Epidemiology of gastric cancers and the role of Helicobacter pylori

Le risque de cancer de l’estomac est associé à la présence d’une gastrite chronique atrophique avec achlorhydrie, généralement associée à une infection par une bactérie commensale, l’Helicobacter pylori (H. pylori). Ce facteur de risque est au centre de l’étude du rôle du milieu environnant et des habitudes alimentaires

Epidemiology of biliary duct cancers

Les cancers des voies biliaires sont rares et représentent 3 % des cancers digestifs. Leur progression est insidieuse, aboutissant souvent à un diagnostic tardif et à un pronostic sombre. L’incidence augmente dans les pays occidentaux au cours des trois dernières décennies. Les cholangiocarcinomes intra (60 %) et extra-hépatiques (25 %) sont à distinguer des cancers de la vésicule biliaire (15 %) dont la preuve histologique est souvent présente, la prédominance plutôt féminine et la répartition géographique différente. Les facteurs de risque sont assez similaires et agissent par l’intermédiaire de l’inflammation des tissus biliaires. Le traitement curatif est la chirurgie, et seule la chimiothérapie palliative des cholangiocarcinomes a fait, récemment, la preuve de sa modeste efficacité.Biliary tract cancers are rare and represent 3% of all digestive tract cancers. These tumors progress insidiously and involve a poor prognosis. Their incidence is increasing in Western countries during the last three decades. Cholangiocarcinoma can affect either the intrahepatic (60%) or extrahepatic (25%) biliary ducts and should be separated from gallbladder carcinoma. This latest is most common in women, gives frequently its histological proof and has different geographic localization. The risk factors induce cancer through inflammatory reaction on the biliary epithelium.Resection is the curative treatment and only palliative chemotherapy is proved efficient in cholangiocarcinoma

Why do results conflict regarding the prognostic value of the methylation status in colon cancers? the role of the preservation method

<p>Abstract</p> <p>Background</p> <p>In colorectal carcinoma, extensive gene promoter hypermethylation is called the CpG island methylator phenotype (CIMP). Explaining why studies on CIMP and survival yield conflicting results is essential. Most experiments to measure DNA methylation rely on the sodium bisulfite conversion of unmethylated cytosines into uracils. No study has evaluated the performance of bisulfite conversion and methylation levels from matched cryo-preserved and Formalin-Fixed Paraffin Embedded (FFPE) samples using pyrosequencing.</p> <p>Methods</p> <p>Couples of matched cryo-preserved and FFPE samples from 40 colon adenocarcinomas were analyzed. Rates of bisulfite conversion and levels of methylation of <it>LINE-1, MLH1 </it>and <it>MGMT </it>markers were measured.</p> <p>Results</p> <p>For the reproducibility of bisulfite conversion, the mean of bisulfite-to-bisulfite standard deviation (SD) was 1.3%. The mean of run-to-run SD of PCR/pyrosequencing was 0.9%. Of the 40 DNA couples, only 67.5%, 55.0%, and 57.5% of FFPE DNA were interpretable for <it>LINE-1, MLH1</it>, and <it>MGMT </it>markers, respectively, after the first analysis. On frozen samples the proportion of well converted samples was 95.0%, 97.4% and 87.2% respectively. For DNA showing a total bisulfite conversion, 8 couples (27.6%) for <it>LINE-1</it>, 4 couples (15.4%) for <it>MLH1 </it>and 8 couples (25.8%) for <it>MGMT </it>displayed significant differences in methylation levels.</p> <p>Conclusions</p> <p>Frozen samples gave reproducible results for bisulfite conversion and reliable methylation levels. FFPE samples gave unsatisfactory and non reproducible bisulfite conversions leading to random results for methylation levels. The use of FFPE collections to assess DNA methylation by bisulfite methods must not be recommended. This can partly explain the conflicting results on the prognosis of CIMP colon cancers.</p

