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1. Revisiting the management of term breech presentation: a proposal for overcoming some of the controversies

Author: Lionel Carbillon, Amelie Benbara, Ahmed Tigaizin, Rouba Murtada, Marion Fermaut, Fatma Belmaghni, Alexandre Bricou, and Jeremy Boujenah
Subjects: Term breech delivery, Small-for-gestational-age, Foetal growth restriction, Oligohydramnios, Delivery route, Pelvimetry, Gynecology and obstetrics, RG1-991
Abstract: Abstract Background The debate surrounding the management of term breech presentation has excessively focused on the mode of delivery. Indeed, a steady decline in the rate of vaginal breech delivery has been observed over the last three decades, and the soundness of the vaginal route was seriously challenged at the beginning of the 2000s. However, associations between adverse perinatal outcomes and antenatal risk factors have been observed in foetuses that remain in the breech presentation in late gestation, confirming older data and raising the question of the role of these antenatal risk factors in adverse perinatal outcomes. Thus, aspects beyond the mode of delivery must be considered regarding the awareness and adequate management of such situations in term breech pregnancies. Main body In the context of the most recent meta-analysis and with the publication of large-scale epidemiologic studies from medical birth registries in countries that have not abruptly altered their criteria for individual decision-making regarding the breech delivery mode, the currently available data provide essential clues to understanding the underlying maternal-foetal conditions beyond the delivery mode that play a role in perinatal outcomes, such as foetal growth restriction and gestational diabetes mellitus. In view of such data, an accurate evaluation of these underlying conditions is necessary in cases of persistent term breech presentation. Timely breech detection, estimated foetal weight/growth curves and foetal/maternal well-being should be considered along with these possible antenatal risk factors; a thorough analysis of foetal presentation and an evaluation of the possible benefit of external cephalic version and pelvic adequacy in each specific situation of persistent breech presentation should be performed. Conclusion The adequate management of term breech pregnancies requires screening and the efficient identification of breech presentation at 36 weeks of gestation, followed by thorough evaluations of foetal weight, growth and mobility, while obstetric history, antenatal gestational disorders and pelvis size/conformation are considered. The management plan, including external cephalic version and follow-up based on the maternal/foetal condition and potentially associated disorders, should be organized on a case-by-case basis by a skilled team after the woman is informed and helped to make a reasoned decision regarding delivery route.
Published: 2020
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2. Patients with stage IV epithelial ovarian cancer: understanding the determinants of survival

Author: Yohann Dabi, Cyrille Huchon, Lobna Ouldamer, Sofiane Bendifallah, Pierre Collinet, Alexandre Bricou, Emile Daraï, Marcos Ballester, Vincent Lavoue, Bassam Haddad, Cyril Touboul, and For the Groupe de Recherche FRANCOGYN
Subjects: Ovarian cancer, Stage IV, Debulking surgery, Chemotherapy, Prognostic factors, Post-operative residual disease, Medicine
Abstract: Abstract Background The most appropriate management for patients with stage IV ovarian cancer remains unclear. Our objective was to understand the main determinants associated with survival and to discuss best surgical management. Methods Data of 1038 patients with confirmed ovarian cancer treated between 1996 and 2016 were extracted from maintained databases of 7 French referral gynecologic oncology institutions. Patients with stage IV diseases were selected for further analysis. The Kaplan–Meier method was used to estimate the survival distribution. A Cox proportional hazards model including all the parameters statistically significant in univariable analysis, was used to account for the influence of multiple variables. Results Two hundred and eight patients met our inclusion criteria: 65 (31.3%) never underwent debulking surgery, 52 (25%) underwent primary debulking surgery (PDS) and 91 (43.8%) neoadjuvant chemotherapy and interval debulking surgery (NACT-IDS). Patients not operated had a significantly worse overall survival than patients that underwent PDS or NACT–IDS (p
Published: 2020
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3. Using a new diagnostic tool to predict lymph node metastasis in advanced epithelial ovarian cancer leads to simple lymphadenectomy decision rules: A multicentre study from the FRANCOGYN group.

Author: Camille Mimoun, Xavier Paoletti, Thomas Gaillard, Adrien Crestani, Jean-Louis Benifla, Matthieu Mezzadri, Sofiane Bendifallah, Cyril Touboul, Alexandre Bricou, Yohann Dabi, Geoffroy Canlorbe, Yohan Kerbage, Vincent Lavoué, Lobna Ouldamer, Lise Lecointre, Charles Coutant, Arnaud Fauconnier, Roman Rouzier, and Cyrille Huchon
Subjects: Medicine, Science
Abstract: ObjectiveThe aim of this study was to develop a new diagnostic tool to predict lymph node metastasis (LNM) in patients with advanced epithelial ovarian cancer undergoing primary cytoreductive surgery.Materials and methodThe FRANCOGYN group's multicenter retrospective ovarian cancer cohort furnished the patient population on which we developed a logistic regression model. The prediction model equation enabled us to create LNM risk groups with simple lymphadenectomy decision rules associated with a user-friendly free interactive web application called shinyLNM.Results277 patients from the FRANCOGYN cohort were included; 115 with no LNM and 162 with LNM. Three variables were independently and significantly (pConclusionThis new tool may prove useful for improving surgical planning and provide useful information for patients.
Published: 2021
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4. Therapeutic value of surgical paraaortic staging in locally advanced cervical cancer: a multicenter cohort analysis from the FRANCOGYN study group

Author: Yohann Dabi, Vanille Simon, Xavier Carcopino, Sofiane Bendifallah, Lobna Ouldamer, Vincent Lavoue, Geoffroy Canlorbe, Emilie Raimond, Charles Coutant, Olivier Graesslin, Pierre Collinet, Alexandre Bricou, Emile Daraï, Cyrille Huchon, Marcos Ballester, Bassam Haddad, Cyril Touboul, and For the Groupe de Recherche FRANCOGYN
Subjects: Cervical cancer, Locally advanced cervical cancer, Nodal surgical staging, Paraaortic lymph nodes invasion, Medicine
Abstract: Abstract Background The prognostic impact of surgical paraaortic staging remains unclear in patients with locally advanced cervical cancer (LACC). The objective of our study was to evaluate the survival impact of surgical staging in patients with LACC and no evidence of paraaortic lymph node (PALN) metastasis on pre-operative imaging work-up. Methods Data of 1447 patients with cervical cancer treated between 1996 and 2016 were extracted from maintained databases of 10 French University hospitals. Patients with locally advanced disease (IB2 or more) treated by concurrent chemoradiation therapy (CRT) and no evidence of paraaortic metastasis on pre-operative imaging work-up were selected for further analysis. The Kaplan–Meier method was used to estimate the survival distribution. A Cox proportional hazards model was used to account for the influence of multiple variables. Results Six hundred and forty-seven patients were included, 377 (58.3%) with surgical staging and 270 (41.7%) without, with a mean follow up of 38.1 months (QI 13.0–56.0). Pathologic analysis revealed positive lymph nodes in 47 patients (12.5%). In multivariate model analysis, surgical staging remained an independent prognostic factor for DFS (OR 0.64, CI 95% 0.46–0.89, p = 0.008) and OS (OR 0.43, CI 95% 0.27–0.68, p
Published: 2018
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5. Identification of a low risk population for parametrial invasion in patients with early-stage cervical cancer

Author: Yohann Dabi, Claire Willecocq, Marcos Ballester, Xavier Carcopino, Sofiane Bendifallah, Lobna Ouldamer, Vincent Lavoue, Geoffroy Canlorbe, Emilie Raimond, Charles Coutant, Olivier Graesslin, Pierre Collinet, Alexandre Bricou, Cyrille Huchon, Emile Daraï, Bassam Haddad, Cyril Touboul, and For the Groupe de Recherche FRANCOGYN
Subjects: Cervical cancer, Early-stage, Radical surgery, Predicting, Parametrial invasion, Low-risk, Medicine
Abstract: Abstract Background Recent studies have challenged radical procedures for less extensive surgery in selected patients with early-stage cervical cancer at low risk of parametrial invasion. Our objective was to identify a subgroup of patients at low risk of parametrial invasion among women having undergone surgical treatment. Methods Data of 1447 patients with cervical cancer treated between 1996 and 2016 were extracted from maintained databases of 10 French University hospitals. Patients with early-stage (IA2–IIA) disease treated by radical surgery including hysterectomy and trachelectomy, were selected for further analysis. The Kaplan–Meier method was used to estimate the survival distribution. A Cox proportional hazards model including all the parameters statistically significant in univariate analysis, was used to account for the influence of multiple variables. Results Out of the 263 patients included for analysis, on final pathology analysis 28 (10.6%) had parametrial invasion and 235 (89.4%) did not. Factors significantly associated with parametrial invasion on multivariate analysis were: age > 65 years, tumor > 30 mm in diameter measured by MRI, lymphovascular space invasion (LVSI) on pathologic analysis. Among the 235 patients with negative pelvic lymph nodes, parametrial disease was seen in only 7.6% compared with 30.8% of those with positive pelvic nodes (p
Published: 2018
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6. Presentation and Prognosis of Primary Expansile and Infiltrative Mucinous Carcinomas of the Ovary

Author: Marine Huin, Jerome Lorenzini, Flavie Arbion, Xavier Carcopino, Cyril Touboul, Yohann Dabi, Yohan Kerbage, Hélène Costaz, Lise Lecointre, Vincent Lavoué, Pierre-Adrien Bolze, Cyrille Huchon, Alexandre Bricou, Geoffroy Canlorbe, Camille Mimoun, Sofiane Bendifallah, Tristan Gauthier, Gilles Body, Lobna Ouldamer, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Nutrition, croissance et cancer (U 1069) (N2C), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Nord [CHU - APHM], Aix Marseille Université (AMU), Centre Hospitalier Intercommunal de Créteil (CHIC), CHU Lille, Hôpital Jeanne de Flandre [Lille], Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, CHU Strasbourg, CHU Pontchaillou [Rennes], Oncogenesis, Stress, Signaling (OSS), Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), CHI Poissy-Saint-Germain, Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], CHU Tenon [AP-HP], CHU Limoges, None, and Jonchère, Laurent
Subjects: expansile mucinous carcinomas, [SDV.CAN] Life Sciences [q-bio]/Cancer, lymphadenectomy, mucinous ovarian carcinoma, [SDV.CAN]Life Sciences [q-bio]/Cancer, General Medicine, prognosis
Abstract: International audience; Objective: The aim of the present study was to evaluate evolution and prognosis of mucinous ovarian carcinomas (mOC), with respect to the two invasive patterns: expansile and infiltrative invasion. Methods: This was a descriptive, retrospective, multicenter study conducted in 13 French centres from 1 January 2001 to 31 December 2019. All patients operated on for epithelial ovarian neoplasia of the mucinous type (infiltrative/ expansile) were included, whether the surgery was performed immediately or after neoadjuvant chemotherapy. Results: A total of 94 women with mucinous carcinomas were included in the present study. Mucinous tumours were divided into 35 expansile (37%) and 59 infiltrative (63%) mOC. There was a statistically significant difference in early and late stages at initial diagnosis between expansile and infiltrative mOC. None of the expansile mOC showed metastatic lymph nodes, whereas almost a quarter of the infiltrative mOC were metastatic to the pelvic /para-aortic region. There was a clear difference in RFS, in favour of expansile mOC, with 90% survival at 5 years, compared with 60% for infiltrative mOC. Conclusions: Although infiltrative and expansile mOC belong to the same histological family, they present many distinctions in clinical presentation, histological invasion, and disease course.
Published: 2022
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7. Lymphovascular space invasion as a prognostic factor of epithelial ovarian cancer: a multicenter study by the FRANCOGYN group

Author: Xavier Carcopino, Vincent Lavoué, Cyrille Huchon, Camille Mimoun, Gilles Body, Julien Cirier, Pierre Collinet, Marcos Ballester, Yohann Dabi, Sofiane Bendifallah, Geoffroy Canlorbe, Jerome Lorenzini, Alexandre Bricou, Cherif Akladios, Charles Coutant, Lobna Ouldamer, Pierre-Adrien Bolze, Cyril Touboul, Service de Gynécologie-Obstétrique, Centre Olympe de Gouge, Centre Expert en Endométriose [CHU Tenon] (GRC6 C3E), CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, CHU Strasbourg, Département de chirurgie, CRLCC Eugène Marquis (CRLCC), Hospices Civils de Lyon (HCL), Service de gynécologie-obstétrique [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Centre National de la Recherche Scientifique (CNRS)-Institut de recherche pour le développement [IRD] : UMR237-Aix Marseille Université (AMU)-Avignon Université (AU), and Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS)
Subjects: Oncology, medicine.medical_specialty, Prognostic factor, [SDV]Life Sciences [q-bio], Carcinoma, Ovarian Epithelial, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Overall survival, Humans, Neoplasm Invasiveness, In patient, Epithelial ovarian cancer, ComputingMilieux_MISCELLANEOUS, Neoplasm Staging, Retrospective Studies, Ovarian Neoplasms, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics and Gynecology, General Medicine, Prognosis, medicine.disease, Lymphovascular, Endometrial Neoplasms, 3. Good health, Predictive factor, Multicenter study, Lymphatic Metastasis, 030220 oncology & carcinogenesis, Female, Ovarian cancer, business
Abstract: The presence of lymphovascular space invasion (LVSI) is not yet included in international recommendations neither as a prognostic factor nor as a parameter for the decision to use adjuvant chemotherapy in FIGO stage I/IIa ovarian cancer (OC).This study set out to evaluate the impact of LVSI on Overall Survival (OS) and Recurrence-Free Survival (RFS) in patients managed for epithelial OC.Retrospective multicenter study by the research group FRANCOGYN between January 2001 and December 2018. All patients managed for epithelial OC surgery and for whom histological slides for the review of LVSI were available, were included. The characteristics of patients with LVSI (LVSI group) were compared to those without LVSI (No-LVSI group). A Cox analysis for OS and RFS analysis was performed in all the populations.French multicenter tertiary care centers RESULTS: Over the study period, 852 patients were included in the 13 institutions. Among them, 289 patients had LVSI (33.9%). There was a significant difference in the distribution of LVSI between early and advanced stages (p 0.001). LVSI was an independent predictive factor for poorer Overall and Recurrence-Free Survival. LVSI affected OS (p 0.001) and RFS (p 0.001), LVSI affected OS and RFS for early stages (p = 0.001; p = 0.001, respectively) and also for advanced stages (p = 0.01; p = 0.009, respectively).The presence of LVSI in epithelial ovarian epithelial tumors has an impact on OS and RFS and should be included in the routine pathology examination to adapt therapeutic management, especially for women in the early stages of the disease.
Published: 2021
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8. Management of borderline ovarian tumours during pregnancy: Results of a French multi-centre study

Author: Geoffroy Canlorbe, M. Koskas, Matthieu Mezzadri, Charles Coutant, Marcos Ballester, Chantal Touboul, Sofiane Bendifallah, L. Ouldamer, Camille Mimoun, Olivier Graesslin, Henri Azaïs, Cyrille Huchon, Emilie Raimond, Pauline Chauvet, Tristan Gauthier, Cherif Akladios, M. Zilliox, M. Lapointe, Yohann Dabi, Pierre-Adrien Bolze, Ludivine Dion, Vincent Lavoué, Alexandre Bricou, Lise Lecointre, Nicolas Bourdel, P. Collinet, Xavier Carcopino, Institut Pascal (IP), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne (UCA)-Institut national polytechnique Clermont Auvergne (INP Clermont Auvergne), and Université Clermont Auvergne (UCA)-Université Clermont Auvergne (UCA)
Subjects: medicine.medical_specialty, medicine.medical_treatment, Cystectomy, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Laparotomy, medicine, Humans, Multicenter Studies as Topic, 030212 general & internal medicine, Stage (cooking), Child, Laparoscopy, ComputingMilieux_MISCELLANEOUS, Neoplasm Staging, Retrospective Studies, Ovarian Neoplasms, 030219 obstetrics & reproductive medicine, medicine.diagnostic_test, business.industry, Obstetrics and Gynecology, Magnetic resonance imaging, medicine.disease, Surgery, Serous fluid, Reproductive Medicine, Population study, Female, Neoplasm Recurrence, Local, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Objective To assess the diagnostic and prognostic characteristics of borderline ovarian tumours (BOTs) detected during pregnancy, and to establish an inventory of French practices. Materials and methods A retrospective multi-centre case study of 14 patients treated for BOTs, diagnosed during pregnancy between 2005 and 2017, in five French pelvic cancerology expert centres, including data on clinical characteristics, histological tumour characteristics, surgical procedure, adjuvant treatments, follow-up and fertility. Results The mean age of patients was 29.3 [standard deviation (SD) 6.2] years. Most BOTs were diagnosed on ultrasonography in the first trimester (85.7 %), and most of these cases (78.5 %) also underwent magnetic resonance imaging to confirm the diagnosis (true positives 54.5 %). Most patients underwent surgery during pregnancy (57 %), with complete staging surgery in two cases (14.3 %). Laparoscopy was performed more frequently than other procedures (50 %), and unilateral adnexectomy was more common than cystectomy (57.5 %). Tumour size influenced the surgical approach significantly (mean size 7.5 cm for laparoscopy, 11.9 cm for laparoconversion, 14 cm for primary laparotomy; P = 0.08), but the type of resection did not. Most patients were initially diagnosed with International Federation of Gynecology and Obstetrics stage IA (92.8 %) tumours, but many were upstaged after complete restaging surgery (57.1 %). Most BOTs were serous (50 %), two cases had a micropapillary component (28.5 %), and one case had a micro-invasive implant. BOTs were bilateral in two cases (14.2 %). Mean follow-up was 31.4 (SD 14.8) months. Recurrent lesions occurred in two patients (14.2 %) and no deaths have been recorded to date among the study population. Conclusion BOTs remain rare, but this study – despite its small sample size – supports the hypothesis that BOTs during pregnancy have potentially aggressive characteristics.
Published: 2021
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9. Risk Factors for Recurrence of Borderline Ovarian Tumours after Conservative Surgery and Impact on Fertility: A Multicentre Study by the Francogyn Group

