C Coutant

Publications (36)59.7 Total impact

• Article: Clinical benefit from neoadjuvant chemotherapy in oestrogen receptor-positive invasive ductal and lobular carcinomas.

  Y Delpech, C Coutant, L Hsu, E Barranger, T Iwamoto, C H Barcenas, G N Hortobagyi, R Rouzier, F J Esteva, L Pusztai
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  ABSTRACT: Background:The aim of this study was to compare clinical and pathological outcomes after neoadjuvant chemotherapy between oestrogen receptor (ER)-positive invasive pure lobular carcinoma (ILC) and invasive ductal carcinoma (IDC).Methods:This analysis included 1895 patients (n=177 ILC; n=1718 IDC), with stage I-III breast cancer, who received neoadjuvant chemotherapy. Clinical and pathological response rates, the frequency of positive surgical margins and rate of breast-conserving surgery were compared.Results:There was a trend for fewer good clinical responses in ILC compared with IDC. Tumour downstaging was significantly less frequent in ILC. Positive or close surgical resection margins were more frequent in ILC, and breast-conserving surgery was less common (P<0.001). These outcome differences remained significant in multivariate analysis, including tumour size, nodal status, age, grade and type of chemotherapy. Invasive pure lobular carcinoma was also associated with a significantly lower pathological complete response (pCR) rate in univariate analysis, but this was no longer significant after adjusting for tumour size and grade.Conclusion:Neoadjuvant chemotherapy results in lower rates of clinical benefit, including less downstaging, more positive margins and fewer breast-conserving surgeries in ER-positive ILC compared with ER-positive IDC. Pathological complete responses are rare in both groups, but do not significantly differ after adjusting for other variables.British Journal of Cancer advance online publication, 8 January 2013; doi:10.1038/bjc.2012.557 www.bjcancer.com.
  British Journal of Cancer 01/2013; · 5.04 Impact Factor
• Article: Ki67 expression in the primary tumor predicts for clinical benefit and time to progression on first-line endocrine therapy in estrogen receptor-positive metastatic breast cancer.

  Y Delpech, Y Wu, K R Hess, L Hsu, M Ayers, R Natowicz, C Coutant, R Rouzier, E Barranger, G N Hortobagyi, D Mauro, L Pusztai
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  ABSTRACT: We examined whether baseline Ki67 expression in estrogen receptor-positive (ER+) primary breast cancer correlates with clinical benefit and time to progression on first-line endocrine therapy and survival in metastatic disease. Ki67 values and outcome information were retrieved from a prospectively maintained clinical database and validated against the medical records; 241 patients with metastatic breast cancer were included--who had ER+ primary cancer with known Ki67 expression level--and received first-line endocrine therapy for metastatic disease. Patients were assigned to low (<10 %), intermediate (10-25 %), or high (>25 %) Ki67 expression groups. Kaplan-Meier survival curves were plotted and multivariate analysis was performed to assess association between clinical and immunohistochemical variables and outcome. The clinical benefit rates were 81, 65, and 55 % in the low (n = 32), intermediate (n = 103), and high (n = 106) Ki67 expression groups (P = 0.001). The median times to progression on first-line endocrine therapy were 20.3 (95 % CI, 17.5-38.5), 10.8 (95 % CI, 8.9-18.8), and 8 (95 % CI, 6.1-11.1) months, respectively (P = 0.0002). The median survival times after diagnosis of metastatic disease were also longer for the low/intermediate compared to the high Ki67 group, 52 versus 30 months (P < 0.0001). In multivariate analysis, high Ki67 expression in the primary tumor remained an independent adverse prognostic factor in metastatic disease (P = 0.001). Low Ki67 expression in the primary tumor is associated with higher clinical benefit and longer time to progression on first-line endocrine therapy and longer survival after metastatic recurrence.
  Breast Cancer Research and Treatment 08/2012; 135(2):619-27. · 4.43 Impact Factor
• Source

  Available from: breast-cancer-research.com

  Article: First clinical results on the potential of intraoperative imaging for sentinel lymph node biopsy in breast cancer

  E Barranger, K Kerrou, S Pitre, MA Duval, C Coutant, R Siebert, J Talbot, Y Charon, S Uzan
  Breast Cancer Research 04/2012; 9:1-2. · 5.33 Impact Factor
• Article: [San Antonio Breast Cancer Symposium 2011 (SABCS): what place will remain to the axillary dissection?].