Adjuvant chemotherapy for biliary tract cancer

Le niveau de preuve de l’efficacité de la chimiothérapie adjuvante dans les tumeurs des voies biliaires reste faible et ne permet pas de proposer de recommandation en ce sens. La présence de facteurs de mauvais pronostic (et notamment une résection R1 ou un envahissement ganglionnaire) pourrait cependant constituer une indication de radiothérapie ou de radiochimiothérapie adjuvante. Ces stratégies doivent être discutées et validées dans des réunions de concertation multidisciplinaire. Malgré l’absence de validation de ces traitements, les études de pratiques suggèrent que plus de la moitié des patients sont traités en France. Seuls des essais prospectifs randomisés permettront de répondre à l’utilité de ces traitements adjuvants dans les cancers des voies biliaires résécables. Ils permettront en outre de déterminer des groupes à risque, peut-être plus susceptibles d’en bénéficier (localisation, statut R0 ou R1, statut ganglionnaire). Un essai français de phase III est en cours sous l’égide de la FFCD (Fédération Française de Cancérologie Digestive) et de la Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) (essai PRODIGE 12). Il évalue l’intérêt d’une chimiothérapie adjuvante associant la gemcitabine à l’oxaliplatine à une surveillance postopératoire.The efficacy level of proof of adjuvant chemotherapy in bile duct tumours remains low and no recommendations are therefore retainable. Bad prognosis factors, including R1 resection or lymph node invasion, could enforce the indication of adjuvant radiotherapy or radio chemotherapy. These strategies must be discussed thoroughly and validated by multidisciplinary meetings. In spite of the absence of validation of these treatments, medical practice investigations in France suggest that more than half of these patients are in fact being treated.Only prospective randomized trials would be able to answer the question of the effectiveness of these adjuvant treatments in resectable bile duct cancers. Moreover will allow to determine high risk groups (tumour localisation, R0 or R1 resection, lymph node involvement) of patients who could benefit from them. Under the aegis of both the French Digestive Cancer Federation (FFCD) and the Anti-Cancer Centers Federation (FNCLCC) a French phase III trial is ongoing (PRODIGE 12 trial) assessing the interest of a combined oxaliplatin and gemcitabin adjuvant regimen compared with only post operative monitoring

Colorectal cancer survival in the USA and Europe: a CONCORD high-resolution study.

OBJECTIVES: To assess the extent to which stage at diagnosis and adherence to treatment guidelines may explain the persistent differences in colorectal cancer survival between the USA and Europe. DESIGN: A high-resolution study using detailed clinical data on Dukes' stage, diagnostic procedures, treatment and follow-up, collected directly from medical records by trained abstractors under a single protocol, with standardised quality control and central statistical analysis. SETTING AND PARTICIPANTS: 21 population-based registries in seven US states and nine European countries provided data for random samples comprising 12 523 adults (15-99 years) diagnosed with colorectal cancer during 1996-1998. OUTCOME MEASURES: Logistic regression models were used to compare adherence to 'standard care' in the USA and Europe. Net survival and excess risk of death were estimated with flexible parametric models. RESULTS: The proportion of Dukes' A and B tumours was similar in the USA and Europe, while that of Dukes' C was more frequent in the USA (38% vs 21%) and of Dukes' D more frequent in Europe (22% vs 10%). Resection with curative intent was more frequent in the USA (85% vs 75%). Elderly patients (75-99 years) were 70-90% less likely to receive radiotherapy and chemotherapy. Age-standardised 5-year net survival was similar in the USA (58%) and Northern and Western Europe (54-56%) and lowest in Eastern Europe (42%). The mean excess hazard up to 5 years after diagnosis was highest in Eastern Europe, especially among elderly patients and those with Dukes' D tumours. CONCLUSIONS: The wide differences in colorectal cancer survival between Europe and the USA in the late 1990s are probably attributable to earlier stage and more extensive use of surgery and adjuvant treatment in the USA. Elderly patients with colorectal cancer received surgery, chemotherapy or radiotherapy less often than younger patients, despite evidence that they could also have benefited

A simplified table using validated diagnostic criteria is effective to improve characterization of colorectal polyps: the CONECCT teaching program