Author: Adele Ozenne, Marion De Berti, Gilles Body, Xavier Carcopino, Olivier Graesslin, Yohan Kerbage, Cherif Akladios, Cyrille Huchon, Alexandre Bricou, Camille Mimoun, Emilie Raimond, Lobna Ouldamer, Service de Gynécologie-Obstétrique [CHRU Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Nutrition, croissance et cancer (U 1069) (N2C), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Service de gynécologie-obstétrique [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Université de Reims Champagne-Ardenne (URCA), Hôpital Jeanne de Flandres, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Strasbourg, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Service de gynécologie-obstétrique [Hôpital Jean Verdier, Bondy], Université Paris 13 (UP13)-Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de gynécologie et obstétrique [Hopital Lariboisière - Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), and HAL UVSQ, Équipe
Subjects: fertility, recurrence, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, ovarian tumours, conservative treatment, [SDV.CAN]Life Sciences [q-bio]/Cancer, General Medicine, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, peritoneal staging, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, [SDV.CAN] Life Sciences [q-bio]/Cancer, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Abstract: Introduction: Borderline ovarian tumours (BOT) represent 10–20% of epithelial tumours of the ovary. Although their prognosis is excellent, the recurrence rate can be as high as 30%, and recurrence in the infiltrative form accounts for 3% to 5% of recurrences. Affecting, in one third of cases, women of childbearing age, the surgical strategy with ovarian conservation is now recommended despite a significant risk of recurrence. Few studies have focused exclusively on patients who have received ovarian conservative treatment in an attempt to identify factors predictive of recurrence and the impact on fertility. The objective of this study was to identify the risk factors for recurrence of BOT after conservative treatment and the impact on fertility. Material and methods: This was a retrospective, multicentre study of women who received conservative surgery for BOT between February 1997 and September 2020. We divided the patients into two groups, the “R group” with recurrence and the “NR group” without recurrence. Results: Of 175 patients included, 35 had a recurrence (R group, 20%) and 140 had no recurrence (NR group, 80%). With a mean follow-up of 30 months (IQ 8–62.5), the overall recurrence rate was 20%. Recurrence was BOT in 17.7% (31/175) and invasive in 2.3% (4/175). The mean time to recurrence was 29.5 months (IQ 16.5–52.5). Initial complete peritoneal staging (ICPS) was performed in 42.5% of patients (n = 75). In multivariate analysis, age at diagnosis, nulliparity, advanced FIGO stage, the presence of peritoneal implants, and the presence of a micropapillary component for serous tumours were factors influencing the occurrence of recurrence. The post-surgery fertility rate was 67%. Conclusion: This multicentre study is to date one of the largest studies analysing the risk factors for recurrence of BOT after conservative surgery. Five risk factors were found: age at diagnosis, nulliparity, advanced FIGO stage, the presence of implants, and a micropapillary component. Only 25% of the patients with recurrence underwent ICPS. These results reinforce the interest of initial peritoneal staging to avoid ignoring an advanced tumour stage.
Published: 2022
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10. Prognostic factors of overall survival for patients with FIGO stage IIIc or IVa ovarian cancer treated with neo-adjuvant chemotherapy followed by interval debulking surgery: A multicenter cohort analysis from the FRANCOGYN study group

Author: Laura Vincent, L Bengrine, Lobna Ouldamer, C. Jankowski, Laurent Arnould, H. Costaz, Cherif Akladios, Marcos Ballester, Geoffroy Canlorbe, Vincent Lavoué, S. Dridi, Pierre Adrien Bolze, M M Padéano, Cyrille Huchon, Sofiane Bendifallah, Groupe de Recherche Francogyn, Alexandre Bricou, C Touboul, Pierre Collinet, Charles Coutant, Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, Nutrition, croissance et cancer (U 1069) (N2C), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe Hospitalier Diaconesses Croix Saint-Simon, CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), CHU Strasbourg, CHU Pontchaillou [Rennes], Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Hôpital Jeanne de Flandres, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Intercommunal de Créteil (CHIC), CHI Poissy-Saint-Germain, Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Jonchère, Laurent, Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Tours
Subjects: Neoplasm, Residual, medicine.medical_treatment, Genes, BRCA2, FIGO Stage IIIC, Genes, BRCA1, Platinum Compounds, Carcinoma, Ovarian Epithelial, Cohort Studies, 0302 clinical medicine, Ascitic Fluid, Overall survival, Peritoneal Lavage, 030212 general & internal medicine, Ovarian Neoplasms, Univariate analysis, Cytoreduction Surgical Procedures, General Medicine, Middle Aged, Prognosis, Debulking, Neoadjuvant Therapy, 3. Good health, Survival Rate, Oncology, 030220 oncology & carcinogenesis, Female, Taxoids, France, Omentum, Cohort study, medicine.medical_specialty, [SDV.CAN]Life Sciences [q-bio]/Cancer, Antineoplastic Agents, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Interval debulking surgery, Neoadjuvant chemotherapy, Pelvis, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, Ovarian cancer, Median follow-up, medicine, Humans, Neoplasm Invasiveness, Aged, Neoplasm Staging, Proportional Hazards Models, business.industry, Retrospective cohort study, medicine.disease, Surgery, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Multivariate Analysis, Lymph Node Excision, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Lymphadenectomy, Lymph Nodes, business
Abstract: International audience; Introduction The aim of this study was to identify prognostic factors of overall survival in patients with FIGO stage IIIc or IVa ovarian cancer (OC) treated by neo-adjuvant chemotherapy (NAC) followed by interval debulking surgery.Materials and methods Data from 483 patients with ovarian cancer were retrospectively collected, from January 1, 2000 to December 31, 2016, from the FRANCOGYN database, regrouping data from 11 centers specialized in ovarian cancer treatment. Median overall survival was determined using the Kaplan-Meier method. Univariate and multivariate analysis were performed to define prognostic factors of overall survival.Results The median overall survival was 52 after a median follow up of 30 months. After univariate analysis, factors significantly associated with decreased overall survival were; no pelvic and/or para-aortic lymphadenectomy (p = 0.002), residual disease (CC1/CC2/CC3) after surgery (p < 0.001), positive cytology after NAC (p < 0.001), omental disease after NAC (p = 0.002), no pathologic complete response (pCR) (p = 0.002). In multivariate analysis, factors significantly associated with decreased overall survival were; residual disease after surgery (HR = 1.93; CI95% (1.16–3.21), p = 0.01) and positive cytology after NAC (HR = 1.59; CI95% (1.01–2.55), p = 0.05). Patients with no residual disease after surgery had a median overall survival of 64 months versus 35 months for patients with residual disease. Patients with negative cytology after NAC had a median overall survival of 71 months versus 43 months for patients with positive cytology after NAC.Conclusion In this first and largest French based retrospective study, complete cytoreductive surgery in ovarian cancer remains the main prognostic factor of overall survival.
Published: 2020
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11. Prise en charge chirurgicale des cancers gynécologiques en période de pandémie COVID-19 – Recommandations du Groupe FRANCOGYN pour le CNGOF

Author: Geoffroy Canlorbe, Ludivine Dion, Vincent Lavoué, Emilie Raimond, P. Collinet, Cherif Akladios, Nicolas Bourdel, Yohann Dabi, Chantal Touboul, Olivier Graesslin, Henri Azaïs, Matthieu Mezzadri, Alexandre Bricou, Lise Lecointre, Marcos Ballester, Camille Mimoun, Tristan Gauthier, Frédéric Kridelka, Pauline Chauvet, Pierre-Adrien Bolze, Sofiane Bendifallah, Xavier Carcopino, C. Huchon, Charles Coutant, M. Koskas, and L. Ouldamer
Subjects: Cervical cancer, medicine.medical_specialty, 030219 obstetrics & reproductive medicine, Hysterectomy, medicine.diagnostic_test, business.industry, General surgery, medicine.medical_treatment, Endometrial cancer, Sentinel lymph node, Obstetrics and Gynecology, Cancer, medicine.disease, Radiation therapy, 03 medical and health sciences, 0302 clinical medicine, Reproductive Medicine, 030220 oncology & carcinogenesis, Obstetrics and Gynaecology, medicine, Hyperthermic intraperitoneal chemotherapy, business, Endometrial biopsy
Abstract: INTRODUCTION: Recommendations for the management of patients with gynecological cancer during the COVID-19 pandemic period. MATERIAL AND METHOD: Recommendations based on the consensus conference model. RESULTS: In the case of a COVID-19 positive patient, surgical management should be postponed for at least 15 days. For cervical cancer, the place of surgery must be re-evaluated in relation to radiotherapy and Radio-Chemotherapy-Concomitant and the value of lymph node staging surgeries must be reviewed on a case-by-case basis. For advanced ovarian cancers, neo-adjuvant chemotherapy should be favored even if primary cytoreduction surgery could be envisaged. It is lawful not to offer hyperthermic intraperitoneal chemotherapy during a COVID-19 pandemic. In the case of patients who must undergo interval surgery, it is possible to continue the chemotherapy and to offer surgery after 6 cycles of chemotherapy. For early stage endometrial cancer, in case of low and intermediate preoperative ESMO risk, hysterectomy with bilateral annexectomy associated with a sentinel lymph node procedure should be favored. It is possible to consider postponing surgery for 1 to 2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For high ESMO risk, it ispossible to favor the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) in order to omit pelvic and lumbar-aortic lymphadenectomies. CONCLUSION: During COVID-19 pandemic, patients suffering from cancer should not lose life chance, while limiting the risks associated with the virus.
Published: 2020
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12. Lymphovascular invasion as a criterion for adjuvant chemotherapy for FIGO stage I-IIa clear cell carcinoma, mucinous,low grade serous and low grade endometrioid ovarian cancer

Author: Geoffroy Canlorbe, Julie Delvallée, Lobna Ouldamer, Charles Coutant, Alexandre Bricou, Pierre Collinet, Emile Daraï, Cyril Touboul, Sofiane Bendifallah, Gilles Body, Cherif Akladios, Mathilde Cancel, Camille Mimoun, Pierre-Adrien Bolze, Xavier Carcopino, Cyrille Huchon, Marcos Ballester, Yohann Dabi, Vincent Lavoué, Nutrition, croissance et cancer (U 1069) (N2C), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHI Créteil, CHU Lille, Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, CHU Strasbourg, Chemistry, Oncogenesis, Stress and Signaling (COSS), Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Gynécologie et Obstétrique [Rennes] = Gynaecology [Rennes], CHU Pontchaillou [Rennes], Hospices Civils de Lyon (HCL), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pitié-Salpêtrière [AP-HP], Groupe Hospitalier Diaconesses Croix Saint-Simon, Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Hôpital Lariboisière-Fernand-Widal [APHP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS)-Institut de recherche pour le développement [IRD] : UMR237-Aix Marseille Université (AMU)-Avignon Université (AU), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CRLCC Eugène Marquis (CRLCC)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), and Jonchère, Laurent
Subjects: Oncology, endocrine system diseases, Lymphovascular invasion, Adjuvant chemotherapy, 0302 clinical medicine, Overall survival, Stage (cooking), Neoplasm Metastasis, Aged, 80 and over, Ovarian Neoplasms, education.field_of_study, 030219 obstetrics & reproductive medicine, Obstetrics and Gynecology, Middle Aged, Prognosis, Adenocarcinoma, Mucinous, Lymphovascular, female genital diseases and pregnancy complications, 3. Good health, Serous fluid, Chemotherapy, Adjuvant, 030220 oncology & carcinogenesis, Clear cell carcinoma, Female, France, Adult, medicine.medical_specialty, Adolescent, Lymphovascular space invasion, Population, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Decision Support Techniques, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, Ovarian cancer, Internal medicine, medicine, Humans, education, [SDV.BDLR] Life Sciences [q-bio]/Reproductive Biology, Aged, Neoplasm Staging, Retrospective Studies, business.industry, [SDV.BDLR]Life Sciences [q-bio]/Reproductive Biology, medicine.disease, Recurrence-free survival, Endometrial Neoplasms, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Reproductive Medicine, business, Adenocarcinoma, Clear Cell
Abstract: International audience; BACKGROUND: The aim of this study was to evaluate the impact of lymphovascular space invasion (LVSI) on overall survival (OS) and recurrence-free survival (RFS) in patients managed for stage I-IIa clear cell carcinoma, mucinous, low-grade serous and low-grade endometrioid ovarian cancer MATERIAL AND METHODS: Retrospective multicentre study of the research group FRANCOGYN between January 2001 and December 2018. All patients managed for stage I-IIa clear cell carcinoma, mucinous /low grade serous and endometrioid ovarian cancer and for whom the presence of histological slides for the review of LVSI was available, were included. Patient’s characteristics with LVSI (LVSI group) were compared to those without LVSI (No LVSI group). A cox analysis for OS and RFS analysis were performed in all population. RESULTS: Over the study period, 133 patients were included in the thirteen institutions. Among them, 12 patients had LVSI (9%). LVSI was an independent predictive factor for poorer Overall and recurrence free survivals. LVSI affected OS (p
Published: 2021
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13. Adherence to European ovarian cancer guidelines and impact on survival: a French multicenter study (FRANCOGYN)

Author: Tamara De Rozario, Denis Querleu, Geoffroy Canlorbe, Yohann Dabi, Cyril Touboul, Pierre Collinet, Charles Coutant, Alexandre Bricou, Lise Lecointre, Cherif Akladios, Mathieu Mezzadri, Lobna Ouldamer, Pierre-Adrien Bolze, Sofiane Bendifallah, Floriane Jochum, Thomas Boisramé, Cyrille Huchon, Vincent Lavoué, Emilie Faller, Les Hôpitaux Universitaires de Strasbourg (HUS), Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Intercommunal de Créteil (CHIC), Université de Rennes - Faculté de Médecine (UR Médecine), Université de Rennes (UR), Chemistry, Oncogenesis, Stress and Signaling (COSS), Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, Hospices Civils de Lyon (HCL), Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Jeanne de Flandre [Lille], Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], CHU Tenon [AP-HP], CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Hôpital Lariboisière-Fernand-Widal [APHP], Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors., Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Réseau nanophotonique et optique, Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes 1 - Faculté de Médecine (UR1 Médecine), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Institut National de la Santé et de la Recherche Médicale (INSERM)-CRLCC Eugène Marquis (CRLCC)-Université de Rennes 1 (UR1)
Subjects: medicine.medical_specialty, [SDV.CAN]Life Sciences [q-bio]/Cancer, Gynecologic oncology, Carcinoma, Ovarian Epithelial, 03 medical and health sciences, surgical oncology, 0302 clinical medicine, Surgical oncology, Internal medicine, Animals, Humans, Medicine, 030212 general & internal medicine, Survival analysis, Aged, Retrospective Studies, Ovarian Neoplasms, Performance status, business.industry, Proportional hazards model, Hazard ratio, Obstetrics and Gynecology, Guideline, Middle Aged, Survival Analysis, medical oncology, 3. Good health, ovarian cancer, Oncology, 030220 oncology & carcinogenesis, Practice Guidelines as Topic, Female, France, Guideline Adherence, business, Cohort study
Abstract: ObjectiveThe primary objective of the study was to validate the European Society for Medical Oncology (ESMO)–European Society of Gynecologic Oncology (ESGO) ovarian cancer guideline as a method of assessing quality of care, and to identify patient characteristics predictive of non-adherence to European guideline care. The secondary objectives were to analyze the evolution of practices over the years and to evaluate heterogeneity between centers.MethodsThis retrospective multicenter cohort study of invasive epithelial ovarian cancer reported to the FRANCOGYN database included data from 12 French centers between January 2000 and February 2017. The main outcome was adherence to ESMO–ESGO guidelines, defined by recommended surgical procedures according to the International Federation of Gynecology and Obstetrics (FIGO) stage and appropriate chemotherapy. Mixed multivariable logistic regression analysis with a random center effect was performed to estimate the probability of adherence to the guidelines. Survival analysis was carried out using the Kaplan–Meier method and a mixed Cox proportional hazards model.Results1463 patients were included in the study. Overall, 317 (30%) patients received complete guideline adherent care. Patients received appropriate surgical treatment in 69% of cases, while adequate chemotherapy was administered to 44% of patients. Both patient demographics and disease characteristics were significantly associated with the likelihood of receiving guideline adherent care, such as age, performance status, FIGO stage, and initial burden of disease. In univariate and multivariate survival analysis, adherence to the guidelines was a statistically significant and independent predictor of decreased overall survival. Patients receiving suboptimal care experienced an increased risk of death of more than 100% compared with those treated according to the guidelines (hazard ratio 2.14, 95% confidence interval 1.32 to 3.47, pConclusionsAdherence to ESMO–ESGO guidelines in ovarian cancer was associated with a higher overall survival and may be a useful method of assessing quality of care.
Published: 2021
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14. Lymphovascular space invasion and estrogen receptor status in high-grade serous ovarian cancer - A multicenter study by the FRANCOGYN group

