C. Mariette

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

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Publications (485)989.06 Total impact

  • Annals of surgery 06/2015; DOI:10.1097/SLA.0000000000001312 · 7.19 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 · 3.94 Impact Factor
  • The Annals of thoracic surgery 06/2015; 99(6):2253-2254. DOI:10.1016/j.athoracsur.2014.11.031 · 3.65 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 · 3.94 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 · 2.36 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 · 4.93 Impact Factor
  • William B Robb, Christophe Mariette
    Annals of surgery 04/2015; DOI:10.1097/SLA.0000000000001263 · 7.19 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 · 54.42 Impact Factor
  • William B Robb, Christophe Mariette
    Diseases of the Colon & Rectum 04/2015; 58(4):e53-e54. DOI:10.1097/DCR.0000000000000342 · 3.20 Impact Factor
  • C. Mariette
    02/2015; 152. DOI:10.1016/S1878-786X(15)30004-8
  • C. Mariette
    02/2015; 152. DOI:10.1016/S1878-786X(15)30005-X
  • C. Mariette
    02/2015; 152. DOI:10.1016/S1878-786X(15)30006-1
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    ABSTRACT: Perioperative oncologic treatments provide a survival benefit for junctional and gastric adenocarcinoma (JGA) and esophageal cancer (EC). Whether neoadjuvant therapy toxicity (NTT) correlates with increased perioperative risk remains unclear. We aimed to evaluate the impact of grade III/IV NTT on postoperative and oncologic outcomes in resected upper gastrointestinal malignancies. A multicenter retrospective analysis was performed on consecutive patients who benefited from neoadjuvant chemo(radio)therapy followed by surgery between 1997 and 2010 for JGA (first cohort, n = 653) and for EC (second cohort, n = 640). Data between patients who experienced NTT were compared to those who did not. NTT was associated with higher postoperative mortality after resection of JGA (P = 0.001) and after esophagectomy (P < 0.001), more non-R0 resections (JGA P = 0.019, EC P = 0.024), a decreased administration of adjuvant treatment among the JGA cohort (P = 0.012), and higher surgical morbidity (JGA P = 0.005, EC P = 0.020). Median survival was reduced in patients who experienced NTT in both cohorts (JGA P = 0.018, EC P = 0.037). After adjustment on confounding variables, NTT was independently associated with postoperative mortality in both cohorts (P ≤ 0.007). NTT is a predictor of postoperative mortality, correlates with higher postoperative morbidity, and negatively affects oncologic outcomes for upper gastrointestinal carcinomas.
    Annals of Surgical Oncology 02/2015; DOI:10.1245/s10434-015-4423-5 · 3.94 Impact Factor
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    ABSTRACT: High center procedural volume has been shown to reduce postoperative mortality (POM); however, the cause of POM has been poorly studied previously. The aim of this study was to define the pattern of POM and major morbidity in relation to center procedural volume. Data from 2,944 consecutive adult patients undergoing esophagectomy for esophageal cancer in 30 centers between 2000 and 2010 were retrospectively collected. Data between patients who suffered 30-day POM were compared with those who did not. Factors associated with POM were identified using binary logistic regression, with propensity matching to compare low- (LV) and high-volume (HV) centers. The 30-day and in-hospital POM rates were 5.0 and 7.3 %, respectively. Pulmonary complications were the most common, affecting 38.1 % of patients, followed by surgical site infection (15.5 %), cardiovascular complications (11.2 %), and anastomotic leak (10.2 %). Factors that were independently associated with 30-day POM included American Society of Anesthesiologists grade IV, LV center, anastomotic leak, pulmonary, cardiovascular and neurological complications, and R2 resection margin status. Surgical complications preceded POM in approximately 30 % of patients compared to medically-related causes in 68 %. Propensity-matched analysis demonstrated LV centers were significantly associated with increased 30-day POM, and POM secondary to anastomotic leak, and pulmonary- and cardiac-related causes. The results of this large, multicenter study provide further evidence to support the centralization of esophagectomy to HV centers, with a lower rate of morbidity and better infrastructure to deal with complications following major surgery preventing further mortality.
    Annals of Surgical Oncology 01/2015; DOI:10.1245/s10434-014-4310-5 · 3.94 Impact Factor
