Response shift effects on measuring post-operative quality of life among breast cancer patients: a multicenter cohort study.

PURPOSE: To characterize response shift effects in patients with breast cancer (BC). METHODS: The QLQ-C30, BR23, and EurQOL-EQ-5D were assessed at baseline and at the end of the first hospitalization. We used the then-test approach to characterize changes in internal standards by calculating the mean difference between the then-test (retrospective measure) and pre-test baseline QoL assessments. The Ideal Scale Approach was also used to assess changes in standards by comparing health and QoL expectancies between baseline and the end of the first hospitalization. Successive Comparison Approach was used to assess changes in values through the longitudinal assessment of the relative importance of EuroQOL dimensions. RESULTS: The results of this study showed that recalibration RS effects occurred early after the first hospitalization for 6/15 dimensions of QLQ-C30 (emotional, cognitive, fatigue, insomnia, appetite loss, diarrhea) and 2/8 of BR-23 (future perspective, systemic therapy side effects). Moreover, health and QoL expectancies changed between the baseline and the end of the first hospitalization, and changes in values were seen for the self-care and usual activities dimensions of the EuroQOL-EQ-5D. CONCLUSIONS: The occurrence of RS early after the first hospitalization suggests that it needs to be taken into account to interpret QoL changes in BC.

Breast cancer in men in Cote d'Or (France): epidemiological characteristics, treatments and prognostic factors.

Breast cancer in men is rare, and clinical trials are thus not feasible. This study aimed to describe the epidemiological characteristics, treatment and prognostic factors of breast cancer in men. A population-based study was performed using data from the Cote d'Or breast and gynaecological cancer registry. Data on male breast cancer diagnosed from 1982 to 2008 were provided. Relative survival rates were estimated at 5 years according to the characteristics of the patient and tumour, and treatment. Prognostic factors of survival in men with breast cancer were identified using a generalised linear model. Seventy-five men with invasive breast cancer were registered. Mean age at diagnosis was 66 years. The use of adjuvant chemotherapy (P= 0.013) and hormone therapy (P < 0.0001) increased over time. Relative survival rate at 5 years was 69% for the whole population. Analysis of relative survival according to the treatment showed that survival was longer for patients treated with surgery + radiotherapy + hormone therapy: 89% at 5 years. Scarff, Bloom and Richardson grade was independent prognostic factor of survival. Male breast cancer is a rare disease with a poor prognosis, and diagnosis is often made at an advanced stage. Early diagnosis and better knowledge of the disease would certainly lead to improvements in the prognosis.

Cost comparison of axillary sentinel lymph node detection and axillary lymphadenectomy in early breast cancer. A national study based on a prospective multi-institutional series of 985 patients 'on behalf of the Group of Surgeons from the French Unicancer Federation'.

BACKGROUND: Our objective was to assess the global cost of the sentinel lymph node detection [axillary sentinel lymph node detection (ASLND)] compared with standard axillary lymphadenectomy [axillary lymph node dissection (ALND)] for early breast cancer patients. PATIENTS AND METHODS: We conducted a prospective, multi-institutional, observational, cost comparative analysis. Cost calculations were realized with the micro-costing method from the diagnosis until 1 month after the last surgery. RESULTS: Eight hundred and thirty nine patients were included in the ASLND group and 146 in the ALND group. The cost generated for a patient with an ASLND, with one preoperative scintigraphy, a combined method for sentinel node detection, an intraoperative pathological analysis without lymphadenectomy, was lower than the cost generated for a patient with lymphadenectomy [€ 2947 (σ = 580) versus € 3331 (σ = 902); P = 0.0001]. CONCLUSION: ASLND, involving expensive techniques, was finally less expensive than ALND. The length of hospital stay was the cost driver of these procedures. The current observational study points the heterogeneous practices for this validated and largely diffused technique. Several technical choices have an impact on the cost of ASLND, as intraoperative analysis allowing to reduce rehospitalization rate for secondary lymphadenectomy or preoperative scintigraphy, suggesting possible savings on hospital resources.