Author: Camille Mimoun, Jerome Lorenzini, Geoffroy Canlorbe, Vincent Lavoué, Marion Deberti, Pierre Collinet, Cherif Akladios, Alexandre Bricou, Cyril Touboul, Charles Coutant, Xavier Carcopino, Cyrille Huchon, Yohann Dabi, Gilles Body, Pierre-Adrien Bolze, Sofiane Bendifallah, Lobna Ouldamer, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Nutrition, croissance et cancer (U 1069) (N2C), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Centre National de la Recherche Scientifique (CNRS)-Institut de recherche pour le développement [IRD] : UMR237-Aix Marseille Université (AMU)-Avignon Université (AU), CHI Créteil, Hôpital Jeanne de Flandre [Lille], Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, CHU Strasbourg, CHU Pontchaillou [Rennes], Chemistry, Oncogenesis, Stress and Signaling (COSS), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon, Departement de Neurologie (HCL), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), CHI Poissy-Saint-Germain, Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CRLCC Eugène Marquis (CRLCC)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), and Jonchère, Laurent
Subjects: Oncology, Adult, medicine.medical_specialty, [SDV.CAN]Life Sciences [q-bio]/Cancer, Kaplan-Meier Estimate, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, 03 medical and health sciences, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, Serous ovarian cancer, Overall survival, Medicine, Humans, Estrogen Receptor Status, Pathology Examination, Aged, Retrospective Studies, Aged, 80 and over, Ovarian Neoplasms, 030219 obstetrics & reproductive medicine, business.industry, Overall Survival, Lymphovascular Space Invasion, Obstetrics and Gynecology, Middle Aged, Prognosis, Lymphovascular, 3. Good health, Predictive factor, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Serous fluid, Recurrence-Free Survival, Reproductive Medicine, Multicenter study, Receptors, Estrogen, 030220 oncology & carcinogenesis, Lymphatic Metastasis, Female, France, business, High-Grade Serous
Abstract: International audience; BACKGROUND: The aim of this study was to evaluate the impact of Lymphovascular Space Invasion (LVSI) on Overall Survival (OS) and Recurrence-Free Survival (RFS) in patients managed for high-grade serous epithelial ovarian cancer (HGSOC). MATERIALS AND METHODS: Retrospective multicenter study by the FRANCOGYN research group between January 2001 and December 2018. All patients managed for HGSOC and for whom histological slides for the review of LVSI were available, were included. The characteristics of patients with LVSI (LVSI group) were compared to those without LVSI (No LVSI group). A Cox analysis for OS and RFS analysis was performed in all populations. RESULTS: Over the study period, 410 patients were included in the thirteen institutions. Among them, 289 patients had LVSI (33.9%). LVSI was an independent predictive factor for poorer Overall and Recurrence-Free Survival. LVSI affected OS (p
Published: 2021
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15. How to predict para-aortic node involvement in advanced cervical cancer? Development of a predictive score. A FRANCOGYN study

Author: C Touboul, Alexandre Bricou, Pierre Collinet, Y. Dabi, Emilie Raimond, Sofiane Bendifallah, Xavier Carcopino, Marcos Ballester, Vincent Lavoué, Cyrille Huchon, H.T. Nguyen-Xuan, Yohan Kerbage, Louise Benoit, Lobna Ouldamer, CHI Poissy-Saint-Germain, Institut Universitaire de Cancérologie [Paris] (IUC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Groupe Hospitalier Diaconesses Croix Saint-Simon, CHU Lille, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Pontchaillou [Rennes], CRLCC Eugène Marquis (CRLCC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES), Assistance Publique - Hôpitaux de Marseille (APHM), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Institut Universitaire de Cancérologie [Sorbonne Université] (IUC), and Université de Rennes (UR)
Subjects: Oncology, medicine.medical_specialty, Multivariate analysis, [SDV]Life Sciences [q-bio], Population, Uterine Cervical Neoplasms, Logistic regression, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, Positron Emission Tomography Computed Tomography, Medicine, Humans, education, Lymph node, Retrospective Studies, Cervical cancer, education.field_of_study, 030219 obstetrics & reproductive medicine, Pelvic MRI, Tumor size, business.industry, Univariate, General Medicine, Middle Aged, medicine.disease, Prognosis, Advanced cervical cancer, 3. Good health, medicine.anatomical_structure, Para-aortic lymph node, Predictive model, 030220 oncology & carcinogenesis, Lymphatic Metastasis, Carcinoma, Squamous Cell, Surgery, Female, France, business
Abstract: International audience; INTRODUCTION: Node involvement is one of the main prognostic factors for cervical cancer. Para-aortic lymph node (PALN) assessment is crucial for treating advanced cervical cancer, to define irradiation fields. Objective of this study was to develop a score predicting para-aortic lymph node involvement in patients with advanced cervical cancer. PATIENTS AND METHOD: We performed a multicenter, retrospective, study on 9 French centers from 2000 to 2015, including patients with advanced squamous cell cervix carcinoma who had PALN status assessed by imaging and/or by surgery. Factors associated with a risk of PALN involvement were determined by univariate and multivariate analysis using a logistic regression model. A score was then developed and validated. RESULTS: A total of 1446 patients treated for cervical cancer were included. Of these, 498 had an advanced squamous cell cervical cancer. Ninety-one patients (18.3%) had positive PALN. After univariate and multivariate analysis, tumor size on pelvic MRI, initial SCC, and suspected pelvic node involvement on PET-CT were included in our score. This model allowed the population to be divided into 3 risk groups. Area under the ROC curve of the score was 0.81 (95%CI = 0.72-0.90). In the low-risk group, 9% (28/287) had PALN involvement, whereas in the high-risk group, 43% (22/51) had PALN involvement. CONCLUSION: We developed a simple score predicting PALN involvement in advanced cervical cancers. Three risk groups can be defined, and patients considered to be at low risk may avoid para-aortic staging as well as extensive field irradiation.
Published: 2021
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16. Does Time-to-Chemotherapy after Primary Complete Macroscopic Cytoreductive Surgery Influence Prognosis for Patients with Epithelial Ovarian Cancer? A Study of the FRANCOGYN Group

Author: Vincent Lavoué, Cyril Touboul, Catherine Uzan, Yohann Dabi, Geoffroy Canlorbe, Thomas Gaillard, Cyrille Huchon, Pierre Collinet, Alexandre Bricou, Cherif Akladios, Marcos Ballester, Henri Azaïs, Charles Coutant, Grégoire Rocher, Pierre-Adrien Bolze, Lobna Ouldamer, Sofiane Bendifallah, Emilie Raimond, Service de Chirurgie et Cancérologie Gynécologique et Mammaire [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), Institut Universitaire de Cancérologie [Paris] (IUC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Hôpital Jeanne de Flandres, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Groupe Hospitalier Diaconesses Croix Saint-Simon, Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, CHU Pontchaillou [Rennes], Centre Hospitalier Intercommunal de Créteil (CHIC), CHU Strasbourg, Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, Centre Hospitalier Universitaire de Reims (CHU Reims), Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Gestionnaire, Hal Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], Service de chirurgie gynécologique et mammaire [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: epithelial ovarian cancer, medicine.medical_specialty, endocrine system diseases, Adjuvant chemotherapy, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Population, lcsh:Medicine, chemotherapy, Gastroenterology, Article, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Overall survival, Epithelial ovarian cancer, cardiovascular diseases, education, education.field_of_study, Chemotherapy, 030219 obstetrics & reproductive medicine, business.industry, lcsh:R, Advanced stage, Retrospective cohort study, General Medicine, female genital diseases and pregnancy complications, 3. Good health, [SDV] Life Sciences [q-bio], 030220 oncology & carcinogenesis, prognosis, business, Cytoreductive surgery
Abstract: To determine if the time-to-chemotherapy (TTC) after primary macroscopic complete cytoreductive surgery (CRS) influences recurrence-free survival (RFS) and overall survival (OS) in patients with epithelial ovarian cancer (EOC). We conducted an observational multicenter retrospective cohort analysis of women with EOC treated from September 2006 to November 2016 in nine institutions in France (FRANCOGYN research group) with maintained EOC databases. We included women with EOC (all FIGO stages) who underwent primary complete macroscopic CRS prior to platinum-based adjuvant chemotherapy. Two hundred thirty-three patients were included: 73 (31.3%) in the early-stage group (ESG) (FIGO I-II), and 160 (68.7%) in the advanced-stage group (ASG) (FIGO III-IV). Median TTC was 43 days (36–56). The median OS was 77.2 months (65.9–106.6). OS was lower in the ASG when TTC exceeded 8 weeks (70.5 vs. 59.3 months, p = 0.04). No impact on OS was found when TTC was below or above 6 weeks (78.5 and 66.8 months, respectively, p = 0.25). In the whole population, TTC had no impact on RFS or OS. None of the factors studied were associated with an increase in TTC. Chemotherapy should be initiated as soon as possible after CRS. A TTC greater than 8 weeks is associated with poorer OS in patients with advanced stage EOC.
Published: 2021
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17. Prognosis impact of posttreatment pelvic MRI in patients treated for stage IB2-IIB cervical cancer with chemoradiation therapy

Author: Cyril Touboul, Olivier Graesslin, François Golfier, Marcos Ballester, Sophie Knight, Alexandre Bricou, Yohan Kerbage, Pierre Adrien Bolze, Sofiane Bendifallah, Cyrille Huchon, Ludivine Dion, Emilie Raimond, Yohann Dabi, Florence Rodriguez, Vincent Lavoué, Lobna Ouldamer, Geoffroy Atrous, Xavier Carcopino, Pierre Collinet, Myriam Mimouni, Tiphaine Moussilmani, Julien Mancini, Jonchère, Laurent, Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Hôpital Nord [CHU - APHM], Biostatistique et technologies de l'information et de la communication (BioSTIC) - [Hôpital de la Timone - APHM] (BiosTIC ), Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance Publique - Hôpitaux de Marseille (APHM), Hospices Civils de Lyon (HCL), Groupe Hospitalier Diaconesses Croix Saint-Simon, Hôpital Jeanne de Flandre [Lille], Nutrition, croissance et cancer (U 1069) (N2C), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Chemistry, Oncogenesis, Stress and Signaling (COSS), Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHI Créteil, Institut Mère Enfant Alix de Champagne, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), CHI Poissy-Saint-Germain, Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CRLCC Eugène Marquis (CRLCC)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Centre National de la Recherche Scientifique (CNRS)-Institut de recherche pour le développement [IRD] : UMR237-Aix Marseille Université (AMU)-Avignon Université (AU), Hôpital de la Timone [CHU - APHM] (TIMONE)-Assistance Publique - Hôpitaux de Marseille (APHM), Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: medicine.medical_specialty, Survival, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, medicine.medical_treatment, Uterine Cervical Neoplasms, [SDV.CAN]Life Sciences [q-bio]/Cancer, Disease, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Hysterectomy, 030218 nuclear medicine & medical imaging, Lesion, 03 medical and health sciences, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Predictive Value of Tests, Recurrence, medicine, Humans, In patient, Pelvic MRI, Stage (cooking), Neoplasm Staging, Retrospective Studies, Cervical cancer, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Chemoradiotherapy, General Medicine, Middle Aged, medicine.disease, Prognosis, Magnetic Resonance Imaging, 3. Good health, Survival Rate, Oncology, Chemoradiation, 030220 oncology & carcinogenesis, Female, Surgery, Radiology, Neoplasm Recurrence, Local, medicine.symptom, business
Abstract: International audience; OBJECTIVES: To evaluate the performances of systematic posttreatment pelvic magnetic resonance imaging (PPMRI) in predicting prognosis of patients treated with chemoradiation therapy (CRT) for locally advanced cervical cancer (LACC). MATERIALS AND METHODS: Multi-institutional data from 216 patients presenting FIGO IB2-IIB cervical cancer for which PPMRI was performed following CRT were retrospectively reviewed. Incomplete response was defined as the identification of persistent lesion on PPMRI. Primary endpoints were patients’ 5-year recurrence free (RFS) and overall (OS) survivals. Secondary endpoint was the identification of residual histologic disease on hysterectomy specimens when completion surgery was performed. RESULTS: PPMRI identified an incomplete response in 102 (47.2%) cases. A 70% or more reduction in tumor size on PPMRI was identified as the best predictive cut-off for recurrence (37.7% sensitivity and 78.7% specificity) and death (50% sensitivity and 77.9% specificity) with significant impact on those risks (HRa: 0.42; 95%CI: 0.23-0.77 and HRa: 0.18; 95%CI: 0.06-0.50, respectively). Completion hysterectomy was performed in 117 (54.4%) cases, with histologic residual disease in 55 (47.4%). PPMRI demonstrated 74.5% sensitivity and 50.8% specificity in predicting residual disease. Although survival of patients with complete response at PPMRI was not impacted by completion hysterectomy, it significantly increased 5-year RFS and OS of those with incomplete response: 38.7% vs. 65.3% (p
Published: 2021
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18. Prognostic Value and Risk Factors of Peritoneal Carcinomatosis Recurrence for Patients with Endometrial Cancer: A Multicenter Study from the FRANCOGYN Group

Author: Marcos Ballester, Vincent Lavoué, A Gaudet Chardonnet, Henri Azaïs, Lobna Ouldamer, Pierre Collinet, Alexandre Bricou, Geoffroy Canlorbe, Cyrille Huchon, Charles Coutant, Sofiane Bendifallah, Emile Daraï, Cyril Touboul, Olivier Graesslin, Emilie Raimond, Martin Koskas, Catherine Uzan, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Groupe Hospitalier Diaconesses Croix Saint-Simon, Centre Hospitalier Universitaire de Reims (CHU Reims), Pathologies biliaires, fibrose et cancer du foie [CHU Saint-Antoine], Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, CHI Créteil, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHI Poissy-Saint-Germain, Chemistry, Oncogenesis, Stress and Signaling (COSS), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Cochin [AP-HP], Pathologies biliaires, fibrose et cancer du foie [CRSA], Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), and Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Oncology, medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Surgical oncology, Internal medicine, Humans, Medicine, Prospective Studies, Risk factor, Prospective cohort study, Peritoneal Neoplasms, Neoplasm Staging, Retrospective Studies, Chemotherapy, business.industry, Endometrial cancer, Mortality rate, Odds ratio, Prognosis, medicine.disease, Endometrial Neoplasms, 3. Good health, Serous fluid, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Surgery, Neoplasm Recurrence, Local, business
Abstract: International audience; Background. The prognosis for patients with endometrial cancer (EC) peritoneal carcinomatosis (PC) recurrence has received little study. This study aimed to determine specific risk factors and prognosis of EC with PC recurrence (PCR) versus no PC recurrence (NPCR). Methods. Data of all patients with EC who received primary surgical treatment between January 2000 and February 2017 were abstracted from the French FRANCOGYN Research Group database. Clinical and pathologic variables were compared between the two groups (PCR vs. NPCR). Multivariate analysis was performed to define prognostic factors for peritoneal recurrence. Overall survivals (OS) of patients after recurrence were compared using the Kaplan-Meier method. Results. The study analyzed 1466 patients, and 257 of these patients (17.5%) had recurrence. At presentation, 63 of these patients had PC. International Federation of Gynecology and Obstetrics (FIGO) stages 3 and 4 disease were significantly associated with PCR versus NPCR (odds ratio 2.24; 95% confidence interval 1.23-4.07; p = 0.008). The death rate for the patients with PC was 47.6%, with a median survival of 12 months after diagnosis of recurrence. According to the histologic subtype, OS was 29 months (Q1-Q3, 13-NA) for endometrioid carcinomas, 7.5 months (Q1-Q3, 4-15) for serous carcinomas, and 10 months (Q1-Q3, 5-15) for clear cell carcinomas. Chemotherapy for treatment of PCR was associated with improved OS after recurrence (OSAR; p = 0.0025). Conclusion. An initial advanced stage of EC is a risk factor for PCR. For women with PCR, a diagnosis of type 1 EC recurrence more than 12 months after the initial treatment and management of PCR with chemotherapy is associated with improved OSAR. Prospective studies are needed to determine the precise optimal management required in this clinical situation and to assess the relevance of biomarkers to predict the risk of PCR for EC patients.
Published: 2021
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19. Recurrence Pattern of Cervical Cancer Based on the Platinum Sensitivity Concept: A Multi-Institutional Study from the FRANCOGYN Group

