, Huchon C, Koskas M, Kridelka F, Lavoue V, Lecointre L, Mezzadri M, Mimoun C, Ouldamer L, Raimond E, Touboul C. Recommendations for the surgical management of gynecological cancers during the COVID-19 pandemic - FRANCOGYN group for the CNGOF. J Gynecol Obstet Hum Reprod 2020; 49:101729. [PMID: 32247066 PMCID: PMC7118621 DOI: 10.1016/j.jogoh.2020.101729] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION In the context of the COVID-19 pandemic, specific recommendations are required for the management of patients with gynecologic cancer. MATERIALS AND METHOD The FRANCOGYN group of the National College of French Gynecologists and Obstetricians (CNGOF) convened to develop recommendations based on the consensus conference model. RESULTS If a patient with a gynecologic cancer presents with COVID-19, surgical management should be postponed for at least 15 days. For cervical cancer, radiotherapy and concomitant radiochemotherapy could replace surgery as first-line treatment and the value of lymph node staging should be reviewed on a case-by-case basis. For advanced ovarian cancers, neoadjuvant chemotherapy should be preferred over primary cytoreduction surgery. It is legitimate not to perform hyperthermic intraperitoneal chemotherapy during the COVID-19 pandemic. For patients who are scheduled to undergo interval surgery, chemotherapy can be continued and surgery performed after 6 cycles. For patients with early stage endometrial cancer of low and intermediate preoperative ESMO risk, hysterectomy with bilateral adnexectomy combined with a sentinel lymph node procedure is recommended. Surgery can be postponed for 1-2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For patients of high ESMO risk, the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) should be applied to avoid pelvic and lumbar-aortic lymphadenectomy. CONCLUSION During the COVID-19 pandemic, management of a patient with cancer should be adapted to limit the risks associated with the virus without incurring loss of chance.
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MESH Headings
- Betacoronavirus
- COVID-19
- Chemotherapy, Adjuvant
- Coronavirus Infections/complications
- Coronavirus Infections/epidemiology
- Coronavirus Infections/prevention & control
- Endometrial Neoplasms/pathology
- Endometrial Neoplasms/surgery
- Female
- France
- Genital Neoplasms, Female/complications
- Genital Neoplasms, Female/pathology
- Genital Neoplasms, Female/surgery
- Genital Neoplasms, Female/therapy
- Gynecology
- Humans
- Interdisciplinary Communication
- Obstetrics
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/pathology
- Pandemics/prevention & control
- Pneumonia, Viral/complications
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/prevention & control
- Receptors, Lymphocyte Homing
- Risk
- SARS-CoV-2
- Societies, Medical
- Trophoblastic Neoplasms/drug therapy
- Uterine Cervical Neoplasms/therapy
- Vaginal Neoplasms/therapy
- Vulvar Neoplasms/surgery
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Affiliation(s)
- Cherif Akladios
- Service de gynécologie, CHU de Hautepierre, 67000 Strasbourg, France
| | - Henri Azais
- Service de gynécologie, Hopital la Pitié Salpetriee, 75013 Paris, France
| | - Marcos Ballester
- Service de gynécologie, Dioconessess Croix Saint Simon, 75012 Paris, France
| | | | | | - Nicolas Bourdel
- Service de gynécologie obstétrique, Chu Clermont Ferrand, 63000 Clermont Ferrand, France
| | - Alexandre Bricou
- Service de gynécologie, Dioconessess Croix Saint Simon, 75012 Paris, France
| | - Geoffroy Canlorbe
- Service de gynécologie, Hopital la Pitié Salpetriee, 75013 Paris, France
| | | | - Pauline Chauvet
- Service de gynécologie obstétrique, Chu Clermont Ferrand, 63000 Clermont Ferrand, France
| | - Pierre Collinet
- Service de gynécologie, Hôpital Jeanne de Flandres, 59 000 Lille, France
| | | | - Yohann Dabi
- Service de gynécologie obstétrique, HôpitalTenon, 75020 Paris, France
| | - Ludivine Dion
- Service de gynécologie, CHU Hôpital Sud, 35000 Rennes, France
| | | | | | - Cyrille Huchon
- Service de gynécologie obstétrique, CHI Poissy, 78300 Poissy, France
| | - Martin Koskas
- Service de gynécologie obstétrique, Hopital Bichat, 75018 Paris, France
| | | | - Vincent Lavoue
- Service de gynécologie, CHU Hôpital Sud, 35000 Rennes, France.
