Stage I Clear Cell and Serous Uterine Carcinoma: What Is the Right Adjuvant Therapy?

This single-center study aimed to retrospectively evaluate the survival outcomes of patients with FIGO stage I clear cell and serous uterine carcinoma according to the type of adjuvant treatment received. The data were collected between 2003 and 2020 and only patients with stage I clear cell or serous uterine carcinoma treated with primary surgery were included. These were classified into three groups: No treatment or brachytherapy only (G1), radiotherapy +/- brachytherapy (G2), chemotherapy +/- radiotherapy +/- brachytherapy (G3). In total, we included 52 patients: 18 patients in G1, 16 in G2, and 18 in G3. Patients in the G3 group presented with poorer prognostic factors: 83.3% had serous histology, 27.8% LVSI, and 27.8% were FIGO stage IB. Patients treated with adjuvant radiotherapy showed an improved 5-year overall survival (OS) (p = 0.02) and a trend towards an enhanced 5-year progression-free survival (PFS) (p = 0.056). In contrast, OS (p = 0.97) and PFS (p = 0.84) in the chemotherapy group with poorer prognostic factors, were similar with increased toxicity (83.3%). Radiotherapy is associated with improved 5-year OS and tends to improve 5-year PFS in women with stage I clear cell and serous uterine carcinoma. Additional chemotherapy should be cautiously considered in serous carcinoma cases presenting poor histological prognostic factors.

The relationship between neighbourhood walkability and cardiovascular risk factors in northern France.

BACKGROUND: Although walkability is known to be associated with obesity and hypertension through increased physical activity; data on cardiovascular risk factors (especially in the Europe) are scarce. We assessed the relationship between neighbourhood walkability and cardiometabolic factors (including obesity, hypertension, the blood lipid profile, and serum glycated haemoglobin (HbA1c) levels) among adults living in northern France. METHODS: Data were extracted from the ELISABET study database (2011-2013). The participants (aged between 40 and 65) resided in or around the cities of Lille and Dunkirk. For each residential address, we determined a neighbourhood walkability index (using a geographic information system) and the Walk Score®. Multilevel linear and logistic models were used to assess the relationships between neighbourhood walkability on one hand and body mass index (BMI), obesity, blood pressure, hypertension, serum HDLC, LDL-C, triglyceride and HbA1c levels, and physical activity level on the other. RESULTS: 3218 participants were included. After adjusting for individual and neighbourhood variables, we found that a higher neighbourhood walkability index was associated with a lower BMI (-0.23 kg.m-2; 95% confidence interval (CI) [-0.44;-0.01] for a one interquartile range (IQR) increment), a lower systolic blood pressure (-1.66 mmHg; 95% CI [-2.46;-0.85] per IQR), a lower prevalence of hypertension (% of increase: -7.12, 95% CI [-13.56;-0.52] per IQR), and a higher prevalence of moderate or high physical activity (% of increase = 6.9; 95% CI [1.2;12.72] per IQR). The walkability index was not significantly associated with other cardiovascular risk factors. Similar results were observed for the Walk Score®. CONCLUSION: Our results showed that residence in a more walkable neighbourhood was associated with a lower prevalence of vascular risk factors. Promoting neighbourhood walkability might help to improve the population's cardiovascular health.

Major impact of COVID-19 national containment on activities in the French northern comprehensive cancer center.

The SARS-CoV-2 pandemic has significantly impacted cancer patient management. National and local recommendations to reduce SARS-CoV-2 transmission have been applied in a comprehensive cancer center located in Northern France. We prospectively measured key indicators for three successive eight-week periods: directly before, during, and right after the containment (from 16 March to 10 May 2020). Overall, the number of newly diagnosed and referred cancer patients in our hospital steadily increased (1027; 1135 and then 1704; +11% during containment and +50% just after). To reduce patient transportation, teleconsultations were implemented. Teleconsulting activity steadily increased during the three periods (5, 2025, and 2351). However, a marked decrease in the number of surgical procedures was observed (448; 330 and 288; -26% during containment and -13% just after). We observed a slight decrease in the number of radiation therapy sessions (7761; 7328 and 7075; -6% during containment and -3% just after) and in day-hospital cycles of IV systemic treatment (2891; 2736 and 2717; -5% during containment and -1% just after). We observed an increase in the number of patients admitted to palliative care and a dramatic reduction in clinical trial enrollment. During this 24-week period, organizational changes were mainly characterized by an increase in newly diagnosed cancer patient referral and the implementation of protective measures, such as teleconsultations. Activities in cancer surgery have decreased while radiotherapy and chemotherapy activities were stable.