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Objectives To determine if ambulatory videothoracoscopic pleural sampling followed by indwelling pleural catheter (VATS-IPC) is safe and effective comparing with videothoracoscopic talc pleurodesis (VATS-TP) reducing total pleural effusion-relative hospitalization days for patients with malignant pleural effusion (MPE).Methods. All patients who underwent either ambulatory VATS- IPC or conventional VATS-TP were extracted from a prospective database. Patients were matched one to one according to the surgical strategy (VATS-IPC versus VATS-TP) and a propensity score including six variables: age, gender, PS, type and size of effusion, dyspnoea. Primary endpoint was effusion-relative hospital stay at 3 months. Secondary endpoints were occurrence of pleurodesis, additional pleural procedures and adverse events at 3 months.Results. From 2019 to 2021, among 176 patients underwent surgical procedure whose 48 an ambulatory hybrid approach by VATS-IPC. Overall effusion-relative hospital stay at 3 months was lower in the VATS-IPC group before and after propensity score (1.80 +/-3.95 vs 6.85 +/- 6.15 days, p Conclusions. Ambulatory VATS-IPC was associated with shorter effusion-relative hospitalization stay with equivalent pleurodesis rate at 3 months, without increased morbimortality for initial management of MPE.

Introduction The maintenance of military surgeons’ operative skills is challenging. Different and specific training strategies have been implemented in this context; however, little has been evaluated with regard to their effectiveness. Cancer surgery is a part of military surgeons’ activities in their home hospitals. This study aimed to assess the role of oncological surgery in the improvement of military surgeons’ operative skills. Methods Between January and June 2019, the surgical activities of the departments of visceral, ear, nose, and throat, urological, and thoracic surgery were retrospectively reviewed and assessed in terms of the operative time (OT). All surgeons working at the Sainte Anne Military Teaching Hospital were sent a survey to rate on a 5-point scale the current surgical practices on their usefulness in improving surgical skills required for treating war injuries during deployment (primary endpoint) and to compare on a 10-point visual analog scale the influence of cancer surgery and specific training on surgical fluency (secondary endpoint). Results Over the study period, 2,571 hours of OT was analyzed. Oncological surgery represented 52.5% of the surgical activity and almost 1,350 hours of cumulative OT. Considering the primary endpoint, the mean rating allocated to cancer surgery was 4.53 ± 0.84, which was not statistically different than that allocated to trauma surgery (4.42 ± 1.02, P = 0.98) but higher than other surgery (2.47 ± 1.00, P Conclusion This study demonstrates the usefulness of cancer surgery in improving the operative skills of military surgeons.

BackgroundCirculating tumor cells (CTCs) have a strong potential as a quasi-non-invasive tool to set up precision medicine strategy for cancer patients. Tremendous efforts have been made to develop the second-generation of “filtration-based” technologies to detect CTCs, revealing a surprising heterogeneity among those cells. Here, we performed the largest and simultaneous analysis of all atypical circulating tumor cells (aCTCs) detected with a filtration-based technology, in a cohort of metastatic breast cancer (mBC) patients, and correlated their presence with clinicopathological and survival data.MethodsThe PERMED-01 study enrolled patients with mBC refractory to systemic therapy. We prospectively analyzed aCTCs present at the time of inclusion in the study, using the Screencell®Cyto device (n=91). Subsets cut-offs were established and evaluated for correlation with clinicopathological data, including progression-free survival (PFS) and overall survival (OS).ResultsThe median number of aCTCs found in mBC was 8.3 per mL of blood. Three subsets of aCTCs, absent from controls, were observed in mBC patients: single (s-aCTCs), circulating tumor micro-emboli (CTM), and giant-aCTCs (g-aCTCs). The presence of g-aCTCs was associated with shorter PFS and OS in multivariate analyses. For 23 cases, the analysis was completed with advanced immunofluorescence staining and showed that CTM and g-aCTCs displayed a hybrid phenotype for epithelial and mesenchymal markers.ConclusionsThis study highlights the heterogeneity of aCTCs in mBC patients both at the cytomorphological and molecular levels when using a Screencell®Cyto device. It reveals the g-aCTC subset as a prognostic factor and a potential stratification tool that might help to orientate late-stage mBC patients’ therapeutic care.