[Retroperitoneal lymphadenectomy and survival of patients treated for an advanced ovarian cancer: the CARACO trial]. / Impact des curages rétropéritonéaux sur la survie des patientes atteintes d'un cancer de l'ovaire à un stade avancé : le protocole CARACO.

The standard management for advanced-stage epithelial ovarian cancer is optimum cytoreductive surgery followed by platinum based chemotherapy. However, retroperitoneal lymph node resection remains controversial. The multiple directions of the lymph drainage pathway in ovarian cancer have been recognized. The incidence and pattern of lymph node involvement depends on the extent of the disease and the histological type. Several published cohorts suggest the survival benefit of pelvic and para-aortic lymphadenectomy. A recent large randomized trial have demonstrated the potential benefit for surgical removal of bulky lymph nodes in term of progression-free survival but failed to show any overall survival benefit because of a critical methodology. Further randomised trials are needed to balance risks and benefits of systematic lymphadenectomy in advanced-stage disease. CARACO is a French ongoing trial, built to bring a reply to this important question. A huge effort for inclusion of the patients, and involving new teams, are mandatory.

Evaluation of quality of life after breast reconstruction using an autologous latissimus dorsi myocutaneous flap.

AIMS: To evaluate the patients' satisfaction with breast reconstruction using the autologous latissimus dorsi technique and the impact of the procedure on the quality of life and body image of women who had mastectomy for breast cancer. METHODS: A retrospective transversal study was conducted at the Georges François Leclerc Cancer Care Center in Dijon, France. From 1990 to 2008, 193 women underwent reconstruction (RW), among these, 141 were matched for age at diagnosis and the date of the mastectomy with women who did not undergo reconstruction (NRW) identified using data from the Côte d'Or breast cancer registry. Questionnaires concerning quality of life, body image and satisfaction (MBROS-S, MBROS-BI, EORTC QLQ-C30, EORTC QLQ-BR23) were sent through the post following surgery. RESULTS: The overall response rate was 77% and the mean (MBROS-S) satisfaction score was 3.36. The quality of life (EORTC QLQ-C30, EORTC QLQ-BR23) in RW was no better than that in NRW, but body image was better (p = 0.0247) especially before 60 years (p = 0.0192), in obese patients (p = 0.03) and when the breasts of RW were heavy (p = 0.0197). Moreover, when the time from the mastectomy was less than 4 years, body image (p = 0.0008) and the sexual activity score (p = 0.0078) were higher in RW. CONCLUSIONS: The level of satisfaction was higher in RW, and breast reconstruction made a strong contribution in terms of improvement in body image. A prospective study to evaluate quality of life in the long term is now necessary.

[Metastatic tumor implantation from a primary cancer of the base of the tongue at the site of placement of a central venous portacath]. / Métastase d'une tumeur de la base de langue sur un système d'accès veineux central totalement implantable.

Central venous catheter placement with an implanted port (portacath) is used to provide long-term venous access. We report a case of metastatic implantation at a port site from a primary cancer of the base of the tongue. Insertion of portacaths must be performed using full sterile precautions to avoid spread of tumor cells; in no case should the port site incisions be in contact with the surgical field in which the tumor resection was performed.

A multicenter cohort study to compare quality of life in breast cancer patients according to sentinel lymph node biopsy or axillary lymph node dissection.

BACKGROUND: This prospective multicenter study assessed and compared the impact of different surgical procedures on quality of life (QoL) in breast cancer patients. PATIENTS AND METHODS: The EORTC QLQ-C30 and the EORTC QLQ-BR-23 questionnaires were used to assess global health status (GHS), arm (BRAS) and breast (BRBS) symptom scales, before surgery, just after surgery and 6 and 12 months later. The Kruskal-Wallis test with the Bonferroni correction was used to compare scores. A mixed model analysis of variance for repeated measurements was then applied to assess the longitudinal effect of surgical modalities on QoL. RESULTS: Before surgery, GHS (P = 0.7807) and BRAS (P = 0.7688) QoL scores were similar whatever the surgical procedure: sentinel node biopsy (SLNB), axillary node dissection (ALND) or SLNB + ALND. As compared with other surgical groups, GHS 75.91 [standard deviation (SD) = 17.44, P = 0.041] and BRAS 11.39 (SD = 15.36, P < 0.0001) were better in the SLNB group 12 months after surgery. Whatever the type of surgery, GHS decreased after surgery (P < 0.0001), but increased 6 months later (P = 0.0016). BRAS symptoms increased just after surgery (P = 0.0329) and until 6 months (P < 0.0001) before decreasing (P < 0.0001). CONCLUSIONS: SLNB improved GHS and BRAS QoL in breast cancer patients. However, surgeons must be cautious, SLNB with ALND results in a poorer QoL.