| | - Lise Lecointre
- Service de gynécologie, CHU de Hautepierre, 67000 Strasbourg, France
| | | | - Camille Mimoun
- Service de gynécologie, Hôpital Lariboisière, 75010 Paris, France
| | | | - Emilie Raimond
- Service de gynécologie obstétrique, CHU 51000 Reims, France
| | - Cyril Touboul
- Service de gynécologie obstétrique, HôpitalTenon, 75020 Paris, France
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Peigné M, Maumy L, Koskas M. A survey of French gynecologists' knowledge and attitudes toward conservative treatment for fertility preservation in young patients with endometrial cancer. J Gynecol Obstet Hum Reprod 2020; 49:101794. [PMID: 32416273 DOI: 10.1016/j.jogoh.2020.101794] [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: 02/17/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe knowledge and attitudes toward fertility preservation (FP) in patients with endometrial atypical hyperplasia or adenocarcinoma (EC/AH) among French gynecologists MATERIALS AND METHODS: A national survey among French gynaecologists: one questionnaire with one common part and two specific parts for gynecological surgeon (GS) or for specialists in reproductive medicine (SRM) was sent from April 2017 to April 2018. Knowledge and attitudes toward FP in EC/AH were evaluated with a "knowledge score" and an "attitudes score" using a four- or five-point Likert scale. RESULTS One hundred forty physicians completed the survey (87 GS, 53 SRM). The knowledge score was low (59.3% medium/low), but it was significantly higher for GS compared to SRM. The better-known treatments were oral progestins and hysteroscopic resection. Among the participants treating EC/AH, 52.6% found it "difficult" to manage patients and 61.8% regretted the lack of official recommendations. Most physicians seemed to be uncomfortable/unsupportive with FP in EC/AH (57.2% "attitude score' below 11/20). There was a positive correlation between knowledge and attitude scores. GS "usually/always" give advice to patients about FP before EC/AH treatment. After maximum 3-6 months, 56.6% of SRM chose In Vitro Fecundation (IVF) to reduce time-to-pregnancy, with GnRH antagonist protocols (28%) or mild-stimulation (15.1%) to avoid hyperoestrogenism. CONCLUSIONS Despite reassuring results in the literature, French gynecologists are uncomfortable with FP using EC/AH conservative management, which may be because of a lack of confidence in their knowledge. Specific guidelines are needed to help physicians manage these young patients and their fertility.
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Affiliation(s)
- Maëliss Peigné
- AP-HP, Department of Obstetrics and Gynecology, Hôpital Bichat-Claude Bernard, F-75018 Paris, France.
| | - Louise Maumy
- AP-HP, Department of Obstetrics and Gynecology, Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Martin Koskas
- AP-HP, Department of Obstetrics and Gynecology, Hôpital Bichat-Claude Bernard, F-75018 Paris, France; Université de Paris, France
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Pauly L, Benoit L, Koskas M. Impact of Extent of Lymphadenectomy on Survival in Patients With Endometrial Cancer: A Matched Cohort Study. Anticancer Res 2020; 40:1563-1570. [PMID: 32132058 DOI: 10.21873/anticanres.14103] [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: 01/28/2020] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM This study aimed to determine whether a pelvic and para-aortic lymphadenectomy (PPAL) improves survival compared with a pelvic lymphadenectomy (PL) in patients with endometrial cancer. PATIENTS AND METHODS Data from all women operated for endometrial cancer between 1998 and 2013 were extracted from the Surveillance, Epidemiology and End Results database. Women treated with PL were matched with those treated with PPAL according to age and risk of recurrence. The primary endpoint was disease-specific survival (DSS). RESULTS A total of 1015 patients who underwent PL were matched with 1015 patients who underwent PPAL. The 3-year DSS probabilities for patients at intermediate- and high-risk (IHR) of recurrence were similar in the PPAL group and the PL group. Multivariate analysis of prognostic factors indicated that in patients with an IHR of recurrence, PPAL did not reduce the risk of death compared with PL. CONCLUSION For patients with an IHR of recurrence, the extent of lymphadenectomy does not impact DSS.
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Affiliation(s)
- Lea Pauly
- Gynecologic Oncology, Bichat University Hospital, Paris Diderot University, Paris, France
| | - Louise Benoit
- Gynecologic Oncology, Bichat University Hospital, Paris Diderot University, Paris, France
| | - Martin Koskas
- Gynecologic Oncology, Bichat University Hospital, Paris Diderot University, Paris, France.,EA 7285, Versailles Saint Quentin Université, Montigny Le Bretonneux, France
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38
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Benoit L, Pauly L, Phelippeau J, Koskas M. Impact of Sociodemographic Characteristics on the Quality of Care in the Surgical Management of Endometrial Cancer: An Analysis of a National Database in the United States. Gynecol Obstet Invest 2020; 85:222-228. [PMID: 32224609 DOI: 10.1159/000506048] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 01/20/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Quality of care is an emerging concern, notably in oncology. The aim of the present study was to identify the sociodemographic factors influencing the quality of care in the USA concerning the surgical management of endometrial cancer (EC) through the Surveillance Epidemiology and End Results (SEER) database using already published Belgian quality indicators (QI). METHODS Using the SEER database 1988-2013, we identified 151,752 patients treated for EC. Six QI were extracted from a Belgian study on quality of care in EC because of their applicability to the SEER. These QI evaluated only the surgical management. We examined the association between sociodemographic characteristics and quality of care with a logistic regression model. We compared our results with those defined as theoretical target by the Belgian initiative and considered a QI to be accurately met if >80% of the population met the indicator, moderately met between 50 and 80%, and poorly met under 50%. RESULTS Concerning the 6 surgical QIs, one was accurately met, 3 were moderately met, and 2 were poorly met. For example, 73% of the patients with a high-risk EC underwent a pelvic lymphadenectomy. Age over 75 years old, black ethnicity, lower-income group, without partner, and uninsured had a negative impact on adherence to QIs. CONCLUSION Demographic discrepancies persist in the surgical management of EC, impacting evidence-based care.
