RESUMEN
OBJECTIVE: BRCA1 promoter methylation (BRCA1pm) is suspected to alter prognosis of patients with epithelial ovarian cancer (EOC). We aimed to evaluate the prognostic impact of this epigenetic modification. METHODS: We conducted a retrospective, monocentric study from 11/2006 to 08/2018. Patients with EOC and available status concerning somatic BRCA1/2 mutation and BRCA1pm were included. Three groups were defined: patients without BRCA1/2 mutation or BRCA1pm, patients with BRCA1/2 mutation and patients with BRCA1pm. BRCA1/2 mutations were analyzed in current care settings by next-generation sequencing (NGS). BRCA1pm analysis was assessed and quantified from bisulfite converted DNAs using fluorescent methylation specific polymerase chain reaction (PCR) and fragment analysis. All patients signed a consent form and the study was authorized by a Personal Protection Committee. Descriptive statistics were used to describe groups. Multivariate analysis was performed using the logistic regression model and including the variables that could be known at the time of diagnosis and that were significant at univariate analysis. Survival was compared between the groups. Kaplan-Mayer curves were used to express the differences in survival that were compared using log rank tests. RESULTS: 145 patients were included: 95 (65.5 %) patients without BRCA1/2 mutation or BRCA1pm, 32 (22.1 %) patients with BRCA1/2 mutation, 18 (12.4 %) patients with BRCA1pm. Median survival was decreased in patients with BRCA1pm. Comparison of survival revealed a significant difference in overall survival (p = 0.0078) with a worse prognosis for patients with a BRCA1pm. CONCLUSION: BRCA1pm in patients with EOC is an independent factor associated with a decreased overall survival. SYNOPSIS: BRCA1 promotor methylation in patients with epithelial ovarian cancer is an independent factor associated with a decreased overall survival.
RESUMEN
INTRODUCTION: Indocyanine green (ICG) for axillary sentinel lymph node (SLN) detection in early breast cancer is at least equivalent to radioisotopic and/or colorimetric techniques. This procedure has not yet been recommended by learned societies in France. Following the recent drug approval of Infracyanin ® in this indication, we wished to study the use of ICG in France. METHODS: We conducted a web-based survey among members of multiple French breast cancer societies throughout November 2021. The survey assessed the profile of the respondent, the use or not of ICG for the detection of SLN in breast cancer, the technique used and the opinion of non-users and their expectations on the subject. RESULTS: Seventy-five surgeons participated. More than a third (37 %) have been using ICG for the detection of SLN in breast cancer for 2 to 3 years. Technique was highly variable. According to 82.1 % of the respondents, less than 20 procedures are necessary to master the use of ICG. The main advantage reported for this method is the reduction of organizational constraints. The obstacles to the use of the ICG are the near infra-red camera equipment, but also the lack of validation by the French guidelines. Among non-users, 83 % would like to develop this technique in their center and 72.3 % are interested in training on this subject. CONCLUSION: This work highlights the need for French learned societies to take a stand on this issue but also the need to carry out studies on the technical aspects in order to standardise practices.
Asunto(s)
Neoplasias de la Mama , Biopsia del Ganglio Linfático Centinela , Humanos , Femenino , Verde de Indocianina , Neoplasias de la Mama/patología , Colorantes , FranciaRESUMEN
INTRODUCTION: Early management of high-grade cervical intraepithelial neoplasia is one of the key steps in cervical cancer prevention after vaccination and screening. It relies on lesion removal by surgical excision, and the French National Cancer Institute (INCa) in 2016 recommend using a loop electro excision procedure (LEEP). However, the laser excision method seems to be as effective with similar rates of negative excision margins and postoperative clearance of HPV. OBJECTIVE: The main objective of our study was to compare the laser excision method to LEEP by evaluating the quality of the surgical margins. We also studied factors associated with the status of the margins and the depth of cones. METHODS: We conducted a retrospective unicentric study between 2009 and 2017. RESULTS: Two hundred and thirty-one patients were included: 154 laser excisions and 77 LEEP. Negative surgical margin was achieved in 69.5 % of laser excisions and 72.7 % of LEEP (p = 0.649). Concerning factors predicting margin status, only a greater cone depth was associated with negative margins (OR: 0.91 (95 %CI: 0.84, 0.89); p = 0.02). The surgical technique was not found to be associated with the status of the margins (OR: 0.85 (95 %CI: 0.46,1.56); p = 0.61). Concerning factors predicting cone depth, only the LEEP was associated with a shorter cone depth (OR: 0.24 (95 %CI: 0.08, 0.69); p 0.008). Significant results are based on univariate analysis. CONCLUSION: No difference was found between the two technics concerning the rate of negative margins. However, LEEP seems to be associated with shorter cone depth in this study.
