[Renal cell carcinoma of patients younger than 40 years old]. / Le carcinome à cellules rénales du sujet de moins de 40ans.

CONTEXT: Clinical and pathological characteristics of renal cell carcinoma (RCC) of patients younger than 40 years old are not well known. The objective of this study was to analyze these characteristics by comparison to a group of patients aged 58 to 62. METHODS: Retrospective study of a group of patients aged less than 40 years old (group 1, n=44) and a group of patients aged 58 to 62 years old (group 2; n=106) treated surgically for a renal mass from January 2000 to July 2009. A comparative analysis of clinical, pathological characteristics and of cancer-specific survival was performed. Specific survival was calculated with the Kaplan-Meier method and compared with the Log-Rank test. Univariate and multivariable analysis were performed to assess and quantify the effect of age on cancer-specific survival. Covariates were gender, age group, tumor size, pT stage, histological sub-type and Fuhrman grade. RESULTS: Clinical and pathological characteristics were similar in both groups (P>0.05) except for histological sub-type (56% of clear cell RCC for group 1 versus 82% for group 2). In the group of patients younger than 40 years, translocation RCC represented 23% of all RCCs. Cancer-specific survival at five years was similar in both groups (80% and 76% for group 1 and 2 respectively, P>0.58). Fuhrman grade was the only independent prognostic factor of cancer-specific survival (P=0.001). CONCLUSION: Patients younger than 40 years were more likely to have a translocation RCC than their older counterparts for who clear cell RCC represented the main histological sub-type. Cancer-specific survival was similar between both groups. Only a systematic specific immunostaining for TFE3 or TFEB will allow to assess the exact incidence and prognosis of this entity.

[Influence of occupational exposures in nonmuscle infiltration bladder cancer: preliminary results of a prospective study from October 2005 to February 2009]. / Influence des expositions professionnelles dans les cancers n'infiltrant pas le muscle détrusor. Résultats préliminaires d'une étude prospective d'octobre2005 à février2009.

UNLABELLED: Bladder cancer is a common condition in industrialized countries. If tobacco is still the main risk factor in lung cancer, occupational exposures carcinogens should not be underestimated. GOAL: The significant excess of bladder cancer in the north part of France, with high manufacture concentration likely to have employees exposed to bladder carcinogens, has led us to study the influence of these exposures in the natural history of bladder cancer. PATIENTS AND METHODS: We prospectively conducted a descriptive case-control study. A questionnaire was developed by the department of occupational disease and clinical, radiological, histological, therapeutic data were registered at the University Hospital of Lille. From October 2005 to February 2009, 69 patients were included in the study, 37 exposed to occupational carcinogens and 32 in the control group. RESULTS: Mean age was 61.6 years vs. 61.8 years and the sex ratio of 7.33 men to one woman vs. one woman for three men respectively in the two groups. The average age of patients exposed to polycyclic aromatic hydrocarbons was 59.7 years. Smokers were 86.5% and 87.5% respectively. Follow-up was 38.4 and 32.9 months respectively. Nonmuscle invasive bladder cancer were more frequent (P=0.019) in the exposed group (84.4%) than in the unexposed group (67.8%) even after adjustment for smoking (P=0.0142). The histological type, grade, presence of CIS, the early recurrence at 3 months, the number of lesions at diagnosis does not differ in the two groups even after adjustment for smoking or after subgroup analysis of the most frequent exposure. The exposure to polycyclic aromatic hydrocarbons (62%) and aromatic amines (37.8%) were the most represented. Of 37 patients, 13 (35%) were making a statement as an occupational disease (eight according to Table 15 ter, two according to Table 16 bis and two presented to IRB). To date one single patient is recognized as an occupational disease. CONCLUSION: We did not observe any worsening of the prognosis of bladder cancer following occupational carcinogen exposure except for the mean age at diagnosis. The small size of the population studied and the importance of smoking partner have hampered the analysis of occupational exposures.

[Effect of wound infiltration of ropivacaine in postoperative pain after extraperitoneal laparoscopic radical prostatectomy]. / Effet de l'infiltration pariétale d'anesthésique local (ropivacaïne) sur la douleur postoperatoire après prostatectomie radicale laparoscopique sous-péritonéale.

PURPOSE: Evaluation of the efficiency of wound infiltration of ropivacaine in postoperative pain after extraperitoneal laparoscopic radical prostatectomy. MATERIAL AND METHODS: Prospective single institution study included 130 patients treated by extraperitoneal laparoscopic radical prostatectomy from January to March 2007. One hundred and two patients were included and randomised in two groups according to the year of birth (pair or impair). Only patients from the first group (year pair) had wound infiltration at the end of the procedure. The second group (year impair) was the control group. An analogic visual scale (EVA) permitted evaluation of pain at 30 minutes, 1, 6 and 12 hours after the procedure. Use of analgesics after procedure were noted for each patient. RESULTS: In the first group, the median of EVA was 1.44, 1.34, 1.72 and 1.51 respectively at 30 minutes, 1, 6 and 12 hours. In the second group, the median of EVA was 1.28, 1.36, 1.46 and 1.44. We found no statistically significant difference for pain and use of analgesic between the two groups (p=0.71, 0.96, 0.47 and 0.86 respectively at 30 minutes, 1, 6 and 12 hours). CONCLUSION: Ropivacaine in wound infiltration did not decrease significantly the postoperative pain and must not be used systematically.

[Sporadic upper urinary tract urothelial cell carcinomas: identification of interaction between toxic carcinogens and individuals genetic susceptibility]. / Tumeurs des voies excrétrices urinaires supérieures sporadiques: identification de l'interaction entre l'exposition aux carcinogènes environnementaux et la susceptibilité génétique des individus.

Upper urinary tract urothelial cell carcinomas (UUT UCC) are rare sporadic tumors. Recent epidemiologic and molecular data have shown a singular susceptibility of UUT UCCs for specific risk factors. The main exogenic factors involved in UUT UCCs carcinogenesis remain tobacco and occupational exposure (aromatic amines, polycyclic hydrocarbures and chlored solvents). Enzymatic variants of detoxification system may be responsible of carcinogenesis with these toxics. Tumors induced by phenacetine consumption are decreasing since it was banned in the 1970s. Also, acid aristolochic exposure (Balkan nephropathy, Chinese Herb nephropathy) has been demonstrated to specifically induce UUT UCCs. Familial genic polymorphism of detoxification system would explain geographic distribution in endemic areas. In Taiwan, chronic arsenic exposition would constitute the main risk factor of UUT UCC. However, theses mechanisms of carcinogenesis remain unclear. The knowledge of UUT UCC development mechanisms implying toxic detoxification systems is still incomplete. To date, there is a growing body of evidence supporting that the interaction between individual genetic susceptibilities and environmental toxic exposure is a key to explain carcinogenesis in the majority of sporadic UUT UCC occurrence.