Author: Geoffroy Canlorbe, Emile Daraï, Cyrille Huchon, Cyril Touboul, Marcos Ballester, Olivier Graesslin, Tiphaine de Foucher, Xavier Carcopino, Pierre Adrien Bolze, Sofiane Bendifallah, Ludivine Dion, Emilie Raimond, François Golfier, Cherif Akladios, Vincent Lavoué, Pierre Collinet, Clémentine Owen, Yohan Kerbage, Lobna Ouldamer, Cecile Hennebert, Y. Dabi, Alexandre Bricou, Lise Lecointre, CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Intercommunal de Créteil (CHIC), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Pontchaillou [Rennes], CHU Pitié-Salpêtrière [AP-HP], Hospices Civils de Lyon (HCL), Les Hôpitaux Universitaires de Strasbourg (HUS), Hôpital Jeanne de Flandre [Lille], Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Hôpital Nord [CHU - APHM], Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Institut Mère Enfant Alix de Champagne, Groupe Hospitalier Diaconesses Croix Saint-Simon, Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Service de Gynécologie-Obstétrique, Maternité, Chirurgie Gynécologique [CHU Pitié-Salpêtrière], and Centre National de la Recherche Scientifique (CNRS)-Institut de recherche pour le développement [IRD] : UMR237-Aix Marseille Université (AMU)-Avignon Université (AU)
Subjects: Oncology, medicine.medical_specialty, Prognostic factor, Multivariate analysis, Standard of care, endocrine system diseases, medicine.medical_treatment, lcsh:Medicine, Article, 03 medical and health sciences, platinum sensitivity, 0302 clinical medicine, Internal medicine, medicine, Lymph node, 030304 developmental biology, Cervical cancer, 0303 health sciences, Chemotherapy, Platinum sensitivity, business.industry, lcsh:R, General Medicine, recurrence pattern, medicine.disease, female genital diseases and pregnancy complications, 3. Good health, medicine.anatomical_structure, 030220 oncology & carcinogenesis, business, Ovarian cancer, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, advanced cervical cancer
Abstract: The standard of care for patients with advanced cervical cancer (ACC) includes platinum-based chemotherapy. The concept of platinum sensitivity is a major prognostic factor for patients with ovarian cancer. The aim of this study was to validate the applicability of the platinum sensitivity concept to ACC patients, and to estimate its prognostic interest in terms of overall survival (OS) and pattern of recurrence (location, timing). Data of women with histologically proven FIGO 2019 stages IB3&ndash, IV ACC, treated between May 2000 and November 2017 with platinum-based regimens, were retrospectively abstracted from 12 institutions from the FRANCOGYN Group. Respective 3-year OSs were 52% (95% CI: 40.8%&ndash, 66.8%), 21.6% (95% CI: 12.6%&ndash, 37.2%), and 14.6% (95% CI: 4.2%&ndash, 50.2%), in case of recurrence &lt, 6 months, between 6 and 17 months, and &ge, 18 months (p &lt, 0.001). Risk of metastatic or multisite recurrence was significantly higher in case of recurrence &lt, 6 months, and risk of local or isolated infradiaphragmatic nodal recurrence was significantly higher in case of recurrence &gt, 0.001). In multivariate analysis, platinum sensitivity status was a strong prognostic factor for OS after recurrence, independent of histological grade, lympho-vascular space involvement, final lymph node status, and treatment. Platinum sensitivity status may help to classify patients in three prognostic subgroups for OS after recurrence, and appears to be a strong prognostic factor correlated to the pattern of recurrence.
Published: 2020
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20. PROGNOSTIC VALUE OF POSTTREATMENT FEDG-PET IMAGING FOLLOWING COMBINED CHEMORADIATION THERAPY IN LOCALLY ADVANCED CERVICAL CANCER

Author: Julien Mancini, Emilie Raimond, Yohan Kerbage, Marcos Ballester, Cyril Touboul, Xavier Carcopino, Ludivine Dion, Vincent Lavoué, Myriam Mimouni, Yohann Dabi, Cyrille Huchon, Alexandre Bricou, Sophie Knight, Pierre Collinet, François Golfier, Olivier Graesslin, Geoffroy Atrous, Lobna Ouldamer, Pierre Adrien Bolze, Sofiane Bendifallah, Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Centre National de la Recherche Scientifique (CNRS)-Institut de recherche pour le développement [IRD] : UMR237-Aix Marseille Université (AMU)-Avignon Université (AU), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Intercommunal de Créteil (CHIC), Hospices Civils de Lyon (HCL), Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Groupe Hospitalier Diaconesses Croix Saint-Simon, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Nutrition, croissance et cancer (U 1069) (N2C), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Chemistry, Oncogenesis, Stress and Signaling (COSS), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Reims (CHU Reims), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre d’Études et de Conservation des Œufs et du Sperme [CHU Jean Verdier] (CECOS), Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Jonchère, Laurent, Service de Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CRLCC Eugène Marquis (CRLCC)-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)
Subjects: Adult, medicine.medical_specialty, Neoplasm, Residual, Locally advanced, Uterine Cervical Neoplasms, [SDV.CAN]Life Sciences [q-bio]/Cancer, Disease, Completion surgery, Disease-Free Survival, 03 medical and health sciences, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Humans, Medicine, In patient, chemoradiation, Neoplasm Staging, Retrospective Studies, Cervical cancer, 030219 obstetrics & reproductive medicine, business.industry, FEDG-PET, Medical record, Obstetrics and Gynecology, Chemoradiotherapy, Pet imaging, Middle Aged, medicine.disease, 3. Good health, Treatment Outcome, Reproductive Medicine, Positron-Emission Tomography, 030220 oncology & carcinogenesis, Vaginal brachytherapy, Female, France, Radiology, prognosis, Neoplasm Recurrence, Local, Radiopharmaceuticals, business
Abstract: International audience; Objectives - To evaluate the performances of posttreatment FEDG-PET to predict the prognosis of patients treated with concurrent chemoradiotherapy (CT/RT) for locally advanced cervical cancer. Materials and methods - The medical records of 131 patients treated in 9 French academic institutions for IB2-IIB cervical cancer and for which a posttherapy FEDG-PET was performed were reviewed. All patients received CT/RT, possibly completed with vaginal brachytherapy (VBT) and completion surgery. Posttreatment FEDG-PET was performed within 3 months after completion of CT/RT or VBT. Incomplete metabolic response (IMR) was defined as the persistence of FEDG uptake. Results - An IMR was identified in 44 (33.6 %) cases. IMR was associated with higher risk of recurrence (aHR = 2.8; 95 %CI: 1.3-5.7; p = 0.006) and death (aHR = 4.5 ;95 %CI: 1.4-13.8; p = 0.009). Completion surgery was performed in 61 (46.9 %) patients with histologic cervical residual disease identified in 31 (50.8 %). FEDG-PET sensitivity and specificity in predicting cervical residual disease following CT/RT was 48.4 % (95 %CI: 30.8-66) and 80 % (95 %CI: 65.7-94.3), respectively. Conclusions - In patients treated with CT/RT for locally advanced cervical cancer, despite limited performances to predict cervical residual disease, posttreatment FEDG-PET is predictive of patients' prognosis and long-term outcome.
Published: 2020
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21. Impact on Prognosis of the Surgical Route, Laparoscopy or Laparotomy, for the Surgical Staging of Early Stage Ovarian Cancer—A Study from the FRANCOGYN Group

Author: Lobna Ouldamer, Geoffroy Canlorbe, Yohan Kerbage, Margaux Merlier, Emilie Raimond, Pierre-Adrien Bolze, Marcos Ballester, Charles Coutant, Vincent Lavoué, Adeline Pierache, Pierre Collinet, Yohann Dabi, Jerome Phalippou, Nassima Ramdane, Alexandre Bricou, Sofiane Bendifallah, Cyrille Huchon, Cherik Akladios, Henri Azaïs, Cyril Touboul, Hôpital Jeanne de Flandre [Lille], Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille, Service de Gynécologie-Obstétrique, Maternité, Chirurgie Gynécologique [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Universitaire de Cancérologie [Paris] (IUC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Groupe Hospitalier Diaconesses Croix Saint-Simon, CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), Nutrition, croissance et cancer (U 1069) (N2C), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, CHU Pontchaillou [Rennes], Université Paris-Est Créteil Val-de-Marne - Faculté de médecine (UPEC Médecine), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHU Strasbourg, Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, Institut Mère Enfant Alix de Champagne, Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), and Institut Universitaire de Cancérologie [Sorbonne Université] (IUC)
Subjects: medicine.medical_specialty, genetic structures, medicine.medical_treatment, overall survival, lcsh:Medicine, Article, 03 medical and health sciences, 0302 clinical medicine, Laparotomy, medicine, Overall survival, Stage (cooking), Laparoscopy, minimally invasive surgery, 030219 obstetrics & reproductive medicine, medicine.diagnostic_test, business.industry, lcsh:R, Retrospective cohort study, General Medicine, medicine.disease, early stage ovarian cancer, Laparoscopic staging, 3. Good health, Surgery, laparoscopic staging, Log-rank test, 030220 oncology & carcinogenesis, Ovarian cancer, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Background and objective: according to the latest ESMO&minus, ESGO recommendations, laparotomy is the standard surgical approach to treat and stage patients with presumed early stage epithelial ovarian cancer (EOC). A few studies have investigated the efficacy and the safety of laparoscopy for the staging of early stage EOC, and this question is still in the center of debates. Recurrence-free survival (RFS) and overall survival (OS) benefits of the minimally invasive surgery (MIS) have still to be specified. The aim of this multicenter and retrospective study is to assess the survival outcomes of laparoscopic staging in comparison with laparotomic staging for patients presenting with an early stage EOC. Methods: data of patients with early stage EOC (FIGO I-IIA) who underwent primary surgery between 2000 and 2018 were extracted from the FRANCOGYN database. OS and RFS of these two groups, constituted according to the surgical route, were compared using Log rank test. Results: of the 144 patients included, 107 patients underwent laparotomy and 37 underwent laparoscopy for a staging purpose. The median follow-up was 36.0 months (18.0 to 58.0). For the laparoscopy and the laparotomy group, the median follow-up period was 24 (11.0 to 50.0) and 42.0 (24.0 to 66.0) months, respectively, (p &lt, 0.001). Tumor recurrence occurred in 33 (23%) patients: 2 (5.4%) in the laparoscopy group and 31 (29%) in the laparotomy group (p = 0.08). The OS rate at 5 years was 97.3% after laparoscopy and 79.8% after laparotomy (p = 0.19). Conclusions: there is no difference associated with the laparoscopic approach for the staging of early stage EOC on RFS and OS in comparison with laparotomy. MIS may be proposed as a safe and adequate alternative to laparotomy when performed by well-trained surgeons.
Published: 2020
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22. Risk factors for recurrence of borderline ovarian tumors in France: A multicenter retrospective study by the FRANCOGYN group

Author: Cyrille Huchon, Sofiane Bendifallah, P. Collinet, Olivier Graesslin, Lobna Ouldamer, E. Sangnier, Camille Mimoun, Alexandre Bricou, Lise Lecointre, Emilie Raimond, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Université de Paris (UP)
Subjects: Adult, medicine.medical_specialty, Multivariate analysis, Time Factors, Adolescent, [SDV]Life Sciences [q-bio], Conservative Treatment, 03 medical and health sciences, Ovarian tumor, Young Adult, 0302 clinical medicine, Surgical oncology, Risk Factors, Internal medicine, medicine, Humans, Stage (cooking), Survival rate, ComputingMilieux_MISCELLANEOUS, Aged, Neoplasm Staging, Retrospective Studies, Aged, 80 and over, Ovarian Neoplasms, Univariate analysis, Analysis of Variance, 030219 obstetrics & reproductive medicine, business.industry, Incidence (epidemiology), Age Factors, Obstetrics and Gynecology, Retrospective cohort study, Middle Aged, 3. Good health, Survival Rate, Reproductive Medicine, 030220 oncology & carcinogenesis, Female, France, Neoplasm Recurrence, Local, business, Follow-Up Studies
Abstract: Introduction Borderline ovarian tumors (BOTs) although rare, have shown an increase in the incidence worldwide. Although the survival rate is high, the recurrence rate is estimated to be between 5% and 34%. The objective of this study was to identify risk factors for recurrence of BOTs. Methods This retrospective multicenter study included 493 patients treated surgically for BOT between January 2001 and December 2018. Results Thirty-seven patients showed recurrence (group R, 7.5%), while 456 did not (group NR, 92.5%). With an average follow-up of 30.5 months (1-276), the overall recurrence rate was 7.5%. Recurrence rates for the BOT and invasive types were 5.7% (n = 28) and 1.4% (n = 7), respectively. The mean time to recurrence was 44.1 (3-251) months. Univariate analysis showed that age at diagnosis, type of surgical procedure, histological type, and FIGO stage were factors influencing recurrence. Multivariate analysis showed that the risk factors for recurrence of BOT were conservative treatment (OR = 7 [95% CI 3.01-16.23]; p Discussion To the best of our knowledge, this multicenter study was one of the largest studies on the risk factors for BOT recurrence. Conservative treatment and advanced FIGO stage were identified as risk factors for BOT recurrence. These results reinforce the need for restaging of patients who did not have an optimal initial surgical staging so as not to avoid missing a tumor in the advanced stage. Referral to a surgical oncology center is suggested to optimize overall patient management.
Published: 2020
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23. Ovarian Cancer in the Elderly Time to Move towards a More Logical Approach to Improve Prognosis-A Study from the FRANCOGYN Group

Author: Xavier Carcopino, Henri Azaïs, Cyril Touboul, Cherif Akladios, Geoffroy Canlorbe, Martin Koskas, Nicolas Bourdel, Pauline Chauvet, Mathieu Mezzadri, Tristan Gauthier, Hélène Costaz, Cyrille Huchon, Pierre Collinet, Frederik Kridelka, Yohann Dabi, Camille Mimoun, Lobna Ouldamer, Alexandre Bricou, Lise Lecointre, Sofiane Bendifallah, Krystel Nyangoh Timoh, Ludivine Dion, Pierre-Adrien Bolze, Olivier Graesslin, Vincent Lavoué, Emilie Raimond, Marcos Ballester, Jean Levêque, CHU Pontchaillou [Rennes], Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA), Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Gynécologie-Obstétrique, Maternité, Chirurgie Gynécologique [CHU Pitié-Salpêtrière], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: medicine.medical_specialty, endocrine system diseases, health care facilities, manpower, and services, medicine.medical_treatment, [SDV]Life Sciences [q-bio], lcsh:Medicine, frailty, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, chemotherapy, elderly, Article, surgery, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, In patient, Survival rate, Chemotherapy, 030219 obstetrics & reproductive medicine, Surgical approach, business.industry, lcsh:R, Logical approach, social sciences, General Medicine, University hospital, medicine.disease, humanities, 3. Good health, ovarian cancer, Multicenter study, 030220 oncology & carcinogenesis, business, Ovarian cancer
Abstract: Background and objective: Elderly and/or frail women with ovarian cancer are often undertreated. The aim of the study is to compare the effects of age and frailty on surgical approaches, postoperative complications, and prognosis in elderly women with ovarian cancer. Methods: A retrospective multicenter study of women &ge, 70 years were treated for ovarian cancer at seven French university hospitals between 2007 and 2015. Results: Of the 1119 women treated for ovarian cancer during the study period, 147 were &ge, 70 years and had complete data. Of these women, 65 were aged 70&ndash, 74 years, and 82 were aged &ge, 75 years. Overall, 77% of the younger women (49/65) received optimal treatment compared with 51% (40/82) of the older women (p = 0.018). Women &ge, 75 years underwent fewer bowel resections (32% vs. 67%, p &lt, 0.001) and experienced fewer postoperative complications (22.6% vs. 38.9%, p &lt, 0.001), 53.2% of the women in this age group were treated by primary surgery or surgery only. These women also received more chemotherapy with platinum only (15% [9/56] vs. 2% [1/57], p = 0.007) and less bevacizumab (9% [5/56] vs. 32% [18/57], p = 0.003). Patients with greater frailty (a modified Charlson Comorbidity Index [mCCI] score &gt, 3) had a five-year survival rate of 30% versus 62% for those with a score &le, 3 (p &lt, 0.001). Conclusions: Surgeons modify their approach to treating ovarian cancer in women &ge, 75 years probably to reduce immediate postoperative complications. The prognosis is significantly worse in patients with greater frailty. Improvements to the sequence of treatments administered, with priority given to neoadjuvant chemotherapy in patients with greater frailty, could help increase the number of women who receive optimal treatment and improve their prognosis.
Published: 2020
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24. Revisiting the management of term breech presentation: a proposal for overcoming some of the controversies

