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Peyle M, Massoud M, Patrier S, Gaillot-Durand L, Side G, Devouassoux-Shisheboran M, Massardier J, Descargues P, Msika A, Hajri T, Rousset P, Haesebaert J, Lotz JP, Jamelot M, You B, Golfier F, Eiriksson L, Allias F, Bolze PA. Impact of molecular genotyping on the diagnosis and treatment of human chorionic gonadotropin-producing tumors. J Gynecol Obstet Hum Reprod 2024; 53:102704. [PMID: 38040333 DOI: 10.1016/j.jogoh.2023.102704] [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: 09/05/2023] [Revised: 11/19/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVES To assess the use of molecular genotyping to accurately diagnose and treat human chorionic gonadotropin (hCG)-producing tumors and to evaluate the discriminating capacity of molecular testing on prognosis and overall survival. METHODS We conducted a retrospective descriptive study of patients registered with the French Reference Center for Trophoblastic Disease between 1999 and 2021. We included all patients with hCG-producing tumors for whom results of molecular genotyping were available. RESULTS Fifty-five patients with molecular genotyping were included: 81.2 % (n = 45) had tumors of gestational origin, 12.7 % (n = 7) of non-gestational origin and 5.5 % (n = 3) of undetermined origin. The results of molecular genotyping influenced the treatment decisions for 17 % of patients in this cohort. Overall survival was 93.3 % for patients with gestational tumors (after a median follow-up of 74 months) compared to 71.4 % for patients with non-gestational tumors (after a median follow-up of 23 months). CONCLUSION In atypical presentations of hCG-producing tumors, molecular genotyping is a valuable tool to guide diagnosis and tailor treatment recommendations.
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Affiliation(s)
- M Peyle
- Centre Français de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Service de Chirurgie Gynécologique et Oncologique, Obstétrique, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France
| | - M Massoud
- Centre Français de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Service de Chirurgie Gynécologique et Oncologique, Obstétrique, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France
| | - S Patrier
- Centre Français de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Service d'anatomie et cytologie pathologique, Centre Hospitalier Universitaire de Rouen, 76000, Rouen, France
| | - L Gaillot-Durand
- Centre Français de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Service de Pathologie - Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France
| | - G Side
- Centre Français de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Service d'anatomie et cytologie pathologique, Centre Hospitalier Universitaire de Rouen, 76000, Rouen, France
| | - M Devouassoux-Shisheboran
- Centre Français de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Service de Pathologie - Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France
| | - J Massardier
- Centre Français de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Service de Gynécologie Obstétrique, Unité de Diagnostic Anténatal, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69500 Bron, France
| | - P Descargues
- Centre Français de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Service de Chirurgie Gynécologique et Oncologique, Obstétrique, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France
| | - A Msika
- Centre Français de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Service de Chirurgie Gynécologique et Oncologique, Obstétrique, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France
| | - T Hajri
- Centre Français de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Service de Chirurgie Gynécologique et Oncologique, Obstétrique, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France
| | - P Rousset
- Centre Français de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Radiologie, Hôpital Lyon Sud, Hospices Civils de Lyon, 165, Chemin du Grand Revoyet, 69495 Pierre-Bénite, France; Université Lyon 1, Centre pour l'Innovation en Cancérologie de Lyon (CICLY), EA3738, Faculté de Médecine Lyon Sud Charles Mérieux, France
| | - J Haesebaert
- Centre Français de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Pôle de Santé Publique, service de recherche et d'épidémiologie cliniques, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, U1290 Reshape, Lyon, France
| | - J P Lotz
- Centre Français de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Hôpital Tenon, Pôle Onco-Hématologie Hôpitaux Universitaires de l'Est Parisien, Assistance Publique-Hôpitaux de Paris, 4 Rue de la Chine, 75020 Paris, France; Sorbonne Université, Faculté de Médecine, 91-105 Bd de l'Hôpital, 75013 Paris, France
| | - M Jamelot
- Centre Français de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Hôpital Tenon, Pôle Onco-Hématologie Hôpitaux Universitaires de l'Est Parisien, Assistance Publique-Hôpitaux de Paris, 4 Rue de la Chine, 75020 Paris, France; Sorbonne Université, Faculté de Médecine, 91-105 Bd de l'Hôpital, 75013 Paris, France
| | - B You
- Centre Français de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Université Lyon 1, Centre pour l'Innovation en Cancérologie de Lyon (CICLY), EA3738, Faculté de Médecine Lyon Sud Charles Mérieux, France; Service d'oncologie médicale, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL EPSILYON, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - F Golfier
- Centre Français de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Service de Chirurgie Gynécologique et Oncologique, Obstétrique, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Université Lyon 1, Centre pour l'Innovation en Cancérologie de Lyon (CICLY), EA3738, Faculté de Médecine Lyon Sud Charles Mérieux, France
| | - L Eiriksson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - F Allias
- Centre Français de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Service de Pathologie - Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France
| | - P A Bolze
- Centre Français de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Service de Chirurgie Gynécologique et Oncologique, Obstétrique, Hospices Civils de Lyon, Hôpital Lyon Sud, 69495 Pierre Bénite, France; Université Lyon 1, Centre pour l'Innovation en Cancérologie de Lyon (CICLY), EA3738, Faculté de Médecine Lyon Sud Charles Mérieux, 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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3
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Jeremie G, Allias F, Trecourt A, Gaillot-Durand L, Bolze PA, Descotes F, Tondeur G, Perrot J, Hajri T, You B, Golfier F, Lopez J, Devouassoux-Shisheboran M. Molecular Analyses of Chorionic-Type Intermediate Trophoblastic Lesions: Atypical Placental Site Nodules are Closer to Placental Site Nodules Than Epithelioid Trophoblastic Tumors. Mod Pathol 2023; 36:100046. [PMID: 36788063 DOI: 10.1016/j.modpat.2022.100046] [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: 08/19/2022] [Revised: 09/09/2022] [Accepted: 10/18/2022] [Indexed: 01/19/2023]
Abstract
Gestational trophoblastic diseases derived from the chorionic-type intermediate trophoblast include benign placental site nodule (PSN) and malignant epithelioid trophoblastic tumor (ETT). Among PSNs, the World Health Organization classification introduced a new entity named atypical placental site nodule (APSN), corresponding to an ETT precursor, for which diagnostic criteria remain unclear, leading to a risk of overdiagnosis and difficulties in patient management. We retrospectively studied 8 PSNs, 7 APSNs, and 8 ETTs to better characterize this new entity and performed immunohistochemical analysis (p63, human placental lactogen, Cyclin E, and Ki67), transcriptional analysis using the NanoString method to quantify the expression of 760 genes involved in the main tumorigenesis pathways, and RNA sequencing to identify fusion transcripts. The immunohistochemical analysis did not reveal any significant difference in Cyclin E expression among the 3 groups (P = .476), whereas the Ki67 index was significantly (P < .001) higher in ETT samples than in APSN and PSN samples. None of the APSN samples harbored the LPCAT1::TERT fusion transcripts, in contrast to 1 of 6 ETT samples, as previously described in 2 of 3 ETT samples. The transcriptomic analysis allowed robust clustering of ETTs distinct from the APSN/PSN group but failed to differentiate APSNs from PSNs. Indeed, only 7 genes were differentially expressed between PSN and APSN samples; CCL19 upregulation and EPCAM downregulation were the most distinguishing features of APSNs. In contrast, 80 genes differentiated ETTs from APSNs, establishing a molecular signature for ETT. Gene set analysis identified significant enrichments in the DNA damage repair, immortality and stemness, and cell cycle signaling pathways when comparing ETTs and APSNs. These results suggested that APSN might not represent a distinct entity but rather a transitional stage between PSN and ETT. RNA sequencing and the transcriptional signature of ETT described herein could serve as triage for APSN from curettage or biopsy material, enabling the identification of cases that need further clinical investigations.
