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Lecomte T, Tougeron D, Chautard R, Bressand D, Bibeau F, Blanc B, Cohen R, Jacques J, Lagasse JP, Laurent-Puig P, Lepage C, Lucidarme O, Martin-Babau J, Panis Y, Portales F, Taieb J, Aparicio T, Bouché O. Non-metastatic colon cancer: French Intergroup Clinical Practice Guidelines for diagnosis, treatments, and follow-up (TNCD, SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, SFP, AFEF, and SFR). Dig Liver Dis 2024; 56:756-769. [PMID: 38383162 DOI: 10.1016/j.dld.2024.01.208] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION This article is a summary of the French intergroup guidelines regarding the management of non-metastatic colon cancer (CC), revised in November 2022. METHODS These guidelines represent collaborative work of all French medical and surgical societies involved in the management of CC. Recommendations were graded in three categories (A, B, and C) according to the level of evidence found in the literature published up to November 2022. RESULTS Initial evaluation of CC is based on clinical examination, colonoscopy, chest-abdomen-pelvis computed tomography (CT) scan, and carcinoembryonic antigen (CEA) assay. CC is usually managed by surgery and adjuvant treatment depending on the pathological findings. The use of adjuvant therapy remains a challenging question in stage II disease. For high-risk stage II CC, adjuvant chemotherapy must be discussed and fluoropyrimidine monotherapy or oxaliplatin-based chemotherapy proposed according to the type and number of poor prognostic features. Oxaliplatin-based chemotherapy (FOLFOX or CAPOX) is the current standard for adjuvant therapy of patients with stage III CC. However, these regimens are associated with significant oxaliplatin-induced neurotoxicity. The results of the recent IDEA study provide evidence that 3 months of treatment with CAPOX is as effective as 6 months of oxaliplatin-based therapy in patients with low-risk stage III CC (T1-3 and N1). A 6-month oxaliplatin-based therapy remains the standard of care for high-risk stage III CC (T4 and/or N2). For patients unfit for oxaliplatin, fluoropyrimidine monotherapy is recommended. CONCLUSION French guidelines for non-metastatic CC management help to offer the best personalized therapeutic strategy in daily clinical practice. Each individual case must be discussed within a multidisciplinary tumor board and then the treatment option decided with the patient.
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Affiliation(s)
- Thierry Lecomte
- Department of Hepatogastroenterology and Digestive Oncology, Tours University Hospital, Tours, France; Inserm UMR 1069, Nutrition, Croissance et Cancer, Université de Tours, Tours, France.
| | - David Tougeron
- Department of Hepatogastroenterology, Poitiers University Hospital, Poitiers, France
| | - Romain Chautard
- Department of Hepatogastroenterology and Digestive Oncology, Tours University Hospital, Tours, France; Inserm UMR 1069, Nutrition, Croissance et Cancer, Université de Tours, Tours, France
| | - Diane Bressand
- Department of Hepatogastroenterology and Digestive Oncology, Tours University Hospital, Tours, France
| | - Frédéric Bibeau
- Department of Pathology, Besançon University Hospital, Besançon, France
| | - Benjamin Blanc
- Department of Digestive Surgery, Dax Hospital, Dax, France
| | - Romain Cohen
- Sorbonne Université, Department of Medical Oncology, Saint-Antoine hospital, AP-HP, Inserm, Unité Mixte de Recherche Scientifique 938 et SiRIC CURAMUS, Saint-Antoine Research Center, Paris, France
| | - Jérémie Jacques
- Department of Hepatogastroenterology, Limoges University Hospital, Limoges, France
| | - Jean-Paul Lagasse
- Department of Hepatogastroenterology and Digestive Oncology, Orléans University Hospital, Orléans, France
| | - Pierre Laurent-Puig
- Department of Biology, AP-HP, European Georges Pompidou Hospital, Paris, France
| | - Come Lepage
- Department of Hepatogastroenterology and Digestive Oncology, Dijon University Hospital, Dijon, France
| | - Olivier Lucidarme
- Department of Radiology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Jérôme Martin-Babau
- Armoricain Center of Radiotherapy, Radiology and Oncology, Côtes D'Armor Private Hospital, Plérin, France
| | - Yves Panis
- Department of Colorectal Surgery, AP-HP, Beaujon Hospital, Clichy, France
| | - Fabienne Portales
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Julien Taieb
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Paris, France
| | - Thomas Aparicio
- Department of Gastroenterology and Digestive Oncology, AP-HP, Saint-Louis Hospital, Paris, France
| | - Olivier Bouché
- Department of Digestive Oncology, Reims, CHU Reims, France