Author: Amélie Benbara, Alexandre Bricou, A. Tigaizin, Lionel Carbillon, Fatma Belmaghni, Marion Fermaut, Jeremy Boujenah, and Rouba Murtada
Subjects: medicine.medical_specialty, Debate, Pregnancy Trimester, Third, medicine.medical_treatment, Severe maternal morbidity, Reproductive medicine, Context (language use), Foetal growth restriction, lcsh:Gynecology and obstetrics, Oligohydramnios, 03 medical and health sciences, 0302 clinical medicine, Small-for-gestational-age, Perinatal morbidity, Pregnancy, Breech presentation, medicine, Humans, 030212 general & internal medicine, Breech Presentation, Version, Fetal, Intensive care medicine, lcsh:RG1-991, reproductive and urinary physiology, Perinatal mortality, 030219 obstetrics & reproductive medicine, Cesarean Section, business.industry, Infant, Newborn, Obstetrics and Gynecology, Pelvimetry, Delivery, Obstetric, medicine.disease, Delivery mode, female genital diseases and pregnancy complications, Gestational diabetes, Delivery route, External cephalic version, Infant, Small for Gestational Age, Small for gestational age, Female, business, Term breech delivery
Abstract: Background The debate surrounding the management of term breech presentation has excessively focused on the mode of delivery. Indeed, a steady decline in the rate of vaginal breech delivery has been observed over the last three decades, and the soundness of the vaginal route was seriously challenged at the beginning of the 2000s. However, associations between adverse perinatal outcomes and antenatal risk factors have been observed in foetuses that remain in the breech presentation in late gestation, confirming older data and raising the question of the role of these antenatal risk factors in adverse perinatal outcomes. Thus, aspects beyond the mode of delivery must be considered regarding the awareness and adequate management of such situations in term breech pregnancies. Main body In the context of the most recent meta-analysis and with the publication of large-scale epidemiologic studies from medical birth registries in countries that have not abruptly altered their criteria for individual decision-making regarding the breech delivery mode, the currently available data provide essential clues to understanding the underlying maternal-foetal conditions beyond the delivery mode that play a role in perinatal outcomes, such as foetal growth restriction and gestational diabetes mellitus. In view of such data, an accurate evaluation of these underlying conditions is necessary in cases of persistent term breech presentation. Timely breech detection, estimated foetal weight/growth curves and foetal/maternal well-being should be considered along with these possible antenatal risk factors; a thorough analysis of foetal presentation and an evaluation of the possible benefit of external cephalic version and pelvic adequacy in each specific situation of persistent breech presentation should be performed. Conclusion The adequate management of term breech pregnancies requires screening and the efficient identification of breech presentation at 36 weeks of gestation, followed by thorough evaluations of foetal weight, growth and mobility, while obstetric history, antenatal gestational disorders and pelvis size/conformation are considered. The management plan, including external cephalic version and follow-up based on the maternal/foetal condition and potentially associated disorders, should be organized on a case-by-case basis by a skilled team after the woman is informed and helped to make a reasoned decision regarding delivery route.
Published: 2020
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25. Management and Survival of Elderly and Very Elderly Patients with Ovarian Cancer: An Age-Stratified Study of 1123 Women from the FRANCOGYN Group

Author: Geoffroy Canlorbe, Hélène Costaz, Pierre-Adrien Bolze, Sofiane Bendifallah, Olivier Graesslin, Cyrille Huchon, Pierre Collinet, Marcos Ballester, Alexandre Bricou, Lise Lecointre, Yolaine Joueidi, Cherif Akladios, Emilie Raimond, Jean Levêque, Krystel Nyangoh Timoh, Nicolas Bourdel, Xavier Carcopino, Cyril Touboul, Frédéric Kridelka, Yohann Dabi, Camille Mimoun, Lobna Ouldamer, Henri Azaïs, Pauline Chauvet, Martin Koskas, Tristan Gauthier, Mathieu Mezzadri, Ludivine Dion, Vincent Lavoué, CHU Pontchaillou [Rennes], Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, and Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: Oncology, medicine.medical_specialty, health care facilities, manpower, and services, medicine.medical_treatment, [SDV]Life Sciences [q-bio], lcsh:Medicine, frailty, chemotherapy, elderly, Article, surgery, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Overall survival, 030212 general & internal medicine, Chemotherapy, business.industry, Endometrial cancer, lcsh:R, social sciences, General Medicine, medicine.disease, humanities, 3. Good health, ovarian cancer, 030220 oncology & carcinogenesis, Cohort, Ovarian cancer, business
Abstract: Elderly women with ovarian cancer are often undertreated due to a perception of frailty. We aimed to evaluate the management of young, elderly and very elderly patients and its impact on survival in a retrospective multicenter study of women with ovarian cancer between 2007 to 2015. We included 979 women: 615 women (62.8%) &lt, 65 years, 225 (22.6%) 65&ndash, 74 years, and 139 (14.2%) &ge, 75 years. Women in the 65&ndash, 74 years age group were more likely to have serous ovarian cancer (p = 0.048). Patients &gt, 65 years had more &gt, IIa FIGO stage: 76% for &lt, 65 years, 84% for 65&ndash, 74 years and 80% for &ge, 75 years (p = 0.033). Women &ge, 75 years had less standard procedures (40% (34/84) vs. 59% (104/177) for 65&ndash, 74 years and 72% (384/530) for &lt, 65 years (p &lt, 0.001). Only 9% (13/139) of women &ge, 75 years had an Aletti score &gt, 8 compared with 16% and 22% for the other groups (p &lt, 0.001). More residual disease was found in the two older groups (30%, respectively) than the younger group (20%) (p &lt, 0.05). Women &ge, 75 years had fewer neoadjuvant/adjuvant cycles than the young and elderly women: 23% &ge, 75 years received &lt, 6 cycles vs. 10% (p = 0.003). Univariate analysis for 3-year Overall Survival showed that age &gt, 65 years, FIGO III (HR = 3.702, 95%CI: 2.30&ndash, 5.95) and IV (HR = 6.318, 95%CI: 3.70&ndash, 10.77) (p &lt, 0.001), residual disease (HR = 3.226, 95%CI: 2.51&ndash, 4.15, p &lt, 0.001) and lymph node metastasis (HR = 2.81, 95%CI: 1.91&ndash, 4.12, 0.001) were associated with lower OS. Women &gt, 65 years are more likely to have incomplete surgery and more residual disease despite more advanced ovarian cancer. These elements are prognostic factors for women&rsquo, s survival regardless of age. Specific trials in the elderly would produce evidence-based medicine and guidelines for ovarian cancer management in this population.
Published: 2020
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26. Identification of a low risk population for parametrial invasion in patients with early-stage cervical cancer

Author: Cyril Touboul, Marcos Ballester, Cyrille Huchon, Xavier Carcopino, Emilie Raimond, Olivier Graesslin, Vincent Lavoué, Alexandre Bricou, Emile Daraï, Geoffroy Canlorbe, Claire Willecocq, Pierre Collinet, Bassam Haddad, Yohann Dabi, Charles Coutant, Lobna Ouldamer, Sofiane Bendifallah, HAL UVSQ, Équipe, Université Paris-Est Créteil Val-de-Marne - Faculté de médecine (UPEC Médecine), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service de Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC), Université Pierre et Marie Curie - Paris 6 (UPMC), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Service de Gynécologie et Obstétrique [Rennes] = Gynaecology [Rennes], CHU Pontchaillou [Rennes], Département de Néonatologie [CHU de Rennes], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de gynécologie-obstétrique [Hôpital Jean Verdier], Université Paris 13 (UP13)-Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), CHI Créteil, Carcinose Angiogenèse et Recherche Translationnelle, Angiogenese et recherche translationnelle (CART U965), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Gynécologie-Obstétrique [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université, Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Service de Gynécologie et Obstétrique [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-hôpital Sud, Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris 13 (UP13)
Subjects: medicine.medical_specialty, Multivariate analysis, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Early-stage, Radical surgery, Urology, Uterine Cervical Neoplasms, lcsh:Medicine, Kaplan-Meier Estimate, General Biochemistry, Genetics and Molecular Biology, Low-risk, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Predicting, medicine, Humans, Neoplasm Invasiveness, Stage (cooking), Aged, Neoplasm Staging, Cervical cancer, Univariate analysis, 030219 obstetrics & reproductive medicine, Hysterectomy, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Parametrial, Proportional hazards model, business.industry, Research, Parametrial invasion, lcsh:R, General Medicine, Middle Aged, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], 030220 oncology & carcinogenesis, Multivariate Analysis, Female, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Background Recent studies have challenged radical procedures for less extensive surgery in selected patients with early-stage cervical cancer at low risk of parametrial invasion. Our objective was to identify a subgroup of patients at low risk of parametrial invasion among women having undergone surgical treatment. Methods Data of 1447 patients with cervical cancer treated between 1996 and 2016 were extracted from maintained databases of 10 French University hospitals. Patients with early-stage (IA2–IIA) disease treated by radical surgery including hysterectomy and trachelectomy, were selected for further analysis. The Kaplan–Meier method was used to estimate the survival distribution. A Cox proportional hazards model including all the parameters statistically significant in univariate analysis, was used to account for the influence of multiple variables. Results Out of the 263 patients included for analysis, on final pathology analysis 28 (10.6%) had parametrial invasion and 235 (89.4%) did not. Factors significantly associated with parametrial invasion on multivariate analysis were: age > 65 years, tumor > 30 mm in diameter measured by MRI, lymphovascular space invasion (LVSI) on pathologic analysis. Among the 235 patients with negative pelvic lymph nodes, parametrial disease was seen in only 7.6% compared with 30.8% of those with positive pelvic nodes (p
Published: 2018
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27. Using a new diagnostic tool to predict lymph node metastasis in advanced epithelial ovarian cancer leads to simple lymphadenectomy decision rules: A multicentre study from the FRANCOGYN group

Author: Arnaud Fauconnier, Matthieu Mezzadri, Sofiane Bendifallah, Jean Louis Benifla, Roman Rouzier, Yohan Kerbage, Vincent Lavoué, Xavier Paoletti, Geoffroy Canlorbe, Camille Mimoun, Charles Coutant, Cyrille Huchon, Lobna Ouldamer, Adrien Crestani, Cyril Touboul, Thomas Gaillard, Yohann Dabi, Alexandre Bricou, Lise Lecointre, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service de gynécologie et obstétrique [Hopital Lariboisière - Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), Département d'Oncologie Chirurgicale [Institut Curie], Institut Curie [Paris], Cancer et génome: Bioinformatique, biostatistiques et épidémiologie d'un système complexe, MINES ParisTech - École nationale supérieure des mines de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut Curie [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de gynécologie-obstétrique [Hôpital Jean Verdier], Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Sorbonne Paris Nord, Service de gynécologie et obstétrique [Créteil], CHI Créteil, Service de Gynécologie-Obstétrique, Maternité, Chirurgie Gynécologique [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Clinique de Gynécologie [Lille] (Hôpital Jeanne de Flandre), Hôpital Jeanne de Flandre [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Gynécologie et Obstétrique [Rennes] = Gynaecology [Rennes], CHU Pontchaillou [Rennes], Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Département de Gynécologie-Obstétrique [CHU Strasbourg], CHU Strasbourg-Hôpital de Hautepierre [Strasbourg], Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Institut Curie [Paris]-MINES ParisTech - École nationale supérieure des mines de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Mines Paris - PSL (École nationale supérieure des mines de Paris), Service de Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], and HAL UVSQ, Équipe
Subjects: Oncology, Epidemiology, medicine.medical_treatment, Cancer Treatment, Pelvic Lymphadenectomy, Lymph node metastasis, Carcinoma, Ovarian Epithelial, Logistic regression, Surgical planning, Metastasis, Mathematical and Statistical Techniques, 0302 clinical medicine, Positron Emission Tomography Computed Tomography, Basic Cancer Research, Medicine and Health Sciences, Blood and Lymphatic System Procedures, Medicine, Ovarian Neoplasms, 0303 health sciences, Multidisciplinary, Cancer Risk Factors, Statistics, Cytoreduction Surgical Procedures, Middle Aged, 3. Good health, Surgical Oncology, Lymphatic Metastasis, 030220 oncology & carcinogenesis, Physical Sciences, Cohort, Female, France, Anatomy, Research Article, Clinical Oncology, medicine.medical_specialty, Science, Clinical Decision-Making, Surgical and Invasive Medical Procedures, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Research and Analysis Methods, Lymphatic System, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, Humans, Statistical Methods, Aged, Retrospective Studies, 030304 developmental biology, Internet, business.industry, Biology and Life Sciences, Lymphadenectomy, Decision rule, medicine.disease, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Logistic Models, Medical Risk Factors, Lymph Node Excision, Lymph Nodes, Clinical Medicine, business, Ovarian cancer, Mathematics, Forecasting
Abstract: Objective The aim of this study was to develop a new diagnostic tool to predict lymph node metastasis (LNM) in patients with advanced epithelial ovarian cancer undergoing primary cytoreductive surgery. Materials and method The FRANCOGYN group’s multicenter retrospective ovarian cancer cohort furnished the patient population on which we developed a logistic regression model. The prediction model equation enabled us to create LNM risk groups with simple lymphadenectomy decision rules associated with a user-friendly free interactive web application called shinyLNM. Results 277 patients from the FRANCOGYN cohort were included; 115 with no LNM and 162 with LNM. Three variables were independently and significantly (p Conclusion This new tool may prove useful for improving surgical planning and provide useful information for patients.
Published: 2021
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28. Bartholin gland abscess during pregnancy: Report on 40 patients

Author: Amélie Benbara, S.N.V. Le, Lionel Carbillon, Alexandre Bricou, J. Boujenah, and R. Murtada
Subjects: Adult, medicine.medical_specialty, Population, Miscarriage, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Escherichia coli, medicine, Humans, Bartholin's Glands, 030212 general & internal medicine, Pregnancy Complications, Infectious, education, Escherichia coli Infections, Retrospective Studies, Gynecology, Bartholin Gland, education.field_of_study, 030219 obstetrics & reproductive medicine, Obstetrics, business.industry, Incidence (epidemiology), Pregnancy Outcome, Obstetrics and Gynecology, Pregnancy Report, Retrospective cohort study, medicine.disease, Abscess, Anti-Bacterial Agents, Reproductive Medicine, Case-Control Studies, Bartholin gland abscess, Female, Vulvar Diseases, business
Abstract: To study the clinical and bacterial characteristic of Bartholin gland abscesses during pregnancy and the obstetric and neonatal outcomes.Retrospective cohort study of all patients with surgical treatment of Bartholin gland abscesses between 2004 and 2015 in our university center. Clinical and bacterial characteristics between pregnant and non-pregnant women were compared.During the period study, 156 patients were included (40 pregnant and 116 non pregnant). The incidence of Bartholin gland abscesses during pregnancy was 0.13%. Eight (20%) abscesses occurred in the first, 18 (45%) in the second, 11 (47.5%) in the third trimester and 3 (7.5%) in the post-partum course. No severe perineal and neonatal infections occurred during pregnancy. One late miscarriage and one preterm delivery were observed. We found more multiparity in the pregnant woman group than in non-pregnant women (62.5% versus 45%, p0.05). A history of Bartholin gland abscesses were also more frequent in pregnant women (55% versus 30.1%, p0.05). First line antibiotic therapy was more frequent in non-pregnant women (20% versus 45%, p0.05). The rate of positive culture did not differ between the two groups (70% versus 55.2%). Among negative pus cultures, no patient in the pregnant woman group had received a first line antibiotic therapy, in contrast with non-pregnant women (0% versus 25%, p0.05). E. coli was the most common pathogen in the two groups (48.9% of positive cultures and 28.2% of the overall population). The distribution of bacterial taxa was not different between the two groups.Bacterial characteristics did not differ from non-pregnant women. Pregnancy could increase the occurrence of Bartholin gland abscesses in patients with previous surgical treatment of abscesses. When appropriate management is applied, maternal and neonatal outcomes are favorable, and severe infections are not to be expected.
Published: 2017
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29. Accident funiculaire après version par manœuvre externe : mythe ou réalité ?

Author: Alexandre Bricou, Amélie Benbara, I. Pharisien, C. Fleury, A. Tigaizin, Lionel Carbillon, and J. Boujenah
Subjects: 03 medical and health sciences, 030219 obstetrics & reproductive medicine, 0302 clinical medicine, Reproductive Medicine, Obstetrics and Gynecology, 030212 general & internal medicine
Abstract: Resume Objectif L’incidence d’un accident funiculaire (AF) (circulaire, bretelle, ou procidence du cordon) preexistant ou survenant au decours d’une version par manœuvre externe (VME) pour siege n’est pas connue. L’objectif de ce travail est d’etudier l’effet d’un succes et d’un echec de la VME sur le risque d’AF. Methode Etude retrospective unicentrique comparant la survenue selon la realisation ou non d’une VME d’un AF, puis au sein de 4 groupes diagnostiquee par la sage-femme ou le medecin selon le mode de naissance (spontanee, instrumentale ou cesarienne) : bras expose a la VME, Groupe 1 succes de VME (definie par le passage en presentation cephalique-PC-), suivi d’une tentative de voie basse (TAVB) et Groupe 2 echecs de VME (defini par l’absence de passage en PC), suivi d’une cesarienne programmee ou d’une TVAB, Bras non expose a la VME, Groupe 3 PC spontanees appariees au groupe 1 sur la parite, l’âge gestationnel, le BMI, le poids et l’annee de naissance, suivie d’une TVAB, Groupe 4 sieges sans realisation VME, suivi d’une TVAB. Resultat Entre 1998 et 2015, 776 patientes avec un siege entre 36 et 37SA ont ete incluses. Les groupes 1, 2 et 4 ont concerne respectivement 198, 446 et 118 patientes. Le groupe 3 a inclus 396 temoins. Aucune difference n’a ete observe sur le risque d’AF entre les 2 bras (17,08 % versus 18,9 %). Quel que soit le mode d’accouchement (voie naturelle ou cesarienne) et le type de presentation, nous n’avons pas observe de difference significative : en cas de presentation cephalique (groupe 1 : 20,7 % versus groupe 3 : 20,1 %) et en cas de presentation du siege (groupe 2 : 15,4 % versus groupe 4 : 13,5 %). Quelle que soit l’issue de la VME, son succes ou echec, aucune difference n’a ete observee sur le taux d’AF (groupe 1 : 20,1 % versus groupe 2 : 15,4 %) Concernant le risque specifique de procidence du cordon en cours de travail, celui-ci a ete observe uniquement dans les groupes 1,2, et 4, c’est-a-dire en cas de presentation du siege sans ou avec VME reussie ou non, respectivement 1 %, 0,8 % et 1,7 %, sans difference significative (0 % dans le groupe 3). Au sein de chaque groupe, le taux de cesarienne n’etait pas different selon presence ou non d’un circulaire. Conclusion La realisation d’une VME n’augmente pas le risque d’AF quelle que soit son issue, succes ou echec.
Published: 2017
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30. EP388 Laparoscopic para-aortic lymph node staging in the care of advanced cervical cancer (IB3-IVA): retroperitoneal or transperitoneal?

