European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD) and European Association for the Study of Obesity (EASO) clinical practice recommendations for the management of non-alcoholic fatty liver disease: evaluation of their application in people with Type 2 diabetes.

AIMS: To evaluate the application of the recently proposed recommendations by the European Association for the Study of the Liver, European Association for the Study of Diabetes and European Association for the Study of Obesity for the diagnosis, treatment and follow-up of non-alcoholic fatty liver disease in people with Type 2 diabetes. METHODS: A total of 179 people with Type 2 diabetes were included in this study. Liver fat content (assessed using proton magnetic resonance spectroscopy), fatty liver index score, non-alcoholic fatty liver disease fibrosis score, and SteatoTest and FibroTest scores were determined. RESULTS: According to proton magnetic resonance spectroscopy, 68.7% of participants had steatosis (liver fat content >5.5%). The application of the guidelines using several combinations (fatty liver index + non-alcoholic fatty liver disease fibrosis scores, Steatotest + FibroTest scores, proton magnetic resonance spectroscopy + non-alcoholic fatty liver disease fibrosis score, proton magnetic resonance spectroscopy + FibroTest) resulted in a referral to a liver clinic for 33.5-84.9% people with Type 2 diabetes. CONCLUSIONS: The application of these new algorithms for the diagnosis, and follow-up of non-alcoholic fatty liver disease would lead to an excessive number of people with Type 2 diabetes being referred to a liver clinic. We suggest that new clinical and/or biological biomarkers of steatosis and fibrosis be specifically validated in people with Type 2 diabetes.

Type 1 diabetes is not associated with an increased prevalence of hepatic steatosis.

AIM: Non-alcoholic fatty liver disease (NAFLD) is commonly associated with Type 2 diabetes. Recently, it has been suggested that NAFLD is also frequently associated with Type 1 diabetes and diabetic complications. In this study, we set out to determine whether Type 1 diabetes was associated with liver fat content measured using magnetic resonance imaging. METHODS: One hundred and twenty-eight patients with Type 1 diabetes, 264 patients with Type 2 diabetes and 67 participants without diabetes were included in this study. Hepatic steatosis was defined as a liver fat content > 5.5%. RESULTS: People with Type 1 diabetes and controls were similar for age and BMI. Liver fat content was significantly higher in patients with Type 2 diabetes than in patients with Type 1 diabetes and controls. In the control group, nine people (13.4%) had steatosis compared with six (4.7%) patients with Type 1 diabetes (P = 0.04). Among patients with Type 2 diabetes group, 166 (62.8%) had steatosis. In multivariate analysis that included patients with Type 1 diabetes and participants without diabetes, steatosis was associated only with BMI, whereas age, sex, statin therapy and Type 1 diabetes were not. In patients with Type 1 diabetes, there was no correlation between liver fat content and estimated glomerular filtration rate or carotid intima media thickness. CONCLUSIONS: Our data showed that Type 1 diabetes was not associated with an increased prevalence of steatosis. Moreover, our study provided no specific arguments concerning a link between liver fat content and diabetic complications in patients with Type 1 diabetes.

Clinical and economic impact of drug eluting beads in transarterial chemoembolization for hepatocellular carcinoma.

WHAT IS KNOWN AND OBJECTIVE: Drug eluting beads (DEBs) theoretically improve the efficacy and safety of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC). Nonetheless, their economic profile has not been assessed. Our retrospective before/after study aimed to compare efficacy, safety and economic profile of two strategies of TACE without (Period 1) or with the possibility of using DEBs (Period 2). METHODS: All HCC patients treated by TACE in our hospital between March 2006 and May 2013 were included. Economic analyses were performed from the French Public Health Insurance point of view according to the French Diagnosis-Related Group prospective payment system and from the analytic accountability. RESULTS AND DISCUSSION: One hundred and sixty-one patients were included. Median time to treatment failure and overall survival were 13.1 and 23.8 months in Period 1 vs. 14.1 and 30.2 months in Period 2 (P = 0.45 and P = 0.40). Mean hospital durations and tariffs were 14.9 ± 7.7 days and € 11 472 ± 5901 in Period 1 vs. 12.4 ± 8.4 days and € 7654 ± 4625 in Period 2 (P = 0.03 and P < 10(-4) ). WHAT IS NEW AND CONCLUSION: The possibility of using DEBs did not improve the prognosis in HCC patients treated by TACE. Nonetheless, it had a better medico-economic profile.