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Affiliation(s)
- Louise Benoit
- Department of Gynecologic and Obstetrics, Bichat University Hospital, Paris Diderot University, Paris, France,
| | - Lea Pauly
- Department of Gynecologic and Obstetrics, Bichat University Hospital, Paris Diderot University, Paris, France
| | - Juliette Phelippeau
- Department of Gynecologic and Obstetrics, Bichat University Hospital, Paris Diderot University, Paris, France
| | - Martin Koskas
- Department of Gynecologic and Obstetrics, Bichat University Hospital, Paris Diderot University, Paris, France.,EA 7285, Versailles Saint Quentin University, Montigny Le Bretonneux, France
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39
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Akladios C, Azais H, Ballester M, Bendifallah S, Bolze PA, Bourdel N, Bricou A, Canlorbe G, Carcopino X, Chauvet P, Collinet P, Coutant C, Dabi Y, Dion L, Gauthier T, Graesslin O, Huchon C, Koskas M, Kridelka F, Lavoue V, Lecointre L, Mezzadri M, Mimoun C, Ouldamer L, Raimond E, Touboul C. [Guidelines for surgical management of gynaecological cancer during pandemic COVID-19 period - FRANCOGYN group for the CNGOF]. ACTA ACUST UNITED AC 2020; 48:444-447. [PMID: 32222433 PMCID: PMC7103920 DOI: 10.1016/j.gofs.2020.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Recommendations for the management of patients with gynecological cancer during the COVID-19 pandemic period. MATERIAL AND METHOD Recommendations based on the consensus conference model. RESULTS In the case of a COVID-19 positive patient, surgical management should be postponed for at least 15 days. For cervical cancer, the place of surgery must be re-evaluated in relation to radiotherapy and Radio-Chemotherapy-Concomitant and the value of lymph node staging surgeries must be reviewed on a case-by-case basis. For advanced ovarian cancers, neo-adjuvant chemotherapy should be favored even if primary cytoreduction surgery could be envisaged. It is lawful not to offer hyperthermic intraperitoneal chemotherapy during a COVID-19 pandemic. In the case of patients who must undergo interval surgery, it is possible to continue the chemotherapy and to offer surgery after 6 cycles of chemotherapy. For early stage endometrial cancer, in case of low and intermediate preoperative ESMO risk, hysterectomy with bilateral annexectomy associated with a sentinel lymph node procedure should be favored. It is possible to consider postponing surgery for 1 to 2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For high ESMO risk, it ispossible to favor the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) in order to omit pelvic and lumbar-aortic lymphadenectomies. CONCLUSION During COVID-19 pandemic, patients suffering from cancer should not lose life chance, while limiting the risks associated with the virus.
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Affiliation(s)
- C Akladios
- Service de gynécologie, CHU de Hautepierre, 67000 Strasbourg, France
| | - H Azais
- Service de gynécologie, hôpital la Pitié-Salpêtrière, 75013 Paris, France
| | - M Ballester
- Service de gynécologie, Dioconessess Croix Saint Simon, 75012 Paris, France
| | - S Bendifallah
- Service de gynécologie obstétrique, hôpital Tenon, 75020 Paris, France
| | - P-A Bolze
- Service de gynécologie obstétrique, CHU Lyon Sud, 69000 Lyon, France
| | - N Bourdel
- Service de gynécologie obstétrique, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - A Bricou
- Service de gynécologie, Dioconessess Croix Saint Simon, 75012 Paris, France
| | - G Canlorbe
- Service de gynécologie, hôpital la Pitié-Salpêtrière, 75013 Paris, France
| | - X Carcopino
- Service de gyécologie, La Timone, 13000 Marseille, France
| | - P Chauvet
- Service de gynécologie obstétrique, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - P Collinet
- Service de gynécologie, hôpital Jeanne de Flandres, 59000 Lille, France
| | - C Coutant
- Centre de lutte contre le cancer, 21000 Dijon, France
| | - Y Dabi
- Service de gynécologie obstétrique, hôpital Tenon, 75020 Paris, France
| | - L Dion
- Service de gynécologie, CHU hôpital Sud, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - T Gauthier
- Service de gynécologie obstétrique, CHU, 87000 Limoges, France
| | - O Graesslin
- Service de gynécologie obstétrique, CHU, 51000 Reims, France
| | - C Huchon
- Service de gynécologie obstétrique, CHI Poissy, 78300 Poissy, France
| | - M Koskas
- Service de gynécologie obstétrique, hôpital Bichat, 75018 Paris, France
| | - F Kridelka
- Service de chirurgie oncologique, CHU, Liège, Belgique
| | - V Lavoue
- Service de gynécologie, CHU hôpital Sud, 16, boulevard de Bulgarie, 35000 Rennes, France.
| | - L Lecointre
- Service de gynécologie obstétrique, hôpital Tenon, 75020 Paris, France
| | - M Mezzadri
- Service de gynécologie, hôpital Lariboisière, 75010 Paris, France
| | - C Mimoun
- Service de gynécologie, hôpital Lariboisière, 75010 Paris, France
| | - L Ouldamer
- Service de gynécologie, CHU Tours, 37000 Tours, France
| | - E Raimond
- Service de gynécologie obstétrique, CHU, 51000 Reims, France
| | - C Touboul
- Service de chirurgie oncologique, CHU, Liège, Belgique
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Gonthier C, Douhnai D, Koskas M. Lymph node metastasis probability in young patients eligible for conservative management of endometrial cancer. Gynecol Oncol 2020; 157:131-135. [PMID: 32139150 DOI: 10.1016/j.ygyno.2020.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/27/2020] [Accepted: 02/13/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Endometrial cancer (EC) is a rare condition in young women. The objective of this study was to evaluate the risk of pelvic lymph node (LN) metastasis in young women with EC who are candidates for conservative management. METHODS Using the SEER database, a population-based analysis was conducted to identify women <45 years with grade 1, 2, or 3 endometrioid adenocarcinoma stage IA (FIGO 2009) who underwent pelvic lymphadenectomy with at least ten LNs removed. The LN macrometastases rate based on conventional histological diagnosis was analyzed according to tumor grade and myometrial invasion (MI) on final histology. RESULTS A cohort of 1284 women was analyzed. The LN metastasis rates were: 2/414 (0.5%) grade 1 EC without MI, 5/239 (2.1%) grade 2 or 3 EC without MI, 5/308 (1.6%) grade 1 EC with MI, and 14/323 (4.3%) grade 2 or 3 EC with MI. Tumor size was not correlated with LN metastasis probability. CONCLUSIONS Young patients eligible for conservative management have a low rate of LN macrometastasis, especially in stage IA without MI grade 1 EC. A systematic lymphadenectomy should not be performed in these patients. Prospective study evaluating the sentinel LN mapping in conservative management of EC could be performed to assess the LN micrometastasis rate.
