Comorbidity is an independent predictor of complete remission in elderly patients receiving induction chemotherapy for acute myeloid leukemia.

BACKGROUND: : Elderly patients with acute myeloid leukemia (AML) have a poor prognosis, which is explained by the disease itself and by host-related factors. The objective of this study was to determine the prognostic role of comorbidities in this population. METHODS: : For this single-center, retrospective study, the authors analyzed the outcome of 133 patients aged >/=70 years who received induction chemotherapy for nonpromyelocytic AML between 1995 and 2004. Comorbidities were evaluated by using an adapted form of the Charlson comorbidity index (CCI). RESULTS: : The median patient age was 73 years. The CCI score was 0 for 83 patients (68%), 1 for 16 patients (13%), and >1 for 23 patients (19%). The complete remission (CR) rate was 56%, and the median overall survival was 9 months. In multivariate analysis, 4 adverse prognostic factors for CR were identified: unfavorable karyotype, leukocytosis >/=30 g/L, CD34 expression on leukemic cells, and CCI >1. A score could be generated to allow the stratification of patients into low-, intermediate-, and high-risk groups with CR rates of 87%, 63%, and 37%, respectively. The risk of early mortality and the probability of survival also were different in the 3 risk groups (P = .02 and P = .01, respectively). CONCLUSIONS: : The results from this study indicated that associated comorbidities are independent factors that may influence achievement of CR in elderly patients with AML. Such a scoring system may be useful in the prognostic staging systems that are used to identify patients with AML who can benefit from induction chemotherapy.

Breast cancer guidelines--Physicians' intentions and behaviors.

Guidelines are written to define what a physician should do, and networks set up to provide every patient with good practice. However, is willingness to treat according norms enough to actually implement it? Between 1997 and 2003, 4,533 women with invasive, noninflammatory, nonmetastatic breast cancer have been treated within the framework of a regional network (R2C). The rate of implementation of 5 consensual norms was assessed. The rate of "abnormal" management regarding surgical re-excision for inadequate margin was found to be 12.6%. The main explanatory variable was patient age >70 years (OR = 4.05). For nodal exploration, the sampling quality threshold was set at 10. Mean rate of lack of compliance was 25.2%. The 2 main explicative factors were surgeon's experience and women's age. The observed rate of "insufficient" irradiation dose was 18.2%. The main explanatory variables were age (with a gradient) and a negative nodal status. Concerning adjuvant chemotherapy, the rate of no treatment (despite consensual indication) was 16.0%. Again, the main explicative factor was age (with a gradient). Women's age appears to be a major explanatory variable predicting lack of physician's compliance with consensual norms. Besides the age of the women, a "better" prognosis (negative nodal status and pT < or = 20 mn) is often associated with lack of compliance. It is not clear, however, if it's the rules that do not fit the clinical situation of aging patients or the physicians who are not aware of the benefit of consensual disease management for aging patients.

[Impact on the quality of pathology reports in the R2c cancer network: analysis of 4521 pathology reports of primary breast tumors]. / Impact du réseau de cancérologie R2c sur la qualité des informations histopathologiques: analyse de 4521 dossiers de cancer du sein.

This study was designed to evaluate the impact on the quality of pathology reports of a cancer network, named R2c covering the west side of PACA region. Over a 7 year-period, we collected 4521 pathology reports on primary breast cancers, filled by pathologists belonging or not the network. The analysis focused on the 6 histo-prognostic factors from the pathology report standardized according to European recommendations. Between the 1997 and 2003 the proportion of reports filled for the 6 factors increased from 29,6 % to 75,1 % among non-member, and from 49,1 % to 89,7 % among members. The histological size or the number of nodes examined is however filled similarly in these two groups. This study shows how the direct implication of the pathologists in a network, with precise criteria improves quality of reports. Nevertheless, network participation is not the only cause of improvement. Having a clinical practice corresponding to the standards determines partly the involvement in a network aiming at rationalizing practices. Moreover, centralised data collection carried out by R2c allows an annual evaluation of the quality of the reports, providing feedback information to members. Lastly, the shared liability in oncology probably has an indirect impact on practices of non-member pathologists.

[Improvement in breast cancer survival between 1975 and 2003 in a cohort of 5722 women]. / Amélioration de la survie après cancer du sein: analyse d'une cohorte de 5,722 patientes traitées de 1975 à 2003 dans un centre de lutte contre le cancer.