Diagnosis of hepatocellular carcinoma in cirrhotic patients: a proof-of-concept study using serum micro-Raman spectroscopy.

Hepatocellular carcinoma (HCC) is the third most common cause of cancer death worldwide. The development of novel diagnostic methods is needed to detect tumours at an early stage when patients are eligible for curative treatments. The purpose of this proof-of-concept study was to determine if micro-Raman spectroscopy applied to the sera of cirrhotic patients may be an alternative method for rapidly discriminating patients with and without HCC. Serum samples were collected from 2 groups of patients: cirrhotic patients with HCC (n = 37) and without HCC (n = 34). Two different approaches were used, dried serum drops and freeze-dried serum, and micro-Raman spectra were acquired in the point-mode with a 785 nm laser excitation in the spectral range of 600-1800 cm(-1). Spectra were quality-tested and pre-processed (smoothing, baseline subtraction, vector normalization). Using principal component analysis, the 2 classes, corresponding to cirrhotic patients with and without HCC, could not be differentiated. In contrast, the support vector machine method using the leave-one-out cross validation procedure was able to correctly classify the two groups of patients with an overall rate of accuracy of 84.5% to 90.2% for dried serum drops and 86% to 91.5% for freeze-dried serum. These results are promising and support the concept that serum micro-Raman spectroscopy may become a useful diagnostic tool to detect biomarkers in the field of cancer, as described here for distinguishing between cirrhotic patients with and without HCC.

Long-term outcome of chronic hepatitis C in a population-based cohort and impact of antiviral therapy: a propensity-adjusted analysis.

This population-based study aimed to assess the determinants of the outcome of chronic hepatitis C with analysis of the impact of antiviral therapy with or without sustained virological response (SVR) on cirrhosis decompensation, hepatocellular carcinoma, liver-related and non-liver-related mortality. A total of 1159 HCV-positive patients newly detected between 1994 and 2001 were included. For each outcome, the prognostic effect of patients' baseline characteristics was estimated by time-dependent Cox models using age as the time-scale and adjusting for treatment received during follow-up. The impact of antiviral therapy was assessed by using a propensity score in a sample including 184 patients treated in the first 24 months following diagnosis who were matched to 184 untreated patients. At the end of a 59-month median follow-up, 100 cases of compensated disease, 58 liver cancer and 163 deaths (55 liver related) were recorded. The 5-year rates of decompensated cirrhosis, hepatocellular carcinoma, liver-related and non-liver-related death were 4.4%, 2.7%, 5.0% and 8.9%, respectively. Multivariate analyses identified two variables with pejorative influence: alcohol consumption (RR = 4.29 for CD; RR = 5.76 for HCC; RR = 6.69 for liver-related death; P < 0.0001); HCV diagnosis unrelated to systematic screening (RR = 2.25 for CD; RR = 3.05 for HCC; RR = 4.31 for liver-related death, P < 0.03). In the matched subset, no significant benefit of antiviral therapy was observed. Nevertheless, among the 144 patients who achieved SVR, no death was observed. This population-based study showed substantial rates of decompensated cirrhosis, hepatocellular carcinoma and non-liver-related mortality. Alcohol consumption and absence of systematic screening were significant determinants of poor outcome, whereas treatment did not have significant influence.

The impact of the prevention programme of hepatitis C over more than a decade: the French experience.