  E Barranger, Y Delpech, C Coutant
  Gynécologie Obstétrique & Fertilité 03/2012; 40(4):201-3. · 0.52 Impact Factor
• Article: Contribution of pelvic and para-aortic lymphadenectomy with sentinel node biopsy in patients with IB2-IIB cervical cancer.

  E Chéreau, J-G Feron, M Ballester, C Coutant, C Bezu, R Rouzier, E Touboul, E Daraï
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  ABSTRACT: Detection of lymph node involvement in women with IB2-IIB cervical cancer could have a positive effect on survival. We set out to evaluate the incidence of pelvic and/or para-aortic lymph node involvement using the sentinel node (SN) biopsy and its impact on survival. From 2002 to 2010, 66 women with IB2-IIB cervical cancer underwent a pelvic and paraaortic lymphadenectomy with SN biopsy. Survival between groups according to lymph node status was evaluated. Mean tumour size was 43.5 mm. At least one SN was detected in 69% of the 45 SN procedures performed. Sixteen of these patients had metastatic SN and the false negative rate was 20%. Metastatic pelvic SNs or non-SNs were detected in 33 patients (50%), including pelvic-positive nodes in 26 (40%), pelvic- and paraaortic-positive lymph nodes in seven (11%), and paraaortic skip metastases in two (6%). Positive paraaortic node was the sole determinant for disease-free survival (DFS) and overall survival (OS; P<0.001). Differences in DFS and OS between groups according to the nodal status were observed (P<0.001). SN procedure gave a higher rate of metastasis detection. Further studies are required to evaluate whether pre-therapeutic node staging, including paraaortic and pelvic lymphanedectomy, should be performed.
  British Journal of Cancer 12/2011; 106(1):39-44. · 5.04 Impact Factor
• Article: External validation of a laparoscopic-based score to evaluate resectability for patients with advanced ovarian cancer undergoing interval debulking surgery.

  E Chereau, V Lavoue, M Ballester, C Coutant, F Selle, A Cortez, E Daraï, J Leveque, R Rouzier
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  ABSTRACT: To evaluate the relevance of laparoscopic index of Fagotti et al during staging laparoscopy (S-LPS) to predict optimal cytoreduction during interval debulking surgery (IDS) after neoadjuvant chemotherapy for ovarian cancer. Fifty-two patients with stage III-IV ovarian cancer were retrospectively analyzed. We evaluated discrimination with a receiver operating characteristic (ROC) curve analysis and calibration of Fagotti et al's model among our population and compared this performance with their data. A score >4 was associated with optimal resection with sensitivity and positive predictive value (PPV) of 95% and 82% respectively. The ROC curve analysis gave an area under the curve (AUC) of 0.72 (95% confidence interval (CI) 0.65-0.80) for our population compared to 0.88 (95% CI 0.84-0.91) in Fagotti et al's population. Percentages predicted in our population were unsatisfactory (p<0.01), illustrating the different rates of optimal cytoreduction between the centers (average error of 25%). The laparoscopic index of Fagotti et al is relevant in prediction of optimal cytoreduction among women undergoing IDS.
  Anticancer research 12/2011; 31(12):4469-74. · 1.73 Impact Factor
• Article: Laparoscopic pelvic lymph node dissection.

  M Ballester, E Chéreau, C Coutant, E Daraï, R Rouzier
  Journal of Visceral Surgery 04/2011; 148(2):e111-6. · 0.57 Impact Factor
• Article: Transvaginal hydrolaparoscopy.

