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2.
Fr J Urol ; 34(1): 102544, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37858379

RESUMO

INTRODUCTION: Active surveillance (AS) has emerged as a primary management strategy for low-risk prostate cancer (PC) patients. We aimed to assess AS uptake over a 1-year snapshot throughout Quebec and to compare it to 2010 multicentric Canadian data. METHODS: A retrospective chart review and data collection was performed in 1 academic and 2 non-academic community centres from Quebec, among men identified in 2016 with localized T1c-T2c PC on biopsy, fulfilling NCCN criteria of low-risk (LR)-PC, including very-low-risk (VLR) and non-VLR-PC, and favourable-intermediate risk (FIR)-PC. AS adherence was defined when chosen as initial strategy, without any radical treatment within 6 months. RESULTS: Overall, 259 patients fulfilled the inclusion criteria with 50.2% of VLR-PC patients. At 6 months, 81% patients in the LR group and 65% in the FIR group were considered as adherent to AS, in both centres, but with an increased use of AS in the community centres compared to 2010 data. The rates of AS maintenance decreased at 12 months to respectively 69% and 58%. Among the VLR group, the rate of initiation was 98% and decreased to 85% at 12 months. CONCLUSION: Our data suggest that the majority of low-risk PC patients indeed initiated an AS in 2016, with even a greater proportion of VLR-PC patients compared to 2010. This ideal strategy should be encouraged and improved at 12 months, and assessed with recent data and longer follow-up.


Assuntos
Neoplasias da Próstata , Conduta Expectante , Masculino , Humanos , Quebeque/epidemiologia , Estudos Retrospectivos , Canadá/epidemiologia , Neoplasias da Próstata/diagnóstico , Fatores de Risco
4.
Int J Oral Maxillofac Surg ; 52(5): 577-583, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36115778

RESUMO

Bilateral sagittal split osteotomy (BSSO) mandibular advancement can cause mandibular lower border notching (MLBN). The objective of this study was to calculate the incidence of MLBN and identify risk factors. This single-centre, retrospective study was performed between January 2018 and November 2020, in the Maxillofacial Surgery Department, Centre Hospitalier Universitaire, Caen. Patients who underwent BSSO advancement and had cone beam computed tomography (CBCT) scans obtained preoperatively, immediately postoperative (within 1 week), and late postoperative (≥1 year) were included. Measurements were made on the CBCT images. A total of 113 patients (226 operated sides) were enrolled. Mean age at the time of surgery was 17 years; 66.4% of patients were female and 33.6% were male. MLBN was observed on 35 operated sides (15.5% of sides). Advanced age (P = 0.002) and the degree of mandibular advancement (P = 0.008) were determined to be risk factors for developing MLBN. Sex, the operated side, third molar removal, and genioplasty were not associated with an increased occurrence of MLBN. Older patient age at the time of surgery and the requirement for a large advancement should be taken into consideration by the surgeon in order to reduce the risk of MLBN by using a modified BSSO procedure or bone grafting.


Assuntos
Mentoplastia , Mandíbula , Humanos , Masculino , Feminino , Adolescente , Estudos Retrospectivos , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Osteotomia Sagital do Ramo Mandibular/métodos , Fatores de Risco
5.
Rev Med Interne ; 43(12): 727-738, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35870984

RESUMO

Neutrophilic dermatoses (ND) are a group of inflammatory skin conditions characterized by a neutrophilic infiltrate on histopathology with no evidence of infection. ND are classified based upon the localization of neutrophils within the skin and clinical features. Recent findings suggest that ND are due to two main mechanisms: i) a polyclonal hereditary activation of the innate immune system (polygenic or monogenic); or ii) a clonal somatic activation of myeloid cells such as encountered in myelodysplastic syndrome or VEXAS syndrome. ND belong to internal medicine as a great number of patients with ND suffer from an underlying condition (such as hematological malignancy, inflammatory bowel disease, auto-immune and auto-inflammatory diseases). ND are diagnoses of exclusion and physicians should always consider differential diagnoses, particularly skin infections. Here, we review the pathophysiology and classification of the main ND (i.e., subcorneal pustular dermatosis (Sneddon-Wilkinson Disease) and Intercellular IgA dermatoses, aseptic pustulosis of the folds, Sweet syndrome, neutrophilic eccrine hidradenitis, pyoderma gangrenosum, erythema elevatum diutinum, neutrophilic urticarial dermatosis and neutrophilic panniculitis), their clinical and histopathological features, and we highlight the investigations that are useful to identify ND-associated diseases and to exclude the differential diagnoses.