Strategies are being explored to increase the efficiency of immune checkpoint inhibitors (ICIs) targeting PD1/PDL1 in triple-negative breast cancer (TNBC), including combination with therapies inhibiting intracellular immune checkpoints such as CISH (Cytokine-induced SH2 protein). Correlation between CISH expression and TNBC features is unknown. We retrospectively analyzed CISH expression in 1936 clinical TNBC samples and searched for correlations with clinical variables, including metastasis-free interval (MFI). Among TNBCs, 44% were identified as “CISH-up” and 56% “CISH-down”. High expression was associated with pathological axillary lymph node involvement, more adjuvant chemotherapy, and Lehmann’s immunomodulatory and luminal AR subtypes. The “CISH-up” class showed longer 5-year MFI (72%) than the “CISH-down” class (60%; p = 2.8 × 10−2). CISH upregulation was associated with activation of IFNα and IFNγ pathways, antitumor cytotoxic immune response, and signatures predictive for ICI response. When CISH and PDL1 were upregulated together, the 5-year MFI was 81% versus 52% when not upregulated (p = 6.21 × 10−6). The two-gene model provided more prognostic information than each gene alone and maintained its prognostic value in multivariate analysis. CISH expression is associated with longer MFI in TNBC and refines the prognostic value of PDL1 expression. Such observation might reinforce the therapeutic relevance of combining CISH inhibition with an anti-PD1/PDL1 ICI.

352 Background: Active surveillance (AS) is a standard of care for low-risk prostate cancer (PC). However, 20 to 50% of patients (pts) will ultimately require a local treatment following AS. The aim of this study is to assess whether apalutamide could decrease the proportion of pts requiring local treatment within 3 years. We report the 1-year safety and quality of life analyses. Methods: multicentric phase II study conducted in patients with low to intermediate risk PC randomized between apalutamide 6 months (240 mg/d) with AS vs AS alone. Toxicity was evaluated each month during treatment and every 3 months thereafter for both arms. Quality of life (SF12) was assessed at baseline, 6 and 12 months post enrollment. Results: Patients were randomized: 51 in apalutamide and 40 in AS arm. Only 50 pts received apalutamide (one refusal). Median age was 64 yrs (47-76), median PSA 5.9 (1.5-21.5), only 2 pts had Gleason ISUP 2, 14% had >T2, the median cancer positive cores was 14.3%. The median testosterone level was 4.7 mg/l. Only 88 were available for safety analyses (48 in apalutamide arm). Maximal grades of reported adverse events during the first year were for the experimental arm: 25%, 56%, 19% and control arm: 20%, 15% 12.5% for G1, G2, G3 respectively. In the experimental arm, grade 1/2 related adverse events (AE) were cutaneous (25%) and HTA (15%), nausea 15%, diarrhea 10%, arthralgia or musculoskeletal event 17% and anemia 6%. Attention disorders were observed in 6% and hypothyroidism in 8%. The most frequent sexual dysfunctions were erectile dysfunction observed in 29% (7.5% in AS arm), gynecomastia in 60%, loss of libido in 21%, and nipple pain in 33%. One-year post enrollment, the testosterone level was 4.86 mg/l (1.5-9.8) vs 4.6 (2-7.7) in apalutamide and AS arm, respectively. Digestive symptoms were Grade 3. Related AEs were an HTA for 2 pts, rash for 1 pt, asthenia for 1 pt, erectile dysfunction for 1 pt, and decreased libido for 1 pt. One serious related AE was reported: grade 2 cerebral ischemic attack. A reduced dose was required for 16.67% of pts and 33.3% had transient discontinuation. The treatment was stopped for toxicity in 3 pts; 94% completed the 6 months of treatment. No differences were observed in physical component summary (PCS) and mental component summary (MCS) of SF12 for treatment vs AS at 6 mo (PCS: 55.1 vs 56.4; MCS 43.4 vs 41.4) and 12 mo (PCS: 53.6 vs 54.1; MCS 44.1 vs 42.9). Conclusions: This is a large randomized study evaluating apalutamide with active surveillance vs active surveillance. No new safety issues were observed and the safety profile was consistent relative to those previously described with apalutamide and castration, no falls or fracture were observed. No detrimental effect of apalutamide on QOL was observed during and after treatment. AEs are important for pts candidates for active surveillance. Clinical trial information: NCT03088124 .