To evaluate improvement in breast cancer management between 1975 and 2003, we constituted a cohort of 5722 women with an invasive non-metastatic breast cancer. An active follow-up was carried out and completed using administrative databases. Survival rates were computed using a classical person-time and a period analyses. Relative survival rates were also presented. Advanced cancers at diagnosis decreased from 70.7% to 45.5% between 1975 and 2003. Person-time analysis showed a 48.8% reduction in death rates over 30 years. Survival at 10 years ranged from 50% (CI95% = 45-55) for women diagnosed in 1975-1979 to 66% (CI95% = 63-69) for those diagnosed in 1990-1994. Using period analysis, we estimated the 10 year survival of women diagnosed in 2000-2003 to be 68% (CI95% = 64-72). Overall relative survival was 76% (CI95% = 71-80) at 10 years. Taking into account known prognosis factors, survival was significantly improved for recent diagnosis periods (p<0.00001). Observed improvement in survival confirmed 'in real life' data from clinical trials.

Immunophenotypic analysis of inflammatory breast cancers: identification of an 'inflammatory signature'.

Inflammatory breast cancer (IBC) is a rare but very aggressive form of breast cancer. Its definition is based on clinical criteria, but a molecular definition could be useful when data are incomplete or features are missing. Recently, the identification of overexpression of E-cadherin in IBC has improved understanding of the molecular basis of this disease. Consequently, the aim of this study was to try to determine an immunophenotypic 'signature' of IBC. A series of 80 cases of IBC were compared with 552 non-IBC control cases and a model was elaborated to evaluate the probability of an inflammatory carcinoma being present in any clinical situation. Tissue microarrays (TMAs) were used to determine the immunohistochemical profile of eight proteins including E-cadherin, EGFR, oestrogen and progesterone receptor (ER and PR), MIB1, ERBB2, MUC1, and P53. All the parameters tested were differentially expressed between IBC and control cases in univariate analysis (p < 0.001). The five variables that were significantly associated with IBC in multivariate analysis were E-cadherin > or = 300 [HR = 5.64 (2.92-10.87)], ER negative [HR = 3.00 (1.67-5.51)], MIB1 > 20 [HR = 3.54 (1.87-6.71)], MUC1 cytoplasmic staining [HR = 2.72 (1.49-4.96)], and ERBB2 positive 2+ or 3+ [HR = 2.46 (1.26-4.78)]. The probability that a breast cancer with this full phenotype at diagnosis was an IBC was 90.5%. If any one of the five parameters was missing, this probability dropped to 75% and was less than 50% when one, two, or three parameters were present. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) of patients with IBC were not significantly different from those of the non-IBC control group that expressed four or five parameters (nIBC-1), but this nIBC-1 control group had a significantly worse outcome than the non-IBC control group (nIBC-2) with only 0-3 parameters (p = 0.0049 for OS and p < 0.0001 for DFS). In conclusion, an immunophenotypic signature was suggested for IBC. This could help to determine the worst cases, independent of clinical criteria.

[Risk of stage underestimation of breast cancer by sentinel lymph node biopsy method]. / Du risque de sous-traitement des cancers du sein en utilisant la technique du ganglion sentinelle.

Sentinel lymph node (SLN) biopsy is fast becoming the standard for testing lymph node involvement in many institutions. However questions remain as to stage underestimation. The aim of this study was to analyse this specific risk in a retrospective study. Between 1975 to 1999, 1,636 patients underwent a breast cancer excision and an axillary lymph node dissection (ALND) for 437 T0, 766 T1 or 433 T2 < or = 30 mm breast cancer without axillary lymph node involvement (NO). We analyse this population because of similar characteristics with SLN biopsy present indication. Node involvement rate was analysed regarding predictive factors of lymph node involvement (LNI): pathologic diameter, grading, peritumoral vascular embols, hormonal receptors, menopause and age. Risk of no adjuvant chemotherapy indication in case of SLN biopsy method using was analysed for pre and post menopaused women. Overall lymph node involvement was 27% (444/1,636): 17% for TO stage (74/437), 26% for T1 stage (202/766), 39% for T2 < or =30 mm stage (168/433). LNI was similar for ductai and lobular invasive breast cancer respectively 27,4% (308/1,125) and 24,3% (52/214). On the other hand LNI rate was sign lower for tubular, medullar and colloids cancers: 15% (20/155). Univariate and multivariate statistical analysis showed LNI significative predictive factors: vascular embols, grade III, age < or = 50 years, tumor diameter > 30 mm. Lymph node involvement rate was defined regarding grading, vascular embols and tumor diameter with increasing rate according to different sub-groups. Among pre-menopaused patients with a false negative rate of SLN of 5%, SLN biopsy without ALND give a specific risk of wrong non-adjuvant chemotherapy indication of 1,4 case/1,000. Among menopaused patients SLN biopsy without ALND give a specific risk of 0,93 cases/1,000. Expected LNI regarding major predictive factors (vascular embols, grading and tumor diameter) allows SLN biopsy risk/benefit evaluation in different sub-groups. SLN biopsy indication could he improved according these data which could be obtain pre-operatively by micro-biopsy.