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Affiliation(s)
- Gaspard Jeremie
- Medical Pole of Biology and Pathology, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France
| | - Fabienne Allias
- Medical Pole of Biology and Pathology, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France; French Reference Center for Trophoblastic Disease, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Alexis Trecourt
- Medical Pole of Biology and Pathology, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France
| | - Lucie Gaillot-Durand
- Medical Pole of Biology and Pathology, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France
| | - Pierre Adrien Bolze
- French Reference Center for Trophoblastic Disease, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France; Department of Gynecology and Obstetrics, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France; Division Santé, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Françoise Descotes
- Medical Pole of Biology and Pathology, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France
| | - Garance Tondeur
- Medical Pole of Biology and Pathology, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France
| | - Jimmy Perrot
- Medical Pole of Biology and Pathology, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France
| | - Touria Hajri
- French Reference Center for Trophoblastic Disease, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Benoit You
- French Reference Center for Trophoblastic Disease, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France; Division Santé, Université Claude Bernard Lyon 1, Villeurbanne, France; Department of Medical Oncology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - François Golfier
- French Reference Center for Trophoblastic Disease, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France; Department of Gynecology and Obstetrics, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France; Division Santé, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Jonathan Lopez
- Medical Pole of Biology and Pathology, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France; Division Santé, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Mojgan Devouassoux-Shisheboran
- Medical Pole of Biology and Pathology, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France; French Reference Center for Trophoblastic Disease, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France; Division Santé, Université Claude Bernard Lyon 1, Villeurbanne, 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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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: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [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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de Foucher T, Hennebert C, Dabi Y, Ouldamer L, Lavoué V, Dion L, Canlorbe G, Bolze PA, Golfier F, Akladios C, Lecointre L, Kerbage Y, Collinet P, Bricou A, Carcopino X, Huchon C, Raimond E, Graesslin O, Owen C, Touboul C, Ballester M, Darai E, Bendifallah S. Recurrence Pattern of Cervical Cancer Based on the Platinum Sensitivity Concept: A Multi-Institutional Study from the FRANCOGYN Group. J Clin Med 2020; 9:E3646. [PMID: 33198384 PMCID: PMC7696862 DOI: 10.3390/jcm9113646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/01/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022] Open
Abstract
The standard of care for patients with advanced cervical cancer (ACC) includes platinum-based chemotherapy. The concept of platinum sensitivity is a major prognostic factor for patients with ovarian cancer. The aim of this study was to validate the applicability of the platinum sensitivity concept to ACC patients, and to estimate its prognostic interest in terms of overall survival (OS) and pattern of recurrence (location, timing). Data of women with histologically proven FIGO 2019 stages IB3-IV ACC, treated between May 2000 and November 2017 with platinum-based regimens, were retrospectively abstracted from 12 institutions from the FRANCOGYN Group. Respective 3-year OSs were 52% (95% CI: 40.8%-66.8%), 21.6% (95% CI: 12.6%-37.2%), and 14.6% (95% CI: 4.2%-50.2%), in case of recurrence <6 months, between 6 and 17 months, and ≥18 months (p < 0.001). Risk of metastatic or multisite recurrence was significantly higher in case of recurrence <6 months, and risk of local or isolated infradiaphragmatic nodal recurrence was significantly higher in case of recurrence >18 months (p < 0.001). In multivariate analysis, platinum sensitivity status was a strong prognostic factor for OS after recurrence, independent of histological grade, lympho-vascular space involvement, final lymph node status, and treatment. Platinum sensitivity status may help to classify patients in three prognostic subgroups for OS after recurrence, and appears to be a strong prognostic factor correlated to the pattern of recurrence.
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Affiliation(s)
- Tiphaine de Foucher
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75020 Paris, France; (C.H.); (C.O.); (C.T.); (E.D.); (S.B.)
| | - Cecile Hennebert
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75020 Paris, France; (C.H.); (C.O.); (C.T.); (E.D.); (S.B.)
| | - Yohan Dabi
- Departement of Obstetrics, Gynaecology and Reproductive Medecine, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France;
| | - Lobna Ouldamer
- Department of Gynaecology, CHRU de Tours, Hôpital Bretonneau, INSERM unit 1069, 2 boulevard Tonnelé, 37044 Tours, France;
| | - Vincent Lavoué
- Department of Gynaecology, CHU de Rennes, 35000 Rennes, France; (V.L.); (L.D.)
| | - Ludivine Dion
- Department of Gynaecology, CHU de Rennes, 35000 Rennes, France; (V.L.); (L.D.)
| | - Geoffroy Canlorbe
- Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, 75013 Paris, France;
| | - Pierre Adrien Bolze
- Department of Gynaecologic and Oncologic Surgery and Obstetrics, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Université Lyon 1, 69000 Lyon, France; (P.A.B.); (F.G.)
| | - François Golfier
- Department of Gynaecologic and Oncologic Surgery and Obstetrics, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Université Lyon 1, 69000 Lyon, France; (P.A.B.); (F.G.)
| | - Cherif Akladios
- Service de Gynécologie Obstétrique, CHU Hautepierre, 67000 Strasbourg, France; (C.A.); (L.L.)
| | - Lise Lecointre
- Service de Gynécologie Obstétrique, CHU Hautepierre, 67000 Strasbourg, France; (C.A.); (L.L.)
| | - Yohan Kerbage
- Department of Gynaecologic surgery, Hôpital Jeanne de Flandre, CHRU LILLE, Rue Eugene avinée, CEDEX, 59037 Lille, France; (Y.K.); (P.C.)
| | - Pierre Collinet
- Department of Gynaecologic surgery, Hôpital Jeanne de Flandre, CHRU LILLE, Rue Eugene avinée, CEDEX, 59037 Lille, France; (Y.K.); (P.C.)
| | - Alexandre Bricou
- Department of Obstetrics and Gynaecology, Jean-Verdier University Hospital, Assistance Publique des Hôpitaux de Paris, 93140 Bondy, 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;
| | - Cyrille Huchon
- Department of Gynaecology, CHI Poissy-St-Germain, Université Versailles-Saint-Quentin en Yvelines, EA 7285 Risques cliniques et sécurité en santé des femmes, Université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France;
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Alix de Champagne Institute, Centre Hospitalier Universitaire, 45 rue Cognacq-Jay, 51092 Reims, France; (E.R.); (O.G.)
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Alix de Champagne Institute, Centre Hospitalier Universitaire, 45 rue Cognacq-Jay, 51092 Reims, France; (E.R.); (O.G.)
| | - Clémentine Owen
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75020 Paris, France; (C.H.); (C.O.); (C.T.); (E.D.); (S.B.)
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75020 Paris, France; (C.H.); (C.O.); (C.T.); (E.D.); (S.B.)
| | - Marcos Ballester
- Department of Gynaecologic and Breast Surgery, Groupe Hospitalier Diaconesses Croix Saint Simon, 125 rue d’Avron, 75020 Paris, France;
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75020 Paris, France; (C.H.); (C.O.); (C.T.); (E.D.); (S.B.)
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75020 Paris, France; (C.H.); (C.O.); (C.T.); (E.D.); (S.B.)
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Knight S, Mancini J, Touboul C, Bolze PA, Bendifallah S, Ballester M, Collinet P, Kerbage Y, Ouldamer L, Atrous G, Lavoué V, Dion L, Dabi Y, Raimond E, Graesslin O, Huchon C, Mimouni M, Bricou A, Golfier F, Carcopino X. Prognostic value of posttreatment FEDG-PET imaging following combined chemoradiation therapy in locally advanced cervical cancer. J Gynecol Obstet Hum Reprod 2020; 49:101774. [PMID: 32330672 DOI: 10.1016/j.jogoh.2020.101774] [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: 06/10/2019] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate the performances of posttreatment FEDG-PET to predict the prognosis of patients treated with concurrent chemoradiotherapy (CT/RT) for locally advanced cervical cancer. MATERIALS AND METHODS The medical records of 131 patients treated in 9 French academic institutions for IB2-IIB cervical cancer and for which a posttherapy FEDG-PET was performed were reviewed. All patients received CT/RT, possibly completed with vaginal brachytherapy (VBT) and completion surgery. Posttreatment FEDG-PET was performed within 3 months after completion of CT/RT or VBT. Incomplete metabolic response (IMR) was defined as the persistence of FEDG uptake. RESULTS An IMR was identified in 44 (33.6 %) cases. IMR was associated with higher risk of recurrence (aHR = 2.8; 95 %CI: 1.3-5.7; p = 0.006) and death (aHR = 4.5 ;95 %CI: 1.4-13.8; p = 0.009). Completion surgery was performed in 61 (46.9 %) patients with histologic cervical residual disease identified in 31 (50.8 %). FEDG-PET sensitivity and specificity in predicting cervical residual disease following CT/RT was 48.4 % (95 %CI: 30.8-66) and 80 % (95 %CI: 65.7-94.3), respectively. CONCLUSIONS In patients treated with CT/RT for locally advanced cervical cancer, despite limited performances to predict cervical residual disease, posttreatment FEDG-PET is predictive of patients' prognosis and long-term outcome.