[Intrathoracic localisation of desmoid tumours: a familial case of isolated desmoid tumours and current published data]. / Localisation intrathoracique des tumeurs desmoïdes: à propos d'un cas familial de tumeurs desmoïdes isolées et revue de la littérature.

We present the case of large desmoid tumor of the anterior chest wall with pleural involvement, which persistently progressed despite hormonotherapy, chemotherapy and surgery. After many years of therapeutic failures, given the tumor size and its hemodynamic repercussions, the patient was presumed to be incurable and only supportive measures were given. One year later, the desmoid tumor had completely disappeared. Even though wide surgical excision is an essential element in the treatment of desmoid tumors, spontaneous regression may occur in very advanced disease.

Malignant extraovarian endometriosis: a review.

AIMS: Malignant transformation in extra-ovarian endometriosis is a rare but known complication. This distinct pathological entity is reviewed with a specific focus on aetiology and treatment. METHODS: Studies were identified by searching the English language literature in the MEDLINE database and by an extensive review of bibliographies from articles found through that search. FINDINGS: Up to 1% of women with endometriosis will develop endometriosis-associated neoplasm. Almost a quarter of the reported cases of malignancy in endometriosis have involved extra-ovarian tissues. In many cases, hormonal factors may play a role in its pathogenesis. Estrogen monotherapy in obese patients significantly increase the risk of malignant extra-gonadal endometrial transformation. Genetic anomalies have also been reported such as loss of heterozygosity on chromosome 5q. For patients with disease confined to the site of origin, a 82-100% 5-year survival has been noted for endometrioid cell type; disseminated intraperitoneal disease, however, has a very poor associated prognosis, with a 0-12% 5-year survival overall. CONCLUSIONS: Women with endometriosis-associated cancers most likely represent a different class of patients than traditional ovarian cancer patients and may require different therapeutic options.

[Management of ureteral injuries]. / Prise en charge des lésions urétérales iatrogènes.

Ureteral injury is a rare but potential serious complication that can occur during a variety of general surgical procedures. Knowledge of the course of the ureter is the first step toward preventing ureteral injuries. While some injuries are noticed intraoperatively, most are missed and present later with pain, sepsis, urinary drainage or renal loss. The choice of treatment is based on the location, type and extend of ureteral injury. For injuries recognized during open surgery, when involving the distal 5 cm of the ureter, an antireflux ureterocystostomy such as the Politano-Leadbetter procedure or a vesicopsoas hitch can be performed. For the middle ureter, an ureteroureterostomy is satisfactory and for the proximal ureter, most injuries can be managed by transureteroureterostomy. In complex situations intestinal interposition, autotransplantation or even nephrectomy can be considered. The majority of patients with delayed diagnosed ureteral injuries should be managed by an initial endo-urologic approach.

The role of surgery and treatment trends in uterine sarcoma.

