Prognostic factors and overall survival of breast cancer in Benin: a hospital-based study.

BACKGROUND: In Benin, a country in West Africa, breast cancer is the leading cancer in women, both in terms of incidence and mortality. However, evidence on the mortality of breast cancer and its associated factors is lacking in this country. Our aim was to describe and analyze the clinical, histopathological, and prognostic aspects of breast cancer in Benin. METHODS: A descriptive and analytical study was carried out at the CNHU-HKM and the CHU-MEL, two major tertiary referral hospitals for breast cancer management located in Cotonou, the capital city of Benin. All breast cancer medical records with histological evidence and immunohistochemistry studies were retrospectively collected between January 1, 2014, and September 30, 2020, in these two tertiary referral hospitals and analyzed in the current study. RESULTS: Finally, 319 medical records were included. The mean age at diagnosis was 48.74 years. The tumors were most frequently classified as T4 (47.6%) with lymph node involvement N2 (34.5%), and metastases were clinically noted in 21.9% of cases. Stage was reported in the medical records of 284 patients. Tumors were diagnosed at very late AJCC stages: stage III (47.5%) and stage IV (24.7%). Grades SBR 2 (49.2%) and SBR 3 (32.6%) were the most frequent grades. Triple-negative breast cancer (31.3%) was the most common molecular type. The overall 5-year survival was 48.49%. In multivariable analysis, the poor prognostic factors were lymph node invasion (HR = 2.63; p = 0.026; CI: [1.12, 6.17]), the presence of metastasis (HR = 3.64; p < 0.001); CI: [2.36, 5.62] and the immunohistochemical profile (HR = 1.29; p < 0.001; CI: [1.13, 1.48]). CONCLUSIONS: Breast cancer in Beninese is predominant in young adults and is often diagnosed at a late stage. The survival of breast cancer patients in Benin can be improved by enhancing early diagnosis and multidisciplinary management.

[Adequacy of histopathology request forms and pathological reports of breast cancer surgical specimens in Benin]. / Conformité des formulaires de demande et des comptes rendus anatomopathologiques de pièces opératoires de cancer du sein au Bénin.

Introduction: Breast cancer requires multidisciplinary management. Pathologists and physicians communicate using the histopathology request form and the pathology report. There are some minimal criteria that both should respect. Objective: We assessed the adequacy of histopathology request forms and pathology reports in the management of female breast cancer specimens in Southern Benin. Method: This was a cross-sectional, descriptive and analytical study, with retrospective data collection over 57 months (4 years and 9 months). The adequacy of the histopathology request forms and pathology reports was assessed on the basis of the recommendations of the Haute Autorité de Santé (HAS) of France. Data processing was done using SPSS software. We checked frequencies with the Chi2 test, with a significance level set at 5%. Results: 31.3% of histopathology request forms complied with HAS recommendations. Pathology reports were presented in a narrative way in 92.7% of cases and 68.8% met the minimal criteria. The presence of vascular embolus, of hormone receptors and the HER2 status were all reported in only 29.2% of the reports. Discussion: The draft of histopathology request forms and pathology reports did not comply to the required minimal criteria. This situation could mainly be explained by the inexistence of consensus between physicians and pathologists and by the lack of immunohistochemistry. Editing national referentials and using synoptic reports would give better results.

Facteurs pronostiques de la pré-éclampsie sévère à la maternité universitaire de Porto-Novo au Bénin

Objectif : Analyser les facteurs pronostiques de la pré-éclampsie sévère. Patientes et Méthodes : Il s'est agi d'une étude prospective et analytique qui a concerné toutes les femmes diagnostiquées prééclampsie sévère et prises en charge à la maternité du Centre Hospitalier Universitaire de Porto-Novo du 1er Juillet 2014 au 30 juin 2016. Résultats : La fréquence de la pré-éclampsie sévère était de 4,8% des accouchements. Le pronostic maternel était plus mauvais chez les gestantes référées des formations sanitaires périphériques, en cas de pression artérielle diastolique ≥ 110 mm Hg et/oualbuminurie ≥ 3 croix. La morbidité maternelle était marquée par l'éclampsie (36,8%) et l'hématome rétroplacentaire (1,8%). Le pronostic périnatal était grevé d'une morbidité dominée par la prématurité induite (39,3%) et la détresse néonatale immédiate (30,5%). Ce pronostic périnatal était mauvais chez les gestantes ayant une pression artérielle diastolique ≥ 110 mm Hg et/ou une albuminurie ≥ 3 croix et/ou une uricémie ≥ 100 mg/l. Conclusion : La pression artérielle diastolique ≥ 110 mm Hg, l'albuminurie ≥ 3 croix et l'uricémie ≥ 100 mg/l ont constitué des facteurs de mauvais pronostic de la pré-éclampsie sévère dans notre étude

[Epidemiology of the gynecological and mammary cancer to the HOMEL and in the CUGO Cotonou, Bénin]. / Épidémiologie des cancers gynécologiques et mammaires à l'hôpital de la Mère et de l'Enfant-Lagune (HOMEL) et à la clinique universitaire de gynécologie et d'obstétrique (CUGO) de Cotonou, Bénin.