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Affiliation(s)
- Clémentine Gonthier
- Department of Gynecologic Oncology, Bichat University Hospital, Paris, France; PREFERE Center, French referent center in conservative management of endometrial cancer, Bichat University Hospital, Paris, France.
| | - Daria Douhnai
- Department of Gynecologic Oncology, Bichat University Hospital, Paris, France
| | - Martin Koskas
- Department of Gynecologic Oncology, Bichat University Hospital, Paris, France; PREFERE Center, French referent center in conservative management of endometrial cancer, Bichat University Hospital, Paris, France; Paris Diderot University Paris 07, France
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Margueritte F, Sallee C, Lacorre A, Gauroy E, Larouzee E, Chereau E, De La Motte Rouge T, Koskas M, Gauthier T. [Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Epidemiology and Risk Factors of Relapse, Follow-up and Interest of a Completion Surgery]. ACTA ACUST UNITED AC 2020; 48:248-259. [PMID: 32004784 DOI: 10.1016/j.gofs.2020.01.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To provide clinical practice guidelines from the French college of obstetrics and gynecology (CNGOF) based on the best evidence available, concerning epidemiology of recurrence, the risk or relapse and the follow-up in case of borderline ovarian tumor after primary management, and evaluation of completion surgery after fertility sparing surgery. MATERIAL AND METHODS English and French review of literature from 2000 to 2019 based on publications from PubMed, Medline, Cochrane, with keywords borderline ovarian tumor, low malignant potential, recurrence, relapse, follow-up, completion surgery. From 2000 up to this day, 448 references have been found, from which only 175 were screened for this work. RESULTS AND CONCLUSION Overall risk of recurrence with Borderline Ovarian Tumour (BOT) may vary from 2 to 24% with a 10-years overall survival>94% and risk of invasive recurrence between 0.5 to 3.8%. Age<40 years (level of evidence 3), advanced initial FIGO stage (LE3), fertility sparing surgery (LE2), residual disease after initial surgery for serous BOT (LE2), implants (invasive or not) (LE2) are risk factors of recurrence. In case of conservative treatment, serous BOT had a higher risk of relapse than mucinous BOT (LE2). Lymphatic involvement (LE3) and use of mini invasive surgery (LE2) are not associated with a higher risk of recurrence. Scores or Nomograms could be useful to assess the risk of recurrence and then to inform patients about this risk (gradeC). In case of serous BOT, completion surgery is not recommended, after conservative treatment and fulfillment of parental project (grade B). It isn't possible to suggest a recommendation about completion surgery for mucinous BOT. There is not any data to advise a frequency of follow-up and use of paraclinic tools in general case of BOT. Follow-up of treated BOT must be achieved beyond 5 years (grade B). A systematic clinical examination is recommended during follow-up (grade B), after treatment of BOT. In case of elevation of CA-125 at diagnosis use of CA-125 serum level is recommended during follow-up of treated BOT (grade B). When a conservative treatment (preservation of ovarian pieces and uterus) of BOT is performed, endovaginal and transabdominal ultrasonography is recommended during follow-up (grade B). There isn't any sufficient data to advise a frequency of these examinations (clinical examination, ultrasound and CA-125) in case of treated BOT. CONCLUSION Risk of relapse after surgical treatment of BOT depends on patients' characteristics, type of BOT (histological features) and modalities of initial treatment. Scores and nomogram are useful tools to assess risk of relapse. Follow-up must be performed beyond 5 years and in case of peculiar situations, use of paraclinic evaluations is recommended.
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Affiliation(s)
- F Margueritte
- Service de gynécologie-obstétrique, CHU de Limoges, hôpital mère-enfant, 8, avenue Dominique-Larrey, 87042 Limoges, France
| | - C Sallee
- Service de gynécologie-obstétrique, CHU de Limoges, hôpital mère-enfant, 8, avenue Dominique-Larrey, 87042 Limoges, France
| | - A Lacorre
- Service de gynécologie-obstétrique, CHU de Limoges, hôpital mère-enfant, 8, avenue Dominique-Larrey, 87042 Limoges, France
| | - E Gauroy
- Service de gynécologie-obstétrique, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France
| | - E Larouzee
- Service de gynécologie-obstétrique, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, 75000 Paris, France
| | - E Chereau
- Service de gynécologie-obstétrique, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France
| | - T De La Motte Rouge
- Département d'oncologie médicale, centre Eugène Marquis, avenue de la Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - M Koskas
- Service de gynécologie-obstétrique, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, 75000 Paris, France
| | - T Gauthier
- Service de gynécologie-obstétrique, CHU de Limoges, hôpital mère-enfant, 8, avenue Dominique-Larrey, 87042 Limoges, France; UMR-1248, faculté de médecine, 87000 Limoges, France.