  E Daraï, C Coutant, L Dessolle, M Ballester
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  ABSTRACT: In 1998, Gordts et al. introduced the concept of transvaginal hydrolaparoscopy (THL) to explore the pelvic cavity through a vaginal incision using a saline solution medium. Several reviews have validated the concept of THL in comparison to the gold standard, i.e. laparosco-py. In a literature review of 187 patients from six studies including one prospective double blind trial, a high concordance was found between THL and laparoscopy ranging from 77.8% to 100%. In a review of 1516 THL, the rate of failure was 5.4% and linked to a retroverted uterus and the presence of adhesions. Another review of 1205 THL, revealed that complete exploration of the pelvis including analysis of both sides with visualization of ovaries and tubes was achieved in 88.3%. In a review of 4232 procedures from 10 studies, bowel injuries occurred in 0.61%. In a multicenter study, the incidence of bowel perforation was 0.65% and decreased to 0.25% after an initial learning experience of 50 THL: 92% of these bowel injuries were managed expectantly without consequences. In addition to diagnostic THL, the relevance of operative THL has been validated mainly for ovarian drilling for polycystic ovary syndrome. Despite the advantages of THL in terms of cost, reliability as compared to laparoscopy in detecting pelvic abnormalities and its superiority in detecting subtle lesions, as well as the feasibility of performing it under local anesthesia thereby contributing to the couple's participation, uptake of THL remains relatively low underlining the need to promote this minimally invasive procedure.
  Minerva ginecologica 02/2011; 63(1):31-8.
• Article: Interest in cavity shaving in breast conservative treatment does not depend on lumpectomy technique.

  J-G Feron, A Nguyen, C Bézu, M Antoine, E Darai, C Coutant, R Rouzier, S Uzan
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  ABSTRACT: In breast conserving surgery (BCS), the usefulness to perform systematic cavity shaving is actively debated. Some investigators argued that systematic cavity shaving could avoid surgical re-excision and make diagnosis of unexpected multifocality. Others argued that usefulness of cavity shaving depends on volumes of resection. In this study one hundred patients undergoing BCS with systematic cavity shaving were included. Margins less than 3 mm were considered to be insufficient. We tested clinico-pathological characteristics in order to identify predictive model of cavity margin shaving utility and we sought to determine if cavity margin shaving usefulness depends on volumes of resection. We showed that cavity shaving avoids the need for re-excision in 24% of cases as well as diagnosis of multifocality in 6% of cases. However, the clinical usefulness of cavity shaving was not related to the volumes of resection.
  Breast (Edinburgh, Scotland) 02/2011; 20(4):358-64. · 2.09 Impact Factor
• Article: [Complications of radical surgery for advanced ovarian cancer].

  E Chéreau, M Ballester, B Lesieur, F Selle, C Coutant, R Rouzier, E Daraï
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  ABSTRACT: Treatment of advanced ovarian cancer should include surgery with optimal cytoreduction, which is the first prognosis factor. This surgery usually requires extensive resection (pelvic surgery, extensive lymphadenectomy, upper abdominal surgery and sometimes multiple intestinal resection). The complete surgery usually requires a resection of the diaphragm peritoneum in 10 to 100% of cases, intestinal resection in 20 to 100% of cases, splenectomy in 1 to 33% of cases, pancreatectomy in 0 11% of cases, resection of liver metastases in 0 to 16% of cases and cholecystectomy in 2 to 20% of cases. The main complications reported were digestive fistula (1.4 to 8.2%), lymphocyst (0.6 to 32%), septic complications (3.7 to 41.4%) and pulmonary complications (0 to 59%) in case of diaphragmatic surgery. The postoperative mortality ranges from 0.3 to 5.7%. Radical surgery increases the rate of complete cytoreduction with significant morbidity and postoperative mortality. Because these complications decrease survival, it is essential to assess the risk of occurrence of these events to inform patients.
  Gynécologie Obstétrique & Fertilité 01/2011; 39(1):21-7. · 0.52 Impact Factor
• Source

  Available from: cnrs.fr

  Article: Impact of serum tumor marker determination on the management of women with borderline ovarian tumors: multivariate analysis of a French multicentre study.