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    ABSTRACT: Objective: The aim of this study was to the determine impact of severe esophageal anastomotic leak (SEAL) upon long-term survival and locoregional cancer recurrence. Background: The impact of SEAL upon long-term survival after esophageal resection remains inconclusive with a number of studies demonstrating conflicting results. Methods: A multicenter database for the surgical treatment of esophageal cancer collected data from 30 university hospitals (2000-2010). SEAL was defined as a Clavien-Dindo III or IV leak. Patients with SEAL were compared with those without in terms of demographics, tumor characteristics, surgical technique, morbidity, survival, and recurrence. Results: From a database of 2944 operated on for esophageal cancer between 2000 and 2010, 209 patients who died within 90 days of surgery and 296 patients with a R1/R2 resection were excluded, leaving 2439 included in the final analysis; 208 (8.5%) developed a SEAL and significant independent association was observed with low hospital procedural volume, cervical anastomosis, tumoral stage III/IV, and pulmonary and cardiovascular complications. SEAL was associated with a significant reduction in median overall (35.8 vs 54.8 months; P = 0.002) and disease-free (34 vs 47.9 months; P = 0.005) survivals. After adjustment of confounding factors, SEAL was associated with a 28% greater likelihood of death [hazard ratio = 1.28; 95% confidence interval (CI): 1.04-1.59; P = 0.022], as well as greater overall (OR = 1.35; 95% CI: 1.15-1.73; P = 0.011), locoregional (OR = 1.56; 95% CI: 1.05-2.24; P = 0.030), and mixed (OR = 1.81; 95% CI: 1.20-2.71; P = 0.014) recurrences. Conclusions: This large multicenter study provides strong evidence that SEAL adversely impacts cancer prognosis. The mechanism through which SEAL increases local recurrence is an important area for future research.
    Annals of Surgery 01/2015; DOI:10.1097/SLA.0000000000001011 · 7.19 Impact Factor
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    ABSTRACT: Self-expanding metallic stents (SEMSs) have been used as a bridge to surgery, relieving dysphagia and maintaining nutrition, in patients with operable but obstructive esophageal cancer (EC). However, the impact of SEMSs on oncologic outcomes is unknown. The aim of this study was to evaluate the impact of SEMS insertion before EC surgery on oncologic outcomes. From 2000 to 2010, two thousand nine hundred and forty-four patients who underwent an operation for EC with a curative intent were included in a multicenter European cohort. Through propensity score analysis, patients who underwent SEMS insertion (SEMS group, n = 38) were matched 1:4 to control patients who did not undergo SEMS insertion (control group, n = 152). The SEMS and control groups were comparable according to age, sex, tumor location, clinical stage, American Society of Anesthesiologists score, dysphagia, malnutrition, neoadjuvant treatment administration, histology, and surgical procedure. Self-expanding metallic stent insertion was complicated by tumoral perforation in 2 patients. The in-hospital postoperative mortality and morbidity rates for the SEMS vs control groups were 13.2% vs 8.6% (p = 0.370) and 63.2% vs 59.2% (p = 0.658), respectively. The R0 resection rate (71.0% vs 85.5%; p = 0.041), median time to recurrence (6.5 vs 9.0 months; p = 0.040), and 3-year overall survival (25% vs 44%; p = 0.023) were significantly reduced in the SEMS group, and the 3-year locoregional recurrence rate was increased (62% vs 34%; p = 0.049). The results remained significant after excluding SEMS-related esophageal perforations. After adjusting for confounding factors, SEMS insertion was a predictor of poor prognosis (hazard ratio = 1.6; p = 0.038). Self-expanding metallic stent insertion, as a bridge to surgery, has a negative impact on oncologic outcomes in EC. Clinicaltrials.gov ID: NCT 01927016. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
    Journal of the American College of Surgeons 12/2014; 220(3). DOI:10.1016/j.jamcollsurg.2014.11.028 · 4.45 Impact Factor
  • Christophe Mariette, William B Robb
    Journal of Clinical Oncology 12/2014; 33(3). DOI:10.1200/JCO.2014.59.3293 · 17.88 Impact Factor
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    ABSTRACT: Colorectal cancers (CRC) with microsatellite instability (MSI) display unique clinicopathologic features including a mucinous pattern with frequent expression of the secreted mucins MUC2 and MUC5AC. The mechanisms responsible for this altered pattern of expression remain largely unknown. We quantified DNA methylation of mucin genes (MUC2, MUC5AC, MUC4) in colonic cancers and examined the association with clinicopathological characteristics and molecular (MSI, KRAS, BRAF and TP53 mutations) features. A control cohort was used for validation. We detected frequent hypomethylation of MUC2 and MUC5AC in CRC. MUC2 and MUC5AC hypomethylation was associated with MUC2 and MUC5AC protein expression (P = 0.004 and P<0.001, respectively), poor differentiation (P = 0.001 and P = 0.007, respectively) and MSI status (P<0.01 and P<0.001, respectively). Interestingly, MUC5AC hypomethylation was specific to MSI cancers. Moreover, it was significantly associated with BRAF mutation and CpG island methylator phenotype (P<0.001 and P<0.001, respectively). All these results were confirmed in the control cohort. In the multivariate analysis, MUC5AC hypomethylation was a highly predictive biomarker for MSI cancers. MUC5AC demethylation appears to be a hallmark of MSI in CRC. Determination of MUC5AC methylation status may be useful for understanding and predicting the natural history of CRC. This article is protected by copyright. All rights reserved.
