C. Mariette

University of Lille Nord de France, Lille, Nord-Pas-de-Calais, France

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Publications (503)1135.95 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Ever accumulating evidence indicates that the long-term effects of radiotherapy and chemotherapy largely depend on the induction (or restoration) of an anticancer immune response. Here, we investigated this paradigm in the context of esophageal carcinomas treated by neo-adjuvant radiochemotherapy, in a cohort encompassing 196 patients. We found that the density of the FOXP3+ regulatory T cell (Treg) infiltrate present in the residual tumor (or its scar) correlated with the pathological response (the less Tregs the more pronounced was the histological response) and predicted cancer-specific survival. In contrast, there was no significant clinical impact of the frequency of CD8+ cytotoxic T cells. At difference with breast or colorectal cancer, a loss-of-function allele of toll like receptor 4 (TLR4) improved cancer-specific survival of patients with esophageal cancer. While a loss-of-function allele of purinergic receptor P2X, ligand-gated ion channel, 7 (P2RX7) failed to affect cancer-specific survival, its presence did correlate with an increase in Treg infiltration. Altogether, these results corroborate the notion that the immunosurveillance seals the fate of patients with esophageal carcinomas treated with conventional radiochemotherapy.
    Oncotarget 09/2015; 6(25):20840-50. · 6.36 Impact Factor
  • Christophe Mariette · William B Robb · Guillaume Piessen · Antoine Adenis
    The Lancet Oncology 08/2015; 16(9). DOI:10.1016/S1470-2045(15)00127-8 · 24.69 Impact Factor
  • C Mariette
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    ABSTRACT: ERAS programs are based on a combination of perioperative measures with a proven efficacy, that combined with each other lead to an enhanced recovery after surgery through a synergistic pathway. Such programs help to decrease postoperative morbidity and to reduce length of hospital stay. Beside immunonutrition, carbohydrate loading until 2 hours before surgery and early postoperative oral feeding are safe and allows enhanced recovery after surgery. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    Journal of Visceral Surgery 08/2015; 152 Suppl 1:S18-S20. DOI:10.1016/S1878-7886(15)30006-0 · 1.75 Impact Factor
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    ABSTRACT: Over the last two decades, many surgical teams have developed programs to treat peritoneal carcinomatosis with extensive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Currently, there are no specific recommendations for HIPEC procedures concerning environmental contamination risk management, personal protective equipment (PPE), or occupational health supervision. A survey of the institutional practices among all French teams currently performing HIPEC procedures was carried out via the French network for the treatment of rare peritoneal malignancies (RENAPE). Thirty three surgical teams responded, 14 (42.4%) which reported more than 10 years of HIPEC experience. Some practices were widespread, such as using HIPEC machine approved by the European Community (100%), individualized or centralized smoke evacuation (81.8%), "open" abdominal coverage during perfusion (75.8%), and maintaining the same surgeon throughout the procedure (69.7%). Others were more heterogeneous, including laminar flow air circulation (54.5%) and the provision of safety protocols in the event of perfusate spills (51.5%). The use of specialized personal protective equipment is ubiquitous (93.9%) but widely variable between programs. Protocols regarding cytoreductive surgery/HIPEC and the associated professional risks in France lack standardization and should be established. Copyright © 2015 Elsevier Ltd. All rights reserved.