International audience; Background. Anti-PD1/PDL1 immune checkpoint inhibitors (ICIs) showed promising results in breast cancer, and exploration of additional actionable immune checkpoints is ongoing. Inflammatory breast cancer (IBC) is an aggressive form of disease, the immune tumor microenvironment (TME) of which is poorly known. We aimed at providing the first comprehensive immune portrait of IBCs. Methods. From the gene expression profiles of 137 IBC and 252 non-IBC clinical samples, we measured the fractions of 22 immune cell types, expression of signatures associated with tertiary lymphoid structures (TLS) and with the response to ICIs (T cell-inflamed signature: TIS) and of 18 genes coding for major actionable immune checkpoints. The IBC/non-IBC comparison was adjusted upon the clinicopathological variables. Results. The immune profiles of IBCs were heterogeneous. CIBERSORT analysis showed profiles rich in macrophages, CD8+ and CD4 + T-cells, with remarkable similarity with melanoma TME. The comparison with non-IBCs showed significant enrichment in M1 macrophages, γδ T-cells, and memory B-cells. IBCs showed higher expression of TLS and TIS signatures. The TIS signature displayed values in IBCs close to those observed in other cancers sensitive to ICIs. Two-thirds of actionable immune genes (HAVCR2/TIM3, CD27, CD70, CTLA4, ICOS, IDO1, LAG3, PDCD1, TNFRSF9, PVRIG, CD274/PDL1, and TIGIT) were overexpressed in IBCs as compared to normal breast and two-thirds were overexpressed in IBCs versus non-IBCs, with very frequent co-overexpression. For most of them, the overexpression was associated with better pathological response to chemotherapy. Conclusion. Our results suggest the potential higher vulnerability of IBC to ICIs. Clinical trials.

International audience; BACKGROUND: The management of older cancer patients has been highly challenging for clinicians in a health-care system operating at maximum capacity during the COVID-19 pandemic. PATIENTS AND METHODS: We analyzed data from 9 different institutions. The primary endpoint was to assess the prevalence of adapted patient care during the pandemic for elderly cancer patients. The secondary endpoint was to assess the incidence of hospitalization and mortality due to COVID-19. All patients were older than 65years of age. RESULTS: We analyzed data from 332 outpatients’ case files between 9th of March and 30th of April 2020. The median age was 75years (range: 65-101) and 53% were male. Because of the COVID-19 pandemic, more than half of the outpatients received modified patient care, defined as postponement or cancellation of surgery, irradiation scheme adapted, systemic treatment or the use of telemedicine. Among patients with localized cancer, 60% had a change in management strategy due to the pandemic. Changes in management strategy were made for 53% of patients at the metastatic stage. GCSF was used , in 83% of patients, increasing considerably in the context of the pandemic. Sixty-nine percent of physicians used telemedicine. In the final analysis, only one patient was hospitalized for COVID-19 infection. No deaths due to COVID-19 were reported in elderly cancer patients during this time period. CONCLUSION: Our study is the first to assess modification of patient care in elderly cancer outpatients during an epidemic. With this unprecedented crisis, our objective is to protect our patients from infection via protective barrier measures and social distancing, but also to guarantee the continuity of cancer care without overexposing this fragile population. Physicians were able to adapt their practice and used new forms of management, like telemedicine.