Asunto(s)
Displasia del Cuello del Útero , Neoplasias del Cuello Uterino , Femenino , Humanos , Neoplasias del Cuello Uterino/cirugía , Neoplasias del Cuello Uterino/patología , Electrocirugia/métodos , Estudios Retrospectivos , Displasia del Cuello del Útero/cirugía , Márgenes de EscisiónRESUMEN
INTRODUCTION: Malnutrition is common in ovarian cancer and is a major cause of morbidity and mortality. We aimed to define the most pertinent way to assess malnutrition in patients with epithelial ovarian cancer (EOC) in order to study its impact on morbidity (intra and post-operative complications) and survival (OS, overall survival and RFS, recurrence-free survival). METHODS: We retrospectively included all patients with EOC from 2003 to 2020. Nutritional status was assessed using the weight loss at diagnosis (more or <5%), albuminemia, the Nutritional Risk Index (NRI), and the Malnutrition Universal Screening Tool (MUST). RESULTS: Six hundred and fifteen patients were included. Among them, 34% declared having lost >5% of their usual weight, 58% had an albuminemia <35 g/L, 86% presented an abnormal NRI and 29% an abnormal MUST score. After univariate analysis, weight loss>5% appeared to be significantly associated with RFS. An abnormal NRI or MUST score were significantly associated with a decrease in OS in univariate analysis. None of the markers of malnutrition studied were correlated with morbidity. CONCLUSION: We were not able to reach a consensus concerning the most accurate definition to define malnutrition and predict morbidity and mortality in EOC. However, this modifiable prognosis factor must be systematically assessed and managed accordingly.
Asunto(s)
Desnutrición , Neoplasias Ováricas , Humanos , Femenino , Carcinoma Epitelial de Ovario/complicaciones , Estudios Retrospectivos , Evaluación Nutricional , Desnutrición/diagnóstico , Desnutrición/complicaciones , Estado Nutricional , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/diagnóstico , Pérdida de Peso , MorbilidadRESUMEN
OBJECTIVE: Environmental factors contribute to more than 25% of all global disease but as medical student, we consider that environmental health is insufficiently taught. We are not armed for facing patient's questions, prevent diseases linked to environmental exposure and adapt care in susceptible population. MATERIAL AND METHODS: We conducted a national French survey, using a web-based questionnaire from October to November 2021. All medical students were interrogated to assess their knowledge on environmental health and their desire to obtain a specific curriculum on this topic. RESULTS: Two hundred and thirty-two students responded to the survey and most (62.7%) had never had any teaching on environmental health during their medical studies. The majority claimed to have no knowledge on environmental health (63.6%), and most had never been read or seen media content about it (59.2%). Those who had knowledge on environmental health, had been informed through social media, questioning the reliability of this content. Most (87.3%) were ready to take a specific course on environmental health issues during their medical studies in order to better inform their patients with evidence-based medicine and identify at risk population. CONCLUSION: Through a survey, we identified the need and the emergency of implanting a curriculum on environmental medicine in our medical education.
