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Funk-Debleds P, Rossi J, Bernard L, Galan A, Kepenekian V, Glehen O, Chambrier C. Post-operative weight loss affects 3-year survival in patients with gastric adenocarcinoma after gastrectomy and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol 2023; 49:106895. [PMID: 37012111 DOI: 10.1016/j.ejso.2023.03.231] [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: 06/22/2022] [Revised: 02/09/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Patients with advanced gastric adenocarcinoma are at high risk of malnutrition. Some patients benefit from total gastrectomy associated with hyperthermic intraperitoneal chemotherapy (HIPEC) with or without cytoreduction surgery (CR) as a curative strategy. The aim of this study was to describe pre- and post-operative nutritional assessments and their impact on survival in these patients. MATERIALS AND METHODS All patients with advanced gastric adenocarcinoma treated with gastrectomy and HIPEC with or without CR at Lyon University Hospital were retrospectively included from April 2012 to August 2017. Carcinologic data, history of weight, anthropometric measures, nutritional biological markers and CT-scan body composition were collected. RESULTS 54 patients were included. Malnutrition affected 48.1% before and 64.8% after surgery, and severe malnutrition respectively 11.1% and 20.3%. Pre-operative sarcopenia diagnosed by CT scan was found in 40.7% of the patients while 81.1% of the sarcopenic patients had a normal or high body mass index. A loss of ⩾ 20% of usual weight on discharge was a pejorative factor of survival at 3 years of follow-up (p = 0.0470). Only 14.8% of the patients continued artificial nutrition following discharge but artificial nutrition was resumed in 30.4% of the patients within 4 months after discharge owing to weight loss. CONCLUSIONS Patients with advanced gastric adenocarcinoma undergoing gastrectomy and HIPEC with or without CR are at high risk of malnutrition. Post-operative weight loss has a pejorative impact on outcome. These patients should be systematically screened for malnutrition with early interventionist nutritional care and close nutritional follow-up.
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Affiliation(s)
- Pamela Funk-Debleds
- Département de Soins de Support, Centre de Lutte Contre le Cancer Léon Bérard, Lyon, France.
| | - Julien Rossi
- Département de Radiologie, Hospices Civils de Lyon, Hôpital Lyon-Sud, Pierre Bénite, France
| | - Lorraine Bernard
- Service de Biostatistique et Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; 4 CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Villeurbanne, France
| | - Alexandre Galan
- Département de Radiologie, Hospices Civils de Lyon, Hôpital Lyon-Sud, Pierre Bénite, France
| | - Vahan Kepenekian
- Département de Chirurgie Viscérale, Hospices Civils de Lyon, Hôpital Lyon-Sud, Pierre Bénite, France
| | - Olivier Glehen
- Département de Chirurgie Viscérale, Hospices Civils de Lyon, Hôpital Lyon-Sud, Pierre Bénite, France; Equipe Accueil CICLY, Université Lyon 1, Lyon, France
| | - Cécile Chambrier
- Unité de Nutrition Clinique Intensive, Hospices Civil de Lyon, Hôpital Lyon-Sud, Pierre Bénite, France
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de la Fouchardière C, Gamradt P, Chabaud S, Raddaz M, Blanc E, Msika O, Treilleux I, Bachy S, Cattey-Javouhey A, Guibert P, Sarabi M, Rochefort P, Funk-Debleds P, Coutzac C, Ray-Coquard I, Peyrat P, Meeus P, Rivoire M, Dupré A, Hennino A. A Promising Biomarker and Therapeutic Target in Patients with Advanced PDAC: The Stromal Protein βig-h3. J Pers Med 2022; 12:jpm12040623. [PMID: 35455739 PMCID: PMC9025577 DOI: 10.3390/jpm12040623] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 02/05/2023] Open
Abstract
With an overall survival rate of 2–9% at 5 years, pancreatic ductal adenocarcinoma (PDAC) is currently the fourth leading cause of cancer-related deaths in the industrialized world and is predicted to become the second by 2030. Owing to often late diagnosis and rare actionable molecular alterations, PDAC has not yet benefited from the recent therapeutic advances that immune checkpoint inhibitors (ICI) have provided in other cancer types, except in specific subgroups of patients presenting with tumors with high mutational burden (TMB) or microsatellite instability (MSI). The tumor microenvironment (TME) plays a substantial role in therapeutic resistance by facilitating immune evasion. An extracellular stromal protein, βig-h3/TGFβi, is involved in the pathogenesis of PDAC by hampering T cell activation and promoting stiffness of the TME. The study BIGHPANC included 41 patients with metastatic PDAC, and analyzed βig-h3 levels in serum and tumor samples to assess the βig-h3 prognostic value. βig-h3 serum levels are significantly associated with overall survival (HR 2.05, 95%CI 1.07–3.93; p = 0.0301). Our results suggest that βig-h3 serum levels may be considered a prognostic biomarker in patients with metastatic PDAC.