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Raqi I, Potier P, Lagasse JP. External Validation of the Oakland Score for Acute Lower Gastrointestinal Bleeding. Cureus 2024; 16:e57264. [PMID: 38686245 PMCID: PMC11056811 DOI: 10.7759/cureus.57264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Acute lower gastrointestinal bleeding (LGIB) presents challenges in emergency settings, with incidence influenced by demographic shifts and anticoagulant usage. The Oakland score aids in risk stratification for safe discharge based on clinical and laboratory parameters. However, external validation remains limited. Methods This study validated the Oakland score in a French cohort of patients with acute LGIB and assessed the discriminatory value of the score using the area under the curve (AUC) and then its sensitivity and specificity. Results A retrospective examination of 343 patient records that satisfied the inclusion criteria showed a median score of 14 points and good discriminatory capacity (area under the receiver operating characteristic (AUROC) curve: 0.83). There was low sensitivity (20.9%) for safe discharge but good specificity (98.5%) when using an 8-point threshold. With a 9-point threshold, the sensitivity was increased to 36.5%, while the specificity remained at 95%. Conclusion Identifying low-risk LGIB patients is accomplished without sacrificing sensitivity by increasing the Oakland score threshold to 9 points. This modification improves patient safety and resource allocation in the emergency room and has been verified by other large series. For wider implementation, additional validation and long-term outcome evaluations are required.
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Affiliation(s)
- Ismail Raqi
- Hepatology and Gastroenterology Department, Ibn Rochd University Hospital, Casablanca, MAR
| | - Pascal Potier
- Hepatology and Gastroenterology Department, University Hospital of Orleans, Orleans, FRA
| | - Jean-Paul Lagasse
- Hepatology and Gastroenterology Department, University Hospital of Orleans, Orleans, FRA
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Reichling C, Taieb J, Derangere V, Le Malicot K, Emile JF, Gornet JM, Becheur H, Fein F, Cojocarasu O, Kaminsky MC, Lagasse JP, Luet D, Nguyen S, Etienne PL, Gasmi M, Vanoli A, Perrier H, Klopfenstein Q, Lepage C, Ghiringhelli F. Combination of tissues analysis and immune infiltrate in localized colon cancer using artificial intelligence in PETACC8 study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3574 Background: We used artificial intelligence to perform tissue classification and count CD3 and CD8 in each subclass and determined their role in outcome prediction in PETACC8 cohort of stage III colon cancer treated with FOLFOX or FOLFOX plus cetuximab. Methods: We developed artificial intelligence aimed to detect tumor, healthy mucosa, stroma and immune cells on whole slide of CD3 and CD8 staining. The invasive margin (IM) was also automatically determined. Using a lasso algorithm, the software was able to detect digital parameters within the tumor core (TC) which were related to patients’ outcome (variable called DGMate for DiGital tuMor pArameTErs). CD3 and CD8 lymphocytes density were also quantified automatically by the software in TC and at IM. Associations with disease-free survival (DFS) were evaluated by multivariable Cox regression adjusting for age, T/N stage, sidedness, KRAS/BRAF, DNA mismatch repair (MMR). Results: On 1220 samples collected, data could be generated for 1018 patients. We observed that a high IM stromal area and a high DGMate were associated with a poorer DFS [HR 5.65 (95% CI, 2.34, 13.67), p < 0.0001; HR 2.72 (95% IC, 1.92, 3.85), p<0.001 respectively for the continuous variable]. A higher density of CD3+ TC, CD3+ IM and CD8+ TC were significantly associated with a longer DFS (HR 0.75 (95% IC, .66, .87), p<0.0001; HR 0.78 (95% IC, .68, .88), p<0.0001; HR 0.83 (95% IC, .71, .96), p=0.01). All these immune variables were significantly correlated with each other. ANOVA test demonstrated that CD3+ TC gave a similar prognostic value compared to the classical CD3/CD8 immunoscore (p=0.44). The combination of IM stromal area, DGMate and CD3 outperformed the classical CD3/CD8 immunoscore to estimate patients’ prognosis (C-index= 0.601 vs 0.578, p-value=0.04). Adding this new variable to classical clinical prognostic parameters we generated a nomogram which predicted the risk of relapse of stage III colon cancer with a stronger predictive value compared to clinical parameters or the immunoscore. Conclusions: We propose a new fully automated method of whole slide analysis using a software based on artificial intelligence which classify tissue and determine tumor and immune parameters on one single slide stained with CD3 antibody. This valuable strategy outperforms immunoscore and clinical outcome prediction models.