Author: Sofiane Bendifallah, Cyrille Huchon, Yohan Kerbage, Jean Levêque, Emile Daraï, F Machuron, Henri Azaïs, C Touboul, Alexandre Bricou, Pierre Collinet, K. Nyangoh Timoh, Vincent Lavoué, Marcos Ballester, L Oulmader, M Pécout, C Bourgin, Emilie Raimond, Geoffroy Canlorbe, Charles Coutant, and Olivier Graesslin
Subjects: Cervical cancer, medicine.medical_specialty, Para-aortic lymph node, Intraoperative Complication, business.industry, medicine.medical_treatment, Postoperative complication, medicine.disease, Surgery, medicine.anatomical_structure, medicine, Lymphadenectomy, Lymph, Stage (cooking), business, Cervix
Abstract: Introduction/Background Para-aortic lymphadenectomy is currently not systematized in the pre-treatment management of advanced cervical cancer (FIGO IB3-IVA). However, metastatic lymph has prognostic and therapeutic importance. We compared morbidity and mortality of retroperitoneal para-aortic lymphadenectomy with transperitoneal approach, in the pre-therapeutic lymph node staging of cervix cancers at a locally advanced stage (FIGO IB3-IVA). Methodology All pre- and postoperative data from 331 patients operated for advanced cervical cancer with a negative Positron Emission Tomography-scanner, managed between 1999 and 2017 in 9 centers in France were listed in the FRANCOGYN database. Morbidity and mortality related to the surgical approach was assessed by studying the rate of per and postoperative complications, as well as the duration of hospitalization. Also analyzed were overall survival as well as survival without recurrence. Results 164 patients received a retroperitoneal approach (group 1) and 167 patients received a transperitoneal approach (group 2). Of these 331 patients, 12 had an intraoperative complication (4 of group 1 and 8 of group 2, p=0.36) and 34 a postoperative complication (12 of group 1 and 22 of group 2, p=0.044), none of which required surgical revision. Hospital stay was shorter in group 1 than in group 2 (3.87±2.47 days versus 5.17±3.04 days, p Conclusion The transperitoneal approach has more complications postoperatively and a longer hospital stay than the retroperitoneal approach. In contrast, there is no significant difference in survival without recurrence or overall survival depending on the approach. Disclosure Nothing to disclose.
Published: 2019
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31. EP823 Patients with stage IV epithelial ovarian cancer: Understanding the determinants of survival

Author: V Lavoue, Francogyn, Y. Dabi, Sofiane Bendifallah, Marcos Ballester, Chantal Touboul, Pierre Collinet, C. Huchon, Alexandre Bricou, B. Haddad, L. Ouldamer, and E Daraï
Subjects: medicine.medical_specialty, Chemotherapy, Referral, Proportional hazards model, business.industry, medicine.medical_treatment, Gynecologic oncology, Disease, medicine.disease, Debulking, Internal medicine, medicine, Stage iv, Ovarian cancer, business
Abstract: Introduction/Background The most appropriate management for patients with stage IV ovarian cancer remains unclear. Our objective was to understand the main determinants associated with survival and to discuss best surgical management in these patients. Methodology Data of 1038 patients with confirmed ovarian cancer treated between 1996 and 2016 were extracted from maintained databases of 7 French referral gynecologic oncology institutions. Patients with stage IV diseases were selected for further analysis. The Kaplan Meier method was used to estimate the survival distribution. A Cox proportional hazards model including all the parameters statistically significant in univariable analysis, was used to account for the influence of multiple variables. Results Two hundred and eight patients met our inclusion criteria: 65 (31.3%) never underwent debulking surgery, 52 (25%) underwent primary debulking surgery (PDS) and 91 (43.8%) neoadjuvant chemotherapy and interval debulking surgery (NACT-IDS). Patients not operated had a significantly worse overall survival than patients that underwent PDS or NACT - IDS (p Conclusion Presence of distant metastases should not refrain surgeons from performing radical procedures, whenever the patient is able to tolerate. Maximal surgical efforts should be done to minimize residual disease as it is the main determinant of survival. Disclosure Nothing to disclose.
Published: 2019
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32. Impact of vaginal brachytherapy in intermediate and high-intermediate risk endometrial cancer: a multicenter study from the FRANCOGYN group

Author: Geoffroy Canlorbe, Emile Daraï, Charles Coutant, Pierre Alain Reboux, Marcos Ballester, Charles Henry Canova, Henri Azaïs, Olivier Graesslin, Pierre Collinet, Jean Levêque, Cyril Touboul, Sofiane Bendifallah, Alexandre Bricou, Lobna Ouldamer, Delphine Hudry, Cyrille Huchon, Martin Koskas, Vincent Lavoué, Catherine Uzan, Emilie Raimond, CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Nutrition, croissance et cancer (U 1069) (N2C), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Reims (CHU Reims), Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, Service de gynécologie et obstétrique [Créteil], CHI Créteil, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de gynécologie-obstétrique [Hôpital Jean Verdier], Université Paris 13 (UP13)-Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Gynécologie et Obstétrique [Rennes] = Gynaecology [Rennes], CHU Pontchaillou [Rennes], Chemistry, Oncogenesis, Stress and Signaling (COSS), Institut National de la Santé et de la Recherche Médicale (INSERM)-CRLCC Eugène Marquis (CRLCC)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Jonchère, Laurent, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris 13 (UP13), Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: medicine.medical_specialty, medicine.medical_treatment, Brachytherapy, Urology, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Endometrial Cancer, 03 medical and health sciences, 0302 clinical medicine, Uterine Corpus, [SDV.CAN] Life Sciences [q-bio]/Cancer, Risk Factors, Adjuvant therapy, Humans, Medicine, Aged, Neoplasm Staging, Retrospective Studies, Local Neoplasm Recurrence, Aged, 80 and over, 030219 obstetrics & reproductive medicine, business.industry, Endometrial cancer, High intermediate risk, Obstetrics and Gynecology, General Medicine, Middle Aged, medicine.disease, Endometrial Neoplasms, 3. Good health, Radiation therapy, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Oncology, Multicenter study, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Case-Control Studies, 030220 oncology & carcinogenesis, Practice Guidelines as Topic, Vaginal brachytherapy, Female, Radiotherapy, Adjuvant, Original Article, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Neoplasm Recurrence, Local, business, Adjuvant
Abstract: International audience; Objective - According to recent European Society of Medical Oncology, European Society of Gynaecological Oncology and European Society of Radiotherapy and Oncology guidelines, adjuvant vaginal brachytherapy (VB) is optional in patients with intermediate risk (IR) and high-intermediate risk (HIR) endometrial cancer (EC). The aim of this French retrospective, multicenter study was to assess the impact of VB in these groups on local recurrence rate, local recurrence-free survival (RFS) and overall survival (OS).Methods - Data of 191 patients with IR and HIR EC who underwent primary surgery with or without VB and no other adjuvant treatment between 2000 and 2016 were extracted from the FRANCOGYN database. Rate of local recurrence, OS and local RFS in these two groups were compared using the Kaplan-Meier method. Results - The number of patients with IR and HIR EC were 118 and 73 respectively. VB was used in 92 patients in IR group and 43 in HIR group. Median follow-up was 22 months. In the HIR group, the local recurrence rate was significantly higher in the no adjuvant therapy group in comparison with the VB group (16.7% and 0% respectively, p=0.02). There was also a significant improvement in local RFS (p=0.01) in VB group. In IR EC, there is no significant difference on local recurrence rate (4.2% and 3.2%, respectively, p=1.00) or local RFS (p=0.54) between the two groups.Conclusions - VB is an efficient adjuvant treatment for patients with HIR EC. VB is not associated with an improvement of RFS or OS in IR EC patient.
Published: 2019
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33. Incidence, patterns and prognosis of first distant recurrence after surgically treated early stage endometrial cancer: Results from the multicentre FRANCOGYN study group

Author: Jean Lévêque, Charles Coutant, Emile Daraï, Lobna Ouldamer, Vincent Lavoué, Sofiane Bendifallah, Gilles Body, Marcos Ballester, Pierre Collinet, Alexandre Bricou, Cyril Touboul, Olivier Graesslin, Groupe de Recherche Francogyn, Emilie Raimond, Nutrition, croissance et cancer (U 1069) (N2C), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, Service de Gynécologie et Obstétrique [Rennes] = Gynaecology [Rennes], CHU Pontchaillou [Rennes], and Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Oncology, medicine.medical_specialty, Lung Neoplasms, [SDV]Life Sciences [q-bio], Diaphragm, Bone Neoplasms, Disease, 030204 cardiovascular system & hematology, Malignancy, Disease-Free Survival, Metastasis, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Medicine, Humans, Stage (cooking), Aged, Neoplasm Staging, Aged, 80 and over, Lung, business.industry, Brain Neoplasms, Incidence (epidemiology), Endometrial cancer, Liver Neoplasms, Cancer, General Medicine, Middle Aged, medicine.disease, 3. Good health, Endometrial Neoplasms, Survival Rate, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Lymphatic Metastasis, Surgery, Female, France, Lymph Nodes, Neoplasm Recurrence, Local, business
Abstract: Patterns of distant metastatic failure of endometrial cancer (EC) by specific anatomic site are not well described in the literature. In this manuscript, we evaluated the metastatic patterns of EC cancer and analysed the potential distribution of metastatic disease in this malignancy. Methods A total of 1444 women with EC were identified. Of which we extracted women with locoregional and distant recurrence or with distant recurrence alone. Women were scored based on first site of metastasis: multiple versus one site: bone, brain, lung, liver or sus diaphragmatic lymph nodes. Results 110 women developed distant metastatic disease with (n = 37(33.6%)) or without (n = 73(66.4%)) locoregional recurrence, including 39 women with exclusive first site of metastatic disease and 34 women with multiple sites of metastatic disease. When considering all women, the most common exclusive first site of metastasis was lung (42.8%). The median time to develop distant metastases was shorter after the completion of treatment for exclusive brain metastatic disease compared with other sites of metastatic− disease (7 months vs, 9 for lung, 10 for liver, 19 for bone and 27 months for sus-diaphragmatic LN; P = 0.004). The rate of 3-year overall survival was higher in the sus-diaphragmatic LN metastase group (83.3% vs 50.6% for lung, 37.3% for bone, 16.7% for brain and 0% for liver; P = 0.0059). Conclusion The present study has demonstrated the site-specific patterns of metastases. These data support current clinical practice of screening for site-specific metastatic disease after initial treatment of early stage EC based on concerning women-specific signs or symptoms.
Published: 2019
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34. Patterns of recurrence and prognosis in locally advanced FIGO stage IB2 to IIB cervical cancer: Retrospective multicentre study from the FRANCOGYN group

Author: Xavier Carcopino, Cyril Touboul, Marcos Ballester, Emilie Raimond, Pierre Collinet, Vincent Lavoué, Olivier Graesslin, Cyrille Huchon, Alexandre Bricou, Geoffroy Canlorbe, Emile Daraï, J. Varinot, Marie-Emmanuelle Neveu, Tiphaine de Foucher, L. Monnier, Lobna Ouldamer, Sofiane Bendifallah, Service de Gynécologie-Obstétrique [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Sorbonne Université, Centre de Recherche Saint-Antoine (CR Saint-Antoine), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Nutrition, croissance et cancer (U 1069) (N2C), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Tours, Service de gynécologie-obstétrique [Hôpital Jean Verdier], Université Paris 13 (UP13)-Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Gynécologie et Obstétrique [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-hôpital Sud, Service de Pathologie [CHU Tenon], Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), Service de gynécologie-obstétrique [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Reims (CHU Reims)-Hôpital Maison Blanche-Institut Mère Enfant, Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC), Université Pierre et Marie Curie - Paris 6 (UPMC), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Carcinose Angiogenèse et Recherche Translationnelle, Angiogenese et recherche translationnelle (CART U965), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Thérapies Laser Assistées par l'Image pour l'Oncologie - U 1189 (ONCO-THAI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Universitaire de Cancérologie [Sorbonne Université] (IUC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), ESIM - Déterminants Sociaux de la Santé et du Recours aux Soins (DS3), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Hôpital Bretonneau, Hôpitaux Universitaires de Paris Seine-Saint-Denis, Service de Gynécologie et Obstétrique [Rennes] = Gynaecology [Rennes], CHU Pontchaillou [Rennes], CRLCC Eugène Marquis (CRLCC), Institut de Recherche pour le Développement (IRD) Marseille (IRD Marseille), Centre Hospitalier Universitaire de Reims (CHU Reims), Centre Hospitalier Intercommunal de Créteil (CHIC), Hôpital Jeanne de Flandre [Lille], AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Universitaire de Cancérologie [Paris] (IUC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université, Hôpital Nord [CHU - APHM]-Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Tenon [APHP], Université Paris 13 (UP13)-Hôpital Jean Verdier [Bondy], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-Hôpital Sud, Centre National de la Recherche Scientifique (CNRS)-Institut de recherche pour le développement [IRD] : UMR237-Aix Marseille Université (AMU)-Avignon Université (AU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Thérapies Laser Assistées par l'Image pour l'Oncologie (ONCO-THAI), and Service de gynécologie et obstétrique [Poissy - Saint-Germain-en-Laye]]
Subjects: Oncology, Survival, medicine.medical_treatment, Brachytherapy, Uterine Cervical Neoplasms, 0302 clinical medicine, Recurrence, Cumulative incidence, Stage (cooking), Lymph node, Peritoneal Neoplasms, Cervical cancer, Aged, 80 and over, 030219 obstetrics & reproductive medicine, General Medicine, Chemoradiotherapy, Middle Aged, 3. Good health, Survival Rate, medicine.anatomical_structure, Time to recurrence, 030220 oncology & carcinogenesis, Lymphatic Metastasis, Vagina, Female, Adult, medicine.medical_specialty, Locally advanced, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Hysterectomy, Disease-Free Survival, 03 medical and health sciences, Young Adult, Internal medicine, medicine, Humans, Aged, Neoplasm Staging, Retrospective Studies, Locally advanced cervical cancer, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, business.industry, Pattern, medicine.disease, Concomitant, Surgery, Neoplasm Recurrence, Local, business, Follow-Up Studies
Abstract: Introduction Evidence-based data describing patterns of recurrence and prognosis in women with FIGO stage IB2 to IIB locally advanced cervical cancer (LACC) are scarce. The purpose of this study was to analyse patterns of recurrence in LACC and their correlation with prognosis, depending on FIGO stage, lymph node (LN) status and treatment modalities. The endpoints of this study were the type of recurrence (locoregional or distant, and time to recurrence), the recurrence free survival, the overall survival and the cumulative incidence for both locoregional and distant recurrence. Materials and methods Data of women with FIGO stage IB2 to IIB CC treated between April 1996 and May 2016 were retrospectively abstracted from nine French institutions. Results The median follow-up for the 501 women included was 35.6 months. Recurrences were observed in 158 (31.5%), with a mean time to recurrence of 20.7 months. Women with IIB CC had poorer prognosis, lower 3-year RFS and higher 3-year cumulative incidence of both locoregional and distant recurrences. Women with positive or unknown LN status had poorer prognosis with higher 3-year cumulative incidence of distant recurrence. Women who underwent concomitant chemo-radiotherapy ± vaginal brachytherapy had poorer prognosis, with lower 3-year RFS and higher 3-year cumulative incidence of distant recurrence. Conclusions Recurrence location and time to recurrence differ widely depending on the FIGO stage, LN status and treatment modalities, with potential impact on follow-up modalities and therapeutic approaches.
Published: 2019
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35. La chimiothérapie hyperthermique intra-péritonéale (CHIP) sauvée par les preuves : la carcinose ovarienne, cible privilégiée de la CHIP ?