  C Poncelet, R Fauvet, C Yazbeck, C Coutant, E Darai
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  ABSTRACT: To evaluate the contribution of preoperative serum tumor markers to manage borderline ovarian tumors (BOT). Retrospective multicentre study including 317 BOT. Serum tumor marker levels of CA125, CA19-9, CEA, and CA15-3 were determined by radio-immunoassay. Among 181 women with serous BOT and 136 women with mucinous BOT, respectively 55 of 114 (48.2%) and 38 of 91 (41.8%) had at least one abnormal value. Women with preoperative tumor marker assays were more likely to have radical treatment (p=0.0001), full staging (p=0.004), and intra-operative histology (p<0.0001). Women with at least one abnormal tumor marker were more likely to undergo laparotomy (p=0.007), to have intra-operative histology (p=0.04) and complete staging (p=0.0008). In multivariate analysis, first-line laparoscopy was associated with abnormal tumor marker levels (OR=9.63; 95%CI=1.40-66.39; p=0.02), while laparotomy was associated with large tumors, bilateral tumors, and ascitis visible on sonography. Serum tumor marker assays modified both preoperative assessment and surgical management of BOT.
  European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 11/2010; 36(11):1066-72. · 2.56 Impact Factor
• Article: [Breast cancer. In favour of models to predict non-sentinel lymph node status].

  C Bézu, A Benbara, S Uzan, R Rouzier, C Coutant
  Gynécologie Obstétrique & Fertilité 10/2010; 38(10):634-6. · 0.52 Impact Factor
• Article: [Advanced ovarian cancer: criteria of resectability].

  E Chéreau, M Ballester, R Rouzier, C Coutant, E Daraï
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  ABSTRACT: Residual disease is the first predictive factor for survival in women with ovarian cancer. Neoadjuvant chemotherapy still has not proved superiority in terms of overall survival compared with complete initial resection. Hence, initial surgery remains the cornerstone of management for patients with advanced ovarian cancer. Various parameters have been proposed to evaluate the ability of complete resection. Clinical evaluation of peritoneal carcinomatosis and ascite is not relevant enough while general status (ASA score) is correlated with the risk of postoperative complications. Preoperative dosage of CA-125 higher than 500 UI/L seems to be related with an increase risk of sub-optimal surgery. Recently, some authors challenged its prognostic value. For a CA-125 threshold at 500 UI/L, sensitivity, specificity, positive and negative predictive values range from 58 to 78%, 64 to 89%, 64 to 84% and 35.7 to 85.4%, respectively. Imaging criteria failed to report concordant results. Indeed, sensitivity, specificity, positive and negative predictive values vary from 52 to 100%, 75 to 100%, 49% to 100% and 50 to 100%, respectively. High-correlation has been demonstrated for carcinomatosis scores evaluating the dissemination of the disease (AUCs of ROCs curves higher than 0.6). At laparotomy, for an Eisenkop score under 6, 99% of patients could benefit of complete resection. At laparoscopy, for a Fagotti score under 4, a complete cytoreduction could be obtained in 78% of patients. This score had the best AUC (0.76). Various scoring systems are available for surgeons to evaluate the resecability of advanced ovarian cancer. Among them, peroperative scoring systems appear the best tool and should be recommended in routine especially at first laparoscopy. Finally, due to the impact on survival of complete initial resection, women with advanced ovarian cancer should be referred to specialized centres.
  Bulletin du cancer 11/2009; 96(12):1189-97. · 0.67 Impact Factor
• Article: [Introducing critical statistics analysis in an article].

  C Coutant
  Gynécologie Obstétrique & Fertilité 09/2009; 37(9):765-6. · 0.52 Impact Factor
• Article: [Relevance of quality of life questionnaires in women with endometriosis].

