29 research outputs found
Chemotherapy of advanced small-bowel adenocarcinoma: a multicenter AGEO study
Les adĂ©nocarcinomes de lâintestin grĂȘle (AIG) sont des tumeurs
rares et de mauvais pronostic à un stade avancé. Les données
publiĂ©es concernant lâefficacitĂ© de la chimiothĂ©rapie palliative sont
peu nombreuses. Le but de notre Ă©tude Ă©tait dâĂ©valuer lâefficacitĂ©
et la tolérance de différents protocoles « modernes » de chimiothérapie
et de comparer lâefficacitĂ© des chimiothĂ©rapies Ă base de
sels de platine dans le traitement de premiÚre ligne des AIG avancés.
Cette étude rétrospective multicentrique a inclus 93 patients
(sexe masculin : 53 % ; ùge médian : 56 ans ; site primitif duodénal
: 53 %) avec un AIG avancé (métastatique : 86 %) traités par
LV5FU2 (n = 10), FOLFOX (n = 48), FOLFIRI (n = 19) ou LV5FU2-
cisplatine (n = 16). Le taux de toxicité grade 3-4 était significativement
plus fréquent dans le groupe de patients traités par
LV5FU2-cisplatine (75 %) comparativement aux autres groupes
de patients (p = 0,001). Les médianes de survie sans progression
(SSP) Ă©taient de 7,7 ; 6,9 ; 6,0 et 4,8 mois (p = 0,16) et les
médianes de survie globale (SG) étaient de 13,5 ; 17,8 ; 10,6 et
9,3 mois (p = 0,25) pour les quatre groupes de patients traités par
LV5FU2, FOLFOX, FOLFIRI et LV5FU2-cisplatine, respectivement.
En analyse multivariĂ©e, lâindice de performance OMS Ă 2
(p < 0,0001) ainsi que des taux Ă©levĂ©s dâACE (p = 0,02) et de CA
19-9 (p = 0,03) avant traitement étaient les seuls facteurs indépendants
significativement associés à un mauvais pronostic.
Dans le sous-groupe de patients traités par sels de platine, ceux
qui ont reçu une chimiothérapie par FOLFOX avaient de meilleures
SSP et SG que les patients traités par LV5FU2-cisplatine. En analyse
multivariée, le traitement par FOLFOX était un facteur significatif
et indépendant de survie prolongée en termes de
SSP (p < 0,0001) et SG (p = 0,02). Ainsi, cette Ă©tude, la plus
grande rapportĂ©e Ă ce jour, suggĂšre dâune part que lâindice de
performance OMS et les taux dâACE et CA 19-9 avant traitement
sont des facteurs pronostiques indĂ©pendants de survie et, dâautre
part que la chimiothérapie par FOLFOX est le traitement de choix
en premiÚre ligne des AIG avancés
Caractérisation du syndrome de sprue réfractaire
PARIS5-BU MĂ©d.Cochin (751142101) / SudocPARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF
Use of Proton Pump Inhibitors and Risk of Pancreatic Cancer: A Nationwide Case-Control Study Based on the French National Health Data System (SNDS)
International audienceBackground: Only a few studies investigated the association between proton pump inhibitors (PPIs) use and pancreatic cancer, with inconsistent results. Moreover, these studies had a number of methodological limitations. Our objective was to assess this association in a nationwide case-control study.Methods: We used the French National Health Data System (SNDS), covering 99% of the French population since 2006. Incident cases of pancreatic cancer, identified between 2014 and 2018, were matched with up to 4 controls on year of birth, sex, frequency of hospitalization within 8 years prior to index date, and department of residence. Associations between PPIs and pancreatic cancer were estimated using conditional logistic regression models adjusted for sociodemographic characteristics, risk factors of pancreatic cancer (including diabetes mellitus, tobacco-related diseases, and morbid obesity), and other comorbidities.Results: 23,321 cases of pancreatic cancer (mean age 69.8 years, 51.7% males) and 75,937 matched controls were included. Overall, 77.8% of cases and 75.5% of controls were PPI ever users. Ever (vs. never) PPI use was associated with an increased risk of pancreatic cancer (adjusted OR [aOR]=1.05, 95% CI: 1.01-1.09). A dose-response relationship was observed (1-30 cumulative defined daily dose [cDDD]: aOR=0.92, 95%CI: 0.87-0.97; 31-180 cDDD: aOR=1.05, 95%CI: 1.00-1.11; 181-1080 cDDD: aOR=1.18, 95%CI: 1.12-1.24; >1080 cDDD: aOR=1.17, 95%CI: 1.10-1.23).Conclusions: Based on these findings, a slight increase in the risk of pancreatic cancer associated with high cumulative doses of PPIs cannot be excluded.Impact: Given the overuse of PPIs, efforts should be continued to limit treatments to appropriate indications and durations
Evolution Ă long terme des falaises des âVaches Noiresâ et occurrence des glissements (Calvados, Basse-Normandie, France)
National audienc
Long term evolution of âLes Vaches Noiresâ cliffs and spatio-temporal occurrence of landslides (Calvados, Basse-Normandie, France). First preliminary results.
International audienc
Long term evolution of âLes Vaches Noiresâ cliffs and spatio-temporal occurrence of landslides (Calvados, Basse-Normandie, France). First preliminary results.
International audienc
The Need for Centralization for Small Intestinal Neuroendocrine Tumor Surgery: A Cohort Study from the GTE-Endocan-RENATEN Network, the CentralChirSINET Study
International audienceBackgroundThe concept of surgical centralization is becoming more and more accepted for specific surgical procedures.ObjectiveThe aim of this study was to evaluate the relationship between procedure volume and the outcomes of surgical small intestine (SI) neuroendocrine tumor (NET) resections.MethodsWe conducted a retrospective national study that included patients who underwent SI-NET resection between 2019 and 2021. A high-volume center (hvC) was defined as a center that performed more than five SI-NET resections per year. The quality of the surgical resections was evaluated between hvCs and low-volume centers (lvCs) by comparing the number of resected lymph nodes (LNs) as the primary endpoint.ResultsA total of 157 patients underwent surgery in 33 centers: 90 patients in four hvCs and 67 patients in 29 lvCs. Laparotomy was more often performed in hvCs (85.6% vs. 59.7%; p < 0.001), as was right hemicolectomy (64.4% vs. 38.8%; p < 0.001), whereas limited ileocolic resection was performed in 18% of patients in lvCs versus none in hvCs. A bi-digital palpation of the entire SI length (95.6% vs. 34.3%, p < 0.001), a cholecystectomy (93.3% vs. 14.9%; p < 0.001), and a mesenteric mass resection (70% vs. 35.8%; p < 0.001) were more often performed in hvCs. The proportion of patients with â„8 LNs resected was significantly higher (96.3% vs. 65.1%; p < 0.001) in hvCs compared with lvCs, as was the proportion of patients with â„12 LNs resected (87.8% vs. 52.4%). Furthermore, the number of patients with multiple SI-NETs was higher in the hvC group compared with the lvC group (43.3% vs. 25.4%), as were the number of tumors in those patients (median of 7 vs. 2; p < 0.001).ConclusionsOptimal SI-NET resection was significantly more often performed in hvCs. Centralization of surgical care of SI-NETs is recommended