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Descamps V, Lariven S, Koskas M, Dieude P, Abramowitz L, Deschamps L, Charpentier C, Brunet-Possenti F. Intérêt potentiel des anti-IL17 dans la prise en charge du psoriasis en cas de pathologie tumorale associée aux HPV à haut risque oncogène (HPVHR). Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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43
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Fernandez H, Brun JL, Legendre G, Koskas M, Merviel P, Capmas P. 1953 Ulipristal Acetate for Adenomyosis: A Multicenter Randomized Trial. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Maggen C, Lok CA, Cardonick E, van Gerwen M, Ottevanger PB, Boere IA, Koskas M, Halaska MJ, Fruscio R, Gziri MM, Witteveen PO, Van Calsteren K, Amant F. Gastric cancer during pregnancy: A report on 13 cases and review of the literature with focus on chemotherapy during pregnancy. Acta Obstet Gynecol Scand 2019; 99:79-88. [PMID: 31529466 PMCID: PMC6972614 DOI: 10.1111/aogs.13731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/21/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 12/14/2022]
Abstract
Introduction Gastric cancer during pregnancy is extremely rare and data on optimal treatment and possible chemotherapeutic regimens are scarce. The aim of this study is to describe the obstetric and maternal outcome of women with gastric cancer during pregnancy and review the literature on antenatal chemotherapy for gastric cancer. Material and methods Treatment and outcome of patients registered in the International Network on Cancer, Infertility and Pregnancy database with gastric cancer diagnosed during pregnancy were analyzed. Results In total, 13 women with gastric cancer during pregnancy were registered between 2002 and 2018. Median gestational age at diagnosis was 22 weeks (range 6‐30 weeks). Twelve women were diagnosed with advanced disease and died within 2 years after pregnancy, most within 6 months. In total, eight out of 10 live births ended in a preterm delivery because of preeclampsia, maternal deterioration, or therapy planning. Two out of six women who initiated chemotherapy during pregnancy delivered at term. Two neonates prenatally exposed to chemotherapy were growth restricted and one of them developed a systemic infection with brain abscess after preterm delivery for preeclampsia 2 weeks after chemotherapy. No malformations were reported. Conclusions The prognosis of gastric cancer during pregnancy is poor, mainly due to advanced disease at diagnosis, emphasizing the need for early diagnosis. Antenatal chemotherapy can be considered to reach fetal maturity, taking possible complications such as growth restriction, preterm delivery, and hematopoietic suppression at birth into account.
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Affiliation(s)
- Charlotte Maggen
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | - Christianne A Lok
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elyce Cardonick
- Department of Obstetrics and Gynecology, Cooper, University Health Care, Camden, NJ, USA
| | - Mathilde van Gerwen
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Ingrid A Boere
- Department of Medical Oncology, Erasmus MC Cancer, Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Martin Koskas
- Gynecologic Oncology, Bichat University Hospital, Paris Diderot University, Paris, France
| | - Michael J Halaska
- Faculty Hospital Kralovske, Vinohrady and 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan - Bicocca, San Gerardo Hospital, Monza, Italy
| | - Mina M Gziri
- Department of Obstetrics, Cliniques Universitaires St Luc, UCL, Sint-Lambrechts-Woluwe, Belgium
| | - Petronella O Witteveen
- Department of Medical Oncology, Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kristel Van Calsteren
- Department of Obstetrics, University Hospitals Leuven, Leuven and Department of Development and regeneration, KU Leuven, Leuven, Belgium
| | - Frédéric Amant
- Department of Oncology, KU Leuven, Leuven, Belgium.,Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands.,Center for Gynecological Oncology Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Canlorbe G, Levêque J, Koskas M. Les résultats de l’essai LACC doivent-ils modifier les pratiques françaises pour le choix de la voie d’abord dans le traitement chirurgical du cancer du col de stade précoce ? Le point de vue de la commission de cancérologie du CNGOF. Bull Cancer 2019; 106:843-846. [DOI: 10.1016/j.bulcan.2019.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 05/12/2019] [Indexed: 11/26/2022]
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46
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Guillon S, Popescu N, Phelippeau J, Koskas M. A systematic review and meta‐analysis of prognostic factors for remission in fertility‐sparing management of endometrial atypical hyperplasia and adenocarcinoma. Int J Gynaecol Obstet 2019; 146:277-288. [DOI: 10.1002/ijgo.12882] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/19/2019] [Accepted: 06/12/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Sarah Guillon
- Division of Gynecologic OncologyBichat University HospitalParis Diderot University Paris France
| | - Nathalie Popescu
- Division of Gynecologic OncologyBichat University HospitalParis Diderot University Paris France
| | - Juliette Phelippeau
- Division of Gynecologic OncologyBichat University HospitalParis Diderot University Paris France
| | - Martin Koskas
- Division of Gynecologic OncologyBichat University HospitalParis Diderot University Paris France
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Reijnen C, Weelden WJV, Arts MSJP, Peters JP, Rijken PF, Vijver KVD, Santacana M, Bronsert P, Bulten J, Hirschfeld M, Colas E, Gil-Moreno A, Reques A, Mancebo G, Alameda F, Krakstad C, Trovik J, Haldorsen IS, Huvila J, Schrouwen S, Koskas M, Walker F, Weinberger V, Minar L, Jandakova E, Snijders MPLM, Erp SVDBV, Küsters-Vandevelde HVN, Matias-Guiu X, Amant F, Massuger LFAG, Bussink J, Pijnenborg JMA. Abstract 4879: Poor outcome in hypoxic endometrial carcinoma is related to vascular density. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-4879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Optimal identification of endometrial carcinoma (EC) patients at high risk of recurrence is currently lacking. Hypoxia is an important feature of aggressive EC leading to activation of hypoxic and angiogenetic target genes. The present study investigates the prognostic role of hypoxia and angiogenesis in EC. Data and tissues were used from 11 collaborating European Network for Individualized Treatment of Endometrial Cancer (ENITEC) centers. Tumor slides were stained for CAIX as a hypoxic marker and CD-34 for assessment of microvessel density (MVD) as a marker for angiogenesis. Complete slides were digitalized and analyzed using ImageJ software after exclusion of areas without tumor. A cutoff of 1% for the fraction of CAIX positive tumor cells was used. The MVD was assessed according to the Weidner method with the median as cutoff. Correlations with disease-specific survival (DSS), disease-free survival (DFS) and distant disease-free survival (DDFS) were calculated using Cox regression analysis. Sixty-three (16.4%) of 385 ECs showed positive CAIX-expression with high vascular density. Multivariable analysis showed that ECs with combined positive CAIX-expression and high vascular density had a reduced DSS (hazard ratio [HR] 3.71, p = 0.002) and DDFS (HR 2.68, p = 0.009) and a trend for reduced DFS (HR 1.87, p = 0.054). Multivariable analyses with CAIX-expression and vascular density as separate markers, showed that both were independent prognostic markers as well. This study found an impaired DSS and DDFS in ECs with positive CAIX-expression and high vascular density. Differential adjuvant treatment might be indicated for these ECs.
Citation Format: Casper Reijnen, Willem Jan van Weelden, Martijn SJP Arts, Johan P. Peters, Paul F. Rijken, Koen van de Vijver, Maria Santacana, Peter Bronsert, Johan Bulten, Marc Hirschfeld, Eva Colas, Antonio Gil-Moreno, Amando Reques, Gemma Mancebo, Fransesc Alameda, Camilla Krakstad, Jone Trovik, Ingfrid S. Haldorsen, Jutta Huvila, Stefanie Schrouwen, Martin Koskas, Francine Walker, Vit Weinberger, Lubos Minar, Eva Jandakova, Marc PLM Snijders, Saskia van den Berg-van Erp, Heidi VN Küsters-Vandevelde, Xavier Matias-Guiu, Frederic Amant, ENITEC-consortium, Leon FAG Massuger, Johan Bussink, Johanna MA Pijnenborg. Poor outcome in hypoxic endometrial carcinoma is related to vascular density [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4879.
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Affiliation(s)
| | | | | | | | | | | | - Maria Santacana
- 3Hospital Universitari Arnau de Vilanova, University of Lleida, Lleida, Spain
| | | | | | | | - Eva Colas
- 5Vall Hebron Institute of Research, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Gil-Moreno
- 5Vall Hebron Institute of Research, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | | | - Jone Trovik
- 9Haukeland University Hospital, Bergen, Norway
| | | | | | | | | | | | | | | | | | | | | | | | - Xavier Matias-Guiu
- 3Hospital Universitari Arnau de Vilanova, University of Lleida, Lleida, Spain
| | - Frederic Amant
- 15Center for Gynaecologic Oncology, Amsterdam, Netherlands
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Reboux PA, Azaïs H, Canova CH, Bendifallah S, Ouldamer L, Raimond E, Hudry D, Coutant C, Graesslin O, Touboul C, Collinet P, Bricou A, Huchon C, Daraï E, Ballester M, Lévêque J, Lavoué V, Koskas M, Uzan C, Canlorbe G. Impact of vaginal brachytherapy in intermediate and high-intermediate risk endometrial cancer: a multicenter study from the FRANCOGYN group. J Gynecol Oncol 2019; 30:e53. [PMID: 31074238 PMCID: PMC6543117 DOI: 10.3802/jgo.2019.30.e53] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/26/2018] [Accepted: 01/09/2019] [Indexed: 11/30/2022] Open
Abstract
Objective According to recent European Society of Medical Oncology, European Society of Gynaecological Oncology and European Society of Radiotherapy and Oncology guidelines, adjuvant vaginal brachytherapy (VB) is optional in patients with intermediate risk (IR) and high-intermediate risk (HIR) endometrial cancer (EC). The aim of this French retrospective, multicenter study was to assess the impact of VB in these groups on local recurrence rate, local recurrence-free survival (RFS) and overall survival (OS). Methods Data of 191 patients with IR and HIR EC who underwent primary surgery with or without VB and no other adjuvant treatment between 2000 and 2016 were extracted from the FRANCOGYN database. Rate of local recurrence, OS and local RFS in these two groups were compared using the Kaplan-Meier method. Results The number of patients with IR and HIR EC were 118 and 73 respectively. VB was used in 92 patients in IR group and 43 in HIR group. Median follow-up was 22 months. In the HIR group, the local recurrence rate was significantly higher in the no adjuvant therapy group in comparison with the VB group (16.7% and 0% respectively, p=0.02). There was also a significant improvement in local RFS (p=0.01) in VB group. In IR EC, there is no significant difference on local recurrence rate (4.2% and 3.2%, respectively, p=1.00) or local RFS (p=0.54) between the two groups. Conclusions VB is an efficient adjuvant treatment for patients with HIR EC. VB is not associated with an improvement of RFS or OS in IR EC patient.