AIMS: To report a series of uterine sarcomas treated in one institution. METHODS: We report 72 cases of uterine sarcomas treated in a single institution, comparing the periods 1966-1989 and 1990-2001. The parameters studied were histological type, tumour stage and treatment. The control of pelvic, local and/or metastatic disease were also studied. RESULTS: The histological types consisted in 34 leiomyosarcomas, 25 mixte mullerian tumours, 12 endometrial stromal sarcoma and one angiosarcoma. The median age at diagnosis was 60.5 years. The presenting symptoms were genital bleeding, pelvic or abdominal pain. The proportion, of stage I was lower in 1966-1989 than in 1990-2002. During the 1966-1989 period, surgery was systematically used. The percentage of second-line surgery (post-radiotherapy or -chemotherapy) rose from 2.2% in 1966-1989 to 19.2% in 1990-2002. Radiotherapy was administered in 55.5% of cases. There was no difference between the two periods. Chemotherapy was administered in 37.5% of cases with also no difference between the two periods. The overall 2-year survival was 54.6% and the 5-year survival 36.1%. The median survival was 32.3 months (3 days-25 years). The overall 5-year survival by stage was 47.5% for stage I, 60.6% for stage II and 15.0% for stages III and IV. The median duration of pelvic disease control was 19.2 months. The 5-year pelvic disease control by FIGO stage was 66.6% for stage I, 62.5% for stage II and 18% for the more advanced stages. CONCLUSION: Surgery remains the reference treatment. Local and regional disease control, as adjuvant therapies do not seem to decrease the risk of metastatic spread or increase survival.

[Evolution of therapeutic practices and survival of ovarian cancer in Bourgandi between 1982-1996: a registry-based study]. / Evolution des pratiques thérapeutiques et survie du cancer de l'ovaire dans le département de la Côte d'Or de 1982 à 1966: données du Registre des cancers gynécologiques de Côte d'Or.

OBJECTIVE: The aim of this study is to describe the evolution of therapeutic practices and the evolution of survival between 1982 and 1996 in a population of ovarian carcinomas. All the patients were registered in the "Registre des Cancers Gynécologiques de Côte-d'Or-France". POPULATION AND METHODS: During this period, 546 cases of ovarian cancers were registered. Data about FIGO staging at the diagnosis, histologic type, initial surgical procedures and survival were studied. RESULTS: During this period, 61.7% of the patients had a complete resection of their tumor. The frequency of complete removal increased significantly during the period of this study. Complete removal moved from 56%, between 1982 and 1984, up to 75%, between 1993 and 1996. Complete removal was possible in 98.1% of the FIGO stage 1 cases while it was possible in only 18.3% of the stage IV. 76.9% of the patients younger than 50 years old had a complete removal while only 29% of the women older than 80 years old had a complete removal. Fifty percent of stage I received chemotherapy as long as 85% of patients younger than 50 years old. After 1993, only 2.6% of them had radiotherapy. The global survival rate at 5 years was 35.4%. CONCLUSIONS: Surgery is the major procedure to obtain a complete remission of ovarian cancer. The efficacy of current chemotherapies may modify the initial management of these tumors, particularly in modifying the chronology of the different therapeutic sequences.

[Malignant tumours arising in extraovarian endometriosis: three case reports and review of the literature]. / Endométriose extraovarienne dégénérée: à propos trois cas et revue de la littérature.

In its extraovarian form, co-existence of carcinoma and endometriosis is a sufficient argument used in favour of the malignant transformation of endometric lesions. Estrogen as well as the loss of 5q chromosome heterozygosity are considerate as initiators of that type of carcinogenesis. Endometrioid histological type is the most frequent and is revealed usually by abdominal pain. The incidence of carcinoma arising in endometriosis is about 0.8% and 5-year survival rate of pelvic endometrioid form is about a 100% after surgery and radiotherapy.

[Conservative surgery in breast cancer: combination skin incision for a better cosmetic result]. / Traitement conservateur du cancer du sein: proposition d'une incision cutanée combinée pour un meilleur résultat esthétique.

The authors report a surgical procedure for lumpectomy combining both areolar and radial skin incision for cancer localized in the inferior, or at the junction of the superior and inferior part of the breast. The skin incision have an "amphore-like" appearance. It allows an easy mammoplasty with all cancerologic securities.

[Metastatic renal cell carcinoma to the thyroid gland: report of seven cases and review of the literature]. / Les métastases intrathyroïdiennes du cancer du rein à cellules claires: présentation de sept cas et revue de la littérature.