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Affiliation(s)
- Sophie Knight
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397, Marseille, France
| | - Julien Mancini
- Aix Marseille Univ, APHM, Inserm, IRD, SESSTIM, Hop Timone, BioSTIC, Marseille, 13385 France
| | - Cyril Touboul
- Departement of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, 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
| | - 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
| | - Marcos Ballester
- Department of Gynaecologic and Breast Surgery, Groupe Hospitalier Diaconesses Croix Saint Simon, 125 rue d'Avron, 75020, Paris, France
| | - Pierre Collinet
- Department of Gynaecologic Surgery, Hôpital Jeanne de Flandre, CHRU LILLE, Rue Eugene avinée 59037 lille cedex, France
| | - Yohan Kerbage
- Department of Gynaecologic Surgery, Hôpital Jeanne de Flandre, CHRU LILLE, Rue Eugene avinée 59037 lille cedex, France
| | - Lobna Ouldamer
- Department of Gynecology, CHRU de Tours, Hôpital Bretonneau, INSERM Unit 1069, 2 Boulevard Tonnelé, 37044 TOURS, France
| | - Geoffroy Atrous
- Department of Gynecology, CHRU de Tours, Hôpital Bretonneau, INSERM Unit 1069, 2 Boulevard Tonnelé, 37044 TOURS, France
| | - Vincent Lavoué
- Department of Gynaecology, CHU de Rennes, France, INSERM 1242, COSS, Rennes, Université de Rennes 1, France
| | - Ludivine Dion
- Department of Gynaecology, CHU de Rennes, France, INSERM 1242, COSS, Rennes, Université de Rennes 1, France
| | - Yohann Dabi
- Departement of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, 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
| | - Cyrille Huchon
- Department of Gynecology, CHI Poissy-St-Germain, Université Versailles-Saint-Quentin en Yvelines, EA 7285 Risques cliniques et sécurité en santé des femmes, Université Versailles-Saint-Quentin en Yvelines, Versailles, France
| | - Myriam Mimouni
- Department of Gynecology, CHI Poissy-St-Germain, Université Versailles-Saint-Quentin en Yvelines, EA 7285 Risques cliniques et sécurité en santé des femmes, Université Versailles-Saint-Quentin en Yvelines, Versailles, France
| | - Alexandre Bricou
- Department of Obstetrics and Gynecology, Jean-Verdier University Hospital, Assistance Publique des Hôpitaux de Paris, University Paris 13, France
| | - François Golfier
- Department of Gynaecologic and Oncologic Surgery and Obstetrics, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Université Lyon 1, 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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9
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Vincent L, Jankowski C, Ouldamer L, Ballester M, Bendifallah S, Bolze PA, Akladios C, Costaz H, Lavoué V, Canlorbe G, Collinet P, Touboul C, Huchon C, Bricou A, Dridi S, Padéano MM, Bengrine L, Arnould L, Coutant C. Prognostic factors of overall survival for patients with FIGO stage IIIc or IVa ovarian cancer treated with neo-adjuvant chemotherapy followed by interval debulking surgery: A multicenter cohort analysis from the FRANCOGYN study group. Eur J Surg Oncol 2020; 46:1689-1696. [PMID: 32417154 DOI: 10.1016/j.ejso.2020.04.029] [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] [Received: 01/31/2020] [Revised: 04/05/2020] [Accepted: 04/15/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The aim of this study was to identify prognostic factors of overall survival in patients with FIGO stage IIIc or IVa ovarian cancer (OC) treated by neo-adjuvant chemotherapy (NAC) followed by interval debulking surgery. MATERIALS AND METHODS Data from 483 patients with ovarian cancer were retrospectively collected, from January 1, 2000 to December 31, 2016, from the FRANCOGYN database, regrouping data from 11 centers specialized in ovarian cancer treatment. Median overall survival was determined using the Kaplan-Meier method. Univariate and multivariate analysis were performed to define prognostic factors of overall survival. RESULTS The median overall survival was 52 after a median follow up of 30 months. After univariate analysis, factors significantly associated with decreased overall survival were; no pelvic and/or para-aortic lymphadenectomy (p = 0.002), residual disease (CC1/CC2/CC3) after surgery (p < 0.001), positive cytology after NAC (p < 0.001), omental disease after NAC (p = 0.002), no pathologic complete response (pCR) (p = 0.002). In multivariate analysis, factors significantly associated with decreased overall survival were; residual disease after surgery (HR = 1.93; CI95% (1.16-3.21), p = 0.01) and positive cytology after NAC (HR = 1.59; CI95% (1.01-2.55), p = 0.05). Patients with no residual disease after surgery had a median overall survival of 64 months versus 35 months for patients with residual disease. Patients with negative cytology after NAC had a median overall survival of 71 months versus 43 months for patients with positive cytology after NAC. CONCLUSION In this first and largest French based retrospective study, complete cytoreductive surgery in ovarian cancer remains the main prognostic factor of overall survival.
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Affiliation(s)
- L Vincent
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France; University of Burgundy, 7 Jeanne d'Arc boulevard, 21000, Dijon, France.
| | - C Jankowski
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France
| | - L Ouldamer
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, 2 Tonnelé boulevard, 37000, Tours, France; INSERM U1069 Université François-Rabelais, 10 Tonnelé boulevard, 37000, Tours, France
| | - M Ballester
- Department of Gynecologic and Breast Surgery, Groupe Hospitalier Diaconesses Croix Saint Simon, 125 Avron Street, 75020, Paris, France
| | - S Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 4 Chine street, 75020, Paris, France
| | - P A Bolze
- Gynecological Surgery Service, CHU Lyon-Sud, 165 Grand Revoyet Road, 69495, Pierre-Bénite, France
| | - C Akladios
- Department of Surgical Gynecology, University Hospital of Strasbourg, Molière Avenue, 67200, Strasbourg, France
| | - H Costaz
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France
| | - V Lavoué
- Department of Gynecological Surgery, Rennes University Hospital, 16 Bulgarie boulevard, 35200, Rennes, France
| | - G Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Pitié-Salpêtrière University Hospital, 47-83 Hopital boulevard, 75013, Paris, France; INSERM,UMR S 938, Sorbonne University, 75005, Paris, France
| | - P Collinet
- Department of Gynecological Surgery, Jeanne de Flandre University Hospital, Eugéne Avinée Avenue, 59000, Lille, France
| | - C Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, 40 Verdun Avenue, 94010, Créteil, France
| | - C Huchon
- Department of Gynecology, Centre Hospitalier de Poissy, 10 Champ Gaillard Street, 78300, Poissy, France
| | - A Bricou
- Department of Gynaecology, Bobigny University, AP-HP, Hôpital Jean-Verdier, 14 Juillet Avenue, 93140, Bondy, France
| | - S Dridi
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France; University of Burgundy, 7 Jeanne d'Arc boulevard, 21000, Dijon, France
| | - M M Padéano
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France
| | - L Bengrine
- Department of Medical Oncology, Georges-Francois Leclerc Cancer Center, Dijon, 1 Professeur Marion Street, 21000, France
| | - L Arnould
- Department of Anatomopathology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France
| | - C Coutant
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France; University of Burgundy, 7 Jeanne d'Arc boulevard, 21000, Dijon, France
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10
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Jacquemond I, Muggeo A, Lamblin G, Tristan A, Gillet Y, Bolze PA, Bes M, Gustave CA, Rasigade JP, Golfier F, Ferry T, Dubost A, Abrouk D, Barreto S, Prigent-Combaret C, Thioulouse J, Lina G, Muller D. Author Correction: Complex ecological interactions of Staphylococcus aureus in tampons during menstruation. Sci Rep 2020; 10:1848. [PMID: 32001730 PMCID: PMC6992739 DOI: 10.1038/s41598-020-57947-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Isaline Jacquemond
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, 43 bd du 11 Novembre, F-69622, Villeurbanne, France.,CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
| | - Anaëlle Muggeo
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
| | - Gery Lamblin
- Department of Gynecology, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - Anne Tristan
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France.,Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Yves Gillet
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France.,Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.,Department of Pediatric Emergency, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - Pierre Adrien Bolze
- Department of Gynecological Surgery and Oncology, Obstetrics, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Michèle Bes
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Claude Alexandre Gustave
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France.,Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Jean-Philippe Rasigade
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France.,Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - François Golfier
- Department of Gynecological Surgery and Oncology, Obstetrics, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Tristan Ferry
- Service des maladies infectieuses et tropicales, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Audrey Dubost
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, 43 bd du 11 Novembre, F-69622, Villeurbanne, France
| | - Danis Abrouk
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, 43 bd du 11 Novembre, F-69622, Villeurbanne, France
| | - Samuel Barreto
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, 43 bd du 11 Novembre, F-69622, Villeurbanne, France.,Université Lyon 1, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France
| | - Claire Prigent-Combaret
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, 43 bd du 11 Novembre, F-69622, Villeurbanne, France
| | - Jean Thioulouse
- Université Lyon 1, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France
| | - Gérard Lina
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France. .,Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.
| | - Daniel Muller
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, 43 bd du 11 Novembre, F-69622, Villeurbanne, France.