    International Journal of Cancer 12/2014; DOI:10.1002/ijc.29342 · 5.01 Impact Factor
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    ABSTRACT: La fistule anastomotique est une complication majeure en chirurgie digestive, responsable d’une augmentation de la morbidité postopératoire, et première cause de mortalité après chirurgie d’exérèse. L’identification des facteurs de risque est un prérequis indispensable à la prévention de la fistule. La fistule peut se manifester par différents tableaux cliniques, allant de l’absence de symptômes, au choc septique avec mise en jeu du pronostic vital. Le scanner injecté avec opacification est l’examen le plus exhaustif pour l’exploration de tout type de fistule et de ses répercussions. Un diagnostic précoce et une prise en charge optimale multidisciplinaire de la fistule permettent de diminuer la morbi-mortalité postopératoire. Elle est basée sur trois options : médicale, interventionnelle de type radiologique ou endoscopique, ou chirurgicale, dont le choix dépend de l’état septique du malade. Si le patient est asymptomatique, le traitement peut être exclusivement médical avec une surveillance rapprochée. Un traitement interventionnel est entrepris pour une fistule symptomatique si le pronostic vital n’est pas engagé. Si par contre le pronostic vital est mis en jeu, une réintervention chirurgicale en urgence est nécessaire, associée à une réanimation intensive. Plus que leur prévention, c’est la précocité et la qualité de la prise en charge des fistules anastomotiques qui en diminuent leur retentissement.
    11/2014; DOI:10.1016/j.jchirv.2014.08.006
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    ABSTRACT: Objectives: To assess the impact of neoadjuvant chemoradiotherapy (NCRT) on anastomotic leakage (AL) and other postoperative outcomes after esophageal cancer (EC) resection. Background: Conflicting data have emerged from randomized studies regarding the impact of NCRT on AL. Methods: Among 2944 consecutive patients operated on for EC between 2000 and 2010 in 30 European centers, patients treated by NCRT after surgery (n = 593) were compared with those treated by primary surgery (n = 1487). Multivariable analyses and propensity score matching were used to compensate for the differences in some baseline characteristics. Results: Patients in the NCRT group were younger, with a higher prevalence of male sex, malnutrition, advanced tumor stage, squamous cell carcinoma, and surgery after 2005 when compared with the primary surgery group. Postoperative AL rates were 8.8% versus 10.6% (P = 0.220), and 90-day postoperative mortality and morbidity rates were 9.3% versus 7.2% (P = 0.110) and 33.4% versus 32.1% (P = 0.564), respectively. Pulmonary complication rates did not differ between groups (24.6% vs 22.5%; P = 0.291), whereas chylothorax (2.5% vs 1.2%; P = 0.020), cardiovascular complications (8.6% vs 0.1%; P = 0.037), and thromboembolic events (8.6% vs 6.0%; P = 0.037) were higher in the NCRT group. After propensity score matching, AL rates were 8.8% versus 11.3% (P = 0.228), with more chylothorax (2.5% vs 0.7%; P = 0.030) and trend toward more cardiovascular and thromboembolic events in the NCRT group (P = 0.069). Predictors of AL were high American Society of Anesthesiologists scores, supracarinal tumoral location, and cervical anastomosis, but not NCRT. Conclusions: Neoadjuvant chemoradiotherapy does not have an impact on the AL rate after EC resection (NCT 01927016).
    Annals of Surgery 11/2014; 260(5):764-771. DOI:10.1097/SLA.0000000000000955 · 7.19 Impact Factor

Publication Stats

3k Citations
989.06 Total Impact Points


  • 2003–2015
    • University of Lille Nord de France
      Lille, Nord-Pas-de-Calais, France
  • 2002–2014
    • Centre Hospitalier Régional Universitaire de Lille
      • • General and Digestive Surgery Service
      • • Institute of Biochemistry and Molecular Biology
      Lille, Nord-Pas-de-Calais, France
  • 2001–2014
    • CHRU de Strasbourg
      Strasburg, Alsace, France
  • 2013
    • Lille Catholic University
      Lille, Nord-Pas-de-Calais, France
  • 2007
    • Centre Hospitalier Universitaire de Clermont-Ferrand
      Clermont, Auvergne, France
    • Centre Georges-François Leclerc
      Dijon, Bourgogne, France
  • 2004–2007
    • Unité Inserm U1077
      Caen, Lower Normandy, France
    • The Nebraska Medical Center
      Omaha, Nebraska, United States
  • 2006
    • Centre Hospitalier Universitaire Rouen
      Rouen, Haute-Normandie, France