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Affiliation(s)
| | - Julien Taieb
- Hôpital Européen Georges-Pompidou, Sorbonne Paris Cite/Paris Descartes University, Paris, France
| | - Valentin Derangere
- Research Platform in Biological Oncology, Center GF Leclerc, Dijon, France
| | | | - Jean Francois Emile
- Service d’Anatomie Pathologique Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | | | | | | | | | | | | | | | | | | | | | - Andr Vanoli
- Clinique Sainte Marie, Chalons Sur Saone, France
| | | | | | - Come Lepage
- Dijon University Hospital, INSERM U1231, Dijon, France
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Capsec J, Lefebvre C, Chupé F, Heitzmann P, Raveneau C, Dardaine-Giraud V, Sauger C, Lagasse JP, Kraft K, Linassier C, Dorval E. Age and factors associated with access and time to post-operative adjuvant chemotherapy in colon cancer: a French epidemiological study. J Gastrointest Oncol 2017; 8:842-849. [PMID: 29184688 DOI: 10.21037/jgo.2017.06.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Studies have shown the negative prognostic impact of increased time between colectomy and postoperative adjuvant chemotherapy (AC) in colon cancer (CC). Our aim was to investigate the role of age and non-organizational factors on access and time to AC. Methods All adult patients undergoing surgery for stage II or III CC in the "Région Centre-Val de Loire" in 2013, were selected. Time to AC and socio-demographic factors were collected. Logistic regression modeling was used to identify factors associated with access to AC, and a multivariate analysis performed to identify factors associated with time to AC. Results Among 404 stage II or III patients who underwent colectomy, 182 (45%; sex ratio 1.5; mean age 67.6 years; range 32-90) received AC. AC patients were younger than those without AC (67.6 vs. 77.9 years) and the difference was even greater for stage III patients (69.0 vs. 82.4). The median time to AC was 48 days, exceeding 42 days in 60% of cases. Living alone, postoperative morbidities, and emergency colectomy were independently associated with increased time to AC. Age and other factors were not associated with delayed AC. Conclusions Emergency colectomy, postoperative morbidities, and living alone are associated with increased time to AC. Organizational measures to reduce the time to AC are therefore unlikely to have an impact. In contrast, age is not associated with increased time to AC, but to access to AC. Reasons for omitting AC in older patients requires further study.
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Affiliation(s)
- Jean Capsec
- OncoCentre, Cancer network of the region Centre-Val de Loire, Tours, France
| | - Carole Lefebvre
- OncoCentre, Cancer network of the region Centre-Val de Loire, Tours, France
| | - Fabienne Chupé
- OncoCentre, Cancer network of the region Centre-Val de Loire, Tours, France
| | - Patrick Heitzmann
- OncoCentre, Cancer network of the region Centre-Val de Loire, Tours, France
| | - Céline Raveneau
- OncoCentre, Cancer network of the region Centre-Val de Loire, Tours, France
| | | | - Carine Sauger
- Antenna of Oncogeriatry of the region Centre-Val de Loire, Tours, France
| | | | | | - Claude Linassier
- OncoCentre, Cancer network of the region Centre-Val de Loire, Tours, France