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11
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Lavoue V, Huchon C, Akladios C, Alfonsi P, Bakrin N, Ballester M, Bendifallah S, Bolze PA, Bonnet F, Bourgin C, Chabbert-Buffet N, Collinet P, Courbiere B, De la Motte Rouge T, Devouassoux-Shisheboran M, Falandry C, Ferron G, Fournier L, Gladieff L, Golfier F, Gouy S, Guyon F, Lambaudie E, Leary A, Lecuru F, Lefrere-Belda MA, Leblanc E, Lemoine A, Narducci F, Ouldamer L, Pautier P, Planchamp F, Pouget N, Ray-Coquard I, Rousset-Jablonski C, Senechal-Davin C, Touboul C, Thomassin-Naggara I, Uzan C, You B, Daraï E. Management of epithelial cancer of the ovary, fallopian tube, and primary peritoneum. Long text of the Joint French Clinical Practice Guidelines issued by FRANCOGYN, CNGOF, SFOG, and GINECO-ARCAGY, and endorsed by INCa. Part 1: Diagnostic exploration and staging, surgery, perioperative care, and pathology. J Gynecol Obstet Hum Reprod 2019; 48:369-378. [PMID: 30936027 DOI: 10.1016/j.jogoh.2019.03.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/19/2019] [Indexed: 11/27/2022]
Abstract
An MRI is recommended for an ovarian mass that is indeterminate on ultrasound. The ROMA score (combining CA125 and HE4) can also be calculated (grade A). In presumed early-stage ovarian or tubal cancers, the following procedures should be performed: an omentectomy (at a minimum, infracolic), an appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C), and pelvic and para-aortic lymphadenectomies (grade B) for all histologic types, except the expansile mucinous subtypes, for which lymphadenectomies can be omitted (grade C). Minimally invasive surgery is recommended for early-stage ovarian cancer, when there is no risk of tumor rupture (grade B). For FIGO stages III or IV ovarian, tubal, and primary peritoneal cancers, a contrast-enhanced computed tomography (CT) scan of the thorax/abdomen/pelvis is recommended (grade B), as well as laparoscopic exploration to take multiple biopsies (grade A) and a carcinomatosis score (Fagotti score at a minimum) (grade C) to assess the possibility of complete surgery (i.e., leaving no macroscopic tumor residue). Complete surgery by a midline laparotomy is recommended for advanced ovarian, tubal, or primary peritoneal cancer (grade B). For advanced cancers, para-aortic and pelvic lymphadenectomies are recommended when metastatic adenopathy is clinically or radiologically suspected (grade B). When adenopathy is not suspected and when complete peritoneal surgery is performed as the initial surgery for advanced cancer, the lymphadenectomies can be omitted because they do not modify either the medical treatment or overall survival (grade B). Primary surgery (before other treatment) is recommended whenever it appears possible to leave no tumor residue (grade B).
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Affiliation(s)
- V Lavoue
- Service de gynécologie, CHU de Rennes, Hôpital sud, 16 Bd de Bulgarie, 35000 Rennes, France; INSERM 1242, Chemistry, Oncogenesis, Stress and Signaling, Centre Eugène Marquis, Rue Bataille Flandres-Dunkerques, Rennes, France.
| | - C Huchon
- Service de Gynécologie, CHI Poissy, France
| | - C Akladios
- Service de Gynécologie, Hôpital Hautepierre, CHU Strasbourg, France
| | - P Alfonsi
- Service d'Anesthésie, Hôpital Saint Joseph, Paris, France
| | - N Bakrin
- Service de chirurgie digestive, CHU Lyon-Sud, Pierre-Bénite, Lyon, France
| | - M Ballester
- Service de gynécologie, GH Diaconesses Croix Saint Simon, Paris, France
| | - S Bendifallah
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, 4 rue de La Chine, APHP, Institut Universitaire de Cancérologie Sorbonne Université, UMRS-938, France
| | - P A Bolze
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre Bénite, Lyon, France
| | - F Bonnet
- Service d'anesthésie, Hôpital Tenon, AP-HP, Paris, France
| | - C Bourgin
- Service de Chirurgie Gynécologique, Hôpital Jeanne de Flandres, CHRU, Lille, France
| | - N Chabbert-Buffet
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, 4 rue de La Chine, APHP, Institut Universitaire de Cancérologie Sorbonne Université, UMRS-938, France
| | - P Collinet
- Service de Chirurgie Gynécologique, Hôpital Jeanne de Flandres, CHRU, Lille, France
| | - B Courbiere
- Pôle Femmes-Parents-Enfants - Centre Clinico-Biologique d'AMP, AP-HM La Conception, 147 bd Baille, 13005 Marseille/Aix Marseille Université, CNRS, IRD, Avignon Université, IMBE UMR 7263, 13397 Marseille, France
| | | | | | - C Falandry
- Service d'oncogériatrie, Hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, Lyon, France
| | - G Ferron
- Service d'oncologie chirurgicale, Institut Claudius Regaud, IUCT Oncopole, Toulouse, France
| | - L Fournier
- Service de radiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - L Gladieff
- Service d'oncologie médicale, Institut Claudius Regaud, IUCT Oncopole, Toulouse, France
| | - F Golfier
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre Bénite, Lyon, France
| | - S Gouy
- Service de chirurgie, Institut Gustave Roussy, Villejuif, France
| | - F Guyon
- Service de chirurgie, Institut Bergonié, Bordeaux, France
| | - E Lambaudie
- Service de chirurgie, Institut Paoli Calmette, Marseille, France
| | - A Leary
- Service d'oncologie médicale, Institut Gustave Roussy, Villejuif, France
| | - F Lecuru
- Service de chirurgie gynécologique et oncologique, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - M A Lefrere-Belda
- Service d'anatomo-pathologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - E Leblanc
- Service de chirurgie, Centre Oscar Lambret, Lille, France
| | - A Lemoine
- Service d'anesthésie, Hôpital Tenon, AP-HP, Paris, France
| | - F Narducci
- Service de chirurgie, Centre Oscar Lambret, Lille, France
| | - L Ouldamer
- Service de chirurgie gynécologique, CHU de Tours, France
| | - P Pautier
- Service d'oncologie médicale, Institut Gustave Roussy, Villejuif, France
| | - F Planchamp
- Service de méthodologie, Institut Bergonié, Bordeaux, France
| | - N Pouget
- Service de chirurgie, Curie (site Saint Cloud), Paris, France
| | - I Ray-Coquard
- Service d'oncologie médicale, Centre Léon Bérard, Lyon, France
| | | | | | - C Touboul
- Service de chirurgie gynécologique, CHI de Créteil, Créteil, France
| | | | - C Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié Salpêtrière, Institut Universitaire de Cancérologie, Sorbonne Université, INSERM U938, France
| | - B You
- Service d'oncologie médicale, Institut de cancérologie des Hospices Civils de Lyon, Pierre-Bénite, Lyon, Paris, France
| | - E Daraï
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, 4 rue de La Chine, APHP, Institut Universitaire de Cancérologie Sorbonne Université, UMRS-938, France
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12
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Lavoué V, Bendifallah S, Collinet P, Graesslin O, Ballester M, Akladios C, Carcopino X, Bricou A, Koskas M, Canlorbe G, Coutant C, Bolze PA, Ouldamer L, Daraï E, Touboul C, Huchon C. La chimiothérapie hyperthermique intra-péritonéale (CHIP) sauvée par les preuves : la carcinose ovarienne, cible privilégiée de la CHIP ? Bull Cancer 2019; 106:175-178. [DOI: 10.1016/j.bulcan.2018.12.009] [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: 10/04/2018] [Revised: 11/26/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
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13
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Lavoué V, Huchon C, Akladios C, Alfonsi P, Bakrin N, Ballester M, Bendifallah S, Bolze PA, Bonnet F, Bourgin C, Chabbert-Buffet N, Collinet P, Courbiere B, De la Motte Rouge T, Devouassoux-Shisheboran M, Falandry C, Ferron G, Fournier L, Gladieff L, Golfier F, Gouy S, Guyon F, Lambaudie E, Leary A, Lécuru F, Lefrère-Belda MA, Leblanc E, Lemoine A, Narducci F, Ouldamer L, Pautier P, Planchamp F, Pouget N, Ray-Coquard I, Rousset-Jablonski C, Sénéchal-Davin C, Touboul C, Thomassin-Naggara I, Uzan C, You B, Daraï E. [Part II drafted from the short text of the French guidelines entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY and endorsed by INCa. (Systemic and intraperitoneal treatment, elderly, fertility preservation, follow-up)]. ACTA ACUST UNITED AC 2019; 47:111-119. [PMID: 30704955 DOI: 10.1016/j.gofs.2018.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Indexed: 10/27/2022]
Abstract
Adjuvant chemotherapy with carboplatin and paclitaxel is recommended for all high-grade ovarian or Fallopian tube cancers, stage FIGO I-IIA (grade A). After a complete first surgery, it is recommended to deliver 6 cycles of intravenous (grade A) or to propose intraperitoneal (grade B) chemotherapy, to be discussed with patient, according to the benefit/risk ratio. After a complete interval surgery for a FIGO III stage, the hyperthermic intra peritoneal chemotherapy (HIPEC) can be proposed in the same conditions of the OV-HIPEC trial (grade B). In case of tumor residue after surgery or FIGO stage IV, chemotherapy associated with bevacizumab is recommended (grade A). For BRCA mutated patient, Olaparib is recommended (grade B).