Assuntos
Pioderma Gangrenoso , Dermatopatias Vesiculobolhosas , Síndrome de Sweet , Vasculite Leucocitoclástica Cutânea , Humanos , Síndrome de Sweet/diagnóstico , Síndrome de Sweet/patologia , Pioderma Gangrenoso/diagnóstico , Dermatopatias Vesiculobolhosas/diagnóstico , Neutrófilos/patologia
7.
Presse Med ; 51(1): 104110, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35026391

RESUMO

Most cutaneous lymphomas are cutaneous T-cell lymphomas, and the most common form is mycosis fungoides. Sézary syndrome is a leukemic form of cutaneous T-cell lymphoma which is characterized by erythroderma and the presence of blood tumor cells. The only potential cure of cutaneous T-cell lymphomas remains allogeneic stem cell transplantation. However, monoclonal antibodies have led to a substantial progress in the treatment of advanced-stage cutaneous T-cell lymphomas. Some of them, such as mogamulizumab (anti-CCR4 monoclobal antibody) or brentuximab vedotin (anti-CD30 coupled to monomethylauristatin E, antibody drug conjugate) have shown efficacy in international randomized controlled studies. Lacutamab, an anti-KIR3DL2 monoclonal antibody, is currently tested in an international, prospective phase 2 trial in cutaneous T-cell lymphomas and peripheral T-cell lymphomas. Finally, immune checkpoint inhibitors have shown clinical benefit in open-label phase 2 studies in cutaneous T-cell lymphomas. This review focuses on the new biotherapies currently used in cutaneous T-cell lymphomas.


Assuntos
Linfoma Cutâneo de Células T , Neoplasias Cutâneas , Anticorpos Monoclonais/uso terapêutico , Terapia Biológica , Brentuximab Vedotin/uso terapêutico , Humanos , Linfoma Cutâneo de Células T/tratamento farmacológico , Estudos Prospectivos , Neoplasias Cutâneas/tratamento farmacológico
8.
Presse Med ; 51(1): 104108, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35026392

RESUMO

BACKGROUND: Primary cutaneous lymphomas are a group of T- (CTCL) and B-cell (CBCL) malignancies. These diseases have different clinical presentations and prognosis. Our knowledge on their epidemiology is limited. Aim of this review was to summarize recent findings on the incidence of CTCL and CBCL, how they change over time, and to describe possible causes and consequences. We found that although there are important differences in the epidemiology of cutaneous lymphomas in different countries, the relative frequency of certain, especially rare lymphomas remains stable. Several studies described growing incidences of both CTCL and CBCL. The emergence of new diagnostic criteria, a more precise definition of the entities and new biomarkers enable a better classification of cases.


Assuntos
Linfoma de Células B , Linfoma Cutâneo de Células T , Neoplasias Cutâneas , Biomarcadores , Humanos , Linfoma de Células B/patologia , Linfoma Cutâneo de Células T/diagnóstico , Linfoma Cutâneo de Células T/epidemiologia , Linfoma Cutâneo de Células T/patologia , Prognóstico , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia
9.
Rev Mal Respir ; 38(10): 953-961, 2021 Dec.
Artigo em Francês | MEDLINE | ID: mdl-34774369

RESUMO

INTRODUCTION: Although pulmonary rehabilitation is a core treatment for chronic obstructive pulmonary disease (COPD) approved by the French National Authority for Health, there is no doubt that it is insufficiently used in France. Pulmonary rehabilitation consists of exercise training and patient education delivered in a multidisciplinary programme of care to reverse the downward spiral of deconditioning caused by the illness as well as improving patients' ability to self-manage. The aim of this study was to identify the obstacles that prevent the delivery of pulmonary rehabilitation, so as to understand its lack of use. METHOD: A qualitative study was undertaken with semi-structured interviews in focus groups and individually, involving the different actors within COPD care pathways, including doctors, other healthcare professionals, and patients. RESULTS: Three group interviews and nine individual interviews were analysed. From these, 13 issues appeared: the disease itself, the perception of the disease, the multidisciplinary work, the relationship between caregivers and the patient, motivation, smoking, the comorbidities, fear, geography, economy, the social, the temporality and the establishment of a pulmonary rehabilitation programme. CONCLUSION: This work illustrates the many barriers that will be interesting to explore, in order to increase the use of pulmonary rehabilitation for patients with COPD.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Comorbidade , Exercício Físico , Humanos , Motivação , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Pesquisa Qualitativa
13.
Br J Dermatol ; 185(2): 419-427, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33400272