| | - Etienne Dorval
- Antenna of Oncogeriatry of the region Centre-Val de Loire, Tours, France
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Emile JF, Julié C, Le Malicot K, Lepage C, Tabernero J, Mini E, Folprecht G, Van Laethem JL, Dimet S, Boulagnon-Rombi C, Allard MA, Penault-Llorca F, Bennouna J, Laurent-Puig P, Taieb J, Thaler J, Greil R, Gaenzer J, Eisterer W, Tschmelitsch J, Keil F, Samonigg H, Zabernigg A, Schmid F, Steger G, Steinacher R, Andel J, Jagdt B, Lang A, Fridrik M, Függer R, Hofbauer F, Woell E, Geissler D, Lenauer A, Prager M, D'Haens G, Demolin G, Kerger J, Deboever G, Ghillebert G, Polus M, Van Cutsem E, Kalantari HR, Delaunoit T, Goeminne JC, Peeters M, Vergauwe P, Houbiers G, Humblet Y, Janssens J, Schrijvers D, Vanderstraeten E, Van Laethem JL, Vermorken J, Van Daele D, Ferrante M, Forget F, Hendlisz A, Yilmaz M, Nielsen SE, Vestermark L, Larsen J, Zawadi MA, Bouche O, Mineur L, Bennouna-Louridi J, Dourthe LM, Ychou M, Boucher E, Taieb J, Pezet D, Desseigne F, Ducreux M, Texereau P, Miglianico L, Rougier P, Fratte S, Levache CB, Merrouche Y, Ellis S, Locher C, Ramee JF, Garnier C, Viret F, Chauffert B, Cojean-Zelek I, Michel P, Lecaille C, Borel C, Seitz JF, Smith D, Lombard-Bohas C, Andre T, Gornet JM, Fein F, Coulon-Sfairi MA, Kaminsky MC, Lagasse JP, Luet D, Etienne PL, Gasmi M, Vanoli A, Nguyen S, Aparicio T, Perrier H, Stremsdoerfer N, Laplaige P, Arsene D, Auby D, Bedenne L, Coriat R, Denis B, Geoffroy P, Piot G, Becouarn Y, Bordes G, Deplanque G, Dupuis O, Fruge F, Guimbaud R, Lecomte T, Lledo G, Sobhani I, Asnacios A, Azzedine A, Desauw C, Galais MP, Gargot D, Lam YH, Abakar-Mahamat A, Berdah JF, Catteau S, Clavero-Fabri MC, Codoul JF, Legoux JL, Goldfain D, Guichard P, Verge DP, Provencal J, Vedrenne B, Brezault-Bonnet C, Cleau D, Desir JP, Fallik D, Garcia B, Gaspard MH, Genet D, Hartwig J, Krummel Y, Budnik TM, Palascak-Juif V, Randrianarivelo H, Rinaldi Y, Aleba A, Darut-Jouve A, de Gramont A, Hamon H, Wendehenne F, Matzdorff A, Stahl MK, Schepp W, Burk M, Mueller L, Folprecht G, Geissler M, Mantovani-Loeffler L, Hoehler T, Asperger W, Kroening H, von Weikersthal LF, Fuxius S, Groschek M, Meiler J, Trarbach T, Rauh J, Ziegenhagen N, Kretzschmar A, Graeven U, Nusch A, von Wichert G, Hofheinz RD, Kleber G, Schmidt KH, Vehling-Kaiser U, Baum C, Schuette J, Haag GM, Holtkamp W, Potenberg J, Reiber T, Schliesser G, Schmoll HJ, Schneider-Kappus W, Abenhardt W, Denzlinger C, Henning J, Marxsen B, Derigs HG, Lambertz H, Becker-Boost I, Caca K, Constantin C, Decker T, Eschenburg H, Gabius S, Hebart H, Hoffmeister A, Horst HA, Kremers S, Leithaeuser M, Mueller S, Wagner S, Daum S, Schlegel F, Stauch M, Heinemann V, Maiello E, Latini L, Zaniboni A, Amadori D, Aprile G, Barni S, Mattioli R, Martoni A, Passalacqua R, Nicolini M, Pasquini E, Rabbi C, Aitini E, Ravaioli A, Barone C, Biasco G, Tamberi S, Gambi A, Verusio C, Marzola M, Lelli G, Boni C, Cascinu S, Bidoli P, Vaghi M, Cruciani G, Di Costanzo F, Sobrero A, Mini E, Petrioli R, Aglietta M, Alabiso O, Capuzzo F, Falcone A, Corsi DC, Labianca R, Salvagni S, Chiara S, Ciuffreda L, Ferraù F, Giuliani F, Lonardi S, Gebbia N, Mantovani G, Sanches E, Mellidez JC, Santos P, Freire J, Sarmento C, Costa L, Pinto AM, Barroso S, Santo JE, Guedes F, Monteiro A, Sa A, Furtado I, Salazar R, Aguilar