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Affiliation(s)
- Pierre Alain Reboux
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Henri Azaïs
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Charles Henry Canova
- Department of Radiation Oncology, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, 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), Paris, France.,INSERM UMR_S_938, "Cancer Biology and Therapeutics", Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, Paris, France
| | - Lobna Ouldamer
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France; INSERM U1069, Université François-Rabelas, Tours, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Delphine Hudry
- Center de Lutte Contre le Cancer Georges François Leclerc, Dijon, France
| | - Charles Coutant
- Center de Lutte Contre le Cancer Georges François Leclerc, Dijon, France
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Cyril Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Pierre Collinet
- Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire, Lille, France
| | - Alexandre Bricou
- Department of Gynaecology and Obstetrics, Jean Verdier University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Paris 13, Bondy, France
| | - Cyrille Huchon
- Department of Gynaecology and Obstetrics, Centre Hospitalier Intercommunal, Poissy, 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), Paris, France
| | - Marcos Ballester
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Jean Lévêque
- CHU de Rennes, Service de Gynécologie, Hopital Sud, Université de Rennes 1, Rennes, France
| | - Vincent Lavoué
- CHU de Rennes, Service de Gynécologie, Hopital Sud, Université de Rennes 1, Rennes, France.,INSERM 1242, Oncogenesis, Stress and Signaling, CRLC Eugène Marquis, Rennes, France
| | - Martin Koskas
- Division of Gynecologic Oncology, Bichat University Hospital, Paris, France
| | - Catherine Uzan
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France.,INSERM UMR_S_938, "Cancer Biology and Therapeutics", Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, Paris, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France.,INSERM UMR_S_938, "Cancer Biology and Therapeutics", Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, Paris, France.
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Visser NCM, van der Putten LJM, van Egerschot A, Van de Vijver KK, Santacana M, Bronsert P, Hirschfeld M, Colas E, Gil-Moreno A, Garcia A, Mancebo G, Alameda F, Krakstad C, Tangen IL, Huvila J, Schrauwen S, Koskas M, Walker F, Weinberger V, Minar L, Hausnerova J, Snijders MPLM, van den Berg-van Erp S, Matias-Guiu X, Trovik J, Amant F, Massuger LFAG, Bulten J, Pijnenborg JMA. Addition of IMP3 to L1CAM for discrimination between low- and high-grade endometrial carcinomas: a European Network for Individualised Treatment of Endometrial Cancer collaboration study. Hum Pathol 2019; 89:90-98. [PMID: 31054899 DOI: 10.1016/j.humpath.2019.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 12/20/2022]
Abstract
Discrimination between low- and high-grade endometrial carcinomas (ECs) is clinically relevant but can be challenging for pathologists, with moderate interobserver agreement. Insulin-like growth factor-II mRNA-binding protein 3 (IMP3) is an oncofoetal protein that is associated with nonendometrioid endometrial carcinomas but has been limited studied in endometrioid carcinomas. The aim of this study is to investigate the diagnostic and prognostic value of IMP3 in the discrimination between low- and high-grade ECs and its added value to L1CAM. IMP3 and L1CAM expression was assessed in tumors from 378 patients treated for EC at 1 of 9 participating European Network for Individualised Treatment of Endometrial Cancer centers. IMP3 was expressed in 24.6% of the tumors. In general, IMP3 was more homogeneously expressed than L1CAM. IMP3 expression was significantly associated with advanced stage, nonendometrioid histology, grade 3 tumors, deep myometrial invasion, lymphovascular space invasion, distant recurrences, overall mortality, and disease-related mortality. Simultaneous absence of IMP3 and L1CAM expression showed the highest accuracy for identifying low-grade carcinomas (area under the curve 0.766), whereas simultaneous expression of IMP3 and L1CAM was strongly associated with high-grade carcinomas (odds ratio 19.7; 95% confidence interval 9.2-42.2). Even within endometrioid carcinomas, this combination remained superior to IMP3 and L1CAM alone (odds ratio 8.6; 95% confidence interval 3.4-21.9). In conclusion, IMP3 has good diagnostic value and together with L1CAM represents the optimal combination of diagnostic markers for discrimination between low- and high-grade ECs compared to IMP3 and L1CAM alone. Because of the homogenous expression of IMP3, this marker might be valuable in preoperative biopsies when compared to the more patchy L1CAM expression.