    European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 07/2015; DOI:10.1016/j.ejso.2015.07.012 · 3.01 Impact Factor
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    ABSTRACT: The aim of this large multicenter study was to assess the impact of salvage esophagectomy after definitive chemoradiotherapy (SALV) on clinical outcome. Data from consecutive adult patients undergoing resection for esophageal cancer in 30 European centers from 2000 to 2010 were collected. First, groups undergoing SALV (n = 308) and neoadjuvant chemoradiotherapy followed by planned esophagectomy (NCRS; n = 540) were compared. Second, patients who benefited from SALV for persistent (n = 234) versus recurrent disease (n = 74) were compared. Propensity score matching and multivariable analyses were used to compensate for differences in some baseline characteristics. SALV versus NCRS groups: In-hospital mortality was similar in both groups (8.4% v 9.3%). The only significant differences in complications were seen for anastomotic leak (17.2% v 10.7%; P = .007) and surgical site infection, which were both more frequent in the SALV group. At 3 years, groups had similar overall (43.3% v 40.1%; P = .542) and disease-free survival (39.2% v 32.8%; P = .232) after matching, along with a similar recurrence pattern. Persistent versus recurrent disease groups: There were no significant differences between groups in incidence of in-hospital mortality or major complications. At 3 years, overall (40.9% v 56.2%; P = .046) and disease-free survival (36.6% v 51.6%; P = .095) were lower in the persistent disease group. The results of this large multicenter study from the modern era suggest that SALV can offer acceptable short- and long-term outcomes in selected patients at experienced centers. Persistent cancer after definitive chemoradiotherapy seems to be more biologically aggressive, with poorer survival compared with recurrent cancer. © 2015 by American Society of Clinical Oncology.
    Journal of Clinical Oncology 07/2015; DOI:10.1200/JCO.2014.59.9092 · 18.43 Impact Factor
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    ABSTRACT: Two randomised trials concerning thoracic oesophageal cancer concluded that for squamous cell carcinoma, chemoradiation alone leads to the same overall survival (OS) as chemoradiation followed by surgery. One of these trials, FFCD 9102, randomised only fit, compliant and operable responders to induction chemoradiation between continuation of chemoradiation and surgery. In the present analysis, the outcome in the patients not eligible for randomisation was calculated to determine if attempt of surgery should be recommended. Eligible patients had operable T3-N0/N1-M0 thoracic oesophageal cancer. After initial chemoradiation, patients with no clinical response, or with contraindication to follow any attributed treatment, were not randomised. OS was studied first in the whole population of not randomised patients, and then specifically in clinical non-responders. The impact of surgery on OS was studied in these two populations. Of the 451 registered patients in the trial, 192 were not randomised. Among them, 111 were clinical non-responders. Median OS was significantly shorter for non-randomised patients (11.5months) than for randomised patients (18.9months; p=0.0024). However, for the 112 non-randomised patients who underwent surgery, median OS was not different from that in randomised patients: 17.3 versus 18.9months (p=0.58). Concerning clinical non-responders, median OS was longer for those who underwent surgery compared to non-operated patients: 17.0 versus 5.5months (hazard ratio (HR)=0.39 [0.25-0.61]; p<0.0001), and again was not different from that in responding, randomised patients (p=0.40). In patients with locally advanced thoracic oesophageal cancer, overall survival did not differ between responders to induction chemoradiation and patients having surgery after clinical failure of chemoradiation. Surgery should therefore be considered in those patients who are still operable. Copyright © 2015 Elsevier Ltd. All rights reserved.
    European journal of cancer (Oxford, England: 1990) 07/2015; 51(13). DOI:10.1016/j.ejca.2015.05.027 · 5.42 Impact Factor
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    ABSTRACT: Presently, there is no scientific evidence supporting a definite role for follow-up after gastrectomy for cancer, and clinical practices are quite different around the globe. The aim of this consensus conference was to present an ideal prototype of follow-up after gastrectomy for cancer, based on shared experiences and taking into account the need to rationalize the diagnostic course without losing the possibility of detecting local recurrence at a potentially curable stage. On June 19-22, 2013 in Verona (Italy), during the 10th International Gastric Cancer Congress (IGCC) of the International Gastric Cancer Association, a consensus meeting was held, concluding a 6-month, Web-based, consensus conference entitled "Rationale of oncological follow-up after gastrectomy for cancer." Forty-eight experts, with a geographical distribution reflecting different health cultures worldwide, participated in the consensus conference, and 39 attended the consensus meeting. Six statements were finally approved, displayed in a plenary session and signed by the vast majority of the 10th IGCC participants. These statements are attached as an annex to the Charter Scaligero on Gastric Cancer. After gastrectomy for cancer, oncological follow-up should be offered to patients; it should be tailored to the stage of the disease, mainly based on cross-sectional imaging, and should be discontinued after 5 years.
