Outcome in Advanced Ovarian Cancer following an Appropriate and Comprehensive Effort at Upfront Cytoreduction: A Twenty-Year Experience in a Single Cancer Institute

Objectives. The purpose of this retrospective evaluation of advanced-stage ovarian cancer patients was to compare outcome with published findings from other centers and to discuss future options for the management of advanced ovarian carcinoma patients. Methods. A retrospective series of 340 patients with a mean age of 58 years (range: 17–88) treated for FIGO stage III and IV ovarian cancer between January 1985 and January 2005 was reviewed. All patients had primary cytoreductive surgery, without extensive bowel, peritoneal, or systematic lymph node resection, thereby allowing initiation of chemotherapy without delay. Chemotherapy consisted of cisplatin-based chemotherapy in combination with alkylating agents before 2000, whereas carboplatin and paclitaxel regimes were generally used after 1999-2000. Overall survival and disease-free survival were analyzed by the Kaplan-Meier method and the log-rank test. Results. With a mean followup of 101 months (range: 5 to 203), 280 events (recurrence or death) were observed and 245 patients (72%) had died. The mortality and morbidity related to surgery were low. The main prognostic factor for overall survival was postoperative residual disease (P < .0002), while the main prognostic factor for disease-free survival was histological tumor type (P < .0007). Multivariate analysis identified three significant risk factors: optimal surgery (RR = 2.2 for suboptimal surgery), menopausal status (RR = 1.47 for postmenopausal women), and presence of a taxane in the chemotherapy combination (RR = 0.72). Conclusion. These results confirm that optimal surgery defined by an appropriate and comprehensive effort at upfront cytoreduction limits morbidity related to the surgical procedure and allows initiation of chemotherapy without any negative impact on survival. The impact of neoadjuvant chemotherapy to improve resectability while lowering the morbidity of the surgical procedure is discussed

Hepatic Resection for Noncolorectal Nonendocrine Liver Metastases: Analysis of 1452 Patients and Development of a Prognostic Model

OBJECTIVE: To determine the utility of hepatic resection (HR) in the treatment of patients with noncolorectal nonendocrine liver metastases (NCNELM). SUMMARY BACKGROUND DATA: The place of HR in the treatment of NCNELM remains controversial, primarily due to the limitations of previously published reports and the heterogeneity of primary tumor sites and histologies. METHODS: A multivariate risk model was developed by analyzing prognostic factors and long-term outcomes in 1452 patients with NCNELM treated with HR at 41 centers from 1983 to 2004. RESULTS: Hepatic metastases were solitary in 56% and unilateral in 71% (mean diameter, 50.5 mm). Extrahepatic metastases were present in 22%. The most common primary sites were breast (32%), gastrointestinal (16%), and urologic (14%). The most common histologies were adenocarcinoma (60%), GIST/sarcoma (13.5%), and melanoma (13%). R(0) resection was achieved in 83% of patients with a 60-day mortality rate of 2.3% and a major complication rate of 21.5%. Tumor recurred in 67% of patients (liver, 24%; extrahepatic, 18%; both, 25%). Overall and disease-free survivals at 5 years were 36% and 21% and at 10 years were 23% and 15%, respectively. In multivariate analysis, factors associated with poor prognosis were patient age >60 years, nonbreast origin, melanoma or squamous histology, disease-free interval <12 months, extrahepatic metastases, R(2) resection, and major hepatectomy (all P ≤ 0.02). A prognostic model based on these factors effectively stratified patients into low-risk (0–3 points, 46% 5-year survival), mid-risk (4–6 points, 33% 5-year survival), and high-risk (>6 points, <10% 5-year survival) groups (P = 0.0001). DISCUSSION: HR for NCNELM is safe and effective, with outcomes mainly dependent on primary tumor site and histology. For individual patients, a statistical model based on key prognostic factors could validate the indication for hepatic resection by predicting long-term survivals

Archives de la Grande Guerre

Alors que le centenaire du début de la première guerre mondiale est devenu un véritable phénomène éditorial, les documents historiques et les fonds d'archives relatifs à cette période restent les parents pauvres de cette commémoration. La Grande Guerre et ses conséquences ont pourtant entraîné la production d'une énorme masse de documents, inédite par son ampleur, sa richesse et son caractère novateur. En partenariat avec les ministères de la Défense et des Affaires étrangères, le Service interministériel des Archives de France (ministère de la Culture et de la Communication) a réuni 80 contributeurs, tant universitaires qu'archivistes, pour réaliser ce manuel de recherche sur la première guerre mondiale. Cet ouvrage présente, en 49 contributions thématiques, les acquis de l'historiographie, les perspectives actuelles de la recherche et les sources archivistiques. Il est destiné aussi bien aux chercheurs et érudits qu'aux généalogistes et amateurs désireux de mieux connaître ce moment fondateur du XXe siècle : chacun, qu'il recherche une information ponctuelle, qu'il désire découvrir un sujet neuf pour lui, ou qu'il souhaite disposer d'un état des sources à consulter, pourra recourir à ce livre et y trouver la réponse à ses interrogations