Prognostic impact of lymph node micro-metastases (pN1mi) has been discordantly reported in the literature. The need to clarify this point for decision-making regarding adjuvant therapy, particularly ...for patients with endocrine receptor (ER)-positive status and HER2-negative tumors, is further reinforced by the generalization of gene expression signatures using pN status in their recommendation algorithm.
We retrospectively analyzed 13 773 patients treated for ER-positive breast cancer in 13 French cancer centers from 1999 to 2014. Five categories of axillary lymph node (LN) status were defined: negative LN (pN0i−), isolated tumor cells pN0(i+), pN1mi, and pN1 divided into single (pN1 = 1) and multiple (pN1 > 1) macro-metastases (>2 mm). The effect of LN micro-metastases on outcomes was investigated both in the entire cohort of patients and in clinically relevant subgroups according to tumor subtypes. Propensity-score-based matching was used to balance differences in known prognostic variables associated with pN status.
As determined by sentinel LN biopsy, 9427 patients were pN0 (68.4%), 546 pN0(i+) (4.0%), 1446 pN1mi (10.5%) and 2354 pN1 with macro-metastases (17.1%). With a median follow-up of 61.25 months, pN1 status, but not pN1mi, significantly impacted overall survival (OS), disease-free survival (DFS), metastasis-free survival (MFS), and breast-cancer-specific survival. In the subgroup of patients with known tumor subtype, pN1 = 1, as pN1 > 1, but not pN1mi, had a significant prognostic impact on OS. DFS and MFS were only impacted by pN1 > 1. Similar results were observed in the subgroup of patients with luminal A-like tumors (n = 7101). In the matched population analysis, pN1macro, but not pN1mi, had a statistically significant negative impact on MFS and OS.
LN micro-metastases have no detectable prognostic impact and should not be considered as a determining factor in indicating adjuvant chemotherapy. The evaluation of the risk of recurrence using second-generation signatures should be calculated considering micro-metastases as pN0.
•LN micro-metastases have no detectable prognostic impact.•pN1 status, but not pN1mi, significantly impacted overall survival, disease-free survival, metastasis-free survival.•In the subgroup of patients with known tumor subtype, pN1=1, as pN1>1, but not pN1mi, had a significant prognostic impact on OS.•LN micro-metastases should not be considered as a determining factor in indicating adjuvant chemotherapy.
Abstract Background Elderly ovarian cancer patients often undergo non-optimal surgery due to their age despite of the high risk of recurrence. The aim of this study was to determine if more ...postoperative complications occurred in patients over 70 years and to compare extent of surgery with younger patients. Materials and methods Between 2001 and 2009, 172 patients with ovarian cancer were included. We compared patient characteristics, surgical course, postoperative complications and outcome for patients under and over 70 years. Results 143 patients were under 70 years and 29 over. There were no difference between the two groups for tumors characteristics, time of surgery, FIGO stage, standard surgical procedures and rate of optimal resection. Patients over 70 years had less peritoneal surgery ( p < 0.001) especially diaphragmatic surgery ( p = 0.006), pelvic ( p = 0.02) and para-aortic ( p = 0.003) lymphadenectomy. There was no difference in the occurrence of per- or post-operative complications and patients over 70 years had shorter duration of hospitalization ( p = 0.04). There was no difference between the two groups for disease-free survival (DFS) ( p = 0.08) but overall survival (OS) was better in patients under 70 years ( p = 0.002). Conclusion Elderly ovarian cancer patients undergo less extensive surgery and have lower OS despite similar postoperative morbidity, optimal resection and DFS. OS decrease could be explained by difference in the management of recurrences.
A prospective study to evaluate the clinical impact of osteopathic manipulative therapy (OMT) on symptoms and quality of life (QOL) of patients with colorectal endometriosis.
Forty-six patients with ...colorectal endometriosis completed the SF-36 QOL and symptoms questionnaire before and after OMT. A comparison and clustering analysis was performed to identify subgroups of patient's profile and symptom classification.
The mean age of the patients was 32±6.2 years. Prior surgery for endometriosis was recorded in 73.9 % of cases but none for deep infiltrating endometriosis. About three-quarters of the patients were nulliparous. The time between pre- and post-OMT completion of questionnaires was 28 days (15-63), A significant improvement in SF-36 QOL physical component summary (P<0.001) and mental component summary (P<0.001) was observed after OMT. Similarly, a significant improvement in gynecological, digestive and general symptoms values was observed. A clustering analysis allowed to identify four profiles of patients with colorectal endometriosis based on symptoms and a respective OMT gain of 30 %, 60 %, 64 % et 45 %.
Our results support that OMT improve QOL and endometriosis symptoms of patients with colorectal endometriosis. Moreover, this symptom classification based on OMT gain can serve to design future randomized trial.