    Gastric Cancer 07/2015; DOI:10.1007/s10120-015-0513-0 · 3.72 Impact Factor
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    ABSTRACT: The objectives of this study were to establish if R1 resection margin after esophagectomy was (i) a poor prognostic factor independent of patient and tumor characteristics, (ii) a marker of tumor aggressiveness, and (iii) to look at the impact of adjuvant treatment in this subpopulation. Data were collected from 30 European centers from 2000 to 2010. Patients with an R1 resection margin (n = 242) were compared with those with an R0 margin (n = 2573) in terms of short- and long-term outcomes. Propensity score matching and multivariable analyses were used to compensate for differences in baseline characteristics. Independent factors significantly associated with an R1 resection margin included an upper third esophageal tumor location, preoperative malnutrition, and pathological stage III. There were significant differences between the groups in postoperative histology, with an increase in pathological stage III and TRG 4-5 in the R1 group. Total average lymph node harvests were similar between the groups; however, there was an increase in the number of positive lymph nodes seen in the R1 group. Propensity matched analysis confirmed that R1 resection margin was significantly associated with reduced overall survival and increased overall, locoregional, and mixed tumor recurrence. Similar observations were seen in the subgroup that received neoadjuvant chemoradiation. In R1 patients, adjuvant therapy improved survival and reduced distant recurrence; however, it failed to affect locoregional recurrence. This large multicenter European study provides evidence to support the notion that R1 resection margin is a prognostic indication of aggressive tumor biology with a poor long-term prognosis.
    Annals of surgery 07/2015; DOI:10.1097/SLA.0000000000001325 · 8.33 Impact Factor
  • Alain Duhamel · Julien Labreuche · Caroline Gronnier · Christophe Mariette
    Annals of surgery 06/2015; DOI:10.1097/SLA.0000000000001312 · 8.33 Impact Factor
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    ABSTRACT: Whereas the optimal therapeutic strategy in node positive esophageal cancer primarily treated by surgery remains unknown, the study was designed to evaluate the impact of adjuvant chemotherapy on survival in such population. Among 2944 consecutive patients operated on for esophageal cancer between 2000 and 2010 in 30 European centers, patients with lymph node metastasis treated by adjuvant treatment (n = 178) were compared to patients who did not received adjuvant treatment (n = 378). Multivariable analyses and propensity score matching were used to compensate for differences in baseline characteristics. After matching, patients were comparable between the two groups. When comparing adjuvant treatment and nonadjuvant treatment groups, there was no significant differences in 3-year overall (40.9 vs. 35.8 %, P = 0.560) and disease-free (33.9 vs. 28.5 %, P = 0.190) survivals. Locoregional recurrence was lower in the adjuvant treatment group (14.4 vs. 30.9 %, P = 0.012). In the adjuvant treatment group, 94 patients received chemotherapy and 84 chemoradiotherapy, without significant survival benefit over chemoradiotherapy compared with chemotherapy alone (P = 0.280). Predictive factors of overall survival were age ≥60 years, ASA III-IV score, and pN+ classification. No survival benefit was observed according to histological subtype or occurrence of postoperative complications. Adjuvant chemo(radio)therapy did not offer survival benefit in lymph node-positive esophageal cancer patients primarily treated with surgery.