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Affiliation(s)
- Christelle de la Fouchardière
- Cancer Research Center of Lyon, UMR INSERM 1052, CNRS 5286, F-69373 Lyon, France; (C.d.l.F.); (P.G.); (I.T.); (S.B.); (M.S.); (C.C.); (M.R.); (A.D.)
- Université Lyon 1, F-69000 Lyon, France
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Pia Gamradt
- Cancer Research Center of Lyon, UMR INSERM 1052, CNRS 5286, F-69373 Lyon, France; (C.d.l.F.); (P.G.); (I.T.); (S.B.); (M.S.); (C.C.); (M.R.); (A.D.)
- Université Lyon 1, F-69000 Lyon, France
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Sylvie Chabaud
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Maxime Raddaz
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Ellen Blanc
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Olivier Msika
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Isabelle Treilleux
- Cancer Research Center of Lyon, UMR INSERM 1052, CNRS 5286, F-69373 Lyon, France; (C.d.l.F.); (P.G.); (I.T.); (S.B.); (M.S.); (C.C.); (M.R.); (A.D.)
- Université Lyon 1, F-69000 Lyon, France
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Sophie Bachy
- Cancer Research Center of Lyon, UMR INSERM 1052, CNRS 5286, F-69373 Lyon, France; (C.d.l.F.); (P.G.); (I.T.); (S.B.); (M.S.); (C.C.); (M.R.); (A.D.)
- Université Lyon 1, F-69000 Lyon, France
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Anne Cattey-Javouhey
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Pierre Guibert
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Matthieu Sarabi
- Cancer Research Center of Lyon, UMR INSERM 1052, CNRS 5286, F-69373 Lyon, France; (C.d.l.F.); (P.G.); (I.T.); (S.B.); (M.S.); (C.C.); (M.R.); (A.D.)
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Pauline Rochefort
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Pamela Funk-Debleds
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Clélia Coutzac
- Cancer Research Center of Lyon, UMR INSERM 1052, CNRS 5286, F-69373 Lyon, France; (C.d.l.F.); (P.G.); (I.T.); (S.B.); (M.S.); (C.C.); (M.R.); (A.D.)
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Isabelle Ray-Coquard
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Patrice Peyrat
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Pierre Meeus
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Michel Rivoire
- Cancer Research Center of Lyon, UMR INSERM 1052, CNRS 5286, F-69373 Lyon, France; (C.d.l.F.); (P.G.); (I.T.); (S.B.); (M.S.); (C.C.); (M.R.); (A.D.)
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Aurélien Dupré
- Cancer Research Center of Lyon, UMR INSERM 1052, CNRS 5286, F-69373 Lyon, France; (C.d.l.F.); (P.G.); (I.T.); (S.B.); (M.S.); (C.C.); (M.R.); (A.D.)
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
| | - Ana Hennino
- Cancer Research Center of Lyon, UMR INSERM 1052, CNRS 5286, F-69373 Lyon, France; (C.d.l.F.); (P.G.); (I.T.); (S.B.); (M.S.); (C.C.); (M.R.); (A.D.)
- Université Lyon 1, F-69000 Lyon, France
- Centre Léon Bérard, F-69008 Lyon, France; (S.C.); (M.R.); (E.B.); (O.M.); (A.C.-J.); (P.G.); (P.R.); (P.F.-D.); (I.R.-C.); (P.P.); (P.M.)