To assess the impact of the French national hepatitis C prevention programme initiated in 1999, we analysed trends in hepatitis C virus (HCV) prevalence, testing and characteristics of HCV-infected patient at first referral from 1994 to 2006. We used four data sources: Two national population-based sero-prevalence surveys carried out in 1994 and 2004; two surveillance networks, one based on public and private laboratories throughout France and the other on hepatology reference centres, which aim to monitor, respectively, trends of anti-HCV screening and of epidemiological-clinical characteristics of HCV patients at first referral. Between 1994 and 2004, the anti-HCV prevalence for adults aged 20-59 years decreased from 1.05 (95% confidence interval 0.75-1.34) to 0.71 (0.52-0.97). During the same period, those anti-HCV positive with detectable HCV RNA decreased from 81 to 57%, whereas, the proportion of anti-HCV positive persons aware of their status evolved from 24 to 56%. Anti-HCV screening activity increased by 45% from 2000 to 2005, but decreased in 2006 (-10%), while HCV positivity among those tested decreased from 4.3 to 2.9%. The proportion of cirrhosis at first referral remains around 10% between 2001 and 2006, with many patients with excessive alcohol consumption (34.7% among males) or viral co-infections (HIV seropositivity for 5.2% patients). Our analysis indicates that the national programme had a positive impact at the population level through improved prevention, screening and management. There is still a need to identify timely those at risk for earlier interventions, to assess co-morbidities better and for a multidisciplinary approach to HCV management.

Obesity, type 2 diabetes and risk of digestive cancer.

The frequency of obesity has been increasing worldwide for 20 years. Many epidemiological studies support a correlation between obesity and increased risk of cancer, particularly digestive cancers in both genders, and gynaecological cancer in women. Currently, about 5% of cancers could be directly related to overweight. Carcinogenesis mechanisms induced by obesity involve insulin resistance, adipokine and angiogenic factor secretions, and inflammation. Experimental and clinical evidence suggest that insulin resistance plays a major role in carcinogenesis. Insulin and non-protein banded IGF-1, whose levels are increased in type 2 diabetes, stimulate cellular growth and inhibit apoptosis. Abnormalities in adipokine secretion by the central adipose tissue play a role at different stages of obesity-induced carcinogenesis. Excess of leptin and PAI-1, associated with a decrease in adiponectin secretion in obese people, contributes to carcinogenesis through cellular growth and angiogenesis stimulation. Remodelling of the extracellular matrix due to metalloproteinase stimulation by PAI-1 is also able to promote cell migration. Obesity not only increases cancer frequency, but is also liable to modify the prognosis and the response to antiangiogenic therapy of digestive cancers. This data suggests the need for clinicians to take into account overweight in cancer risk evaluation and to consider obesity and metabolic disorders as confounding factors in designing therapeutic studies.

[Fast technique to quantify liver steatosis at 3T: principles, parametric imaging and applications]. / Technique rapide de mesure de la stéatose hépatique à 3T: théorie, imagerie paramétrique, applications.

The purpose of this article is to present a fast and clinically usable technique for quantification of liver steatosis. This technique, based on a triple-echo gradient-echo sequence (in-phase, opposed-phase, in-phase), has recently been validated with excellent correlation and accuracy compared to proton MR spectroscopy. The theoretical principles are reviewed, with emphasis on the need to correct for the T2* decay inherent to the use of in-phase and opposed-phase sequences. T1 decay also is negligible due to the use of a low flip angle (20 degrees). The advantage of this technique is that it can generate a parametric representation (map) of liver steatosis, after fast and simple post-processing, based on measurements from standard images (addition, subtraction, division, multiplication) available on the MR scanning console. This parametric method allows quantification of steatosis in focal lesions. The main limitation of the technique relates to its ambiguity with lipid content over 50%, a phenomenon that does not occur with liver steatosis.

Specific phenotype associated with diabetes mellitus secondary to chronic hepatitis C infection.