    Annals of Surgical Oncology 06/2015; DOI:10.1245/s10434-015-4658-1 · 3.93 Impact Factor
  • The Annals of thoracic surgery 06/2015; 99(6):2253-2254. DOI:10.1016/j.athoracsur.2014.11.031 · 3.85 Impact Factor
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    ABSTRACT: Minimal data have previously emerged from studies regarding the factors associated with recurrence in patients with ypT0N0M0 status. The purpose of the study was to predict survival and recurrence in patients with pathological complete response (pCR) following chemoradiotherapy (CRT) and surgery for esophageal cancer (EC). Among 2944 consecutive patients with EC operations in 30 centers between 2000 and 2010, patients treated with neoadjuvant CRT followed by surgery who achieved pCR (n = 191) were analyzed. The factors associated with survival and recurrence were analyzed using a Cox proportional hazard regression analysis. Among 593 patients who underwent neoadjuvant CRT followed by esophagectomy, pCR was observed in 191 patients (32.2 %). Recurrence occurred in 56 (29.3 %) patients. The median time to recurrence was 12 months. The factors associated with recurrence were postoperative complications grade 3-4 [odds ratio (OR): 2.100; 95 % confidence interval (CI) 1.008-4.366; p = 0.048) and adenocarcinoma histologic subtype (OR 2.008; 95 % CI 0.1.06-0.3.80; p = 0.032). The median overall survival was 63 months (95 % CI 39.3-87.1), and the median disease-free survival was 48 months (95 % CI 18.3-77.4). Age (>65 years) [hazard ratio (HR): 2.166; 95 % CI 1.170-4.010; p = 0.014), postoperative complications grades 3-4 [HR 2.099; 95 % CI 1.137-3.878; p = 0.018], and radiation dose (<40 Gy) (HR 0.361; 95 % CI 0.159-0.820; p = 0.015) were identified as factors associated with survival. An intensive follow-up may be beneficial for patients with EC who achieve pCR and who develop major postoperative complications or the adenocarcinoma histologic subtype.
    Annals of Surgical Oncology 05/2015; DOI:10.1245/s10434-015-4619-8 · 3.93 Impact Factor
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    ABSTRACT: Oesophageal carcinoma is a rare disease with often dismal prognosis. Despite multiple trials addressing specific issues, currently, many questions in management remain unanswered. This work aimed to specifically address areas in the management of oesophageal cancer where high level evidence is not available, performing trials is very demanding and for many questions high-level evidence will not be available in the forseeable future. Two experts of each national, oesophageal cancer research group from Austria, France, Germany, the Netherlands and Switzerland were asked to provide statements to controversial issues. After an initial survey, further questions were formulated and answered by all experts. The answers were then discussed and qualitatively analysed for consensus and controversy. Topics such as indications for PET-CT, reasons for induction chemotherapy, radiotherapy dose, the choice of definitive chemo-radiotherapy versus surgery in squamous cell cancer, the role of radiotherapy in adenocarcinoma and selected surgical issues were identified as topics of interest and discussed. Areas of significant controversy exist in the management of oesophageal cancer, mostly due to high-level evidence. This is not expected to change in the upcoming years.
    Radiation Oncology 05/2015; 10(1):116. DOI:10.1186/s13014-015-0418-4 · 2.55 Impact Factor
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    ABSTRACT: The benefit of preoperative chemotherapy in resectable gastroesophageal adenocarcinomas was not observed in signet ring cell subtype. However, the potential interest of taxane-based preoperative chemotherapy on this subtype is still an unresolved issue. Nineteen patients with localized signet ring cell adenocarcinomas received taxane-based regimens, and 17 patients underwent surgery. Complete resection was achieved in 80 %, and median overall survival was 40.8 months (95 % confidence interval (CI), 20.2—not reached). Even though one patient achieved a complete pathological response, seven patients had an upstaging of their tumors at surgery. The potential benefits of taxane-based chemotherapy seem to be limited to a reduced number of patients. Electronic supplementary material The online version of this article (doi:10.1186/s13045-015-0148-y) contains supplementary material, which is available to authorized users.