EA, Herrero FR, Tabernero J, Valera JS, Ayerbes MV, Batlle JF, Gil S, Esteve AA, Garcia-Giron C, Vivanco GL, Salvia AS, Orduña VA, Garcia RV, Gallego J, Sureda BM, Remon J, Safont Aguilera MJ, Nogueras LC, Merino BQ, Castro CG, de Prado PM, Pericay CP, Figueiras MC, Jordan IG, Gome Reina MJ, Garcia ALL, Garcia-Ramos AA, Cervantes A, Martos CF, Gaspar EM, Montero IC, Emperador PE, Carbonero AL, Castillo MG, Garcia TG, Lopez JG, Flores EG, Morales MG, Muñoz ML, Martín AL, Maurel J, Camara JC, Garcia RD, Salgado M, Busquier IH, Ruiz TC, Muñoa AL, Aliguer MN, de Taranco AVO, Ureña MM, Gaspa FL, Ponce JJ, Roig CB, Jimenez PV, Brotons AG, Rodriguez SA, Martinez JA, Ruiz LC, Ruiz MC, Bridgewater J, Glynne-Jones R, Tahir S, Hickish T, Cassidy J, Samuel L. Prospective validation of a lymphocyte infiltration prognostic test in stage III colon cancer patients treated with adjuvant FOLFOX. Eur J Cancer 2017. [DOI: 10.1016/j.ejca.2017.04.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Bachet JB, Lucidarme O, Taïeb J, Maillard E, Levache CB, Raoul JL, Lecomte T, Hebbar M, Brocard F, Pernot S, Breysacher G, Lagasse JP, Di Fiore F, Etienne PL, Dupuis OJM, Aleba A, Lepage C, Rougier P. FOLFIRINOX as induction treatment in rectal cancer patients with synchronous metastases (RCSM): Results of the FFCD 1102 phase II trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Julien Taïeb
- APHP and Paris Descartes University, Paris, France
| | | | - Charles-Briac Levache
- Department of Radiotherapy and Medical Oncology, Polyclinique Francheville, Périgueux, France
| | | | | | | | | | - Simon Pernot
- Hôpital Européen Georges-Pompidou, Paris, France
| | | | | | - Frédéric Di Fiore
- Digestive Oncology Unit, IRON group, Rouen Hospital, University of Normandy, Rouen, France
| | | | | | | | - Come Lepage
- CHU Le Bocage HGE, INSERM U866, Dijon, France
| | - Philippe Rougier
- Paris Descartes University, Georges Pompidou European Hospital, Paris, France
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Thaler J, Greil R, Gaenzer J, Eisterer W, Tschmelitsch J, Samonigg H, Zabernigg A, Schmid F, Steger G, Steinacher R, Andel J, Lang A, Függer R, Hofbauer F, Woell E, Geissler D, Lenauer A, Prager M, Van Laethem JL, Van Cutsem E, D'Haens G, Demolin G, Kerger J, Deboever G, Ghillebert G, Polus M, Van Cutsem E, RezaieKalantari H, Delaunoit T, Goeminne JC, Peeters M, Vergauwe P, Houbiers G, Humblet Y, Janssens J, Schrijvers D, Vanderstraeten E, Van Laethem JL, Vermorken J, Van Daele D, Ferrante M, Forget F, Hendlisz A, Yilmaz M, Nielsen SE, Vestermark L, Larsen J, Ychou M, Zawadi A, Zawadi MA, Bouche O, Mineur L, Bennouna-Louridi J, Dourthe LM, Ychou M, Boucher E, Taieb J, Pezet D, Desseigne F, Ducreux M, Texereau P, Miglianico L, Rougier P, Fratte S, Levache CB, Merrouche, Y, Ellis S, Locher C, Ramee JF, Garnier C, Viret F, Chauffert B, Cojean-Zelek I, Michel P, Lecaille C, Borel C, Seitz JF, Smith D, Lombard-Bohas C, Andre T, Gornet JM, Fein F, Coulon-Sfairi MA, Kaminsky MC, Lagasse JP, Luet D, Etienne PL, Gasmi M, Vanoli A, Nguyen S, Aparicio T, Perrier H, Stremsdoerfer N, Laplaige P, Arsene D, Auby D, Bedenne L, Coriat R, Denis B, Geoffroy P, Piot G, Becouarn Y, Bordes G, Deplanque G, Dupuis O, Fruge F, Guimbaud R, Lecomte T, Lledo G, Sobhani I, Asnacios A, Azzedine A, Desauw C, Galais MP, Gargot