RESUMEN
OBJECTIVE: To describe the patterns of recurrence and the prognosis of patients with a recurrent TP53 mutated endometrial carcinoma treated initially by surgery. METHODS: All patients with endometrial carcinoma, treated at hospital European Georges Pompidou between 2001 and 2021 were retrospectively included. Patients were separated into two groups: TP53-mutated and not TP53-mutated (POLE/ultramutated-like (POLEmut), dMMR (mismatch repair-deficient) and NSMP (No specific molecular profile)). We estimated survival using recurrence free survival, overall survival and overall survival from recurrence. The risk of recurrence according to TP53 status and the type of recurrence (locoregional recurrence, peritoneal recurrence, and metastasis) were also compared between the two groups. RESULTS: Two hundred and ninety-one patients with endometrial carcinoma were included. Of these, 57 were TP53-mutated and 234 patients were not TP53-mutated. TP53 mutated patients had the worst recurrence free survival and overall survival (p < 0.001 for each). The hazard rate of recurrence was higher during the first three years for TP53 mutated endometrial carcinoma then tend to join the one of no TP53 mutated. There was a statistical difference between the two groups in terms of cumulative incidence of peritoneal recurrence (p = 0.002). There was, however, no statistical difference in overall survival from recurrence. CONCLUSIONS: TP53-mutated endometrial carcinoma were more likely to experience a recurrence during the first three years and most often peritoneal recurrence compared to not TP53-mutated. TP53 status in endometrial carcinoma could be useful to define follow-up. Further prospective studies are required to assess the predictive impact of TP53 mutation on chemotherapy benefit.
Asunto(s)
Neoplasias Endometriales , Neoplasias Peritoneales , Femenino , Humanos , Neoplasias Endometriales/genética , Neoplasias Endometriales/cirugía , Neoplasias Endometriales/patología , Mutación , Recurrencia Local de Neoplasia/genética , Pronóstico , Estudios RetrospectivosRESUMEN
OBJECTIVE: To compare survival and morbidity rates between primary cytoreductive surgery (pCRS) and interval cytoreductive surgery (iCRS) for epithelial ovarian cancer (EOC), using a propensity score. DESIGN: We conducted a propensity score-matched cohort study, using data from the FRANCOGYN cohort. SETTING: Retrospective, multicentre study of data from patients followed in 15 French department specialized in the treatment of ovarian cancer. SAMPLE: Patients included were those with International Federation of Gynaecology and Obstetrics (FIGO) stage III or IV EOC, with peritoneal carcinomatosis, having undergone CRS. METHODS: The propensity score was designed using pre-therapeutic variables associated with both treatment allocation and overall survival (OS). MAIN OUTCOME MEASURES: The primary outcome was OS. Secondary outcomes included recurrence-free survival (RFS), quality of CRS and other variables related to surgical morbidity. RESULTS: A total of 513 patients were included. Among these, 334 could be matched, forming 167 pairs. No difference in OS was found (hazard ratio, HR = 0.8, p = 0.32). There was also no difference in RFS (median = 26 months in both groups) nor in the rate of CRS leaving no macroscopic residual disease (pCRS 85%, iCRS 81.4%, p = 0.76). The rates of gastrointestinal tract resections, stoma, postoperative complications and hospital stay were significantly higher in the pCRS group. CONCLUSIONS: Analysis of groups of patients made comparable by propensity score matching showed no difference in survival, but lower postoperative morbidity in patients treated with iCRS.