AIM: A link between chronic hepatitis C virus (HCV) infection, Type 2 diabetes mellitus and insulin resistance has been suggested by several studies. However, HCV infection appears to be associated with insulin resistance but not with the metabolic syndrome. The aim of this study was to determine whether chronic HCV infection had an impact on the clinical characteristics of Type 2 diabetes. METHODS: We studied retrospectively a group of patients with diabetes mellitus associated with HCV infection (HCV-DM) and compared them with patients with conventional Type 2 diabetes (DM). RESULTS: The HCV-DM patients had a lower body mass index (P = 0.001) and systolic blood pressure (P = 0.04) compared with patients with DM diabetes. Ten patients (27.0%) in the HCV-DM group and 35 (47.3%) in the DM group had microalbuminuria (P = 0.04). DM patients had significantly higher serum creatinine levels than HCV-DM patients [87 (72-108) vs. 77 (64-86) micromol/l, P = 0.02; median (interquartile range)] but creatinine clearance (Cockroft Gault calculation) was similar. One HCV-DM patient (2.7%) and 44 DM patients (59.4%) were treated with hypolipidaemic therapy (P = 0.0001). Even although nearly two-thirds of the overall DM group were prescribed cholesterol-lowering drugs, DM patients had significantly higher total cholesterol, high-density lipoprotein cholesterol and triglyceride levels than HCV-DM patients. CONCLUSION: Our study provides further evidence that HCV-DM patients have specific clinical characteristics in comparison with classical DM patients. These data suggest an association between HCV virus infection and the development of insulin resistance or diabetes mellitus without the typical features of the metabolic syndrome.

[The role of echoendoscopic biopsy in diagnosing tuberculosis of pancreas]. / Tuberculose pancréatique: apport de la ponction sous échoendoscopie.

The diagnosis of an abdominal mass using imaging techniques is difficult for clinicians and radiologists. We report a case of an atypical peripancreatic mass, mimicking a carcinoma on abdominal computed tomography and which was only diagnosed after an echoendoscopic biopsy of the mass was performed. It is difficult to differentiate abdominal tuberculosis from a neoplasm, especially if there is no pulmonary tuberculosis. Usually, the diagnosis of abdominal tuberculosis is only confirmed histologically, after surgical resection of the mass. Echoendoscopic biopsy confirmed the infectious nature of the mass and prevented complicated and difficult surgery.

Is the management of hepatitis C patients appropriate? A population-based study.

BACKGROUND: In order for hepatitis C patients to receive antiviral treatment, they must reach medical care. AIM: To assess the proportion of patients reaching medical care after hepatitis C diagnosis in a general population (1 006 171 inhabitants) in France. METHODS: Between 1994 and 1999, 1508 cases were diagnosed, of which 1251 were eligible for the study. RESULTS: Two-hundred and two patients did not have any medical care; among them, 55.4% had normal alanine transferase, 58.4% had risk factors related to lifestyle and 22.8% were alcoholics. Amongst the 1049 other patients, 41.6% had a liver biopsy, 25.0% were treated. Treatment was more often carried out in males than in females (OR: 1.59; P = 0.001), and in patients under 65 than in older patients (OR: 2.22; P < 0.008). Among non-treatment reasons, alcoholism (P = 0.001), drug-addiction (P = 0.04) and escaping monitoring (P = 0.04) were more frequent in males than in females, whereas normal alanine transferase was more frequent in females than in males (P = 0.004). Amongst 278 patients with a Metavir score >A1F1, 71 (25.5%) did not undergo treatment. CONCLUSION: In a general population, one patient in six did not receive on-going health care; a quarter of patients with a Metavir score >A1F1 did not receive any treatment. These results showed insufficient clinical management, which could compromise the effectiveness of treatment in general population.

[Risk of cirrhosis in chronic viral hepatitis patients]. / Risque de cirrhose chez les malades atteints d'hépatite chronique virale.

The risk of cirrhosis in HCV and HBV-related liver diseases is higher in males than in females ; it increases exponentially after the age of 40 for the two genders. Alcohol consumption exceeding 50 gr per day multiplies cirrhosis risk by 6.0 in HBV patients and by 2.4 in HCV patients. B and C virus liver-related diseases are worsened by HIV co-infection particularly in patients with CD4 count lower than 200 per ml. Steatosis due to high body mass index (BMI) and/or metabolic syndrome is a newly described risk factor for cirrhosis in HBV and HCV patients and for hepatocellular carcinoma in HCV patients. Steatosis may become in a near future one of the major predicting factors of severity for chronic liver disease. The knowledge of worsening factors in patients suffering from chronic B and C viral hepatitis must lead clinicians to consider specific therapeutics against these factors and antiviral treatment even in case of borderline indication.