D, Lam YH, Abakar-Mahamat A, Berdah JF, Catteau S, Clavero-Fabri MC, Codoul JF, Legoux JL, Goldfain D, Guichard P, Verge DP, Provencal J, Vedrenne B, Brezault-Bonnet C, Cleau D, Desir JP, Fallik D, Garcia B, Gaspard MH, Genet D, Hartwig J, Krummel Y, MatysiakBudnik T, Palascak-Juif V, Randrianarivelo H, Rinaldi Y, Aleba A, Darut-Jouve A, de Gramont A, Hamon H, Wendehenne F, Matzdorff A, Stahl MK, Schepp W, Burk M, Mueller L, Folprecht G, Geissler M, Mantovani-Loeffler L, Hoehler T, Asperger W, Kroening H, von Weikersthal LF, Fuxius S, Groschek M, Meiler J, Trarbach T, Rauh J, Ziegenhagen N, Kretzschmar A, Graeven U, Nusch A, von Wichert G, Hofheinz RD, Kleber G, Schmidt KH, Vehling-Kaiser U, Baum C, Schuette J, Haag GM, Holtkamp W, Potenberg J, Reiber T, Schliesser G, Schmoll HJ, Schneider-Kappus W, Abenhardt W, Denzlinger C, Henning J, Marxsen B, GuenterDerigs H, Lambertz H, Becker-Boost I, Caca K, Constantin C, Decker T, Eschenburg H, Gabius S, Hebart H, Hoffmeister A, Horst HA, Kremers S, Leithaeuser M, Mueller S, Wagner S, Daum S, Schlegel F, Stauch M, Heinemann V, Labianca R, Colucci G, Amadori D, Mini E, Falcone A, Boni C, Maiello E, Latini L, Zaniboni A, Amadori D, Aprile G, Barni S, Mattioli R, Martoni A, Passalacqua R, Nicolini M, Pasquini E, Rabbi C, Aitini E, Ravaioli A, Barone C, Biasco G, Tamberi S, Gambi A, Verusio C, Marzola M, Lelli G, Boni C, Cascinu S, Bidoli P, Vaghi M, Cruciani G, Di Costanzo F, Sobrero A, Mini E, Petrioli R, Aglietta M, Alabiso O, Capuzzo F, Falcone A, Corsi DC, Labianca R, Salvagni S, Chiara S, Ferraù F, Giuliani F, Lonardi S, Gebbia N, Mantovani G, Sanches E, Sanches E, Mellidez JC, Santos P, Freire J, Sarmento C, Costa L, Pinto AM, Barroso S, Santo JE, Guedes F, Monteiro A, Sa A, Furtado I, Tabernero J, Salazar R, Aguilar EA, Herrero FR, Tabernero J, Valera JS, ValladaresAyerbes M, FeliuBatlle J, Gil S, Garcia-Giron C, Vivanco GL, Salvia AS, Orduña VA, Garcia RV, Gallego J, Sureda BM, Remon J, Safont Aguilera MJ, CireraNogueras L, Merino B, Castro CG, de Prado PM, PijaumePericay C, ConstenlaFigueiras M, Jordan I, GomeReina MJ, Garcia ALL, Garcia-Ramos AA, Cervantes A, Martos CF, MarcuelloGaspar E, Montero IC, Emperador PE, Carbonero AL, Castillo MG, Garcia TG, Lopez JG, Flores EG, GuillotMorales M, LlanosMuñoz M, Martín AL, Maurel J, Camara JC, Garcia RD, Salgado M, HernandezBusquier I, Ruiz TC, LacastaMuñoa A, Aliguer M, Ortiz de Taranco AV, Ureña MM, Gaspa FL, Ponce JJ, Roig CB, Jimenez PV, GalanBrotons A, AlbiolRodriguez S, Martinez JA, Ruiz LC, CentellesRuiz M, Bridgewater J, Glynne-Jones R, Tahir S, Hickish T, Cassidy J, Samuel L. Prognostic value of KRAS mutations in stage III colon cancer: post hoc analysis of the PETACC8 phase III trial dataset. Ann Oncol 2015; 26:822-825. [DOI: 10.1093/annonc/mdv070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
We report the case of a keratoacanthoma of the anal margin in a 34 year-old man. Initial biopsies were negative. Diagnosis was made by histological examination of the surgical specimen. Nine cases of perianal keratoacanthoma have been previously reported in the literature. Our case is remarkable because of the young age of the patient. We discuss the differential diagnosis of anal keratoacanthoma that must be distinguished from well-differentiated squamous cell carcinoma.