RESUMEN
PURPOSE: In early-stage epithelial ovarian cancer (EOC), patients usually undergo a hysterectomy. However, in fertility sparing surgery (FSS), carefully selected patients could conserve their uterus. The aim of our study was to evaluate the incidence and epidemiologic characteristics associated with uterine involvement in patients with early-stage EOC, outside of FSS. METHODS: We conducted a retrospective, monocentric, study from 2003 to 2019 and included all patients with a presumed early-stage EOC (FIGO I) who underwent a hysterectomy. The incidence of uterine involvement, predictive factors of uterine involvement, and the impact of uterine involvement on survival (recurrence-free survival and overall survival) were analyzed. RESULTS: Eighty-five patients had an early-stage EOC. Of these, six had an uterine involvement (7%). The populations of patients with or without uterine involvement did not differ except for CA 125 at diagnosis (136 ± 138 versus 356 ± 723, p = 0.04, respectively). No patient or tumor characteristics were predictive of uterine involvement. Uterine involvement was not associated with recurrence-free survival (HR = 1.26, IC95% 0.36-4.4, p = 0.72) or overall survival (HR = 0.7, IC95% 0.1-6.1, p = 0.77). CONCLUSION: Due to the small size of our sample, no conclusion can be drawn, yet it could be hypothesized that, for selected patients, a systematic hysterectomy could be discussed, notably in restaging surgery.
Asunto(s)
Preservación de la Fertilidad , Neoplasias Ováricas , Humanos , Femenino , Carcinoma Epitelial de Ovario/cirugía , Carcinoma Epitelial de Ovario/patología , Neoplasias Ováricas/patología , Estudios Retrospectivos , Útero/cirugía , Útero/patologíaRESUMEN
Breast cancer is a major public health issue and the role of pollutants in promoting breast cancer progression has recently been suggested. We aimed to assess if a mixture of pollutants, cigarette smoke, could favor the aggressivity of breast cancer cells. We also evaluated the impact of the tumor microenvironment, largely represented by adipocytes, in mediating this modification of cell phenotype. Breast cancer cells lines, MCF-7 were cultured using a transwell coculture model with preadipocytes hMADS cells or were cultured alone. Cells were treated with cigarette smoke extract (CSE) and the four conditions: control, treated by CSE, coculture, and coexposure (coculture and CSE) were compared. We analyzed morphological changes, cell migration, resistance to anoikis, stemness, epithelial-to-mesenchymal transition (EMT), and the presence of hormonal receptors in each condition. A complete transcriptomic analysis was carried out to highlight certain pathways. We also assessed whether the aryl hydrocarbon receptor (AhR), a receptor involved in the metabolism of xenobiotics, could mediate these modifications. Several hallmarks of metastasis were specific to the coexposure condition (cell migration, resistance to anoikis, stemness characterized by CD24/CD44 ratios and ALDH1A1 and ALDH1A3 rates) whereas others (morphological changes, EMT, loss of hormonal receptors) could be seen in the coculture condition and were aggravated by CSE (coexposure). Moreover, MCF-7 cells presented a decrease in hormonal receptors, suggesting an endocrine treatment resistance. These results were confirmed by the transcriptomic analysis. We suggest that the AhR could mediate the loss of hormonal receptor and the increase in cell migration.
Asunto(s)
Neoplasias de la Mama , Fumar Cigarrillos , Femenino , Humanos , Mama/metabolismo , Neoplasias de la Mama/metabolismo , Transición Epitelial-Mesenquimal , Células MCF-7 , Microambiente TumoralRESUMEN
International Federation of Gynecology and Obstetrics (FIGO) staging classification for stage IV epithelial ovarian cancer (EOC) separates stages IVA (pleural effusion) and IVB (parenchymal and/or extra-abdominal lymph node metastases). We aimed to evaluate its prognostic impact and to compare survival according to the initial metastatic location. We conducted a multicenter study between 2000 and 2020, including patients with a FIGO stage IV EOC. Primary endpoint was overall survival (OS). The secondary endpoints were progression-free survival (PFS) and recurrence rates. We included 307 patients: 98 (32%) had FIGO stage IVA and 209 (68%) had FIGO stage IVB. The median OS and PFS of stage IVA patients were significantly lower than those of stage IVB patients (31 versus 45 months (p = 0.02) and 18 versus 25 months (p = 0.01), respectively). Recurrence rate was higher in stage IVA than IVB patients (65% versus 47% (p = 0.004)). Initial pleural involvement was a poor prognostic factor with a median OS of 35 months versus 49 months for patients without initial pleural involvement (p = 0.024). Patients with FIGO stage IVA had a worse prognosis than patients with FIGO stage IVB EOC. Pleural involvement appears to be relevant for predicting survival. We suggest a modification of the current FIGO staging classification.