RESUMO

BACKGROUND: The prognosis of Sézary syndrome (SS) and mycosis fungoides (MF) depends on lymph node (LN) involvement. The usefulness of LN image-guided core-needle biopsies (CNBs), instead of surgical sampling, has been poorly evaluated. OBJECTIVES: To determine the prognostic value of LN CNB in MF/SS. METHODS: A retrospective search was conducted to identify all LN biopsy specimens of MF/SS between 2008 and 2019. Biopsies were staged according to the International Society for Cutaneous Lymphomas/European Organisation for Research and Treatment of Cancer (ISCL/EORTC) criteria. We performed immunolabelling and determined the tumour clone frequency (TCF) by high-throughput sequencing of the T-cell receptor beta locus. RESULTS: We included 119 consecutive biopsies from 100 patients, 45 with MF and 55 with SS. N1, N2 and N3 stages were diagnosed in 34 (29%), 26 (22%) and 59 (49%) cases, respectively. The TCF, Ki67 index, and percentage of cells positive for thymocyte selection-associated high mobility group box protein (TOX), programmed cell death protein 1 (PD1), killer cell immunoglobulin-like receptor 3DL2 (KIR3DL2) and cluster of differentiation (CD)30 were all positively correlated with the N stage. Median overall survival (OS) for N1/N2 vs. N3 patients was 42 months (range 26-not reached) vs. 14 months (range 5-30), respectively (P < 0·001). In univariate analyses, an age > 75 years, LN short-axis diameter > 15 mm, N3 stage, presence of large-cell transformation, TOX > 60%, PD1 > 25%, Ki67 > 30%, KIR3DL2 > 15%, CD30 > 10% and TCF > 25% were identified as adverse prognostic factors. In multivariate analyses, only an age > 75 years and Ki67 index > 30% were associated with reduced OS. We developed a new prognostic index associating the N stage and the Ki67 index, which better discriminates N3 patients with poor prognosis. CONCLUSIONS: CNB allows an objective assessment of the LN involvement in MF/SS, relevant for staging and prognosis.


Assuntos
Micose Fungoide , Síndrome de Sézary , Neoplasias Cutâneas , Idoso , Biópsia por Agulha , Humanos , Biópsia Guiada por Imagem , Linfonodos/patologia , Micose Fungoide/patologia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Síndrome de Sézary/patologia , Neoplasias Cutâneas/patologia
16.
J Eur Acad Dermatol Venereol ; 35(4): 815-823, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33251620

RESUMO

Actinic cheilitis is a premalignant condition that can progress to squamous cell carcinoma with a higher propensity for metastasis than cutaneous squamous cell carcinoma. Optimal treatment for actinic cheilitis has not been established, and evidence-based estimates of clinical cure in the dermatology literature are limited. Here, we review and synthesize outcome data published for patients with actinic cheilitis after treatment with various modalities. A systematic review was conducted in MEDLINE, Embase and the Cochrane library for English, French and German-language studies and references of included articles from inception to 20 January 2020. Studies were included if they reported on at least six patients with biopsy-proven actinic cheilitis. After quality appraisal, results of studies with the strongest methodology criteria were synthesized. 18 studies of 411 patients (published 1985 to 2016) were included. The majority of the studies were case series. Carbon dioxide laser ablation and vermilionectomy were associated with the most favourable outcomes with fewest recurrences. Chemical peel and photodynamic therapy were associated with higher recurrence. Adverse effects generally resolved in the weeks following treatment and cosmetic outcomes were favourable overall. In conclusion, there is a lack of high-quality comparative studies evaluating different treatment options for actinic cheilitis. The included publications used various outcome measures; however, the majority reported on the recently defined core outcome sets. These results suggest that both carbon dioxide laser ablation and vermilionectomy are effective treatments for actinic cheilitis. Prospective head-to-head studies are needed to compare these treatment modalities and to assess patient preferences.


Assuntos
Carcinoma de Células Escamosas , Queilite , Neoplasias Cutâneas , Queilite/terapia , Humanos , Recidiva Local de Neoplasia , Estudos Prospectivos
17.
Br J Dermatol ; 184(6): 1059-1067, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33131055

RESUMO

BACKGROUND: Primary cutaneous lymphomas (PCLs) are a heterogeneous group of T-cell (CTCL) and B-cell (CBCL) malignancies. Little is known about their epidemiology at initial presentation in Europe and about potential changes over time. OBJECTIVES: The aim of this retrospective study was to analyse the frequency of PCLs in the French Cutaneous Lymphoma Registry (GFELC) and to describe the demography of patients. METHODS: Patients with a centrally validated diagnosis of primary PCL, diagnosed between 2005 and 2019, were included. RESULTS: The calculated incidence was unprecedently high at 1·06 per 100 000 person-years. The number of included patients increased yearly. Most PCL subtypes were more frequent in male patients, diagnosed at a median age of 60 years. The relative frequency of rare CTCL remained stable, the proportion of classical mycosis fungoides (MF) decreased, and the frequency of its variants (e.g. folliculotropic MF) increased. Similar patterns were observed for CBCL; for example, the proportion of marginal-zone CBCL increased over time. CONCLUSIONS: Changes in PCL frequencies may be explained by the emergence of new diagnostic criteria and better description of the entities in the most recent PCL classification. Moreover, we propose that an algorithm should be developed to confirm the diagnosis of PCL by central validation of the cases.


Assuntos
Linfoma de Células B , Linfoma Cutâneo de Células T , Micose Fungoide , Neoplasias Cutâneas , Europa (Continente) , Humanos , Linfoma Cutâneo de Células T/epidemiologia , Masculino , Pessoa de Meia-Idade , Micose Fungoide/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Neoplasias Cutâneas/epidemiologia
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