Background: The cancer population seems to be more susceptible to COVID-19 infection and have worse outcomes Front of this pandemic, we had to adapt our patient care to protect our patients without compromising their prognosis related to their cancer The national PRATICOVID study aims to describe the modification of the medical and surgical patient care for this population, according to the recommendations in this context of pandemic, within our hospitals which are strongly mobilized Methods: We analyzed data from 9 different institutions, 3 Military Hospitals, 4 Academics Hospital, 2 Private Hospital, from oncologists, surgeons, radiotherapists The primary endpoint was to assess the prevalence of adapted patient care during pandemic The secondary endpoints were to describe the point of view of clinicians and patients during and after the pandemic Results: We analyzed 435 medical care between 9th of March and 30th of April The median age was 69 years (range, 24-99), 54% was male 167 patients (38 4%) were newly diagnosed and only 4% were included in a clinical trial Because of COVID-19 pandemic, 47 6% of the outpatients had modified patient care The main primary tumor site was breast cancer (22 7%) at a metastatic stage 24 6% have postponed surgery, or not receive perioperative chemotherapy, 18 4% received hypofractioned schedule and 57% had an adaptive systemic protocol (stopped, oral protocol, spacing between cures) 70% of physicians are used telemedicine During this period, 67% of the physicians were relaxed to taking care of their patients 57% of the patients have seen to be relaxed or low worried about the pandemic However, 71% are worried after the lockdown, because of future patient care, stage at diagnosis, access to clinical trial, our abilities to receive in the same time all the patients Conclusions: PRATICOVID study is the first to assess modification of patients cares during an epidemic in cancer outpatients Faces with this unprecedented crisis, physicians were able to adapt their practice in order to protect their patients against the virus and while ensuring the course of patient care But physicians are worried after de lockdown because of the care pathway’s issues Clinical trial identification: CNIL;reference number: 2217722v0 Legal entity responsible for the study: The authors Funding: Has not received any funding Disclosure: All authors have declared no conflicts of interest

The cancer population seems to be more susceptible to COVID‐19 infection and have worse outcomes. We had to adapt our medical practice to protect our patients without compromising their cancer prognosis. The national PRATICOVID study aims to describe the adaptation of cancer patient care for this population. We analyzed data from nine different institutions. The primary endpoint was to assess the prevalence of adapted patient care during the pandemic. The secondary endpoints were to describe the point of view of clinicians and patients during and after the pandemic. We analyzed 435 medical procedures between 9th of March and 30th of April. Because of the COVID‐19 pandemic, 47.6% of the outpatients received modified patient care. Twenty‐four percent of scheduled surgeries were postponed, or were performed without perioperative chemotherapy, 18.4% followed a hypofractioned schedule, and 57% had an adaptive systemic protocol (stopped, oral protocol, and spacing between treatments). Seventy percent of physicians used telemedicine. During this period, 67% of the physicians did not feel distressed taking care of their patients. However, 70% of physicians are worried about the aftermath of the lockdown, as regards future patient care. The PRATICOVID study is the first to assess modification of patient care in cancer outpatients during an epidemic. With this unprecedented crisis, physicians were able to adapt their practice in order to protect their patients against the virus while ensuring continuity of patient care. But physicians are worried about the aftereffects of the lockdown specifically in regard to care pathway issues., The PRATICOVID study is the first to assess modification of patient care in cancer outpatients during an epidemic. With this unprecedented crisis, physicians were able to adapt their practice in order to protect their patients against the virus while ensuring continuity of patient care.

Resume Introduction Le deficit acquis en facteur X (FX) est dans la majorite des cas associe a l’amylose AL. Le deficit non amyloide acquis en FX (DNAA-FX), d’etiologie variee, n’a ete qu’exceptionnellement rapporte dans la litterature. Observation Nous rapportons ici le premier cas de DNAA-FX satellite d’une leucemie lymphoide chronique atypique diagnostique chez un patient de 66 ans, lors de la survenue d’hematomes spontanes. Apres echec de deux cures d’immunoglobulines polyvalentes, un traitement specifique de l’hemopathie a permis la resolution des symptomes et la disparition de l’hypocoagulabilite. Conclusion Le DNAA-FX doit etre evoque en cas de manifestations hemorragiques ou d’anomalies de la crase sanguine au cours d’une hemopathie lymphoide de bas grade. La survenue d’un DNAA-FX peut alors etre consideree comme une indication de mise en traitement de l’hemopathie afin de prevenir des complications hemorragiques potentiellement fatales.

Resume Introduction Les etudes evaluant la chimiotherapie a haute dose avec autogreffe de cellules-souches hematopoietiques (HDC-ACSH) dans la prise en charge des cancers du sein metastatiques (CSM), localement avances (CSLA) ou inflammatoires (CSI) ont pour point commun l’absence ou le manque de donnees sur la surexpression de la proteine human epidermal growth factor receptor-2 (Her2). Patientes et methodes Nous avons analyse retrospectivement les donnees des patientes ayant recu une HDC-ACSH pour la prise en charge d’un CS a l’institut Paoli-Calmettes entre 2003 et 2012. Les patientes ont ete classees en 3 sous-groupes selon l’expression des recepteurs hormonaux (RH) et/ou de Her2 : HER2 (Her2+ et RH+ ou−) ; luminal (RH+ et Her2−) ; triple negatif (TN) (RH− et Her2−). L’objectif principal etait l’analyse de la survie globale (SG) selon le sous-type IHC. Resultats Trois cent soixante-dix-sept patientes ont ete incluses. Pour les CSM, le sous-type TN apparaissait comme de moins bon pronostic avec une SG mediane de 19,68 mois (IC95 % 11,76–44,4) contre 44,64 mois (IC95 % 40,32–67,56) pour le sous-groupe luminal et une SG mediane non atteinte pour le sous-groupe HER2 (p Conclusion L’HDC-ACSH ne modifie pas le pronostic des sous-groupes IHC chez les patientes atteintes de CS.

Objectifs Depuis decembre 2019, nous devons faire face a la pandemie mondiale du COVID-19. Cela a entraine une adaptation des soins, notamment pour les patients atteints d’un cancer urologique. L’etude PRATICOVID vise a decrire la modification de la prise en charge medicale et chirurgicale des patients pour cette population, selon les recommandations dans ce contexte de pandemie, au sein de nos hopitaux fortement mobilises. Methodes Nous avons analyse les donnees de 9 institutions differentes : 3 hopitaux militaires, 4 hopitaux universitaires, 2 hopitaux prives. Nous avons considere les patients suivis par les oncologues, chirurgiens et radiotherapeutes. Au total, 435 patients ont ete inclus entre le 9 mars et le 30 avril 2020 dans l’etude PRATICOVID. Parmi eux 178 patients presentaient un cancer urologique. Le critere d’evaluation principal etait d’evaluer la prevalence des soins adaptes aux patients pendant la pandemie. Les criteres d’evaluation secondaires etaient de decrire le point de vue des cliniciens et des patients pendant et apres la pandemie. Resultats Cent quarante-cinq patients avec un cancer urologique ont ete retenus pour l’analyse finale. L’âge median etait de 71 ans (24–97), dont 90,3 % etaient des hommes. Parmi les patients, 62 (42,8 %) etaient nouvellement diagnostiques et seuls 10 etaient inclus dans un essai clinique. En raison de la pandemie de COVID19, 46,2 % des patients ambulatoires avaient modifie les soins aux patients. Le cancer de la prostate representait 50,7 % des cancers urologiques avec une modification de prise en charge. La chirurgie ne concernait que 11 % des patients inclus contre 56,6 % pour les traitements systemiques. Parmi les patients, 31,7 % ont beneficies exclusivement d’une teleconsultation. Parmi les medecins, 67 % etaient detendus et 57 % des patients se sont dits detendus ou peu inquiets par rapport a la pandemie. Parmi les patients, 71 % sont inquiets pour l’evolution de leur maladie. Conclusion L’etude PRATICOVID est la premiere a evaluer la modification des soins lors d’une epidemie des patients cancereux. Le suivi a long terme de ces patients est necessaire pour mesurer l’impact en termes de survie globale, specifique et sans progression.