RESUMEN
INTRODUCTION: Breast cancer (BC) is frequent with a poor prognosis in case of metastasis. The role of the environment has been poorly evaluated in its progression. We searched to assess whether a mixture of pollutants could be responsible of BC aggressiveness. METHODS: Patients undergoing surgery for their BC were prospectively included in the METAPOP cohort. Forty-two POPs were extracted, among them 17 dioxins (PCDD/F), 16 polychlorobiphenyls (PCB), 8 polybromodiphenylethers (PBDE) and 2,2',4,4',5,5'-hexabromobiphenyl (PBB153) were measured in the adipose tissue surrounding the tumor. BC aggressiveness was defined using tumor size and metastasis (distant or lymph nodes). Two complementary models were used to evaluate the impact of the mixture of pollutants: the BKMR (Bayesian Kernel machine regression) and WQS (weighted quantile sum regression) models. The WQS estimates the weight (positive or negative) of a certain chemical based on its quantile and the BKMR model applies a kernel-based approach to estimate posterior inclusion probabilities. The sub-group of patients with a body mass index (BMI) > 22 kg/ m2 was also analyzed. RESULTS: Ninety-one patients were included. Of these, 38 patients presented a metastasis, and the mean tumor size was 25.4 mm. The mean BMI was 24.5 kg/m2 (+/- 4.1). No statistical association was found in the general population. However, in patients with a BMI > 22 kg/ m2, our mixture was positively associated with tumor size (OR: 9.73 95 %CI: 1.30-18.15) and metastasis (OR = 3.98 95 %CI = 1.09-17.53) using the WQS model. Moreover, using the BKMR model on chemical families, dioxin like chemicals and PCDD were associated with a higher risk of metastasis. DISCUSSION: These novel findings identified a mixture associated with breast cancer aggressiveness in patients with a BMI > 22 kg/ m2.
Asunto(s)
Neoplasias de la Mama , Contaminantes Orgánicos Persistentes , Femenino , Humanos , Teorema de BayesRESUMEN
OBJECTIVE: Parametrial involvement (PI) in endometriosis is poorly defined resulting in an underestimation of its impact during surgical excision. The aim of our study was to assess the surgical complications associated with parametrectomy during surgery for endometriosis. Our secondary objective was to compare the surgical complications rates of a parametrectomy to the excision of other deep pelvic endometriotic locations. STUDY DESIGN: Patients who underwent surgery for deep pelvic endometriosis from 2013 to 2018 in a French referral center were retrospectively included. Surgical complications were assessed according to whether a parametrectomy had been performed. The extent of surgery (colpectomy, torus, utero-sacral (USL) and/or rectal resection) was also assessed. Voiding dysfunction was defined as the need for self-catheterization ≥1 month and intra and postoperative complications were graded using the Clavien-Dindo classification (CDC). RESULTS: We included 753 patients: 285 (37.8 %) with PI. Patients with PI had higher ASRM scores and more extensive surgery than those without. These patients also had higher rates of voiding dysfunctions (17.5 % versus 8.98 %, p < 0.01), and postoperative complications (44.6 % versus 24.6 %, p < 0.01), including major complications (CDC 3-4) (14.7 % vs 8.5 %, p = 0.01). The extent of the surgical resection of endometriosis was strongly associated with surgical complications after multivariable analysis, and the addition of a parametrectomy during surgery greatly increased rates of adverse postoperative events. Voiding dysfunction was frequent in women with combined resection of the torus, utero-sacral ligaments, parametrium and vagina (adjusted OR = 37.28, 95 %CI = 6.84-203.11, p < 0.01, reference: resection of the USL). CONCLUSION: Parametrectomy significantly impacts postoperative complications in patients undergoing surgery for endometriosis.