    Journal of Hematology & Oncology 05/2015; 8(1):52. DOI:10.1186/s13045-015-0148-y · 4.81 Impact Factor
  • William B Robb · Christophe Mariette
    Annals of surgery 04/2015; DOI:10.1097/SLA.0000000000001263 · 8.33 Impact Factor
  • Antoine Adenis · William B Robb · Christophe Mariette
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    ABSTRACT: To the Editor: In their review of esophageal carcinoma, Rustgi and El-Serag (Dec. 25 issue)(1) do not recommend chemoradiotherapy for the treatment of unresectable disease on the basis of low efficacy and high rates of complications. However, we would like to note that the landmark Radiation Therapy Oncology Group (RTOG) 85-01 trial, which used definitive chemoradiotherapy with fluorouracil and cisplatin, was associated with a median survival of 14 months and a 5-year survival of 27%.(2) So it is not surprising to find that all guidelines recommend definitive chemoradiotherapy for patients with nonmetastatic unresectable disease and those not amenable for surgery. . . .
    New England Journal of Medicine 04/2015; 372(15):1470-1473. DOI:10.1056/NEJMc1500692#SA2 · 55.87 Impact Factor
  • William B Robb · Christophe Mariette
    Diseases of the Colon & Rectum 04/2015; 58(4):e53-e54. DOI:10.1097/DCR.0000000000000342 · 3.75 Impact Factor
  • C. Mariette
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    ABSTRACT: Based on a grade A level of evidence, immunonutrition should be given to all patients operated on for a digestive cancer 5 to 7 days prior to surgery whatever could be the patient nutritional status. Immunonutrition should be continued in the postoperative phase in malnourished patients for 5 to 7 days or until patients are able to recover oral feeding covering at least 60% of their needs. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    Journal de Chirurgie Viscerale 02/2015; 152. DOI:10.1016/S1878-786X(15)30004-8
  • C. Mariette
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    ABSTRACT: Les programmes de réhabilitation rapide postopératoire sont une combinaison de mesures péri-opératoires ayant montré chacune leur efficacité mais qui combinées les unes aux autres agissent de façon synergique dans le but d’accélérer la récupération postopératoire, amenant à une diminution de la morbidité postopératoire et de la durée d’hospitalisation. À côté de l’immunonutrition, la charge en hydrate de carbone jusqu’à 2 heures avant l’induction anesthésique, la réintroduction d’une alimentation orale dans les 24 heures postopératoires, sont sûres et permettent d’accélérer la récupération postopératoire.
    Journal de Chirurgie Viscerale 02/2015; 152. DOI:10.1016/S1878-786X(15)30005-X
  • C. Mariette
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    ABSTRACT: Nutrition is part of the treatment plan. Nutritional support as well as immunonutrition have been shown to decrease the rate of postoperative complications. Many issues remain to be investigated to better understand underlying mechanisms and to offer patients a personalized approach. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    Journal de Chirurgie Viscerale 02/2015; 152. DOI:10.1016/S1878-786X(15)30006-1

Publication Stats

3k Citations
1,135.95 Total Impact Points


  • 2003–2015
    • University of Lille Nord de France
      Lille, Nord-Pas-de-Calais, France
  • 2006–2014
    • CHRU de Strasbourg
      Strasburg, Alsace, France
  • 2002–2014
    • Centre Hospitalier Régional Universitaire de Lille
      • • Institute of Biochemistry and Molecular Biology
      • • General and Digestive Surgery Service
      Lille, Nord-Pas-de-Calais, France
  • 2013
    • Lille Catholic University
      Lille, Nord-Pas-de-Calais, France
  • 2006–2013
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 2012
    • Université du Droit et de la Santé Lille 2
      Lille, Nord-Pas-de-Calais, France
  • 2007
    • Centre Hospitalier Universitaire de Clermont-Ferrand
      Clermont, Auvergne, France
    • Centre Georges-François Leclerc
      Dijon, Bourgogne, France
  • 2003–2006
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2004
    • The Nebraska Medical Center
      Omaha, Nebraska, United States