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Affiliation(s)
- Annabel Maruani
- Service d'Anatomie et de Cytologie Pathologiques, CHR d'Orléans
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Lagasse JP, Causse X, Boulet JM, Djarech H, Ripault MP, Labarriere D. [Correction of immune thrombocytopenia associated with hepatitis C virus infection after combination therapy with interferon alpha and ribavirin]. Gastroenterol Clin Biol 2001; 25:429-30. [PMID: 11449132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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d'Alteroche L, Oung C, Fourquet F, Picon L, Lagasse JP, Metman EH. Evolution of clinical and radiological features at diagnosis of achalasia during a 19-year period in central France. Eur J Gastroenterol Hepatol 2001; 13:121-6. [PMID: 11246610 DOI: 10.1097/00042737-200102000-00006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Symptoms of achalasia are often misinterpreted, resulting in delayed diagnosis. The aims of our study were (1) to estimate the evolution of clinical and radiological features of a large population of achalasic patients between two successive periods; and (2) to determine the influence of symptoms on diagnostic delay. METHODS Between 1980 and 1998, all achalasia patients treated in our unit were assessed at the time of manometric diagnosis for clinical and radiological features. These data were compared between two successive periods (1980-1994 and 1994-1998). Then, a correlation between the diagnostic delay, clinical and radiological data and symptoms was investigated. RESULTS Three hundred and forty-five consecutive achalasia patients were assessed (mean age at diagnosis, 56 years; mean diagnostic delay, 5.7 years). The duration of the disease was correlated with the oesophageal diameter (P = 0.0001). Dysphagia, chest pain and heartburn were more frequent in young patients (respectively, P = 0.003, 0.0001 and 0.001). Women had 1.7 times the risk of men for suffering of chest pain (95% CI, 1.1 -2.6) and 2.2 times the risk for heartburn (95% CI, 1.2-4.0). Pulmonary involvement was more frequent when the oesophagus was dilated (P = 0.0002), and 3.4 times more frequent when associated with regurgitations (95% CI, 1.3-8.9). The oesophageal diameter was significantly smaller (38 vs 48 mm) in the last period, but we have not observed any significant shortening of the diagnostic delay. No symptoms influenced the diagnostic delay. CONCLUSIONS Despite a smaller oesophageal diameter at the time of diagnosis, during the period 1994-1998, diagnostic delay was not reduced. No clinical features associated with late diagnoses could be identified.
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Affiliation(s)
- L d'Alteroche
- Department of Gastroenterology, Trousseau University Hospital, Tours, France.
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Ardizzone JF, Causse X, Potier P, Lagasse JP, Gros J, Doyen M, Labarriere D, Legoux JL. [Current decontamination procedures for digestive tract endoscopy equipment are effective against risk of hepatitis C virus transmission]. Gastroenterol Clin Biol 2000; 24:975-6. [PMID: 11084442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Joseph-Reinette C, Causse X, Schoenwald M, Lagasse JP, Doumerc S, Labarière D, Ardizonne JF, Legoux JL. [Severe mixed thrombopenia during interferon treatment for chronic viral hepatitis C]. Presse Med 1999; 28:1572-4. [PMID: 10544706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Thrombocytopenia occurred in a woman given alpha interferon for chronic hepatitis C without cirrhosis. Both central thrombocytopenia, clearly demonstrated, and peripheral thrombocytopenia, probably of autoimunne origin, were involved. CASE REPORT A 55-year-old woman with active chronic hepatitis C (Metavir score A2, F2) was given alpha interferon. One month after treatment onset, she developed thrombocytopenia (32 G/L). A second bone marrow aspirate and osteomedullary biopsy evidenced megalokaryocytes and the platelet count responded to polyvalent immunoglobulins. Five months after discontinuing interferon, the platelet count progressively returned to normal. DISCUSSION Central thrombocytopenia is classically described in patients given interferon and usually appears during the first weeks of treatment. In our case, the central mechanism was clearly demonstrated by the bone marrow aspirate and osteomedullary biopsy findings at a time when the platelet count was 32 G/L. A peripheral immunological participation was more difficult to prove but was strongly suggested by the persistence of thrombocytopenia despite the interruption of the interferon and the efficacy of immunoglobulins.
