A population-based study of adjuvant chemotherapy for stage-II and -III colon cancers
Registre Bourguignon des Cancers Digestifs, Inserm U866, Université de Bourgogne, CHU de Dijon, BP 87900, 21079 Dijon cedex, France. Gastroentérologie Clinique et Biologique
(Impact Factor: 1.14).
02/2010; 34(2):144-9. DOI: 10.1016/j.gcb.2009.08.012
Although clinical trials have demonstrated that adjuvant chemotherapy improves survival for stage-III colon cancer, the benefits remain controversial for stage-II lesions. The objective of the present study was to determine the extent to which adjuvant chemotherapy is used for patients with stage-II and -III colon cancers.
The study population comprised 1074 patients with stage-II and -III colon cancers diagnosed in 2000 in 12 French administrative districts and recorded in population-based cancer registries. Data were collected using a standardized procedure.
Overall, 20.4% of patients with stage II and 61.9% with stage III received adjuvant chemotherapy. Age at diagnosis was the strongest determinant of chemotherapy. Among stage-II patients, those receiving chemotherapy decreased from 57.6% in patients aged <or=50 years to 1.1% in those aged >or=85. The corresponding percentages with stage III were 93.6% and 1.4%. In multivariate analyses, other factors found to be independently and significantly associated with administration of adjuvant chemotherapy for stage II were extension of the cancer (stage IIA vs. stage IIB), clinical presentation (obstruction or perforation vs. uncomplicated cancer) and discussion of the case at a multidisciplinary case-review meeting. For stage III, apart from age, discussion of the case at a multidisciplinary meeting was the only factor independently associated with administration of chemotherapy.
Adjuvant chemotherapy for stage-III colon cancer is used extensively for patients under 75 years of age. However, many elderly patients do not receive such treatment. On the other hand, a substantial percentage of stage-II colon cancer patients receive adjuvant chemotherapy despite its uncertain benefits.
Available from: Simone Mathoulin-Pelissier
- "We examine differences across patient-, tumor- and hospital-related factors using 27 criteria (11 for colon and 16 for rectal cancer) to describe the quality of colorectal cancer care. We also use statistical models to investigate factors linked to three specific quality indicators identified by the National Quality Forum/American College of Surgeons/Commission on Cancer and National Comprehensive Cancer Network (NCCN)/American Society of Clinical Oncology  and potentially linked to better survival: examination of ≥12 lymph nodes (LN) [12,13], use of adjuvant chemotherapy for stage II patients  and non-use for stage III patients . "
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Colorectal cancer (CRC) care has improved considerably, particularly since the implementation of a quality of care program centered on national evidence-based guidelines. Formal quality assessment is however still needed. The aim of this research was to identify factors associated with practice variation in CRC patient care.
CRC patients identified from all cancer centers in South-West France were included. We investigated variations in practices (from diagnosis to surgery), and compliance with recommended guidelines for colon and rectal cancer. We identified factors associated with three colon cancer practice variations potentially linked to better survival: examination of ≥12 lymph nodes (LN), non-use and use of adjuvant chemotherapy for stage II and stage III patients, respectively.
We included 1,206 patients, 825 (68%) with colon and 381 (32%) with rectal cancer, from 53 hospitals. Compliance was high for resection, pathology report, LN examination, and chemotherapy use for stage III patients. In colon cancer, 26% of stage II patients received adjuvant chemotherapy and 71% of stage III patients. 84% of stage US T3T4 rectal cancer patients received pre-operative radiotherapy. In colon cancer, factors associated with examination of ≥12 LNs were: lower ECOG score, advanced stage and larger hospital volume; factors negatively associated were: left sided tumor location and one hospital district. Use of chemotherapy in stage II patients was associated with younger age, advanced stage, emergency setting and care structure (private and location); whereas under-use in stage III patients was associated with advanced age, presence of comorbidities and private hospitals.
Although some changes in practices may have occurred since this observational study, these findings represent the most recent report on practices in CRC in this region, and offer a useful methodological approach for assessing quality of care. Guideline compliance was high, although some organizational factors such as hospital size or location influence practice variation. These factors should be the focus of any future guideline implementation.
BMC Cancer 07/2012; 12(1). DOI:10.1186/1471-2407-12-297 · 3.36 Impact Factor
Available from: Boualem Boashash
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ABSTRACT: The Wigner-Ville Distribution (WVD) has recently been shown to be a valuable tool for time-Frequency Signal Analysis. Its first order moments yield directly the instantaneous frequency of the Signal. The problem of applying a window to the WVD is shown to be the same as that occurring when one uses the Fourier Transform. The choice of any classical window does not affect the estimation of the instantaneous frequency fi(t) in both deterministic and random cases. It is shown that the WVD estimator of the "evolutive spectrum" is unbiased in both time and frequency. Accuracy and statistical stability of the method are discussed. Its application to the analysis of microstructure temperature gradient signals shows that the WVD exhibits more information about the turbulence effect than the Short Time Fourier Transform.
Acoustics, Speech, and Signal Processing, IEEE International Conference on ICASSP '86.; 05/1986
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ABSTRACT: Deuxième cancer chez l’homme et troisième chez la femme en France, le cancer colorectal est un véritable enjeu de santé publique.
Son incidence est en augmentation ces dernières années et malgré le développement de nouvelles thérapeutiques, il garde un mauvais pronostic.
Grâce, entre autres, à la mise en place d’une campagne de dépistage nationale par Hémoccult®, son diagnostic se fait à un stade de plus en plus précoce, rendant possible une résection chirurgicale à but curatif et la réalisation d’une chimiothérapie adjuvante.
Dans le cas de cancers coliques de stade III opérés, une chimiothérapie adjuvante par FOLFOX 4 doit être proposée. Néanmoins, compte tenu des toxicités de cette chimiothérapie, de l’âge parfois élevé des patients, de comorbidités importantes ou de complications post-chirurgicales, celle-ci ne peut parfois pas être réalisée.
Quels sont les principaux facteurs pronostiques des cancers colorectaux opérés permettant de discuter la chimiothérapie adjuvante ? La classification TNM, le nombre de ganglions examinés, le statut MSI et la présence ou non d’une perforation ou d’un envahissement péri-nerveuse, lymphatique ou veineuse sont les facteurs pronostiques validés. Quelles sont les alternatives à la chimiothérapie adjuvante par FOLFOX 4 ?
La Presse Médicale 01/2012; 41(1). DOI:10.1016/j.lpm.2011.03.021 · 1.08 Impact Factor
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