Asunto(s)
Endometriosis , Laparoscopía , Enfermedades del Recto , Endometriosis/complicaciones , Endometriosis/cirugía , Femenino , Humanos , Laparoscopía/métodos , Peritoneo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Pronóstico , Enfermedades del Recto/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Adverse outcome pathways (AOPs) are formalized and structured linear concepts that connect one molecular initiating event (MIE) to an adverse outcome (AO) via different key events (KE) through key event relationships (KER). They are mainly used in eco-toxicology toxicology, and regulatory health issues. AOPs must respond to specific guidelines from the Organization for Economic Co-operation and Development (OECD) to weight the evidence between each KE. Breast cancer is the deadliest cancer in women with a poor prognosis in case of metastatic breast cancer. The role of the environments in the formation of metastasis has been suggested. We hypothesized that activation of the AhR (MIE), a xenobiotic receptor, could lead to breast cancer related death (AO), through different KEs, constituting a new AOP. An artificial intelligence tool (AOP-helpfinder), which screens the available literature, was used to collect all existing scientific abstracts to build a novel AOP, using a list of key words. Four hundred and seven abstracts were found containing at least a word from our MIE list and either one word from our AO or KE list. A manual curation retained 113 pertinent articles, which were also screened using PubTator. From these analyses, an AOP was created linking the activation of the AhR to breast cancer related death through decreased apoptosis, inflammation, endothelial cell migration, angiogenesis, and invasion. These KEs promote an increased tumor growth, angiogenesis and migration which leads to breast cancer metastasis and breast cancer related death. The evidence of the proposed AOP was weighted using the tailored Bradford Hill criteria and the OECD guidelines. The confidence in our AOP was considered strong. An in vitro validation must be carried out, but our review proposes a strong relationship between AhR activation and breast cancer-related death with an innovative use of an artificial intelligence literature search.
Asunto(s)
Rutas de Resultados Adversos , Neoplasias de la Mama , Apoptosis , Inteligencia Artificial , Femenino , Humanos , Medición de RiesgoRESUMEN
INTRODUCTION: Female malignancies can require complex surgeries with expert techniques. A French certification of competence in gynecological cancer surgery has been elaborated in 2021 to certify specialized surgeons. For trainees, this would require a practical curriculum (number of rotations in certain departments), a surgical logbook and the theoretical European exam. The objective of our work was to interrogate trainees in gynecology and obstetrics on their oncological training and their opinion on the certification. MATERIAL AND METHODS: We conducted a national French prospective, observational study, using a web-based questionnaire from 06/2021-02/2022. All trainees were interrogated on their overall training in gynecological oncology. The opinion on the certification was assessed for the sub-group willing to specialize in oncological surgical gynecology. RESULTS: One hundred and twenty-five responded, and 66.1% wanted to specialize in surgical oncology. Many had completed one rotation in a specialized gynecological oncology center (45.3%) and in digestive surgery (48.8%). Concerning the theoretical training, 92% of the respondents believed it to be insufficient. Eighty participants (64%) wished to specialize in oncological surgical gynecology and were interrogated on the certification. The majority (65%) thought the three criteria were difficult to achieve but adequate. The most difficult criterium was the practical curriculum (70.5%) followed by the surgical logbook (55.1%) due to inequalities of training amongst French regions. CONCLUSION: Trainees in gynecology and obstetrics seem ready to take a specialized certification in surgical gynecological oncology to improve patient care. However, they expressed concerns due the disparities amongst regions in accessing certain specialized departments.