International audienceIntroduction and study aims Accurate real-time endoscopic characterization of colorectal polyps is key to choosing the most appropriate treatment. Mastering the currently available classifications is challenging. We used validated criteria for these classifications to create a single table, named CONECCT, and evaluated the impact of a teaching program based on this tool.Methods A prospective multicenter study involving GI fellows and attending physicians was conducted. During the first session, each trainee completed a pretest consisting in histological prediction and choice of treatment of 20 colorectal polyps still frames. This was followed by a 30-minute course on the CONECCT table, before taking a post-test using the same still frames reshuffled. During a second session at 3 – 6 months, a last test (T3 M) was performed, including these same still frames and 20 new ones.Results A total 419 participants followed the teaching program between April 2017 and April 2018. The mean proportion of correctly predicted/treated lesions improved significantly from pretest to post-test and to T3 M, from 51.0 % to 74.0 % and to 66.6 % respectively (P < 0.001). Between pretest and post-test, 343 (86.6 %) trainees improved, and 153 (75.4 %) at T3 M. Significant improvement occurred for each subtype of polyp for fellows and attending physicians. Between the two sessions, trainees continued to progress in the histology prediction and treatment choice of polyps CONECCT IIA. Over-treatment decreased significantly from 30.1 % to 15.5 % at post-test and to 18.5 % at T3 M (P < 0.001).Conclusion The CONECCT teaching program is effective to improve the histology prediction and the treatment choice by gastroenterologists, for each subtype of colorectal polyp

MRI-Based Radiomics Input for Prediction of 2-Year Disease Recurrence in Anal Squamous Cell Carcinoma

International audiencePurpose: Chemo-radiotherapy (CRT) is the standard treatment for non-metastatic anal squamous cell carcinomas (ASCC). Despite excellent results for T1-2 stages, relapses still occur in around 35% of locally advanced tumors. Recent strategies focus on treatment intensification, but could benefit from a better patient selection. Our goal was to assess the prognostic value of pre-therapeutic MRI radiomics on 2-year disease control (DC). Methods: We retrospectively selected patients with non-metastatic ASCC treated at the CHU Bordeaux and in the French FFCD0904 multicentric trial. Radiomic features were extracted from T2-weighted pre-therapeutic MRI delineated sequences. After random division between training and testing sets on a 2:1 ratio, univariate and multivariate analysis were performed on the training cohort to select optimal features. The correlation with 2-year DC was assessed using logistic regression models, with AUC and accuracy as performance gauges, and the prediction of disease-free survival using Cox regression and Kaplan-Meier analysis. Results: A total of 82 patients were randomized in the training (n = 54) and testing sets (n = 28). At 2 years, 24 patients (29%) presented relapse. In the training set, two clinical (tumor size and CRT length) and two radiomic features (FirstOrder_Entropy and GLCM_JointEnergy) were associated with disease control in univariate analysis and included in the model. The clinical model was outperformed by the mixed (clinical and radiomic) model in both the training (AUC 0.758 versus 0.825, accuracy of 75.9% versus 87%) and testing (AUC 0.714 versus 0.898, accuracy of 78.6% versus 85.7%) sets, which led to distinctive high and low risk of disease relapse groups (HR 8.60, p = 0.005). Conclusion: A mixed model with two clinical and two radiomic features was predictive of 2-year disease control after CRT and could contribute to identify high risk patients amenable to treatment intensification with view of personalized medicine

Incidence et modalités de la prise en charge des tumeurs de l'intestin grêle en Bourgogne

DIJON-BU Médecine Pharmacie (212312103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Epidémiologie des cancers digestifs rares (incidence, tendances chronologiques, pronostic)

L objectif principal de ce travail était d améliorer les connaissances épidémiologiques des tumeurs digestives rares jusqu alors parcellaires puisque essentiellement basées sur des données hospitalières. Nous avons pu montrer qu à l image des autres cancers digestifs, leur incidence est en constante augmentation, et concernant adénocarcinomes de l oesophage que cette hausse était en passe de devenir préoccupante. Ce travail réunit des données épidémiologiques sur les cancers digestifs rares à partir de bases de population qui pour la plupart étaient inexistantes. Ces données sont précieuses pour estimer la prise en charge médicale ou les besoins de surveillance de ces cancers, pour concevoir et analyser des enquêtes à visée étiologique, définir une politique de prévention et éventuellement de dépistage. Nous avons pu prouver que les données de registres avaient non seulement un intérêt dans l étude des caractéristiques épidémiologiques des tumeurs digestives rares, mais qu elles étaient incontournables.DIJON-BU Médecine Pharmacie (212312103) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF