D. Goere

Leukocytosis and neutrophilia predicts outcome in anal cancer

OBJECTIVE Leukocytosis and neutrophilia could be the tip of the iceberg in the inflammatory tumor microenvironment. We aimed to validate their prognostic significance in a cohort of patients treated with definitive chemoradiation for anal squamous cell carcinoma (SCC). MATERIALS & METHODS Clinical records from all consecutive patients treated in a single institution between 2006 and 2016 with curative-intent radiotherapy were retrospectively analyzed. Leukocytosis and neutrophilia, defined as leukocyte or neutrophil count over 10,000 and 7500/mm3, respectively, were studied in terms of overall survival (OS), progression (PFS), locoregional (LFS) and distant (DFS)-free survival. RESULTS We identified 103 non-metastatic HIV-negative patients, with concurrent chemotherapy use in 78%. Twelve and 8% displayed baseline leukocytosis and neutrophilia, respectively. Estimated 3-year OS and PFS were 88% and 67%, respectively. In univariate analysis, both leukocytosis and neutrophilia were strongly associated with inferior OS, PFS, LFS and DFS (p<0.01). In multivariate analysis, leukocytosis and neutrophilia remained strongly associated with patient outcome (p<0.01), independently from tumor T and N-stage. Anemia was an independent predictor of worse OS and PFS, while chemoradiation overall treatment time below 50days improved PFS. CONCLUSION Leukocytosis and neutrophilia are strong prognostic factors for OS, PFS, LFS and DFS in anal cancer treated with chemoradiation. These biomarkers could help identify patients with higher risk of tumor relapse that require treatment intensification.

Chirurgie à visée curative des métastases péritonéales

RésuméL’exérèse complète des métastases péritonéales (MP), suivie de chimiohyperthermie intrapéritonéale (CHIP, dont l’impact thérapeutique précis n’est pas encore connu), permet d’obtenir de nombreuses guérisons chez les patients éligibles. C’est devenu le standard thérapeutique lorsqu’elle est possible. Ces résultats en termes de survie sont strictement identiques à ceux des hépatectomies pour métastases hépatiques (MH). La survie des patients présentant des MP débutantes est particulièrement bonne, bien supérieure à celle de tout patient hépatectomisé pour MH. La principale avancée sera de savoir opérer tôt les patients présentant des MP débutantes ou ceux qui ont un haut risque de développer des MP. Le concept de second-look + CHIP découle tout logiquement de ce constat. À l’opposé, une exérèse incomplète des MP contre-indique la CHIP, de même qu’une extension péritonéale importante (même si elle est complètement résécable).AbstractThe complete resection of the peritoneal metastases (PM), followed with HIPEC (hyperthermic intraperitoneal chemotherapy, whose precise therapeutic impact is not yet well-known), allows to obtain numerous cures in eligible patients. This is currently the gold-standard treatment when it is possible. Its survival results are strictly similar to those obtained with hepatectomy for liver metastases (LM). The survival rate of the patients with early PM is particularly high, far superior to those of any hepatectomized patient. The main progress will be to early-operate these patients, or to propose a prophylactic approach to those presenting a high-risk to develop PM. The concept of second-look surgery + HIPEC is the logical extension of this combined approach. In contrast, a non-complete cytoreductive surgery and a large peritoneal extension are contraindications to use this approach.

Caractérisation des tumeurs neuroendocrines digestives ou thoraciques

Once the diagnosis of a neuroendocrine tumour has been made, characterisation is an essential step before therapy. It comes before the decision regarding treatment is made. This requires a multidisciplinary team of experts located in specialist centres that currently make up the RENATEN and TENPATH networks. It is directed by knowledge of the location of the primary tumour and anatomical pathological differentiation. The aim of this characterisation step is to highlight factors that may have an impact on the diagnosis and the prognosis or predict the response to treatment.RésuméUne fois le diagnostic de tumeur neuroendocrine (TNE) posé, la caractérisation est une étape essentielle de la prise en charge d’une TNE. Elle précède la décision thérapeutique. Celle-ci fait appel à une expertise multidisciplinaire au sein des centres experts actuellement regroupés au sein des réseaux RENATEN et TENpath. Elle est orientée par la connaissance de la localisation du primitif et la différenciation anatomopathologique. Cette étape de caractérisation a comme objectif: la mise en évidence de facteurs à impact diagnostique, pronostique ou prédictif de la réponse thérapeutique.