Primary liver cancer in Côte d'Or (France).

The registry of digestive tract tumours established for the department of Cote d'Or (France) was used to study the incidence and some of the characteristics of primary liver cancer (PLC) in this area. The annual age-standardized incidence rate was 7.6/100,000 for males, and 1.8/100,000 for females. As compared to other areas the Cote d'Or is in the intermediate incidence areas. The risk of PLC was higher in urban than in rural areas in men (p less than 0.01). There was no significant variation in PLC incidence over the eight years of the study. Alfafoetoprotein levels over 200 ng/ml were observed in only 48.9% of the cases. Alfafoetoprotein measurement has to be complemented by other investigations in screening of high-risk patients. Liver cirrhosis was present in 70.9% of the cases in which the information was available. The male:female ratio in the non-cirrhotic group was 1.5:1, very different to the 8.8:1 in the cirrhotic group. Cirrhosis was associated with excessive alcohol consumption in 92% of cases. The prevalence of serological markers of hepatitis B virus infection was investigated in 91 patients. Hepatitis Bs-antigen was found in 8.8% and evidence of past or present infection in 28.2%. In view of the prevalence of chronic alcoholism in patients with cirrhosis it is suggested that alcohol leads to an increased risk of cirrhosis followed by an increased incidence of PLC. Further studies are needed to elucidate the eventual role of HBV infection and other suspected environmental factors in the aetiology of PLC.

Effect of different doses of dietary calcium on murine colonic cell proliferation.

One-hundred and twenty 6-week-old 257BL/65 mice were fed for 2 or 7 weeks with diets supplemented with different combinations of bile acids and calcium. The effect of calcium, bile acids and the duration of these treatments on proliferative indices of the colonic mucosa was studied with a multiway analysis of variance. In mice not treated with bile acids, a low level (0.1%) of calcium in the diet was related to a significantly higher number of cells in each compartment of the crypt, compared with diets supplemented with 0.5 and 1% calcium (P < 0.01). There was no difference between the groups fed with normal and high calcium diets. Bile acids significantly increased proliferative indices in all animal groups whatever the duration of the treatment; however, this effect was significantly lower in the mice fed with 0.5% and 1% calcium than in those fed with 0.1% calcium (P < 0.01). There was a significant interaction between the effect of bile acids and the effect of calcium regarding the number of labeled cells and the labeling indices. Duration of the treatment had little effect on these indices. The effect of bile acids on colonic proliferative activity could be significantly reduced by calcium supplementation, and this effect was stable with time. Although there was no toxic effect of the highest calcium diet, there was no advantage in increasing the calcium dose beyond 0.5%.

Biliary tract cancers in Cote-d'Or (France): incidence and natural history.

The registry of digestive tract tumours established for the department of Cote-d'Or (France) was used to study the epidemiological characteristics and the natural history of biliary tract cancers. Age standardised incidence rates for gallbladder cancers were 2.7/100,000 for women and 0.9/100,000 for men. The corresponding rates for extrahepatic bile duct cancers were 0.5/100,000 and 1.7/100,000, and for ampulla of Vater cancer 0.3/100,000 and 0.3/100,000. The three cancers differ in their descriptive epidemiology and should be considered separately in epidemiological analytical investigations. The incidence of each of the three diseases increased with age, and cancers of known histological type were mainly adenocarcinomas. Some gallbladder cancers were undifferentiated or squamous cell carcinomas. There was no significant variation in incidence for gallbladder cancer and extrahepatic bile duct cancer over the eight years of the study. The association with gallstones was frequent in gallbladder cancer: 70.5% compared to 13.0% in other biliary tract cancers (less than 0.001). Although the association of gallbladder cancer with gallstones is frequent, few patients with cholelithiasis experience development of a gallbladder cancer. It is necessary to identify among patients with gallstones a subgroup at high risk of gallbladder cancer in whom prophylactic surgery might be justified. Biliary tract cancers are seldom diagnosed early: lymph nodes or visceral metastases were present in 77% of gallbladder cancers, in 83% of extrahepatic bile duct cancers, and in 55% of ampulla of Vater cancers at the time of diagnosis. The corresponding resectability rates were 46.1%, 11.9%, and 38.9%. The five-year overall survival rates were 2.9% for gallbladder cancer, 0% for extrahepatic bile duct cancer, and 18.3% for ampulla of Vater cancer. The corresponding five-year survival rates after surgery for cure were 10.3%, 0%, and 35.7%. Biliary tract cancer still represent a great therapeutic challenge.