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Affiliation(s)
- V Lavoué
- Service de gynécologie, hôpital sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France; Inserm 1242, chemistry, oncogenesis, stress and signaling, centre Eugène-Marquis, rue Bataille-Flandres-Dunkerques, 35000 Rennes, France.
| | - C Huchon
- Service de gynécologie, CHI Poissy, 78000 Poissy, France
| | - C Akladios
- Service de gynécologie, hôpital Hautepierre, CHU de Strasbourg, 67000 Strasbourg, France
| | - P Alfonsi
- Service d'anesthésie, hôpital Saint-Joseph, 75014 Paris, France
| | - N Bakrin
- Service de chirurgie digestive, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - M Ballester
- Service de gynécologie, groupe hospitalier Diaconesses-Croix-Saint-Simon, 75020 Paris, France
| | - S Bendifallah
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Institut universitaire de cancérologie, UMRS-938, Sorbonne université, 75000 Paris, France
| | - P A Bolze
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - F Bonnet
- Service d'anesthésie, hôpital Tenon, AP-HP, 75020 Paris, France
| | - C Bourgin
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandres, CHRU de Lille, 59000 Lille, France
| | - N Chabbert-Buffet
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Institut universitaire de cancérologie, UMRS-938, Sorbonne université, 75000 Paris, France
| | - P Collinet
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandres, CHRU de Lille, 59000 Lille, France
| | - B Courbiere
- Pôle Femmes-Parents-Enfants, centre clinico-biologique d'AMP, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; CNRS, IRD, IMBE UMR 7263, Avignon université, Aix Marseille université, 13397 Marseille, France
| | | | - M Devouassoux-Shisheboran
- Service d'anatomo-pathologie, hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - C Falandry
- Service d'oncogériatrie, hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - G Ferron
- Service d'oncologie chirurgicale, institut Claudius-Regaud, IUCT Oncopole, 31000 Toulouse, France
| | - L Fournier
- Service de radiologie, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - L Gladieff
- Service d'oncologie médicale, institut Claudius-Regaud, IUCT Oncopole, 31000 Toulouse, France
| | - F Golfier
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - S Gouy
- Service de chirurgie, institut Gustave-Roussy, 94000 Villejuif, France
| | - F Guyon
- Service de chirurgie, institut Bergonié, 33000 Bordeaux, France
| | - E Lambaudie
- Service de chirurgie, institut Paoli-Calmette, 13000 Marseille, France
| | - A Leary
- Service d'oncologie médicale, institut Gustave-Roussy, 94000 Villejuif, France
| | - F Lécuru
- Service de chirurgie gynécologique et oncologique, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - M A Lefrère-Belda
- Service d'anatomo-pathologie, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - E Leblanc
- Service de chirurgie, centre Oscar-Lambret, 59000 Lille, France
| | - A Lemoine
- Service d'anesthésie, hôpital Tenon, AP-HP, 75020 Paris, France
| | - F Narducci
- Service de chirurgie, centre Oscar-Lambret, 59000 Lille, France
| | - L Ouldamer
- Service de chirurgie gynécologique, CHU de Tours, 37000 Tours, France
| | - P Pautier
- Service d'oncologie médicale, institut Gustave-Roussy, 94000 Villejuif, France
| | - F Planchamp
- Service de méthodologie, institut Bergonié, 33000 Bordeaux, France
| | - N Pouget
- Service de chirurgie, Curie (site Saint-Cloud), 75000 Paris, France
| | - I Ray-Coquard
- Service d'oncologie médicale, centre Léon-Bérard, 69000 Lyon, France
| | | | | | - C Touboul
- Service de chirurgie gynécologique, CHI de Créteil, 94000 Créteil, France
| | | | - C Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, 75013 Paris, France; Inserm U938, institut universitaire de cancérologie, Sorbonne université, 75000 Paris, France
| | - B You
- Service d'oncologie médicale, institut de cancérologie, hospices civils de Lyon, Pierre-Bénite, 69000 Lyon, France
| | - E Daraï
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Institut universitaire de cancérologie, UMRS-938, Sorbonne université, 75000 Paris, France
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14
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Lavoué V, Huchon C, Akladios C, Alfonsi P, Bakrin N, Ballester M, Bendifallah S, Bolze PA, Bonnet F, Bourgin C, Chabbert-Buffet N, Collinet P, Courbiere B, De la Motte Rouge T, Devouassoux-Shisheboran M, Falandry C, Ferron G, Fournier L, Gladieff L, Golfier F, Gouy S, Guyon F, Lambaudie E, Leary A, Lécuru F, Lefrère-Belda MA, Leblanc E, Lemoine A, Narducci F, Ouldamer L, Pautier P, Planchamp F, Pouget N, Ray-Coquard I, Rousset-Jablonski C, Sénéchal-Davin C, Touboul C, Thomassin-Naggara I, Uzan C, You B, Daraï E. [Part I drafted from the short text of the French Guidelines entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY and endorsed by INCa. (Diagnosis management, surgery, perioperative care, and pathological analysis)]. ACTA ACUST UNITED AC 2019; 47:100-110. [PMID: 30686724 DOI: 10.1016/j.gofs.2018.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Indexed: 10/27/2022]
Abstract
Faced to an undetermined ovarian mass on ultrasound, an MRI is recommended and the ROMA score (combining CA125 and HE4) can be proposed (grade A). In case of suspected early stage ovarian or fallopian tube cancer, omentectomy (at least infracolonic), appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C) and pelvic and para-aortic lymphadenectomy are recommended (grade B) for all histological types, except for the expansive mucinous subtype where lymphadenectomy may be omitted (grade C). Minimally invasive surgery is recommended for early stage ovarian cancer, if there is no risk of tumor rupture (grade B). Laparoscopic exploration for multiple biopsies (grade A) and to evaluate carcinomatosis score (at least using the Fagotti score) (grade C) are recommended to estimate the possibility of a complete surgery (i.e. no macroscopic residue). Complete medial laparotomy surgery is recommended for advanced cancers (grade B). It is recommended in advanced cancers to perform para-aortic and pelvic lymphadenectomy in case of clinical or radiological suspicion of metastatic lymph node (grade B). In the absence of clinical or radiological lymphadenopathy and in case of complete peritoneal surgery during an initial surgery for advanced cancer, it is possible not to perform a lymphadenectomy because it does not modify the medical treatment and the overall survival (grade B). Primary surgery is recommended when no tumor residue is possible (grade B).
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Affiliation(s)
- V Lavoué
- Service de gynécologie, hôpital sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France; Inserm 1242, Chemistry, Oncogenesis, Stress and Signaling, Centre Eugène Marquis, rue Bataille Flandres-Dunkerques, 35000 Rennes, France.
| | - C Huchon
- Service de gynécologie, CHI Poissy, 78000 Poissy, France
| | - C Akladios
- Service de gynécologie, hôpital Hautepierre, CHU Strasbourg, 67000 Strasbourg, France
| | - P Alfonsi
- Service d'anesthésie, hôpital Saint-Joseph, 75014 Paris, France
| | - N Bakrin
- Service de chirurgie digestive, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - M Ballester
- Service de gynécologie, groupe hospitalier Diaconesses Croix Saint Simon, 75020 Paris, France
| | - S Bendifallah
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; UMRS-938, institut universitaire de cancérologie Sorbonne université, 75000 Paris, France
| | - P A Bolze
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - F Bonnet
- Service d'anesthésie, hôpital Tenon, AP-HP, 75020 Paris, France
| | - C Bourgin
- Service de chirurgie gynécologique, hôpital Jeanne de Flandres, CHRU, 59000 Lille, France
| | - N Chabbert-Buffet
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; UMRS-938, institut universitaire de cancérologie Sorbonne université, 75000 Paris, France
| | - P Collinet
- Service de chirurgie gynécologique, hôpital Jeanne de Flandres, CHRU, 59000 Lille, France
| | - B Courbiere
- Pôle Femmes-Parents-Enfants-Centre Clinico-Biologique d'AMP, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; IMBE UMR 7263, Aix-Marseille université, CNRS, IRD, Avignon université, 13397 Marseille, France
| | | | - M Devouassoux-Shisheboran
- Service d'anatomopathologie, hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - C Falandry
- Service d'oncogériatrie, hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - G Ferron
- Service d'oncologie chirurgicale, institut Claudius Regaud, IUCT Oncopole, 31000 Toulouse, France
| | - L Fournier
- Service de radiologie, hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - L Gladieff
- Service d'oncologie médicale, institut Claudius Regaud, IUCT Oncopole, 31000 Toulouse, France
| | - F Golfier
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - S Gouy
- Service de chirurgie, institut Gustave Roussy, 94000 Villejuif, France
| | - F Guyon
- Service de chirurgie, institut Bergonié, 33000 Bordeaux, France
| | - E Lambaudie
- Service de chirurgie, institut Paoli Calmette, 13000 Marseille, France
| | - A Leary
- Service d'oncologie médicale, institut Gustave Roussy, 94000 Villejuif, France
| | - F Lécuru
- Service de chirurgie gynécologique et oncologique, hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - M A Lefrère-Belda
- Service d'anatomopathologie, hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - E Leblanc
- Service de chirurgie, Centre Oscar Lambret, 59000 Lille, France
| | - A Lemoine
- Service d'anesthésie, hôpital Tenon, AP-HP, 75020 Paris, France
| | - F Narducci
- Service de chirurgie, Centre Oscar Lambret, 59000 Lille, France
| | - L Ouldamer
- Service de chirurgie gynécologique, CHU de Tours, 37000 Tours, France
| | - P Pautier
- Service d'oncologie médicale, institut Gustave Roussy, 94000 Villejuif, France
| | - F Planchamp
- Service de méthodologie, institut Bergonié, 33000 Bordeaux, France
| | - N Pouget
- Service de chirurgie, Curie (site Saint Cloud), 75000 Paris, France
| | - I Ray-Coquard
- Service d'oncologie médicale, Centre Léon Bérard, 69000 Lyon, France
| | | | | | - C Touboul
- Service de chirurgie gynécologique, CHI de Créteil, 94000 Créteil, France
| | | | - C Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, 75013 Paris, France; Inserm U938, institut universitaire de cancérologie, Sorbonne université, 75000 Paris, France
| | - B You
- Service d'oncologie médicale, institut de cancérologie des hospices Civils de Lyon, Pierre-Bénite, 69000 Lyon Paris, France
| | - E Daraï
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; UMRS-938, institut universitaire de cancérologie Sorbonne université, 75000 Paris, France
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15
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Bolze PA, Descargues P, Poilblanc M, Cotte E, Sesques A, Paparel P, Charlot M, Hajri T, Rousset P, Golfier F. [Contribution of meb to endometriosis patients' diagnosis and treatment]. ACTA ACUST UNITED AC 2018; 47:3-10. [PMID: 30563784 DOI: 10.1016/j.gofs.2018.11.014] [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: 10/03/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Diagnosis and treatment of endometriosis may be complex and therefore justify the discussion of therapeutic decisions in a multidisciplinary endometriosis board (MEB). The development of endometriosis regional expert centers requires an assessment of the quality and relevance of MEB. METHODS Qualitiative retrospective study on patients whose management was discussed in Centre Hospitalier Lyon-Sud between June 2013 and December 2017. RESULTS Among 376 patients presented in MEB, 309 (80.2%) were painful and 184 (59.5%) had complex endometriosis. A complete clinical evaluation was performed in 120 (38.8%) patients. MRI was performed for 370 (98.4%) patients including 303 (81.9%) with a second reading by an expert radiologist. These second readings allowed a diagnosis correction in 88 (60.7 %) patients with complex endometriosis. MR enterography (27.8 %) and rectal endoscopic sonography (14.4%) were the most frequently used third-line exams to complete the initial imaging of digestive lesion in patients with rectal endometriosis. Surgery was proposed for 199 (52,9%) patients including 108 (58,7%) with complex endometriosis. CONCLUSION One of the major interests of MEB in endometriosis is the second reading of MRI, which, by identifying complex endometriosis initially undiagnosed or underestimated, enabled to better discuss the benefits/risks of therapeutic choices, and to organize complex surgeries when those were retained. The development of MEB in regional expert centers will contribute to optimizing the relevance of care for patients with endometriosis.