- Correspondence: ; Tel.: +33-469-166-669
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Varnier R, Garrivier T, Hafliger E, Favre A, Coutzac C, Spire C, Rochefort P, Sarabi M, Desseigne F, Guibert P, Cattey-Javouhey A, Funk-Debleds P, Mastier C, Buisson A, Pérol D, Trédan O, Blay JY, Phelip JM, de la Fouchardiere C. Hyperprogressive Disease After Combined Anti-PD-L1 and Anti-CTLA-4 Immunotherapy for MSI-H/dMMR Gastric Cancer: A Case Report. Front Oncol 2021; 11:756365. [PMID: 34631593 PMCID: PMC8499695 DOI: 10.3389/fonc.2021.756365] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/08/2021] [Indexed: 12/30/2022] Open
Abstract
Immune checkpoint inhibitors (ICI) have been developed in gastric adenocarcinomas and approved in first-line metastatic setting (in combination with chemotherapy) as well as in pretreated patients. Microsatellite instability-high (MSI-H) tumors are predicted to derive high benefit from ICI but data in gastric locations are limited. Here, we describe the case of a 68-year old patient with stage IV MSI-H gastric adenocarcinoma, referred to our center to receive immunotherapy after failure of standard of care (surgery with perioperative platin-based chemotherapy and paclitaxel plus ramucirumab at disease progression). The patient received one injection of durvalumab and tremelimumab and was hospitalized eighteen days after because of occlusive syndrome. The CT scan showed hyperprogression of the lymph nodes and hepatic lesions, compressing the gastric stump. He died few days later. Molecular analyses did not explain this outcome. To our knowledge, this is one of the first reported cases of hyperprogressive disease after combined ICI for a patient with MSI-H tumor. We review the potential causes and discuss the emerging literature regarding predictive factors of hyperprogression in the particular subset of MSI-H patients. If some data were available in retrospective studies, validation of strong predictive factors is needed to avoid such dramatic evolutions.
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Affiliation(s)
- Romain Varnier
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Emilie Hafliger
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Aymeric Favre
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Clélia Coutzac
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Clément Spire
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Matthieu Sarabi
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Pierre Guibert
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | | | | | - Adrien Buisson
- Department of Biopathology, Centre Léon Bérard, Lyon, France
| | - David Pérol
- Department of Clinical Research, Centre Léon Bérard, Lyon, France
| | - Oliver Trédan
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Jean-Marc Phelip
- Department of Hepato-Gastroenterology and Digestive Oncology, St Etienne University Hospital, St Etienne, France
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Mercier C, Drareni K, Dougkas A, Farsi F, Funk-Debleds P, Roux P, Fingal C, Nazare JA, Bensafi M, Dayde D, Mourier V, Giboreau A. Food-Related Quality of Life in Cancer Patients: Development and Validation of a Questionnaire. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab036_015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Monitoring psychosocial, emotional, and hedonic aspects of food behavior is important to understand cancer patients’ distress and help to reduce risks of malnutrition. However, to date, there is no specific tool to measure the impact of diet, eating behavior, and chemotherapy side effects on patients’ food-related quality of life during cancer and its treatments. The objective was to develop and validate a questionnaire that aims to assess the food-related quality of life in cancer patients undergoing chemotherapy.
Methods
Relevant items from the existing food-related quality of life assessment tools were selected to compose the present 46-item questionnaire. The validation of the questionnaire was conducted in 276 healthy volunteers and 173 cancer patients. Exploratory Factor Analysis
(EFA) was performed in both groups, construct and discriminant validity, and test-retest reliability were calculated.
Results
The questionnaire was perceived as clear and required less than14 minutes for completion (93% complete responses) in a pre-test (n = 156). The EFA allowed the inclusion of 9 dimensions in the food-related quality of life questionnaire. Common patterns between patients and healthy volunteers (factor loadings ≥ 0.4 in both groups) were used to calculate scores by dimension. Scores in the dimensions of adapting diet and sensorial discomfort (taste/odor) were higher in cancer patients, whilst scores in the dimension of discomfort in satiety were higher in healthy volunteers. Among patients with cancer, the total scores in sensorial discomfort, digestive discomfort, and discomfort in satiety were higher under chemotherapy than no treatment. Reproducibility after one week was in increasing order; digestive discomfort 0.6, adapting diet 0.61, products’ quality 0.67, cooking 0.75, healthy diet 0.76, eating and pleasure 0.80, discomfort in satiety 0.82, and sensorial discomfort 0.85.
Conclusions
This 46-item questionnaire can discriminate cancer patients versus healthy volunteers, and patients receiving vs those not receiving chemotherapy. A good to very good reproducibility was found for the most important factors of food-related quality of life of patients with cancer, i.e, eating and pleasure, sensorial discomfort, and discomfort in satiety.
Funding Sources
This study is funded by La Région Auvergne Rhône-Aples and La Métropôle de Lyon.
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Affiliation(s)
| | | | | | - Fadila Farsi
- Réseau Régional de Cancérologie Auvergne-Rhône-Alpes
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Funk-Debleds P, Ducroux E, Guillaud O, Ursic-Bedoya J, Decullier E, Vallin M, Euvrard S, Pageaux GP, Boillot O, Dumortier J. Subsequent nonmelanoma skin cancers and impact of immunosuppression in liver transplant recipients. J Am Acad Dermatol 2018; 79:84-91. [DOI: 10.1016/j.jaad.2017.12.063] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 12/20/2017] [Accepted: 12/24/2017] [Indexed: 11/25/2022]
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