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Abstract
OBJECTIVE The aim of this retrospective study was to determine the risk factors of early complications after progressive pneumatic dilation for achalasia. METHODS Five hundred four dilations were performed in 237 consecutive achalasic patients between 1980 and 1994 with the same technique: low-pressure pneumatic dilation every other day with balloons of increasing diameter until success criteria were obtained (depending on manometric examination and esophageal x-ray transit performed 24 h after each dilation). Clinical, radiographical, endoscopical, and manometrical data as technical procedure characteristics for patients with perforations or other early complications were compared with those without complications. RESULTS We observed 15 complications (6% of patients): 7 perforations (3%), 3 asymptomatic esophageal mucosal tears, 4 esophageal hematomas, and 1 fever. Perforations occurred in 6 of 7 patients during the first dilation. The mean age was 68.5 yr in the group with complications versus 56.4 yr for the remainder (p < 0.05). Two deaths occurred in patients older than 90 yr. Instability of the balloon during dilations was noted in 8 of 15 cases of complications versus 57 of 222 patients (p < 0.05). No other data differed significantly. CONCLUSIONS This study showed a low prevalence of early complications using this progressive technique. Patients with hiatal hernia, esophageal diverticulum, or vigorous achalasia may safely undergo progressive pneumatic dilation. Only patients older than 90 yr should be referred for progressive pneumatic dilation with caution. Most of perforations arose during the first dilation, but there was no predictive pretherapeutic factor of perforation.
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Affiliation(s)
- E H Metman
- Service d'Hépato-gastroentérologie, Hôpital Trousseau, Tours, France
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Lagasse JP, Causse X, Legoux JL, Leyman P, Labarrière D, Brun H. Cytomegalovirus gastritis simulating cancer of the linitis plastica type on endoscopic ultrasonography. Endoscopy 1998; 30:S101-2. [PMID: 9932768 DOI: 10.1055/s-2007-1001430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- J P Lagasse
- Dept. of Gastroenterology, CHR D'Orléans, France
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Legoux JL, Labarrière D, Grézard O, Jaltel M, Lagasse JP, Bahallah ML, Maitre F, Causse X. [Chronic renal insufficiency (interstitial nephritis) under mesalazine]. Gastroenterol Clin Biol 1998; 22:737-9. [PMID: 9823565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Lagasse JP, Bahallah ML, Salem N, Debillon G, Labarrière D, Serve MP, Advenier V, Causse X, Legoux JL. [Acute thrombosis of the portal system. Treatment with alteplase and heparin or with heparin alone in 10 patients]. Gastroenterol Clin Biol 1998; 21:919-23. [PMID: 9587554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We report the efficacy of alteplase (a recombinant tissue plasminogen activator) with heparin or heparin alone in the treatment of acute thrombosis of the portal venous system. METHODS Ten consecutive patients with acute portal venous system thrombosis were studied. Five patients were treated with alteplase and heparin, and the remaining 5 patients, who were asymptomatic or had a contraindication to alteplase, were treated with heparin alone. RESULTS In 3 of the 5 patients treated with alteplase, ultrasonography showed total resolution of the thrombus; the remaining 2 had partial resolution of the thrombus. In 4 of the 5 patients treated with heparin alone, ultrasonography showed total resolution of the thrombus, and no change in one. No bleeding occurred. CONCLUSION Treatment with heparin can result in complete recanalisation of acute portal venous system thrombosis. These data suggest that combined therapy with systemic alteplase does not increase the efficacy of heparin.
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Affiliation(s)
- J P Lagasse
- Service d'Hépato-Gastroentérologie, CHR, Orléans
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Lagasse JP, Picon L, Metman EH, Babuty D, Degiovanni E, Huten N. [Acute reversible pan-dysautonomia: effect of erythromycin on gastrointestinal involvement]. Gastroenterol Clin Biol 1997; 21:331-4. [PMID: 9208000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We describe a case of acute autonomic neuropathy in an 18-year-old woman. Gut dysfunction was sufficiently severe for the patient to undergo laparotomy for suspected mechanical-intestinal obstruction before the diagnosis was made. Apart from the gut, other organs affected included the pupils, sweat and lachrymal glands. Cardiovascular autonomic function tests showed the involvement of sympathetic adrenergic nerves. Small bowel barium X-ray showed resolution of gastric stasis and emergence of jejunum dilatation during intravenous administration of erythromycin but this treatment did not eliminate intestinal obstructive symptoms. The patient had an incomplete recovery in 3 months. Erythromycin might have therapeutic value in patients with intestinal motility dysfunction in acute dysautonomia.
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Metman EH, Lagasse JP, Pic P, Picon L, Danquechin Dorval E, Goudeau A. [Varicella and primary achalasia of the lower esophageal sphincter]. Gastroenterol Clin Biol 1996; 20:1138-9. [PMID: 9033863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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