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Affiliation(s)
- P A Bolze
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - P Descargues
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | - M Poilblanc
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - E Cotte
- Service de chirurgie digestive, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - A Sesques
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Service de médecine de la reproduction, hospices civils de Lyon, université Claude-Bernard Lyon 1, hôpital Femme-Mère-Enfant, 56, boulevard Pinel, 69500 Bron, France
| | - P Paparel
- Service de chirurgie urologique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - M Charlot
- Service d'imagerie médicale, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - T Hajri
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - P Rousset
- Service d'imagerie médicale, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - F Golfier
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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16
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Jacquemond I, Muggeo A, Lamblin G, Tristan A, Gillet Y, Bolze PA, Bes M, Gustave CA, Rasigade JP, Golfier F, Ferry T, Dubost A, Abrouk D, Barreto S, Prigent-Combaret C, Thioulouse J, Lina G, Muller D. Complex ecological interactions of Staphylococcus aureus in tampons during menstruation. Sci Rep 2018; 8:9942. [PMID: 29967393 PMCID: PMC6028614 DOI: 10.1038/s41598-018-28116-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/11/2018] [Indexed: 01/08/2023] Open
Abstract
Menstrual toxic shock syndrome (mTSS) is a severe disease that occurs in healthy women vaginally colonized by Staphylococcus aureus producing toxic shock toxin 1 and who use tampons. The aim of the present study was to determine the impact of the composition of vaginal microbial communities on tampon colonisation by S. aureus during menses. We analysed the microbiota in menstrual fluids extracted from tampons from 108 healthy women and 7 mTSS cases. Using culture, S. aureus was detected in menstrual fluids of 40% of healthy volunteers and 100% of mTSS patients. Between class analysis of culturomic and 16S rRNA gene metabarcoding data indicated that the composition of the tampons' microbiota differs according to the presence or absence of S. aureus and identify discriminating genera. However, the bacterial communities of tampon fluid positive for S. aureus did not cluster together. No difference in tampon microbiome richness, diversity, and ecological distance was observed between tampon vaginal fluids with or without S. aureus, and between healthy donors carrying S. aureus and mTSS patients. Our results show that the vagina is a major niche of. S. aureus in tampon users and the composition of the tampon microbiota control its virulence though more complex interactions than simple inhibition by lactic acid-producing bacterial species.
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Affiliation(s)
- Isaline Jacquemond
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, 43 bd du 11 Novembre, F-69622, Villeurbanne, France
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
| | - Anaëlle Muggeo
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
| | - Gery Lamblin
- Department of Gynecology, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - Anne Tristan
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Yves Gillet
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Department of Pediatric Emergency, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - Pierre Adrien Bolze
- Department of Gynecological Surgery and Oncology, Obstetrics, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Michèle Bes
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Claude Alexandre Gustave
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Jean-Philippe Rasigade
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - François Golfier
- Department of Gynecological Surgery and Oncology, Obstetrics, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Tristan Ferry
- Service des maladies infectieuses et tropicales, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Audrey Dubost
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, 43 bd du 11 Novembre, F-69622, Villeurbanne, France
| | - Danis Abrouk
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, 43 bd du 11 Novembre, F-69622, Villeurbanne, France
| | - Samuel Barreto
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, 43 bd du 11 Novembre, F-69622, Villeurbanne, France
- Université Lyon 1, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France
| | - Claire Prigent-Combaret
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, 43 bd du 11 Novembre, F-69622, Villeurbanne, France
| | - Jean Thioulouse
- Université Lyon 1, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France
| | - Gérard Lina
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France.
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.
| | - Daniel Muller
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, 43 bd du 11 Novembre, F-69622, Villeurbanne, France.
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17
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Collinet P, Fritel X, Revel-Delhom C, Ballester M, Bolze PA, Borghese B, Bornsztein N, Boujenah J, Brillac T, Chabbert-Buffet N, Chauffour C, Clary N, Cohen J, Decanter C, Denouël A, Dubernard G, Fauconnier A, Fernandez H, Gauthier T, Golfier F, Huchon C, Legendre G, Loriau J, Mathieu-d'Argent E, Merlot B, Niro J, Panel P, Paparel P, Philip CA, Ploteau S, Poncelet C, Rabischong B, Roman H, Rubod C, Santulli P, Sauvan M, Thomassin-Naggara I, Torre A, Wattier JM, Yazbeck C, Bourdel N, Canis M. Management of endometriosis: CNGOF/HAS clinical practice guidelines - Short version. J Gynecol Obstet Hum Reprod 2018; 47:265-274. [PMID: 29920379 DOI: 10.1016/j.jogoh.2018.06.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/18/2022]
Abstract
First-line diagnostic investigations for endometriosis are physical examination and pelvic ultrasound. The second-line investigations are: targeted pelvic examination performed by an expert clinician, transvaginal ultrasound performed by an expert physician sonographer (radiologist or gynaecologist), and pelvic MRI. Management of endometriosis is recommended when the disease has a functional impact. Recommended first-line hormonal therapies for the management of endometriosis-related pain are combined hormonal contraceptives (CHCs) or the 52mg levonorgestrel-releasing intrauterine system (IUS). There is no evidence base on which to recommend systematic preoperative hormonal therapy solely to prevent surgical complications or facilitate surgery. After surgery for endometriosis, a CHC or 52mg levonorgestrel-releasing IUS is recommended as first-line treatment when pregnancy is not desired. In the event of failure of the initial treatment, recurrence, or multiorgan involvement, a multidisciplinary team meeting is recommended, involving physicians, surgeons and other professionals. A laparoscopic approach is recommended for surgical treatment of endometriosis. HRT can be offered to postmenopausal women who have undergone surgical treatment for endometriosis. Antigonadotrophic hormonal therapy is not recommended for patients with endometriosis and infertility to increase the chances of spontaneous pregnancy, including postoperatively. Fertility preservation options must be discussed with patients undergoing surgery for ovarian endometriomas.