PURPOSE: The aim of this study was to retrospectively report clinical manifestations, type of treatment, survival rate of thyroid metastases from renal carcinoma. PATIENTS AND METHODS: Seven patients were retrospectively collected from files of different Burgundy's hospitals. All renal and thyroid gland specimens were controlled by the anatomopathologist. RESULTS: Tumors occurred in four women and three men (mean age: 66 years). Symptoms were generally a solitary mass. The metastatic tumor to the thyroid gland was the initial presentation of renal carcinoma in one case. In the other cases, patients had documented previous evidence of renal carcinoma as remotely 8.1 years before the thyroid metastases. Thyroglobulin immunohistochemistry was always negative in the foci of metastatic renal carcinoma. All patients had surgical resection of there metastasis. The majority of patients died with disseminated malignancies (mean: 38.1 months after there thyroid resection). Three patients are still alive, one after a complementary pancreatic resection for a secondary pancreatic metastasis and one other with cervical and mediastinal lymph node recurrence. CONCLUSIONS: Surgical treatment of the metastatic disease is suggested, as this may prolonged patient survival.

Concurrent lymphoma and metastatic breast carcinoma in the axillary, confounding sentinel lymph-node biopsy.

We describe the case of a female patient who presented with the concurrence of two tumors, breast cancer and low grade lymphoma, in different nodes but in the same axillary lymphatic site. The sentinel node biopsy procedure for the detection of carcinoma cells in two well-identified sentinel nodes which had been colonised by lymphoplasmocytic cells was negative. Tumor collision lead to a mistake in the appropriate staging of the breast tumor by sentinel lymph-node biopsy. We believe that sentinel lymph-node biopsy should be avoided in cases of lymphoma.

[Histological and cytopathological cancer specimens: good practice in operating room]. / Prélèvements anatomopathologiques en cancérologie : règles de bonnes pratiques au bloc opératoire.

Concerning good practice for the management of histological cancer specimen, the main recommendations concern: (1) the quality of transmission in information between professionals; (2) the necessity of fresh, unfractionated, oriented surgical samples; (3) the importance of an appropriate storage condition for samples collected for extemporaneous examination, freezing or cell culture; (4) the quality of the deep freezer at temperatures of -80 degrees C or liquid nitrogen for frozen samples storage; (5) the importance of fixing tissues shortly after sample collection in buffered Formal solution in order to prevent cell lysis.

[Role of microbiopsy in diagnostic and therapeutic approach of mammary suspect microcalcification]. / Place de la microbiopsie dans la prise en charge des microcalcifications mammaires suspectes.

PURPOSE: To determine the sensibility, the specificity, the positive and negative predictive values of microcalcifications detection by core needle biopsy and intra-operative pathologic examination. MATERIALS AND METHODS: A hundred and one patients (between 1998 and 1999) were investigated in this retrospective study. The initial presentation was breast microcalcifications without palpable tumour. The mean age of patients was 55 (34-79) years. Mammography was performed in 3 standard projections. All suspect microcalcifications were recommended for surgical excision. In the others cases, 5 core biopsies were taken of the lesion. Needle guidance was accomplished by means of either dedicated stereotaxic device or ultrasound equipment. All biopsies were performed with a biopsy device fitted with 14 G needles. The mean follow-up period was 3 years. RESULTS: Clinical or surgical follow-up was available in 101 lesions. Only 4 benign lesions did not have surgery. The 97 remaining were subsequently excised. Pathologic study showed cancer in 38 (39%) lesions, carcinoma in-situ in 14 lesions, and benign disease in 45 lesions. There was 1 false-negative biopsy. The specificity and sensitivity of percutaneous biopsy diagnosis were 73,6 and 93,7% respectively. Intra-operative pathologic diagnoses were concordant in 77% of 30 cases. Discordance occurred in 2 cases of atypical hyperplasia with a single false-negative result for a carcinoma that led to an additional surgical procedure. Positive and negative predictive values of intra-operative pathologic diagnosis were 82 and 100% respectively. CONCLUSION: Needle biopsy findings are accurate and allow definitive therapeutic surgery, including mastectomy.