  E Daraï, C Coutant, M Bazot, G Dubernard, R Rouzier, M Ballester
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  ABSTRACT: High recurrence rates have been reported in women treated for endometriosis despite advances in medical and surgical treatments improving both fertility and symptoms. It should therefore be considered a chronic disorder. In this particular setting, the main objectives for practitioners are to limit disease progression, recurrence and to improve quality of life (QOL). Previous studies have demonstrated a relation between an increase in pain intensity and a decrease in QOL. However, visual analogue scales to measure general well-being are insufficient to quantify the impact of endometriosis on QOL. Several generic questionnaires, mainly the SF-36, are available in various languages but are not specific of women with endometriosis. Some specific questionnaires are available but have been validated in English population for the most part rending comparison between countries difficult. Despite these limits, QOL should be systematically monitored over time by a validated questionnaire for this chronic disorder and could be a criterion for therapeutic strategy.
  Gynécologie Obstétrique & Fertilité 03/2009; 37(3):240-5. · 0.52 Impact Factor
• Article: Cancer du sein : Prédictivité de la réponse à la chimiothérapie néoadjuvante

  R Rouzier, C Coutant, R Incitti, R Natowicz, G Chahine, S Uzan, D Attalah
  Journal Médical Libanais. 01/2009; Vol.57(2):89-92.
• Article: [Models to predict non sentinel lymph node status in breast cancer patients with metastatic sentinel lymph node].

  C Coutant, R Rouzier, C Olivier, C Bezu, O Marpeau, Y Delpech, S Uzan, E Daraï
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  ABSTRACT: In breast cancer, nine models have been developed to predict non SN status in patients with SN metastasis. Four models are nomograms: the Memorial Sloan-Kettering Cancer Center nomogram (MSKCC nomogram), the nomogram of Degnim et al. (Mayo nomogram), the nomogram of Pal et al. (Cambridge nomogram), and the nomogram of Kohrt et al. (Stanford nomogram). Three models are scoring systems: the Tenon score, the score from the M.D. Anderson Cancer Center (MDA score), and the score of Saidi et al. Finally, two are recursive partitioning tools developed by Kohrt et al. Before being used in routine, these models have to be validated in independent populations based on discrimination and calibration. However, the main issue is their clinical utility based not only on the low false negative rate but also its potential to discriminate patients with a low risk of non SN involvement. Several institutions have tested the MSKCC nomogram, with AUC ranging from 0.58 to 0.86. It was not validated by four studies which did not recommend its use even in patients with micrometastasis.The external validation of the Tenon score confirmed its relevance with an AUC of 0.82.
  Gynécologie Obstétrique & Fertilité 01/2009; 37(2):160-6. · 0.52 Impact Factor
• Article: [Colorectal endometriosis and fertility].

  E Daraï, M Bazot, R Rouzier, C Coutant, M Ballester
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  ABSTRACT: Endometriosis is a common gynaecological condition affecting 10 to 15% of the female population. Deep infiltrating endometriosis (DIE) is diagnosed in 20% of women with endometriosis. Moreover, bowel endometriosis is found in five to 12% of patients with endometriosis. Colorectum represents 90% of all bowel locations. For women with infertility associated with colorectal endometriosis, no predictive criteria of fertility outcome are available. In a literature review, the pregnancy rate after colorectal resection reached 63%. These results, particularly high, raise the issue on legitimacy of colorectal resection in infertile women. Recent studies suggest that predictive criteria of success after colorectal resection are; a young age; a low American Society of Reproductive Medicine (ASRM) score and the laparoscopic route. In contrast, the presence of adenomyosis appears a negative predictive factor of fertility outcome. Despite encouraging results on the fertility of colorectal resection for endometriosis, only studies comparing the results of assisted reproductive therapy to those of surgery are required to identify good candidates for surgery.
  Gynécologie Obstétrique & Fertilité 12/2008; 36(12):1214-7. · 0.52 Impact Factor
• Article: Intramammary lymph node metastasis of breast cancer after sentinel node biopsy: two cases and a review of the literature.

  A-S Bats, C Coutant, M Antoine, S Uzan, E Barranger
  European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 06/2008; 35(3):331-2. · 2.56 Impact Factor
• Article: Prediction of the outcome of preoperative chemotherapy in breast cancer by DNA probes that convey information on both complete and non complete responses

  R Natowicz, R Incitti, EG. Horta, B Charles, P Guinot, K Yan, C Coutant, F Andre, L Pusztai, R Rouzier
  BMC Bioinformatics 01/2008; 9(149):1-17. · 2.75 Impact Factor