Aim To analyse the morphological magnetic resonance imaging (MRI) features of borderline ovarian tumours (BOT) and to evaluate whether MRI can be used to distinguish serous from mucinous subtypes. ...Materials and methods A retrospective study of 72 patients who underwent BOT resection was undertaken. MRI images were reviewed blindly by two radiologists to assess MRI features: size, tumour type, grouped and irregular thickened septa, number of septa, loculi of different signal intensity, vegetations, solid portion, signal intensity of vegetations, normal ovarian parenchyma, and pelvic ascites. Statistical analysis was performed using Mann–Whitney and Fisher's exact tests. Logistic regression analysis was used to assess the predictive value of the MRI findings for histological subtypes. Results At histology, there were 33 serous BOT (SBOT) and 39 mucinous BOT (MBOT). Predictive MRI criteria for SBOT were bilaterality, predominantly solid tumour, and the presence of vegetations, especially exophytic or with a high T2 signal ( p < 0.01), whereas predictive MRI criteria for MBOT were multilocularity, number of septa, loculi of different signal intensity, and grouped and irregular thickened septa ( p < 0.01). Using multivariate analysis, vegetations were independently associated with SBOT odds ratio (OR) = 29.5 and multilocularity with MBOT (OR = 3.9). Conclusion Vegetations and multilocularity are two independent MRI features that can help to distinguish between SBOT and MBOT.
To develop a questionnaire based on patients’ verbal descriptors, to measure the painful symptoms of endometriosis.
We performed a two-round modified DELPHI procedure mixing endometriosis patients ...and physicians to select a set of statements to describe the painful symptoms of endometriosis. Each panelist rated each statement based on diagnosis validity and clarity. The clinicians were experts in endometriosis management selected from various geographic regions in France. Patients were women with surgically confirmed endometriosis who volunteered from a patient association and from the recruitment of the participating physicians. The first round questions were derived from words and phrases in narratives of pain by endometriosis patients.
Overall, 76 experts were invited, and of these 56 (74%), comprising 33 patients and 23 gynecologists, responded to the first round questionnaire, and 40 (71.4%) to the second round. Among the 48 statements assessed in the first-round questionnaire, 11 were selected after completion of the two round DELPHI procedure. After discussion and rewording of some items, a total of 21 questions were selected during a final face-to-face meeting. The content of the final questionnaire is organized according to four dimensions: (i) spontaneous pelvic pain and dysmenorrhea, (ii) dyspareunia, (iii) painful bowel symptoms, (iv) and other symptoms. We also provide an English (UK) version produced using several steps of translation and back-translation.
The questionnaire has content validity to measure the subjective experiences of patients with painful endometriosis and can provide a solid basis on which to develop an efficient patient-centered outcome to measure the painful symptoms in therapeutic or in diagnostic studies of endometriosis.
To evaluate the relevance of laparoscopic index of Fagotti et al during staging laparoscopy (S-LPS) to predict optimal cytoreduction during interval debulking surgery (IDS) after neoadjuvant ...chemotherapy for ovarian cancer.
Fifty-two patients with stage III-IV ovarian cancer were retrospectively analyzed. We evaluated discrimination with a receiver operating characteristic (ROC) curve analysis and calibration of Fagotti et al's model among our population and compared this performance with their data.
A score >4 was associated with optimal resection with sensitivity and positive predictive value (PPV) of 95% and 82% respectively. The ROC curve analysis gave an area under the curve (AUC) of 0.72 (95% confidence interval (CI) 0.65-0.80) for our population compared to 0.88 (95% CI 0.84-0.91) in Fagotti et al's population. Percentages predicted in our population were unsatisfactory (p<0.01), illustrating the different rates of optimal cytoreduction between the centers (average error of 25%).
The laparoscopic index of Fagotti et al is relevant in prediction of optimal cytoreduction among women undergoing IDS.
Ovarian cancer had a poor prognosis that could be heterogeneous according specialized center or not and according elderly in comparison with their younger counterpart. National recommendations are ...required to propose homogeneous practice and increase overall ovarian cancer prognosis.
Based on an updated review of the international literature covering the different surgical techniques and complications of risk reducing mastectomies (RRM) in non-genetic context, the Commission of ...Senology (CS) of the College National des Gynécologues Obstétriciens Français (CNGOF) aimed to establish recommendations on the techniques to be chosen and their implementation.
The CNGOF CS, composed of 24 experts, developed these recommendations. A policy of declaration and monitoring of links of interest was applied throughout the process of making the recommendations. Similarly, the development of these recommendations did not benefit from any funding from a company marketing a health product. The CS adhered to and followed the AGREE II (Advancing guideline development, reporting and evaluation in healthcare) criteria and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to assess the quality of the evidence on which the recommendations were based. The potential drawbacks of making recommendations in the presence of poor quality or insufficient evidence were highlighted.
The CS considered 6 questions in 4 thematic areas, focusing on oncologic safety, risk of complications, aesthetic satisfaction and psychological impact, and preoperative modalities.
The application of the GRADE method resulted in 7 recommendations, 6 with a high level of evidence (GRADE 1±) and 1 with a low level of evidence (GRADE 2±).
There was significant agreement among the CS members on recommendations for preferred surgical techniques and practical implementation.
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