Asunto(s)
Neoplasias de los Genitales Femeninos , Ginecología , Obstetricia , Oncología Quirúrgica , Certificación , Femenino , Neoplasias de los Genitales Femeninos/cirugía , Ginecología/educación , Humanos , Obstetricia/educación , Estudios Prospectivos , Oncología Quirúrgica/educaciónRESUMEN
During surgery for advanced epithelial ovarian cancer (EOC), the most important prognostic factor is the absence of residual tumor. Invisible microscopic peritoneal metastasis (mPM) are not removed during surgery and can be responsible of peritoneal recurrences. The aim of this current systematic review is to assess the role of fluorescence in evaluating mPM in EOC. We performed a systematic review using bibliographic citations from PubMed, Clinical Trials.gov, Embase, Cochrane Library, and Web of Science databases. MeSH terms for fluorescence, EOC and peritoneal carcinomatosis were combined and not restricted to the English language. The final search was performed on September 1rst, 2021. The primary outcome was to determine the diagnostic accuracy of fluorescence. We also reviewed the different techniques used. Eighty-seven studies were identified. Of these, 10 were included for analysis. The sensitivity and specificity of fluorescence ranged between 66.7-100% and 54.2-100%, respectively. Most importantly, the negative predictive value (NPV) ranged from 90 to 100% Due to the heterogeneity of the studies, no consensus was reached concerning the optimal use of fluorescence in terms of type of dye, type and timing of injection and imager to use. No adverse event was reported. Fluorescence can safely be used in EOC to evaluate mPM with a high NPV. However, a randomized controlled trial is needed to homogenize current practice.
Asunto(s)
Neoplasias Ováricas , Neoplasias Peritoneales , Carcinoma Epitelial de Ovario/cirugía , Procedimientos Quirúrgicos de Citorreducción/métodos , Femenino , Fluorescencia , Humanos , Neoplasias Ováricas/patología , Neoplasias Peritoneales/secundarioRESUMEN
In order to promote biomedical research, the French ministry of Solidarity and Health has developed a software that is used to rate medical doctors according to their scientific production: the SIGAPS points (System of Interrogation, Management and Analysis of Scientific Publications). These points (1-32 points) are attributed after the publication of a scientific paper according to the quality of the journal (based on the impact factor) and the doctor's rank among the authors. These points are then transformed into a sum of money received by the health facility (1 point = approximately 648 euros), 4 years in a row. Does this "fee-for-service" encourage doctors to publish quickly at any price, regardless of the quality of their research?
TITLE: Qui veut gagner des points SIGAPS ? ABSTRACT: Afin de promouvoir la recherche en santé, le ministère des Solidarités et de la Santé a fait appel à un logiciel permettant de noter les médecins en fonction en leur production scientifique : les points SIGAPS (Système d'interrogation, de gestion et d'analyse des publications scientifiques). Ces points (entre 1 et 32 points) sont attribués aux auteurs de publications après la parution de leur article, selon la qualité de la revue dans laquelle ils publient (fondée sur son facteur d'impact) et selon leur rang dans la liste des auteurs. Ces points seront ensuite transformés en une somme d'argent qui sera perçue pendant 4 ans par l'établissement de santé auquel ils sont rattachés (1 point correspondant à 648 euros environ). Mais cette « rémunération à l'acte de recherche ¼ ne pousse-t-elle pas les médecins à publier plus rapidement et surtout à tout prix, quelle que soit la qualité de leur recherche ?
Asunto(s)
Bibliometría , Investigación Biomédica , Humanos , Programas InformáticosRESUMEN
OBJECTIVE: The objective of our study was to analyze quality of life (QOL) in an e-cohort of patients treated for breast cancer (BC) by endocrine therapy (ET), by means of validated quality of life questionnaires. STUDY DESIGN AND SETTING: A retrospective, observational, e-cohort study was conducted (Seintinelles platform). Female patients treated for nonmetastatic and nonrecurrent BC, treated in France after 2005, filled in online questionnaires concerning: QOL (QLQ-C30 and QLQ-BR23), tolerability of treatment and demographic characteristics. A multivariate analysis including variables significant on univariate analysis (P < .05) to select QOL predictors was performed. RESULTS: We included 1,198 patients, 1140 of whom declared that they were taking ET (37.7% tamoxifen, 17.1% aromatase inhibitor (AI), 5.6% LHRH-agonist and 39.6% sequential tamoxifen and AI). Different tolerability profiles were observed when comparing the tamoxifen and AI groups. Treatment adherence was similar in the 2 groups. QOL varied slightly according to the type of ET. On multivariate analysis, ET had no impact on QOL. However, individual patient characteristics (socioeconomic, education and age) were significantly associated with QOL CONCLUSION: Using a real-life study questionnaire on a large e-cohort, individual patient characteristics were strongly associated with deterioration of QOL. The use of e-cohorts must be encouraged to modulate the conclusions of randomized trials.