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Affiliation(s)
- Nicole C M Visser
- Department of Pathology, Radboud University Medical Centre, 6500HB, Nijmegen, the Netherlands; Radboud Institute for Molecular Life Sciences, 6500HB, Nijmegen, the Netherlands.
| | - Louis J M van der Putten
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, 6500HB, Nijmegen, the Netherlands
| | - Alex van Egerschot
- Department of Pathology, Radboud University Medical Centre, 6500HB, Nijmegen, the Netherlands
| | | | - Maria Santacana
- Department of Pathology and Molecular Genetics and Oncological Pathology Group, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLLEIDA, CIBERONC, 25198, Lleida, Spain
| | - Peter Bronsert
- Institute for Surgical Pathology, Medical Centre-University of Freiburg, 79085, Freiburg, Germany; Comprehensive Cancer Centre Freiburg, Medical Centre-University of Freiburg, 79106, Freiburg, Germany; Faculty of Medicine, University of Freiburg, 79085, Freiburg, Germany
| | - Marc Hirschfeld
- Department of Obstetrics and Gynaecology, University Medical Centre Freiburg, 79106, Freiburg, Germany; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), 69120, Heidelberg, Germany
| | - Eva Colas
- Biomedical Research Group in Gynaecology, Vall Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, CIBERONC, 08193, Barcelona, Spain
| | - Antonio Gil-Moreno
- Biomedical Research Group in Gynaecology, Vall Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, CIBERONC, 08193, Barcelona, Spain; Gynecological Department, Vall Hebron University Hospital, CIBERONC, 8035, Barcelona, Spain
| | - Angel Garcia
- Pathology Department, Vall Hebron University Hospital, 8035, Barcelona, Spain
| | - Gemma Mancebo
- Department of Obstetrics and Gynaecology, Hospital del Mar, 8003, Barcelona, Spain
| | - Francesc Alameda
- Department of Pathology, Hospital del Mar, 8003, Barcelona, Spain
| | - Camilla Krakstad
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, 5021, Bergen, Norway; Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, 5021, Bergen, Norway
| | - Ingvild L Tangen
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, 5021, Bergen, Norway; Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, 5021, Bergen, Norway
| | - Jutta Huvila
- Department of Pathology, University of Turku, 20500, Turku, Finland
| | - Stefanie Schrauwen
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, 3000, Leuven, Belgium
| | - Martin Koskas
- Obstetrics and Gynaecology Department, Bichat-Claude Bernard Hospital, 75877, Paris, France
| | - Francine Walker
- Pathology Department, Bichat-Claude Bernard Hospital, 75877, Paris, France
| | - Vit Weinberger
- Department of Obstetrics and Gynaecology, University Hospital Brno, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
| | - Lubos Minar
- Department of Obstetrics and Gynaecology, University Hospital Brno, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
| | - Jitka Hausnerova
- Department of Pathology, University Hospital Brno, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
| | - Marc P L M Snijders
- Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, 6500, GS, Nijmegen, the Netherlands
| | | | - Xavier Matias-Guiu
- Department of Pathology and Molecular Genetics and Oncological Pathology Group, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLLEIDA, CIBERONC, 25198, Lleida, Spain
| | - Jone Trovik
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, 5021, Bergen, Norway; Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, 5021, Bergen, Norway
| | - Frédéric Amant
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, 3000, Leuven, Belgium; Department of Gynaecologic Oncology, Centre Gynaecologic Oncology Amsterdam (CGOA), Netherlands Cancer Institute and Amsterdam University Medical Centres, Academic Medical Centre, 1105, AZ, Amsterdam, the Netherlands
| | - Leon F A G Massuger
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, 6500HB, Nijmegen, the Netherlands
| | - Johan Bulten
- Department of Pathology, Radboud University Medical Centre, 6500HB, Nijmegen, the Netherlands
| | - Johanna M A Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, 6500HB, Nijmegen, the Netherlands
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Graesslin O, Verdon R, Raimond E, Koskas M, Garbin O. [Management of tubo-ovarian abscesses and complicated pelvic inflammatory disease: CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines]. ACTA ACUST UNITED AC 2019; 47:431-441. [PMID: 30880246 DOI: 10.1016/j.gofs.2019.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/10/2019] [Indexed: 01/09/2023]
Abstract
A tubo-ovarian abscess (ATO) should be suspected in a context of pelvic inflammatory disease (PID) in case of severe pain associated with the presence of general signs and palpation of an adnexal mass at pelvic examination. Imaging allows most often a rapid diagnosis, by ultrasound or CT, the latter being irradiant but also allowing to consider the differential diagnoses (digestive or urinary diseases) in case of pelvic pain. MRI, non-irradiating examination, whenever it is feasible, provides relevant information, more efficient, guiding quickly the diagnosis. The diagnosis of tubo-ovarian abscess should lead to the hospitalization of the patient, the collection of bacteriological samples, the initiation of a probabilistic antibiotherapy associated with drainage of the purulent collection. In severe septic forms (generalized peritonitis, septic shock), surgery (laparoscopy or laparotomy) keeps its place. In other situations, ultrasound-guided trans-vaginal puncture in the absence of major hemostasis disorders or severe sepsis is a less morbid alternative to surgery and provides high rates of cure. Today, ultrasound-guided trans-vaginal puncture has been satisfactory evaluated in the literature and is part of a logic of therapeutic de-escalation. Randomized trials evaluating laparoscopic drainage versus radiological drainage should be able to answer, in the coming years, questions that are still outstanding (impact on chronic pelvic pain, fertility). The recommendations for the management of ATO published in 2012 by the CNGOF remain valid, legitimizing the place of radiological drainage associated with antibiotic therapy.
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Affiliation(s)
- O Graesslin
- Service de gynécologie-obstétrique, institut Mère-Enfant Alix-de-Champagne, CHU, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - R Verdon
- Service de maladies infectieuses et tropicales, CHRU de Caen, 14000 Caen, France
| | - E Raimond
- Service de gynécologie-obstétrique, institut Mère-Enfant Alix-de-Champagne, CHU, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - M Koskas
- Service de gynécologie-obstétrique, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris, France
| | - O Garbin
- Service de gynécologie, CMCO, pôle de gynécologie des hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
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