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Affiliation(s)
- P Collinet
- CHRU Lille, Clinique de gynécologie, Hôpital Jeanne de Flandre, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France
| | - X Fritel
- Service de Gynécologie-Obstétrique et Médecine de la reproduction, Inserm CIC 1402, 2, rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France; Inserm CIC 1402, 86000 Poitiers, France
| | - C Revel-Delhom
- Haute Autorité de Santé, 5 avenue du Stade de France, 93218 La Plaine St Denis Cedex, France
| | - M Ballester
- Service de Gynécologie-Obstétrique et Médecine de la reproduction, CHU Tenon, APHP, 4, rue de la Chine, 75020 Paris, France
| | - P A Bolze
- Service de Chirurgie Gynécologique Oncologique, Obstétrique, CHU Lyon Sud, 165, chemin du Grand Revoyet, 69495 Pierre Bénite, France; Université Claude Bernard Lyon 1, 69000 Lyon, France
| | - B Borghese
- Service de Chirurgie Gynécologie Obstétrique 2 et Médecine de la Reproduction, CHU Cochin, APHP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Equipe Génomique, Epigénétique et Physiopathologie de la Reproduction, Département Développement, Reproduction, Cancer, Inserm U1016, Université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École de Médecine, 75270 Paris cedex 06, France
| | | | - J Boujenah
- Service de Gynécologie-Obstétrique, CHU Bondy, avenue du 14 Juillet, 93140 Bondy, France; Centre médical du Château, 22, rue Louis-Besquel, 94300 Vincennes, France
| | - T Brillac
- 98 route de Blagnac, 31200 Toulouse, France
| | - N Chabbert-Buffet
- Service de Gynécologie-Obstétrique et Médecine de la reproduction, CHU Tenon, APHP, 4, rue de la Chine, 75020 Paris, France; GRC-6 Centre Expert en Endométriose (C3E), Sorbonne Université, 75005 Paris, France; UMR-S938 INSERM Sorbonne Université, 75005 Paris, France
| | - C Chauffour
- Service de Gynécologie-Obstétrique et Reproduction Humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - N Clary
- 3 rue Pablo Picasso, 92160 Antony, France
| | - J Cohen
- Service de Gynécologie-Obstétrique et Médecine de la reproduction, CHU Tenon, APHP, 4, rue de la Chine, 75020 Paris, France
| | - C Decanter
- Service d'Assistance médicale à la procréation et de préservation de la fertilité, Hôpital Jeanne de Flandre, CHRU Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France; EA 4308 Gamétogenèse et qualité du gamète, CHRU Lille, 59037 Lille cedex, France
| | - A Denouël
- EndoFrance, BP 50053, 01124 Montluel cedex, France
| | - G Dubernard
- Clinique gynécologique et obstétricale, CHU de Lyon HCL - GH Nord-Hôpital de la Croix Rousse, CHU de Lyon - HCL, 103, Grande Rue de la Croix-Rousse, 69317 Lyon cedex, France
| | - A Fauconnier
- Service de Gynécologie-Obstétrique, CHI Poissy-St-Germain, 10, rue du ChampGaillard, 78303 Poissy, France; EA 7285 Risques cliniques et sécurité en santé des femmes, Université Versailles - Saint-Quentin-en-Yvelines, 78180 Saint-Quentin-en-Yvelines, France
| | - H Fernandez
- Service de Gynécologie-Obstétrique, CHU Bicêtre, APHP, 78, avenue du Général de Gaulle, 94275 Le Kremlin-Bicêtre, France; CESP-INSERM, U1018, Equipe Epidémiologie et évaluation des stratégies de prise en charge: VIH, reproduction, pédiatrie, Université Paris Sud, 94807 Villejuif, France
| | - T Gauthier
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8, avenue Dominique Larrey, 87042 Limoges, France; UMR-1248, Faculté de Médecine, 87042 Limoges, France
| | - F Golfier
- Service de Chirurgie Gynécologique et Oncologique - Obstétrique, CHU Lyon Sud, 69495 Pierre-Bénite cedex, France
| | - C Huchon
- Service de Gynécologie-Obstétrique, CHI Poissy-St-Germain, 10, rue du ChampGaillard, 78303 Poissy, France
| | - G Legendre
- Service de Gynécologie-Obstétrique, CHU Angers, 4, rue Larrey, 49033 Angers cedex 01, France; CESP-INSERM, U1018, Equipe 7, Genre, Santé Sexuelle et Reproductive, Université Paris Sud, 94276 Le Kremlin-Bicêtre cedex, France
| | - J Loriau
- Service de Chirurgie digestive, GH Paris Saint-Joseph, 185, rue Raymond-Losserand, 75001 Paris, France
| | - E Mathieu-d'Argent
- Service de Gynécologie-Obstétrique et Médecine de la reproduction, CHU Tenon, APHP, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, 75005 Paris, France; GRC6-UPMC: centre expert en endométriose (C3E), hôpital Tenon, Paris, France
| | - B Merlot
- 10 Clinique Tivoli-Ducos, 33000 Bordeaux, France
| | - J Niro
- Service de Gynécologie-Obstétrique, Centre Hospitalier de Versailles, 177, route de Versailles, 78157 Le Chesnay cedex, France
| | - P Panel
- Service de Gynécologie-Obstétrique, Centre Hospitalier de Versailles, 177, route de Versailles, 78157 Le Chesnay cedex, France
| | - P Paparel
- Service d'Urologie, CHU Lyon Sud, 165, chemin du Grand Revoyet, 60495 Pierre Bénite, France
| | - C A Philip
- Clinique gynécologique et obstétricale, CHU de Lyon HCL - GH Nord-Hôpital de la Croix Rousse, CHU de Lyon - HCL, 103, Grande Rue de la Croix-Rousse, 69317 Lyon cedex, France
| | - S Ploteau
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital MèreEnfant, CHU Nantes, 8, boulevard Jean-Monnet, 44093 Nantes, France
| | - C Poncelet
- Service de Gynécologie-Obstétrique, CH Renée Dubos, 6, avenue de l'Ile-de-France, 95300 Pontoise, France; Université Paris 13, Sorbonne Paris Cité, UFR SMBH, 93022 Bobigny, France
| | - B Rabischong
- Service de Gynécologie-Obstétrique et Reproduction Humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - H Roman
- Centre Expert de Diagnostic et Prise en Charge Multidisciplinaire de l'Endométriose, Clinique Gynécologique et Obstétricale, CHU Charles Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - C Rubod
- CHRU Lille, Clinique de gynécologie, Hôpital Jeanne de Flandre, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France
| | - P Santulli
- Service de Chirurgie Gynécologie Obstétrique 2 et Médecine de la Reproduction, CHU Cochin, APHP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Equipe Génomique, Epigénétique et Physiopathologie de la Reproduction, Département Développement, Reproduction, Cancer, Inserm U1016, Université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École de Médecine, 75270 Paris cedex 06, France
| | - M Sauvan
- Service de Gynécologie-Obstétrique, CHU Bicêtre, APHP, 78, avenue du Général de Gaulle, 94275 Le Kremlin-Bicêtre, France
| | - I Thomassin-Naggara
- Service d'Imagerie, Hôpital Tenon, APHP, 4, rue de la Chine, 75020 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, Institut Universitaire de Cancérologie, Assistance Publique, 75006 Paris, France
| | - A Torre
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Arnaud de Villeneuve, CHU Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - J M Wattier
- Centre d'étude et traitement de la douleur, Hôpital Claude Huriez, CHRU Lille, rue Michel-Polonowski, 59000 Lille, France
| | - C Yazbeck
- Service de Gynécologie-Obstétrique, Hôpital Foch, APHP, 40, rue Worth, 92151 Suresnes, France; Centre d'Assistance Médicale à la Procréation, Clinique Pierre Cherest, 5, rue Pierre-Cherest, 92200 Neuilly-Sur-Seine, France
| | - N Bourdel
- Service de Gynécologie-Obstétrique et Reproduction Humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - M Canis
- Service de Gynécologie-Obstétrique et Reproduction Humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
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18
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Collinet P, Fritel X, Revel-Delhom C, Ballester M, Bolze PA, Borghese B, Bornsztein N, Boujenah J, Bourdel N, Brillac T, Chabbert-Buffet N, Chauffour C, Clary N, Cohen J, Decanter C, Denouël A, Dubernard G, Fauconnier A, Fernandez H, Gauthier T, Golfier F, Huchon C, Legendre G, Loriau J, Mathieu-d'Argent E, Merlot B, Niro J, Panel P, Paparel P, Philip CA, Ploteau S, Poncelet C, Rabischong B, Roman H, Rubod C, Santulli P, Sauvan M, Thomassin-Naggara I, Torre A, Wattier JM, Yazbeck C, Canis M. [Management of endometriosis: CNGOF-HAS practice guidelines (short version)]. ACTA ACUST UNITED AC 2018; 46:144-155. [PMID: 29550339 DOI: 10.1016/j.gofs.2018.02.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Indexed: 10/17/2022]
Abstract
First-line investigations to diagnose endometriosis are clinical examination and pelvic ultrasound. Second-line investigations include pelvic examination performed by a referent clinician, transvaginal ultrasound performed by a referent echographist, and pelvic MRI. It is recommended to treat endometriosis when it is symptomatic. First-line hormonal treatments recommended for the management of painful endometriosis are combined with hormonal contraceptives or levonorgestrel 52mg IUD. There is no evidence to recommend systematic preoperative hormonal therapy for the unique purpose of preventing the risk of surgical complications or facilitating surgery. After endometriosis surgery, combined hormonal contraceptives or levonorgestrel SIU 52mg are recommended as first-line therapy in the absence of desire of pregnancy. In case of initial treatment failure, recurrence, or multiple organ involvement by endometriosis, medico-surgical and multidisciplinary discussion is recommended. The laparoscopic approach is recommended for the surgical treatment of endometriosis. HRT may be offered in postmenopausal women operated for endometriosis. In case of infertility related to endometriosis, it is not recommended to prescribe anti-gonadotropic hormone therapy to increase the rate of spontaneous pregnancy, including postoperatively. The possibilities of fertility preservation should be discussed with the patient in case of surgery for ovarian endometrioma.
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Affiliation(s)
- P Collinet
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France.