Author: Martin Koskas, Cyrille Huchon, Olivier Graesslin, Pierre Collinet, Geoffroy Canlorbe, Groupe de Recherche Francogyn, Lobna Ouldamer, Xavier Carcopino, Cyril Touboul, Charles Coutant, Cherif Akladios, Alexandre Bricou, Pierre Adrien Bolze, Sofiane Bendifallah, Emile Daraï, Marcos Ballester, Vincent Lavoué, Service de Gynécologie et Obstétrique [Rennes] = Gynaecology [Rennes], CHU Pontchaillou [Rennes], Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Thérapies Laser Assistées par l'Image pour l'Oncologie - U 1189 (ONCO-THAI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Strasbourg, Service de gynécologie-obstétrique [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Service de gynécologie-obstétrique [Hôpital Jean Verdier], Université Paris 13 (UP13)-Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, Service de Chirurgie Gynécologique Oncologique et Obstétrique [CHU Lyon Sud], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Nutrition, croissance et cancer (U 1069) (N2C), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Carcinose Angiogenèse et Recherche Translationnelle, Angiogenese et recherche translationnelle (CART U965), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Nord [CHU - APHM]-Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU), Centre National de la Recherche Scientifique (CNRS)-Institut de recherche pour le développement [IRD] : UMR237-Aix Marseille Université (AMU)-Avignon Université (AU), Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris 13 (UP13), Service de Gynécologie et Obstétrique [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-hôpital Sud, CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Service de Gynécologie-Obstétrique [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université, Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-Hôpital Sud, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Thérapies Laser Assistées par l'Image pour l'Oncologie (ONCO-THAI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Tenon [APHP], Université Paris 13 (UP13)-Hôpital Jean Verdier [Bondy], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Centre Régional de Lutte contre le cancer - Centre Georges-François Leclerc (CRLCC - CGFL), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Tours, and Service de gynécologie et obstétrique [Poissy - Saint-Germain-en-Laye]]
Subjects: Gynecology, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, Cancer Research, medicine.medical_specialty, business.industry, [SDV.CAN]Life Sciences [q-bio]/Cancer, Hematology, General Medicine, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, medicine.disease, 3. Good health, Peritoneal carcinomatosis, 03 medical and health sciences, 0302 clinical medicine, Oncology, 030220 oncology & carcinogenesis, medicine, Carcinoma, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Ovarian cancer, business, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2019
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36. Cervical cancer recurrence: Proposal for a classification based on anatomical dissemination pathways and prognosis

Author: Florence Huguet, Emilie Raimond, Marcos Ballester, Emile Daraï, Pierre Collinet, J. Varinot, Lobna Ouldamer, Geoffroy Canlorbe, Alexandre Bricou, Cyrille Huchon, Sofiane Bendifallah, Vincent Lavoué, Cyril Touboul, Olivier Graesslin, Tiphaine de Foucher, and Xavier Carcopino
Subjects: Adult, medicine.medical_specialty, Uterine Cervical Neoplasms, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Single site, 0502 economics and business, medicine, Humans, Peritoneal Neoplasms, Aged, Pelvic Neoplasms, Retrospective Studies, Cervical cancer, Aged, 80 and over, business.industry, Optimal treatment, 05 social sciences, Middle Aged, medicine.disease, Prognosis, Combined Modality Therapy, Surgery, Survival Rate, Oncology, Median time, 030220 oncology & carcinogenesis, Abdominal Neoplasms, Lymphatic Metastasis, 050211 marketing, Female, Neoplasm Recurrence, Local, business, Follow-Up Studies
Abstract: Introduction Precise definitions of recurrences and optimal treatment strategy are yet to be clearly defined among patients with cervical cancer (CC). The purpose of this study was to develop a reproducible classification of CC recurrence. Materiel and methods Data of women with FIGO stages I-IV CC treated between January 2000 and January 2015 were retrospectively abstracted from nine French institutions. We proposed a rTNM classification for recurrence: locoregional (rT), nodal (rN), or distant organ (rM). According to rTNM prognosis, we then defined a rSTAGE classification (I, II, IIIA, IIIB, IVA, IVB). Results Among the 1028 women treated for FIGO stages I-IV CC during the study period, 216 recurrences were observed (21%). The 3-year survival after recurrence was 38.8%, with a median time to recurrence of 9 months (95% CI, 30.9–48.7). A trend for a lower 3-year survival after recurrence was observed in women with multiple-site vs single-site recurrence (p = 0.1). Among the women in the rT group, a difference in 3-year survival after recurrence was found between rT1 single site, rT2 single site and rT3 single site (p = 0.02). The 3-year survival after recurrence was 69.1%, 49.2%, 37.5%, 34.2%, 23.1% and 24.4% for rStage I, II, IIIA, IIIB, IVA and IVB, respectively (p = 0.007). Conclusion rTNM classifications and rSTAGE are discriminatory and allow all recurrence modalities to be classified.
Published: 2019

37. Endometriosis and uterine malformations: infertility may increase severity of endometriosis

Author: Jeremy Boujenah, C. Poncelet, Christophe Sifer, Eleonora Salakos, Alexandre Bricou, Joanna Shore, and Mélodie Pinto
Subjects: Adult, Infertility, medicine.medical_specialty, medicine.medical_treatment, media_common.quotation_subject, Endometriosis, Fertility, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Uterine malformation, Severity of illness, medicine, Humans, media_common, Gynecology, 030219 obstetrics & reproductive medicine, Assisted reproductive technology, business.industry, Female infertility, Case-control study, Obstetrics and Gynecology, General Medicine, medicine.disease, Case-Control Studies, Urogenital Abnormalities, 030220 oncology & carcinogenesis, Female, business, Infertility, Female
Abstract: Introduction The aim of our study was to compare the stage and severity of endometriosis in fertile and infertile women with congenital uterine malformations. Material and methods We performed an observational study from September 2007 to December 2015 in a tertiary care university hospital and assisted reproductive technology center. A total of 52 patients with surgically proven uterine malformations were included. We compared 41 infertile patients with uterine malformations with 11 fertile patients with uterine malformation. The main outcome was the stage, score and type of endometriosis in regard to infertility and class of uterine malformation. Results The rate of endometriosis did not differ between the two groups (43.9 vs. 36.4%). The mean revised American Fertility Society score was higher in infertile patients with uterine malformations (19.02 vs. 6, p < 0.05). No significant difference was found in the rate of superficial peritoneal endometriosis (43.9 vs. 37.5%). Endometrioma and deep infiltrating endometriosis were associated with uterine malformations in infertile women, respectively 14.6 and 0%. No difference in the characteristics of endometriosis was found regarding the class of malformation. Conclusions The association of uterine malformations and infertility may increase the severity of endometriosis and raise the issue of their diagnosis and management.
Published: 2016
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38. Disproportion fœto-placentaire à terme : physiologique ou pathologique

Author: Lionel Carbillon, Amélie Benbara, J. Boujenah, P. Lorain, and Alexandre Bricou
Subjects: 03 medical and health sciences, 030219 obstetrics & reproductive medicine, 0302 clinical medicine, Reproductive Medicine, Obstetrics and Gynecology, 030212 general & internal medicine, General Medicine
Abstract: Resume Buts La fonction placentaire etant difficile a evaluer, le rapport entre son poids et celui du nouveau-ne (PW/BW) pourrait etre le reflet de sa dysfonction. L’objectif de ce travail est d’etudier l’incidence, les facteurs de risque et les consequences maternelles et fœtales d’un rapport PW/BW eleve a terme. Materiels et methodes Il s’agit d’une etude retrospective observationnelle cas-temoin unicentrique. Les grossesses singleton avec un PW/BW superieur ou egal a 0,25 apres 37 SA ont ete incluses apres exclusion des grossesses gemellaires et des morts fœtales in utero. L’appariement a ete effectue avec un groupe temoin de patientes presentant un ratio PW/BW compris entre 0,15 et 0,25. Les caracteristiques maternelles, les donnees fœtales ante-partum, les caracteristiques du travail et les donnees neonatales ont ete comparees. Resultats Aucune difference significative n’a ete mise en evidence concernant les caracteristiques maternelles. Il y avait plus de pre-eclampsie (15,5 % versus 1,7 % ; p p Conclusion L’hypertrophie placentaire disproportionnee caracterisee par une elevation du rapport PW/BW est associee au developpement d’une pre-eclampsie a terme suggerant differents mecanismes physiopathologiques.
Published: 2016
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39. Grossesse extra-utérine cornuale : prise en charge, fertilité ultérieure et devenir obstétrical

Author: Amélie Benbara, J. Boujenah, Christophe Poncelet, G. Moreaux, Lionel Carbillon, C Nguyen, K Nikodijevic, and Alexandre Bricou
Subjects: Gynecology, 03 medical and health sciences, medicine.medical_specialty, 030219 obstetrics & reproductive medicine, 0302 clinical medicine, Reproductive Medicine, business.industry, 030220 oncology & carcinogenesis, Obstetrics and Gynecology, Medicine, General Medicine, business
Abstract: Gynecologie Obstetrique & Fertilite - Sous presse. Epreuves corrigees par l'auteur. Disponible en ligne depuis le mercredi 9 decembre 2015
Published: 2016
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40. Mise au point sur les méthodes de détection des ganglions sentinelles dans le cancer du sein

Author: Alexandre Bricou, J. Boujenah, E. Barranger, and E. Cohen
Subjects: Lymphatic metastasis, business.industry, Coloring agents, Obstetrics and Gynecology, General Medicine, 030230 surgery, Sentinel node, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Breast cancer, Reproductive Medicine, 030220 oncology & carcinogenesis, Dual isotope, medicine, Axillary Dissection, business, Nuclear medicine, Lymph node, Indocyanine green fluorescence
Abstract: The sentinel node procedure (GS) is the recommended technique for axillary surgical exploration in localized breast cancer with no clinical or radiological lymph node involvement. This surgical technique is based on a dual isotope and colorimetric detection. Although it allows a significant reduction in morbidity compared to axillary dissection (CA), this procedure induces a number of organizational constraints, in particular for the radioisotope injection. Specially for this reason, other GS methods have emerged in recent years, some of which appear promising (detection by fluorescence and magnetic iron). The objective of this paper was to carry out a synthesis of the reference method of detection (radioisotope) GS and analyze the recent literature on new detection methods.
Published: 2016
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41. Recommendations for the surgical management of gynecological cancers during the COVID-19 pandemic - FRANCOGYN group for the CNGOF

Author: Martin Koskas, Marcos Ballester, Ludivine Dion, Cyril Touboul, Geoffroy Canlorbe, Vincent Lavoué, Yohann Dabi, Tristan Gauthier, Emilie Raimond, Cherif Akladios, Charles Coutant, Xavier Carcopino, Frédéric Kridelka, Matthieu Mezzadri, Pierre-Adrien Bolze, Lobna Ouldamer, Henri Azaïs, Alexandre Bricou, Lise Lecointre, Sofiane Bendifallah, Pierre Collinet, Camille Mimoun, Pauline Chauvet, Nicolas Bourdel, Olivier Graesslin, and Cyrille Huchon
Subjects: Cervical cancer, medicine.medical_specialty, 030219 obstetrics & reproductive medicine, Hysterectomy, business.industry, medicine.medical_treatment, Endometrial cancer, General surgery, Sentinel lymph node, Obstetrics and Gynecology, Cancer, COVID-19, Introduction, Guideline, Management, Gynaecological cancer, medicine.disease, Radiation therapy, 03 medical and health sciences, 0302 clinical medicine, Reproductive Medicine, 030220 oncology & carcinogenesis, Obstetrics and Gynaecology, Medicine, Lymphadenectomy, Hyperthermic intraperitoneal chemotherapy, business
Abstract: Introduction In the context of the COVID-19 pandemic, specific recommendations are required for the management of patients with gynecologic cancer. Materials and method The FRANCOGYN group of the National College of French Gynecologists and Obstetricians (CNGOF) convened to develop recommendations based on the consensus conference model. Results If a patient with a gynecologic cancer presents with COVID-19, surgical management should be postponed for at least 15 days. For cervical cancer, radiotherapy and concomitant radiochemotherapy could replace surgery as first-line treatment and the value of lymph node staging should be reviewed on a case-by-case basis. For advanced ovarian cancers, neoadjuvant chemotherapy should be preferred over primary cytoreduction surgery. It is legitimate not to perform hyperthermic intraperitoneal chemotherapy during the COVID-19 pandemic. For patients who are scheduled to undergo interval surgery, chemotherapy can be continued and surgery performed after 6 cycles. For patients with early stage endometrial cancer of low and intermediate preoperative ESMO risk, hysterectomy with bilateral adnexectomy combined with a sentinel lymph node procedure is recommended. Surgery can be postponed for 1–2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1–2 endometrioid cancer on endometrial biopsy). For patients of high ESMO risk, the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) should be applied to avoid pelvic and lumbar-aortic lymphadenectomy. Conclusion During the COVID-19 pandemic, management of a patient with cancer should be adapted to limit the risks associated with the virus without incurring loss of chance.
Published: 2020
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42. Interest of a hand-held gamma camera (TReCam) in breast SNOLL procedure

Author: Amélie Benbara, Laurent Pinot, Alexandre Bricou, Marie-Alix Duval, Eric Vicaut, Françoise Bouvet-Lefebvre, Yves Charon, Michael Soussan, Laurent Menard, M.-A. Verdier, and Nicolas Sellier
Subjects: business.industry, Computer science, law, Hand held, Computer vision, General Medicine, Artificial intelligence, business, Gamma camera, law.invention
Published: 2020
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43. Comparison of pelvic and para-aortic lymphadenectomy versus para-aortic lymphadenectomy alone for locally advanced FIGO stage IB2 to IIB cervical cancer using a propensity score matching analysis: Results from the FRANCOGYN study group

Author: Emile Daraï, Florence Huguet, Marcos Ballester, Pierre Collinet, Vincent Lavoué, Geoffroy Canlorbe, Emilie Raimond, J. Varinot, Xavier Carcopino, Cyrille Huchon, Groupe de Recherche Francogyn, Lobna Ouldamer, Sofiane Bendifallah, Tiphaine de Foucher, Cyril Touboul, Alexandre Bricou, Olivier Graesslin, CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 (UPMC), Institut Universitaire de Cancérologie [Sorbonne Université] (IUC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, Tours, France., Department of Obstetrics, Gynecology and Reproductive Medicine, Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique-Hôpitaux de Paris, France., CRLCC Eugène Marquis (CRLCC), Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Service de gynécologie-obstétrique [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France., Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France., Department of Gynecologic Surgery, Jeanne de Flandre Hospital, CHU de Lille, Lille, France., Department of Obstetrics and Gynecology, Poissy-St Germain Hospital, Poissy, France., Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Universitaire de Cancérologie [Paris] (IUC), and Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), CNRS, IRD, Marseille, France.
Subjects: Adult, medicine.medical_specialty, Survival, medicine.medical_treatment, Locally advanced, Urology, Uterine Cervical Neoplasms, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Pelvis, 03 medical and health sciences, 0302 clinical medicine, Nodal status, medicine, Para aortic lymphadenectomy, Humans, Aorta, Abdominal, Stage (cooking), Propensity Score, Lymph node, Aged, Neoplasm Staging, Cervical cancer, Locally advanced cervical cancer, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, 030219 obstetrics & reproductive medicine, business.industry, Lymphadenectomy, General Medicine, Middle Aged, medicine.disease, Prognosis, humanities, 3. Good health, Survival Rate, MESH: Locally advanced cervical cancer, medicine.anatomical_structure, Oncology, 030220 oncology & carcinogenesis, Lymphatic Metastasis, Propensity score matching, Lymph Node Excision, Surgery, Female, Neoplasm Recurrence, Local, business
Abstract: Introduction Pre-treatment evaluation of nodal status is crucial in women presenting with locally advanced cervical cancer (LACC). However, the prognostic impact of surgical staging remains to be proved, as published results comparing surgical versus radiological staging are contradictory. The aim of this study was to compare the prognosis of women with FIGO stage IB2–IIB CC who underwent surgical nodal staging including either exclusive para-aortic lymphadenectomy (PAL) or comprehensive pelvic + para-aortic lymphadenectomy (P-PAL). Materials and methods Data of 314 women with FIGO stage IB2 to IIB CC treated between January 2000 and January 2015 were retrospectively abstracted from nine French institutions. The prognosis and outcomes were compared by Propensity score (PS) matching (PSM) analysis. Results The median follow-up was 33 months (2–114). When comparing women who underwent PAL vs P-PAL, the recurrence rates were 26% (37/144) and 28% (41/144), respectively (p = 0.595). The respective 3-year recurrence free survival (RFS) for P-PAL and PAL were 72.9% (95% CI, 65.7–81.0) and 70.7% (95% CI, 62.4–80.2), (p = 0.394). The respective 3-year overall survival (OS) rates for P-PAL and PAL were 86.8% (95% CI, 81.1–92.9) and 78.6% (95% CI, 70.4–87.7) (p = 0.592). In the sub-group of women with lymph node metastases, RFS was improved for women who underwent P-PAL compared to those with exclusive PAL (p = 0.027), with no difference in OS (p = 0.187). Conclusions Comprehensive P-PAL does not seem to be of significant therapeutic benefit compared to exclusive PAL.
Published: 2018
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44. [Hyperthermic intra-peritoneal chemotherapy (HIPEC) saved by evidence-based medecine: Ovarian carcinomatosis, HIPEC's favorite target?]

Author: Vincent, Lavoué, Sofiane, Bendifallah, Pierre, Collinet, Olivier, Graesslin, Marcos, Ballester, Cherif, Akladios, Xavier, Carcopino, Alexandre, Bricou, Martin, Koskas, Geoffroy, Canlorbe, Charles, Coutant, Pierre Adrien, Bolze, Lobna, Ouldamer, Emile, Daraï, Cyril, Touboul, and Cyrille, Huchon
Subjects: Carcinoma, Humans, Autopsy, Hyperthermia, Induced, Colorectal Neoplasms
Published: 2018

45. Lymphadenectomy in elderly patients with high-intermediate-risk, high-risk or advanced endometrial cancer: Time to move from personalized cancer medicine to personalized patient medicine!