[Incidence, diagnosis, treatment and prognosis of cancer of the pancreas: development in Côte-d'Or from 1976 to 1985]. / Incidence, diagnostic, traitement et pronostic du cancer du pancréas: évolution en Côte-d'Or de 1976 à 1985.

The aim of this study was to analyze the epidemiological aspects of pancreatic cancers and their time trends in the Côte-d'Or population between 1976 and 1985. Over a period of ten years, 444 cases were diagnosed. The incidence rates standardized according to the world reference population were 8.2/100,000 in males and 3.8/100,000 in females. The Côte-d'Or is an intermediate risk area for pancreatic cancer. This cancer was slightly more common in urban than in rural areas (NS). The initially urban predominance of pancreatic cancer in males was no longer present 10 years later. Between 1976 and 1985, incidence of pancreatic cancer decreased by a mean of 4.7% per year in males (NS) and 0.5% per year in females (NS). A high proportion of the cancers (73.9%) were located in the head of the pancreas; among histologically confirmed cases, 69.7% were adenocarcinomas. Criteria for diagnosis evolved throughout the 10 years. The rate of histological confirmation increased annually by a mean of 3.0% (P less than 0.001). The relative importance among diagnostic procedures of direct biliary and pancreatic examinations decreased (P less than 0.05) whereas that of ultrasonography and radioscan increased (P less than 0.001). The overall surgical rate was 64.4% and the rate of curative surgery was 4.4%. The operability rate increased annually by a mean of 2.0% (NS). The overall survival rate was 13.2% after 1 year, 4.5% after 3 years and 3.2% after 5 years. Prognosis depended neither on age nor on sex or cancer location. The 5-year survival rate was 38.5% in the limited group of patients (n = 13) who underwent surgery for cure, and 0.0% in patients with palliative treatment. These data emphasize the severity of pancreatic cancers and the absence of any therapeutical improvement between 1976 and 1985 in spite of the evolution in diagnostic procedures.

[Cancer of the esophagus in the department of Côte-d'Or]. / Le cancer de l'oesophage dans le département de la Côte-d'Or.

The registry of digestive tract tumors established for the department of Côte-d' Or was used to study the incidence and characteristics of oesophageal cancer in the area. The crude annual incidence rate was 15.5/100,000 for males, ans 1.1/100,000 for females. The corresponding age standardized rate (world standard) were 12.7 and 0.6. The sex ratio was 21.2. As compared to other cancer registries the Côte-d' Or is in intermediate range for males, in the low range for females. The incidence of oesophageal cancer was similar in urban and rural areas. The risk of oesophageal cancer in males was five times higher in workers than in high executives and professionals. There was no significant variation in oesophageal cancer incidence over the 8 years of the study. Rates tended to decrease slightly in both sexes. Most cancers were squamous cell carcinomas (92%). Adenocarcinomas represented 5% of the cases. The risk of an associated tumour of the upper respiratory and digestive tract was important (17.5%). Only 10.4% of the patients underwent curative surgery, while 53.4% were referred for radiotherapy alone. The overall 1-year survival rate was 18.4%, and the 5-year survival rate was 2.8%. The 5-year survival rate was 7.2% after curative surgery, and 3.2% after radiotherapy. These results underline the fact that the prognosis of oesophageal cancer in a well defined population where only one patient out of ten can benefit from curative surgery, remains poor.

[Colorectal cancer in the Department of Côte-d'Or]. / Le cancer colo-rectal dans le département de la Côte-d'Or.