INTRODUCTION: The gynecological and mammary cancers constitute a major preoccupation for the international community because they represent an important cause of mortality and morbidity among women. However, their systematic tracking is not always current in our countries of the south. This survey aims to evaluate the epidemiological features of these cancers in hospital-academic environment in Cotonou. METHOD: It is a retrospective survey with a structural descriptive and analytic aim during a period of 9 years, from January 1st, 2000 to December 31, 2008. RESULTS: On 210 cases of recorded gynecological and mammary cancers during this period, the cancer of the breast comes at the first rank with 44,3% of the cases. The cancer of the cervix represents 26,7% of the cases followed by the cancer of the ovaries (18,6%) and the cancer of the endometrium (9,5%). The cancers of the vulva and the vagina are weakly represented. The delay of consultation after the apparition of the first signs in our series is most often included between 1 and 6 months (32,2%) but goes also beyond 3 years (26,1%). The cancer of the cervix and the endometrium are found in most aged women, whereas the cancer of the breast covers all ages. Most cancers (65%) are diagnosed at an advanced stage (III stage or IV). The different anatomopathological types that are found more frequently are the ductal invasive carcinoma (33%) for the breast, the squamous cell carcinoma for cervix (62%) and the endometrioid adenocarcinoma for the endometrium (30%). The costly management of the cancers reduces the therapeutic possibilities, leading to 42% of survival at 5 years. CONCLUSION: In our survey, it comes out again that the screening of gynecological cancers is not well organized in our country as well as the health education of the woman and reproduction. It appears appropriate to set in motion a management program of the cancers in our country what would allow an early screening and appropriate management.

[Delivery in free position perhaps a solution to change delivery in traditional position in delivery rooms in Africa: results of a prospective study in Cotonou in Bénin]. / L'accouchement en position libre peut-il être une solution de rechange à l'accouchement en position classique dans les salles de naissance en Afrique : résultats d'une étude. prospective à Cotonou au Bénin

INTRODUCTION: In most of Africa's birthing units, women are often forbidden to stand during labour and delivery. This study aimed to determine the effect of a freely vertical position (standing,sitting, crouching) compared with the traditional supine position on the course of delivery and on perinatal and maternal outcomes(including the satisfaction level of mothers).Methods: We compared a group of 490 women who chose to deliver in a freely vertical position with 490 women who delivered in a traditional position, at the Hopital de Ia mere et de l'enfant Lagune of Cotonou, from January 1, 2009, to December 31,2011. Variables studied include length of labour, type of delivery,frequency of episiotomy, fetal and neonatal well-being indices(fetal heart rate, Apgar score, resuscitation), and postnatal maternal outcomes (perineal tears, hemorrhagic complications),including maternal satisfaction. Descriptive analysis includes comparisons between those two groups.Results: Both groups had similar maternal (25 years old) and gestational (39 weeks) ages. The "Choice of position" group had a greater number of nulliparous women (53% vs. 40%,P < 0.001) and a higher educational level (high-school diploma and postgraduate training: 77.5% vs. 45.1 %; P < 0.001 ). The average length of the active phase was shortened by 20 minutes in women who freely chose their delivery position (P < 0.01 ).Moreover, these women experienced spontaneous delivery in higher numbers, with 10 times fewer assisted deliveries (0.4%vs. 4.3%; P < 0.01) and two times fewer episiotomy interventions(3.5% vs. 8.0%; P < 0.01) than their counterparts. When women freely choose their delivery position, there are close to three times fewer cases of fetal heart rate anomalies and meconium liquor (2.9% vs. 8.9%; P < 0.01 and 0.4% vs. 1.4%; P < 0.01 ).Perineal and cervical tears are rare and occur in similar numbers in both groups, and the same can be said of cases of postpartum hemorrhage. The number of satisfied mothers is higher in the"Choice of position" group (87.0% vs. 61.2%; P < 0.01 ).Conclusion: The choice of a freely vertical position seems to be an efficient and safe option during labour and delivery, and is more satisfying for mothers.