Asunto(s)
Neoplasias de la Mama , Calidad de Vida , Antineoplásicos Hormonales/efectos adversos , Inhibidores de la Aromatasa/efectos adversos , Neoplasias de la Mama/patología , Estudios de Cohortes , Femenino , Humanos , Estudios Retrospectivos , Tamoxifeno/uso terapéuticoRESUMEN
BACKGROUND: Lymphadenectomy is debated in patients with ovarian cancer. The aim of our study was to evaluate the impact of lymphadenectomy in patients with high-grade serous ovarian cancer receiving neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). METHODS: A retrospective, unicentric study including all patients undergoing NACT and IDS was carried out from 2005 to 2018. Patients with and without lymphadenectomy were compared in terms of recurrence free survival (RFS), overall survival (OS), and complication rates. RESULTS: We included 203 patients. Of these, 133 had a lymphadenectomy (65.5%) and 77 had involved nodes (57.9%). Patients without a lymphadenectomy were older, had a more extensive disease and less complete CRS. No differences were noted between the lymphadenectomy and no lymphadenectomy group concerning 2-year RFS (47.4% and 48.6%, p = 0.87, respectively) and 5-year OS (63.2% versus 58.6%, p = 0.41, respectively). Post-operative complications tended to be more frequent in the lymphadenectomy group (18.57% versus 31.58%, p = 0.09). In patients with a lymphadenectomy, survival was significantly altered if the nodes were involved (positive nodes: 2-year RFS 42.5% and 5-year OS 49.4%, negative nodes: 2-year RFS 60.7% and 5-year OS 82.2%, p = 0.03 and p < 0.001, respectively). CONCLUSION: Lymphadenectomy during IDS does not improve survival and increases post-operative complications.
Asunto(s)
Carcinoma Epitelial de Ovario/cirugía , Procedimientos Quirúrgicos de Citorreducción/métodos , Escisión del Ganglio Linfático/métodos , Neoplasias Quísticas, Mucinosas y Serosas/cirugía , Neoplasias Ováricas/cirugía , Complicaciones Posoperatorias/epidemiología , Anciano , Antineoplásicos/uso terapéutico , Carcinoma Epitelial de Ovario/patología , Supervivencia sin Enfermedad , Femenino , Humanos , Persona de Mediana Edad , Terapia Neoadyuvante , Neoplasias Quísticas, Mucinosas y Serosas/patología , Neoplasias Ováricas/patología , Estudios Retrospectivos , Medición de Riesgo , Tasa de SupervivenciaRESUMEN
The aryl hydrocarbon receptor (AhR) is a transcriptional factor that regulates multiple functions following its activation by a variety of ligands, including xenobiotics, natural products, microbiome metabolites, and endogenous molecules. Because of this diversity, the AhR constitutes an exposome receptor. One of its main functions is to regulate several lines of defense against chemical insults and bacterial infections. Indeed, in addition to its well-established detoxication function, it has several functions at physiological barriers, and it plays a critical role in immunomodulation. The AhR is also involved in the development of several organs and their homeostatic maintenance. Its activity depends on the type of ligand and on the time frame of the receptor activation, which can be either sustained or transient, leading in some cases to opposite modes of regulations as illustrated in the regulation of different cancer pathways. The development of selective modulators and their pharmacological characterization are important areas of research.