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Our aim was to assess the proportion of patients in a well-defined population reaching specialized medical care after hepatitis C diagnosis.Hepatitis C-positive patients recorded in the population-based registry of Cote-d'Or, an administrative district in France, constituted the study population.Between 1994 and 1999, new hepatitis C-positive serology was diagnosed in 847 patients, of whom 690 were eligible for this study. A total of 135 patients had not been given specialized medical care after diagnosis; among them, 50.4% had a normal serum alanine transferase level at diagnosis, 62.2% had risk factors related to lifestyle (drug addiction, sexual risk...), and 26.7% were current alcoholics. The 555 other patients were involved in specialized medical care after diagnosis: 42.7% had a liver biopsy and 27.0% were treated. Treatment was carried out more often in males than in females (OR: 1.67; P0.005), and in patients less than 65 years old (OR: 2.94; P0.0002). Nearly 30.5% of patients with a Metavir score greater than A1F1 did not undergo treatment.This study shows that in a general population at least one patient out of five with hepatitis C infection remains outside the health care system. It also reveals that management practices vary with gender. Further surveys are needed to better understand this phenomenon.

The aim of this population-based study was to determine the effectiveness of antiviral therapy in non selected chronic hepatitis C patients.The study was performed in all new patients with anti-HCV antibodies who had registered in a specialised viral hepatitis registry since 1994 and who lived in the French departments of Côte-d'Or and Doubs (1 005 817 inhabitants).1251 of the 1508 recorded cases were studied; 262 were treated. Results of treatment were available in 238 cases, 157 were treated with interferon alone and 81 with interferon + ribavirine. Sustained virological response was observed in 18% of cases after interferon alone and 46.9% after interferon + ribavirine. In multivariate analysis, age under 40 and combined therapy were positively correlated to sustained virological response. Premature treatment discontinuation was associated with a lack of sustained response which was unrelated to gender or liver fibrosis. Fifty seven patients received combined therapy after unsuccessful monotherapy: sustained virological response rates were 33.3% in responders-relapsers and 23.7% in non-responders to initial therapy.This study showed that sustained response rates were similar in non selected patients from the general population and in highly selected patients from randomised trials. These results emphasize the necessity of increasing the ratio of treated patients which is still too low in general population.

Introduction Les cancers coliques presentant le phenotype CIMP (CpG island methylator phenotype) possedent des caracteristiques anatomocliniques et moleculaires specifiques et proches de celles des cancers MSI-High (MicroSatellite Instability High). La plupart des etudes portant sur la methylation ne distinguent que 2 groupes de cancers : hautement methyles (CIMP-High) et peu ou pas methyles (CIMP-Low ou No-CIMP). Dans notre etude, nous avons defini trois sous groupes de methylation (No-CIMP, CIMP-Low et CIMP-High) et evalue leur valeur pronostique sur une base de population de cancers coliques sporadiques. Patients et Methodes Un total de 582 adenocarcinomes coliques a ete caracterise par MSP fluorescente (methylation specific PCR) a l’aide de 5 marqueurs (hMLH1, P16, MINT1, MINT2, MINT31). Le statut No-CIMP a ete defini par l’absence de methylation des marqueurs etudies, le statut CIMP-Low lorsque 1 a 3 marqueurs etaient methyles, et CIMP-High lorsque 4 a 5 marqueurs etaient methyles. Le statut de methylation a ete confronte aux donnees anatomocliniques et moleculaires (statut MSI, mutation de BRAF et KRAS). La survie globale et relative des patients a ete evaluee en fonction du statut de methylation. Resultats Dans le groupe MSS (MicroSatellite Stable), le statut CIMP-High a ete retrouve significativement associe a une localisation proximale (p = 0,011), a la mutation de BRAF (p Conclusion Notre travail demontre que les patients des groupes No-CIMP et CIMP-Low et porteurs d’une tumeur MSS ont des caracteristiques anatomocliniques similaires mais une survie differente. Cette etude souligne l’effet pronostique pejoratif de la methylation chez les patients MSS et l’importance majeure d’identifier les 3 groupes de methylation.

Objectif Il n’existe que peu de donnees statistiques sur la prise en charge du cancer du pancreas dans la population generale. Le but de ce travail etait de decrire les tendances de la prise en charge et de la survie des cancers du pancreas entre 1976 et 2005. Materiels et Methodes Les donnees provenaient du Registre Bourguignon des cancers Digestifs, et couvraient une periode de 30 annees. L’evolution des moyens diagnostiques, du stade, du traitement et de la survie ont ete analyses au cours de 6 periodes de 5 ans. Une analyse multivariee de la survie relative a ete faite. Resultats Au total, 2 986 cas de cancers pancreatiques ont ete enregistres. Les methodes diagnostiques ont evolue au cours du temps. L’echographie et le scanner sont progressivement devenus les methodes diagnostiques principales, faisant disparaitre les diagnostics reposant sur les constatations operatoires. L’histologie etait connue chez 39,8 % des patients au cours de la premiere periode, et chez 57,2 % au cours de la derniere (p Conclusion Au cours des 30 dernieres annees, malgre l’evolution des methodes diagnostiques, il y eut peu de changements concernant le stade au moment du diagnostic, le taux d’exerese a visee curative et le pronostic des patients atteints de cancer du pancreas. Il reste un des challenges majeurs de la cancerologie.