The present study is based on the data of the digestive tract cancer registry set up for the French department of Cote d'Or (population 455,727). During 1976-1980, 581 colon cancers and 489 rectal cancers were diagnosed. They represent 47 per cent of all recorded gastro intestinal cancers. The annual adjusted incidence rates for colon cancers, adjusted to the world population were 17.5 for males, 13.3 for females. The corresponding rates for rectal cancers were 18.2 for males, 9.7 for females. These rates rank among the high rates found in North America and Western Europe. They are particularly high for rectal cancers. There was an urban predominance for colon cancer in males. Among colorectal cancers, 75 per cent were located in the rectum or sigmoid. Sixty-one per cent of the cases of large bowel cancer underwent curative surgery. The overall 5-year survival rate was 30.0 per cent for colon cancer, 27.4 per cent for rectal cancer. After curative surgery the 5 year survival rates were respectively 53.7 per cent and 47.8 per cent. The most important determinant of survival was the pathological stage of the tumour. These results underline the fact that by its frequency and its severity, colorectal cancer represents a major cancer problem.

[Malpighian cancer of the anal canal in Côte-d'Or. Epidemiological and therapeutic aspects]. / Le cancer malpighien du canal anal en Côte-d'Or. Aspects épidémiologiques et thérapeutiques.

The registry of digestive tract tumours established for the department of Côte-d'Or was used to study the incidence and the treatment of squamous cell cancer of the anal canal. In the course of 7 years (1976-1982), 45 new cases of anal canal cancer were recorded. Age standardized rates using world standard population are 1.3/100,000 for females, 0.3/100,000 for males. As compared to other cancer registries, Côte-d'Or is in the high range for females, in the average range for males, the cases included 44% with T1-T2 tumours (less than 4 cm), 47% with T3-T4 tumours (more than 4 cm) and 9% unknown (Tx). Lymph node involvement was found in 1/3 of cases, metastatic disease in 11%. Six patients were treated by local excision, 13 by abdomino-perineal resection (combined with postoperative radiotherapy in 5 cases), 20 by radiotherapy (combined with a derivation in 2 cases) and 6 by symptomatic treatment. For T1-T2 normal anal function was preserved in 79% of cases. The 5 year local recurrence rate for curative treatment was 44%. The 5 year observed survival rate was 42.6%; the 5 year relative survival rate was 53.3%. The survival was related to the age, to the sex, to the size of the tumour, and to the nodal status.

[Colorectal cancers disclosed by an obstruction. Frequency and prognosis in a population]. / Les cancers colorectaux révélés par une occlusion: fréquence et pronostic dans une population.

The registry of digestive tumors of the department of Cote-d'Or recorded between 1976 and 1982, among 1543 colorectal cancers, 142 cases (9.2%) diagnosed with acute obstruction. Distribution of the tumors along the large bowel was as follows: rectal cancers were rarely obstructive (3.8%) whereas it was a more common feature in the sigmoid (14.2%), the caecum (12.2%) and the transverse colon (15.8%). Symptoms preceded the acute obstruction in 39.7% of the cases. Limited tumors were rare in obstructive cancers, 2.8% were Dukes A, 30.3% Dukes B; the corresponding data for non obstructive cancers were 15.6 and 27.7% respectively (P less than 0.01). Treatment was surgical in 97.9% of obstructive cancers. Surgery was more often palliative in obstructive tumors (45.8%) than in the other types of tumors (21.3%; P less than 0.01). The postoperative mortality rate was 30.9%, ie 21.6% after curative surgery, 30% after palliative surgery, 43.6% after derivative surgery. The overall survival rates for obstructive cancers were 42.7% after one year and 17.6% after 5 years; they were respectively 59.1 and 31.1% for non obstructive cancers (P less than 0.001). After curative surgery and excluding postoperative mortality prognosis was the same for obstructive and obstructive cancers within the same Dukes' stage. This study permitted to highlight the rather high frequency of obstructive colorectal cancers, and their bad prognosis linked to the extension of the tumors and to high postoperative mortality rates.