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, Inserm CIC 1402, 2, rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France; Inserm CIC 1402, 86000 Poitiers, France
| | - C Revel-Delhom
- Haute Autorité de santé, 5, avenue du Stade-de-France, 93218 La Plaine-Saint-Denis cedex, France
| | - M Ballester
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - P A Bolze
- Service de chirurgie gynécologique oncologique, obstétrique, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Claude-Bernard-Lyon 1, 69000 Lyon, France
| | - B Borghese
- Service de chirurgie gynécologie-obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, département développement, reproduction, cancer, Inserm U1016, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France
| | | | - J Boujenah
- Service de gynécologie-obstétrique, CHU Bondy, avenue du 14-Juillet, 93140 Bondy, France; Centre médical du Château, 22, rue Louis-Besquel, 94300 Vincennes, France
| | - N Bourdel
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; Faculté de médecine, Encov-ISIT, UMR6284 CNRS, université d'Auvergne, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - T Brillac
- 98, route de Blagnac, 31200 Toulouse, France
| | - N Chabbert-Buffet
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; GRC-6 centre expert en endométriose (C3E), Sorbonne université, Paris, France; UMR-S938 Inserm Sorbonne université, Paris, France
| | - C Chauffour
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - N Clary
- 3, rue Pablo-Picasso, 92160 Antony, France
| | - J Cohen
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Decanter
- Service d'assistance médicale à la procréation et de préservation de la fertilité, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France; EA 4308 gamétogenèse et qualité du gamète, CHRU de Lille, 59037 Lille cedex, France
| | - A Denouël
- EndoFrance, BP 50053, 01124 Montluel cedex, France
| | - G Dubernard
- Université Claude-Bernard-Lyon 1, 69000 Lyon, France; Clinique gynécologique et obstétricale, hôpital de la Croix-Rousse, groupe hospitalier Nord, CHU de Lyon-HCL, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex, France
| | - A Fauconnier
- Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France; EA 7285 risques cliniques et sécurité en santé des femmes, université Versailles-Saint-Quentin-en-Yvelines, Saint-Quentin-en-Yvelines, France
| | - H Fernandez
- Service de gynécologie-obstétrique, CHU Bicêtre, AP-HP, 78, avenue du Général-de-Gaulle, 94275 Le Kremlin-Bicêtre, France; CESP-INSERM, U1018, équipe épidémiologie et évaluation des stratégies de prise en charge, VIH, reproduction, pédiatrie, université Paris-Sud, Paris, France
| | - T Gauthier
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 8, avenue Dominique-Larrey, 87042 Limoges, France; UMR-1248, faculté de médecine, 87042 Limoges, France
| | - F Golfier
- Service de chirurgie gynécologique oncologique, obstétrique, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - C Huchon
- Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France
| | - G Legendre
- Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 01, France; CESP-Inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, université Paris-Sud, 94276 Le Kremlin-Bicêtre cedex, France
| | - J Loriau
- Service de chirurgie digestive, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75001 Paris, France
| | - E Mathieu-d'Argent
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, Paris, France; GRC6-UPMC, centre expert en endométriose (C3E), hôpital Tenon, Paris, France
| | - B Merlot
- Service de chirurgie gynécologique, clinique Tivoli, 220, rue Mandron, 33000 Bordeaux, France
| | - J Niro
- Service de gynécologie-obstétrique, centre hospitalier de Versailles, 177, route de Versailles, 78157 Le Chesnay cedex, France
| | - P Panel
- Service de gynécologie-obstétrique, centre hospitalier de Versailles, 177, route de Versailles, 78157 Le Chesnay cedex, France
| | - P Paparel
- Service d'urologie, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 60495 Pierre-Bénite, France
| | - C A Philip
- Université Claude-Bernard-Lyon 1, 69000 Lyon, France; Clinique gynécologique et obstétricale, hôpital de la Croix-Rousse, groupe hospitalier Nord, CHU de Lyon-HCL, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex, France
| | - S Ploteau
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Mère-Enfant, CHU de Nantes, 8, boulevard Jean-Monnet, 44093 Nantes, France
| | - C Poncelet
- Service de gynécologie-obstétrique, centre hospitalier Renée-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France; Université Paris 13, Sorbonne Paris Cité, UFR SMBH, 93022 Bobigny, France
| | - B Rabischong
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - H Roman
- Centre expert de diagnostic et prise en charge multidisciplinaire de l'endométriose, clinique gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - C Rubod
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France
| | - P Santulli
- Service de chirurgie gynécologie-obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, département développement, reproduction, cancer, Inserm U1016, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France
| | - M Sauvan
- Service de gynécologie-obstétrique, CHU Bicêtre, AP-HP, 78, avenue du Général-de-Gaulle, 94275 Le Kremlin-Bicêtre, France
| | - I Thomassin-Naggara
- Service d'imagerie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Sorbonne universités, UPMC université Paris 06, Paris, France; Institut universitaire de cancérologie, Assistance publique, Paris, France
| | - A Torre
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - J M Wattier
- Centre d'étude et traitement de la douleur, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France
| | - C Yazbeck
- Service de gynécologie-obstétrique, hôpital Foch, AP-HP, 40, rue Worth, 92151 Suresnes, France; Centre d'assistance médicale à la procréation, clinique Pierre-Cherest, 5, rue Pierre-Cherest, 92200 Neuilly-Sur-Seine, France
| | - M Canis
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; Faculté de médecine, Encov-ISIT, UMR6284 CNRS, université d'Auvergne, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France
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19
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Roman H, Ballester M, Loriau J, Canis M, Bolze PA, Niro J, Ploteau S, Rubod C, Yazbeck C, Collinet P, Rabischong B, Merlot B, Fritel X. [Strategies and surgical management of endometriosis: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29526793 DOI: 10.1016/j.gofs.2018.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The article presents French guidelines for surgical management of endometriosis. Surgical treatment is recommended for mild to moderate endometriosis, as it decreases pelvic painful complaints and increases the likelihood of postoperative conception in infertile patients (A). Surgery may be proposed in symptomatic patients with ovarian endometriomas which diameter exceeds 20mm. Cystectomy allows for better postoperative pregnancy rates when compared to ablation using bipolar current, as well as for lower recurrences rates when compared to ablation using bipolar current or CO2 laser. Ablation of ovarian endometriomas using bipolar current is not recommended (B). Surgery may be employed in patients with deep endometriosis infiltrating the colon and the rectum, with good impact on painful complaints and postoperative conception. In these patients, laparoscopic route increases the likelihood of postoperative spontaneous conception when compared to open route. When compared to conservative rectal procedures (shaving or disc excision), segmental colorectal resection increases the risk of postoperative stenosis, requiring additional endoscopic or surgical procedures. In large deep endometriosis infiltrating the rectum (>20mm length of bowel infiltration), conservative rectal procedures do not improve postoperative digestive function when compared to segmental resection. In patients with bowel anastomosis, placing anti-adhesion agents on contact with bowel suture is not recommended, due to higher risk of bowel fistula (C). Various other recommendations are proposed in the text, however, they are based on studies with low level of evidence.
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Affiliation(s)
- H Roman
- Centre expert de diagnostic et prise en charge multidisciplinaire de l'endométriose, clinique gynécologique et obstétricale, CHU Charles Nicolle, 1, rue de Germont, 76031 Rouen, France.
| | - M Ballester
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - J Loriau
- Service de chirurgie digestive, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond Losserand, 75001 Paris, France
| | - M Canis
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie Aubrac, 63003 Clermont-Ferrand, France; Faculté de médecine, Encov-ISIT, UMR6284 CNRS, université d'Auvergne, 28, place Henri Dunant, 63000 Clermont-Ferrand, France
| | - P A Bolze
- Service de chirurgie gynécologique oncologique, obstétrique, CHU Lyon Sud, 165, chemin du Grand Revoyet, 69495 Pierre Bénite, France; Université Claude Bernard Lyon 1, 69000 Lyon, France
| | - J Niro
- Service de chirurgie gynécologique, clinique Tivoli, 220, rue Mandron, 33000 Bordeaux, France
| | - S Ploteau
- Service de gynecologie-obstétrique et médecine de la reproduction, hôpital Mère-Enfant, CHU Nantes, 8, boulevard Jean-Monnet, 44093 Nantes, France
| | - C Rubod
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France
| | - C Yazbeck
- Service de gynécologie-obstétrique, hôpital Foch, AP-HP, 40, rue Worth, 92151 Suresnes, France; Centre d'assistance médicale à la procréation, clinique Pierre Cherest, 5, rue Pierre Cherest, 92200 Neuilly-Sur-Seine, France
| | - P Collinet
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France
| | - B Rabischong
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie Aubrac, 63003 Clermont-Ferrand, France; Faculté de médecine, Encov-ISIT, UMR6284 CNRS, université d'Auvergne, 28, place Henri Dunant, 63000 Clermont-Ferrand, France
| | - B Merlot
- Service de chirurgie gynécologique, clinique Tivoli, 220, rue Mandron, 33000 Bordeaux, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, inserm CIC 1402, 2, rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France; Inserm CIC 1402, 86000 Poitiers, France
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