Author: Jean Levêque, Geoffroy Canlorbe, Charles Coutant, Krystel Nyangoh Timoh, Martin Koskas, Cyril Touboul, Vincent Lavoué, Nina Hudry, Pierre Collinet, Adelaïde Racin, Marcos Ballester, Emile Daraï, Olivier Graesslin, Lobna Ouldamer, Alexandre Bricou, Sofiane Bendifallah, Emilie Raimond, Cyrille Huchon, Groupe de Recherche Francogyn, CHU Pontchaillou [Rennes], Chemistry, Oncogenesis, Stress and Signaling (COSS), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), ESIM - Déterminants Sociaux de la Santé et du Recours aux Soins (DS3), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, CHI Créteil, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris 13 (UP13), CHI Poissy-Saint-Germain, CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche Saint-Antoine (CRSA), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)
Subjects: Databases, Factual, medicine.medical_treatment, Logistic regression, Paraaortic lymphadenectomy, Cohort Studies, 0302 clinical medicine, Elderly, Precision Medicine, ComputingMilieux_MISCELLANEOUS, Aged, 80 and over, 030219 obstetrics & reproductive medicine, General Medicine, Prognosis, 3. Good health, Oncology, 030220 oncology & carcinogenesis, Lymphatic Metastasis, Female, France, Cancer-specific survival, medicine.medical_specialty, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Risk Assessment, Disease-Free Survival, 03 medical and health sciences, Cancer Medicine, Internal medicine, High-risk endometrial cancer, medicine, Humans, Neoplasm Invasiveness, Geriatric Assessment, Aged, Neoplasm Staging, Retrospective Studies, Proportional hazards model, business.industry, Endometrial cancer, High intermediate risk, Retrospective cohort study, Lymphadenectomy, medicine.disease, Survival Analysis, Endometrial Neoplasms, Logistic Models, Multivariate Analysis, Lymph Node Excision, Surgery, Lymph Nodes, business, Forecasting
Abstract: Pelvic and paraaortic lymphadenectomy are recommended for women with high-intermediate, high-risk and advanced endometrial cancer (EC). Lymphadenectomy is less frequently performed in elderly patients than in younger patients. We examined the survival of elderly women diagnosed with high-risk EC according to whether lymphadenectomy was performed or not.We selected women over 70 years with high-intermediate risk, high-risk or advanced EC from a multicenter retrospective cohort of women diagnosed between 2001 and 2013. Multivariate logistic regression models and Cox proportional hazards survival methods for overall survival (OS), disease-free survival (DFS) and cancer-specific survival (CSS) were used for analyses.71 women had lymphadenectomy and were compared with the 213 who did not. Recurrence was similar in both groups (42% vs 33%, respectively, p = 0.17) but more deaths were reported in the group without lymphadenectomy (38% vs 23%, respectively, p 0.001). There was no difference in adjuvant treatment in the two groups (17% vs 27%, respectively, p = 0.27). Elderly patients without lymphadenectomy had lower 3-year DFS (56% vs 71%, p = 0.076), CSS (67% vs 85%, p 0.001) and OS (50% vs 71% p 0.001). The Cox proportional hazard models showed independently poorer prognosis in women without lymphadenectomy (3.027, 95% CI 1.58-5.81, p 0.001), histology type 2 (3.46, 95% CI 1.51-7.97, p = 0.003) and lymphovascular space involvement (3.47, 95% CI 1.35-8.98, p = 0.01) on 3-year CSS.No lymphadenectomy in elderly patients with high-risk or advanced EC is independently associated with poorer prognosis. Elderly patients with EC should benefit from lymphadenectomy when indicated.
Published: 2018
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46. A Proposal for a Classification for Recurrent Endometrial Cancer: Analysis of a French Multicenter Database From the FRANCOGYN Study Group

Author: Geoffroy Canlorbe, Charles Coutant, Emile Daraï, Sofiane Bendifallah, Olivier Graesslin, Amélie Benbara, Marcos Ballester, Vincent Lavoué, Xavier Carcopino, Lionel Carbillon, Emilie Raimond, C Touboul, Pierre Collinet, Mathilde Daix-Moreux, Cyrille Huchon, Lobna Ouldamer, Alexandre Bricou, Service de gynécologie-obstétrique [Hôpital Jean Verdier], Université Paris 13 (UP13)-Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Service de Gynécologie et Obstétrique [Rennes] = Gynaecology [Rennes], CHU Pontchaillou [Rennes], Service de rhumatologie [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Centre Hospitalier Universitaire de Reims (CHU Reims), Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, Service d'obstétrique-gynécologie [Lille], Hôpital Jeanne de Flandre [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Service de gynécologie-obstétrique [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Service de gynécologie et obstétrique [Créteil], CHI Créteil, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Service de Gynécologie-Obstétrique [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université, Service de Gynécologie et Obstétrique [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-hôpital Sud, Service de rhumatologie, inflammation-immunopathologie- biothérapie [CHU Saint-Antoine] (DHU i2B ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Sorbonne Université (SU), Centre National de la Recherche Scientifique (CNRS)-Institut de recherche pour le développement [IRD] : UMR237-Aix Marseille Université (AMU)-Avignon Université (AU), Hôpital Nord [CHU - APHM]-Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU), Hôpital Jean Verdier [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris 13 (UP13)
Subjects: medicine.medical_specialty, medicine.medical_treatment, Salpingo-oophorectomy, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Hysterectomy, Gastroenterology, Metastasis, 03 medical and health sciences, 0302 clinical medicine, Endometrial cancer, Recurrence free survival, Internal medicine, medicine, Humans, Recurrences, Neoplasm Metastasis, Survival rate, Retrospective Studies, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics and Gynecology, Retrospective cohort study, medicine.disease, Classification, Recurrent Endometrial Cancer, Confidence interval, 3. Good health, Endometrial Neoplasms, Survival Rate, Oncology, 030220 oncology & carcinogenesis, Lymphatic Metastasis, Female, France, Neoplasm Recurrence, Local, business, Relapses
Abstract: ObjectiveEndometrial cancer (EC) recurrences are relatively common with no standardized way of describing them. We propose a new classification for them called locoregional, nodal, metastasis, carcinomatosis recurrences (rLMNC).Patients and MethodsThe data of 1230 women with EC who were initially treated by primary surgery were included in this French multicenter retrospective study. Recurrences were classified based on dissemination pathways: (1) locoregional recurrence (rL); (2) nodal recurrence (rN) for lymphatic pathway; (3) distant organ recurrence (rM) for hematogenous pathway; and (4) carcinomatosis recurrence (rC) for peritoneal pathway. These pathways were further divided into subgroups. We compared recurrence free survival and overall survival (OS) between the 4 groups (rL/rN/rM/rC).ResultsThe median follow-up was 35.6 months (range, 1.70–167.60). One hundred ninety-eight women (18.2%) experienced a recurrence: 150 (75.8%) experienced a single-pathway recurrence and 48 (24.2%) a multiple-pathway recurrence. The 5-year OS was 34.1% (95% confidence interval [CI], 27.02%–43.1%), and the median time to first recurrence was 18.9 months (range, 0–152 months). The median survival after recurrence was 14.8 months (95% CI, 11.7–18.8). Among women with single pathway of recurrence, a difference in 5-year OS (P < 0.001) and survival after recurrence (P < 0.01) was found between the 4 rLNMC groups. The carcinomatosis group had the worst prognosis compared with other single recurrence pathways. Women with multiple recurrences had poorer 5-year OS (P < 0.001) and survival after recurrence (P < 0.01) than those with single metastasis recurrence, other than women with peritoneal carcinomatosis.ConclusionsThis easy-to-use and intuitive classification may be helpful to define EC recurrence risk groups and develop guidelines for the management of recurrence. Its prognosis value could also be a tool to select homogenous populations for further trials.
Published: 2018
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47. Change in hazard rates of recurrence over time following diagnosis of endometrial cancer: An age stratified multicentre study from the FRANCOGYN group

Author: Jean Lévêque, Sofiane Bendifallah, Olivier Graesslin, Goeffroy Canlorbe, Groupe de Recherche Francogyn, Gilles Body, Pierre Collinet, Cyrille Huchon, Emilie Raimond, Cyril Touboul, Lobna Ouldamer, Charles Coutant, Emile Daraï, Marcos Ballester, Vincent Lavoué, and Alexandre Bricou
Subjects: 0301 basic medicine, Adult, medicine.medical_specialty, Salpingo-oophorectomy, Hysterectomy, Metastasis, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Advanced disease, Initial treatment, Humans, Prospective Studies, Stage (cooking), Aged, Neoplasm Staging, Aged, 80 and over, business.industry, Endometrial cancer, Hazard ratio, Age Factors, General Medicine, Middle Aged, medicine.disease, Endometrial Neoplasms, Survival Rate, 030104 developmental biology, Increased risk, Oncology, 030220 oncology & carcinogenesis, Lymphatic Metastasis, Surgery, Targeted surveillance, Female, France, Neoplasm Recurrence, Local, business
Abstract: Predicting the pattern of recurrence can aid in the development of targeted surveillance and treatment strategies. The objectives of this study were to identify patterns of recurrence in women with operable endometrial cancer (EC) and to identify high-risk periods for recurrence in function of age.The data of 1153 women who received primary surgical treatment for stage I-III EC between January 2001 and December 2013 were abstracted from a prospectively maintained multicentre database. The time to first recurrence was calculated from the date of diagnosis, and the associated hazard function was examined to determine the peak risk period of recurrence. We categorized age at diagnosis as65 and ≥ 65 years old and analysed the hazard rate (HR) by stratifying age groups.Women with EC aged ≥65 years maintain a significant recurrence rate during follow-up whatever the stratification (locoregional recurrence, distant recurrence, ESMO/ESGO/ESTRO subgroup). Multivariable Cox proportional hazard regression showed that the increased risk of recurrence of EC was associated with advanced age, advanced disease ESMO/ESGO/ESTRO subgroup but not with initial treatment received.The annual HR of recurrence is not uniformly distributed over time but is dynamic and markedly determined by prognostic factors at diagnosis.
Published: 2018

48. Endometriosis Fertility Index ou classification de l’American Society of Reproductive Medicine pour les patientes infertiles endométriosiques opérées. Lequel est le plus pertinent ?

Author: J. Boujenah, Alexandre Bricou, Charlotte Sonigo, Christophe Sifer, M. Monforte, Jean-Noël Hugues, Isabelle Cedrin-Durnerin, and Christophe Poncelet
Subjects: Gynecology, medicine.medical_specialty, Pregnancy, business.industry, media_common.quotation_subject, Female infertility, Clinical pregnancy, Endometriosis, External validation, Reproductive medicine, Obstetrics and Gynecology, Fertility, General Medicine, medicine.disease, Postoperative management, Reproductive Medicine, medicine, business, media_common
Abstract: The revised American Fertility Society classification system has been most used after surgery by all consensus on endometriosis fertility. However, it does not predict pregnancy. The EFI score has been recently developed to aim at predicting clinical pregnancy after surgery. Several study performed its external validation. It may be a useful new tool to counsel couples for personalized postoperative management.
Published: 2015
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49. Impact d’un test de signature génomique en sénologie sur les décisions en réunion de concertation pluridisciplinaire : une expérience française

Author: I. Tengher, P. Agranat, Alexandre Bricou, Marcos Ballester, C. Dreyfus, Martine Antoine, and Joseph Gligorov
Subjects: Gynecology, medicine.medical_specialty, Reproductive Medicine, business.industry, Recurrence score, Obstetrics and Gynecology, Medicine, General Medicine, business, Early breast cancer
Abstract: Resume Objectifs La signature genomique comportant 21 genes (Oncotype DX ® ) permet d’estimer le risque de recidive et de predire le benefice d’une chimiotherapie adjuvante dans les cancers du sein hormonodependants a un stade precoce, n’ayant pas de surexpression ou d’amplification de HER2. Son resultat correspond a un score de recidive ou « recurence score » (RS) permettant de classer les patientes en trois groupes (risque faible, intermediaire ou eleve). L’objectif de cette etude bicentrique prospective est de definir l’impact d’Oncotype Dx ® sur les pratiques cliniques. Methodes Entre aout 2013 et mai 2015, un test Oncotype DX ® a ete propose a certaines patientes presentant une indication de chimiotherapie pour les cancers localises du sein RH+ et HER2 negatifs en reunion de concertation pluridisciplinaire. Les modifications therapeutiques apres connaissance du RS ont ete colligees. Une estimation de l’impact economique a ete realisee et une correlation entre le RS et les marqueurs usuels pronostiques du cancer du sein a ete recherchee. Resultats Trente-neuf patientes ont eu un test, vingt-six (66,7 %) d’entre elles n’ont finalement pas eu d’indication retenue de chimiotherapie. L’economie obtenue grâce a la realisation du test a ete estimee a environ 173 000 euros. Il n’a pas ete mis en evidence de correlation entre le RS, les facteurs decisionnels et pronostiques usuels du cancer du sein ou encore avec adjuvant ! Online. Conclusions Le RS possede une valeur informative decisionnelle supplementaire par rapport aux autres criteres decisionnels usuels. L’utilisation du test Oncotype DX ® reduit dans notre experience les indications de chimiotherapie adjuvante. L’impact medico-economique pourrait etre important.
Published: 2015
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50. Patterns of care and the survival of elderly patients with high-risk endometrial cancer: A case-control study from the FRANCOGYN group

Author: Geoffroy Canlorbe, Cyrille Huchon, Pierre Collinet, Charles Coutant, Marcos Ballester, Vincent Lavoué, Sofiane Bendifallah, Emilie Raimond, C Touboul, Lobna Ouldamer, Olivier Graesslin, Antoine Rousselin, K. Nyangoh Timoh, Alexandre Bricou, Nina Hudry, Jean Levêque, Emile Daraï, Chemistry, Oncogenesis, Stress and Signaling (COSS), Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Gynécologie et Obstétrique [Rennes] = Gynaecology [Rennes], CHU Pontchaillou [Rennes], CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Epidémiologie, Systèmes d'Information, Modélisation, Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Universitaire de Reims (CHU Reims), Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, Service de gynécologie et obstétrique [Créteil], CHI Créteil, Service d'obstétrique-gynécologie [Lille], Hôpital Jeanne de Flandre [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de gynécologie-obstétrique [Hôpital Jean Verdier], Université Paris 13 (UP13)-Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CRLCC Eugène Marquis (CRLCC)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Cadieu, Muriel, Service de Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Jean Verdier [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris 13 (UP13)
Subjects: Oncology, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, medicine.medical_treatment, 0302 clinical medicine, Elderly, 030212 general & internal medicine, Practice Patterns, Physicians', ComputingMilieux_MISCELLANEOUS, Aged, 80 and over, Age Factors, General Medicine, Prognosis, humanities, 3. Good health, Survival Rate, Treatment Outcome, Lymphatic Metastasis, 030220 oncology & carcinogenesis, Female, medicine.medical_specialty, Standard of care, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, High-risk endometrial cancer, medicine, Adjuvant therapy, Humans, Aged, Neoplasm Staging, Patterns of care, Chemotherapy, business.industry, Endometrial cancer, Case-control study, Cancer, medicine.disease, Endometrial Neoplasms, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Case-Control Studies, Chemotherapy: cancer-specific survival, Lymph Node Excision, Lymphadenectomy, Surgery, Neoplasm Grading, business
Abstract: The standard of care of endometrial cancer involves complex procedures such as pelvic and para-aortic lymphadenectomy and omentectomy, particularly for high-risk endometrial cancer. Few data are available about these complex surgical procedures and adjuvant therapy in elderly women. We aim to examine treatment and survival of elderly women diagnosed with high-risk endometrial cancer.We performed a case-control study of women diagnosed between 2001 and 2013 with high-risk endometrial cancers. Women older than 70 years (n = 198) were compared with patients70 years (n = 198) after matching on high-risk for recurrence and LVSI status.Elderly patients had lymphadenectomies less frequently compared with younger patients (76% vs 96%, p 0.001) and no adjuvant treatment more frequently (17% vs 8%, p = 0.005) due to less chemotherapy being administered (23% vs 46%, p 0.001). The 3-year DFS, CSS and OS of patients ≥70 years was 52% (43-61), 81% (74-88) and 61% (53-70), respectively. These were significantly lower than the 3-year DFS, CSS, and OS of younger patients, which was 75% (68-82) (p 0.001), 92% (87-96) (p 0.008) and 75% (69-82) (p = 0.018), respectively. Cox proportional hazard models found that elderly women had 57% increased risk of recurrence (hazard ratio 1.57, 95% CI 1.04-2.39) compared with younger patients.Although we found an independently significant lower DFS in elderly patients with high-risk endometrial cancer when compared with young patients, elderly women are less likely to be treated with lymphadenectomy and chemotherapy. Specific guidelines for management of elderly patients with high-risk endometrial cancer are required to improve their prognosis.
Published: 2017
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