International audience; Purpose: Studies examining high-dose chemotherapy with autologous hematopoietic stem cell transplantation (HDC-AHSCT) strategies in inflammatory breast cancer (IBC), showed encouraging results in terms of disease-free survival (DFS), and overall survival (OS). The lack of data regarding HER2 status in all of these studies prevented any prognostic analysis involving breast cancer subtypes. Methods: All consecutive female patients treated for IBC with HDC and AHSCT at Institut Paoli-Calmettes between 2003 and 2012 were included. Since 2005, trastuzumab was included in initial treatment. Patient, tumor and treatment characteristics were collected. Patients were categorized in three subtypes based on hormonal receptor (HR) and HER2 status of the primary tumor: Luminal, (HR+/HER2-), HER2 (HER2+, any HR), and triple negative (TN) (HER2-and HR-). The main objective was the analysis of OS according to the IHC subtypes. Results: Sixty-seven patients were included. Eleven patients received trastuzumab. Median follow up was 80.04 months (95% CI 73.2-88.08). Five-year OS and DFS for the whole population patients were 74% (95% CI 61-83) and 65 % (95% CI 52-75), respectively. OS differed across subtypes (p=0.057) : HER2 subgroup appeared to have the best prognosis with a 5-year OS of 89% (95% CI 64-97) compared to 57% (95% CI 33-76) for the TN subgroup (HR 5.38, 95% CI 1.14-25.44; p=0.034). Conclusions: In IBC patients receiving HDC-AHSCT, OS favorably compares with data available in the literature on similar groups of patients. TN patients carried the least favourable OS and HER2 patients, half of them also receiving trastuzumab, had the best outcome. These findings provide additional information and options for patients with IBC and who could potentially benefit of HDC-AHSCT.

Central nervous system involvement by malignant cells is a rare complication of Waldenström macroglobulinemia, and this clinicopathological entity is referred to as the Bing-Neel syndrome. There is currently no consensus on the diagnostic criteria, therapeutic approaches and response evaluation for this syndrome. In this series, we retrospectively analyzed 44 French patients with Bing-Neel syndrome. Bing-Neel syndrome was the first manifestation of Waldenström macroglobulinemia in 36% of patients. When Waldenström macroglobulinemia was diagnosed prior to Bing-Neel syndrome, the median time interval between this diagnosis and the onset of Bing-Neel syndrome was 8.9 years. This study highlights the possibility of the occurrence of Bing-Neel syndrome without any other evidence of progression of Waldenström macroglobulinemia. The clinical presentation was heterogeneous without any specific signs or symptoms. Biologically, the median lymphocyte count in the cerebrospinal fluid was 31/mm(3). Magnetic resonance imaging revealed abnormalities in 78% of the cases. The overall response rate after first-line treatment was 70%, and the overall survival rate after the diagnosis of Bing-Neel syndrome was 71% at 5 years. Altogether, these results suggest that Bing-Neel syndrome should be considered in the context of any unexplained neurological symptoms associated with Waldenström macroglobulinemia. The diagnostic approach should be based on cerebrospinal fluid analysis and magnetic resonance imaging of the brain and spinal axis. It still remains difficult to establish treatment recommendations or prognostic factors in the absence of large-scale, prospective, observational studies.

Resume Introduction Les manifestations neurologiques au cours de la maladie de Waldenstrom sont frequentes, principalement en lien avec une atteinte peripherique dysimmunitaire ou avec un syndrome d’hyperviscosite. Le syndrome de Bing et Neel correspond a l’infiltration du systeme nerveux central par le processus lymphoproliferatif. Cette entite extremement rare reste peu decrite dans la litterature. Observations Nous rapportons 4 observations de patients pour lesquels la survenue de troubles neurologiques centraux a conduit au diagnostic de syndrome de Bing et Neel. Ces quatre observations illustrent des presentations cliniques, des attitudes diagnostiques et therapeutiques ainsi que des evolutions differentes au cours de ce syndrome. Ces heterogeneites sont discutees dans le cadre d’une revue de la litterature. Conclusion Les manifestations cliniques polymorphes du syndrome de Bing et Neel peuvent simuler de nombreux diagnostics. Il convient toutefois de savoir l’evoquer. L’analyse du liquide cephalorachidien et de l’IRM peuvent permettre un diagnostic rapide ou orienter une biopsie. Des remissions prolongees sont possibles avec un traitement adapte.

Infections are an important cause of cancer in the world, representing approximately 16% of the neoplasia. Ten infectious agents have been classified as carcinogens of group I. Four of these pathogens (Helicobacter pylori, hepatitis B and C viruses, and some human papillomavirus) are responsible for 95% of cases of infection-related cancers. The carcinogenesis mechanisms are multiple, either direct via certain proteins from these microorganisms, or more often indirect through chronic inflammation. This allowed to consider prevention of certain cancers, for example with a prophylactic vaccine strategy. Advances were also made in the curative field. However, efforts remain to be done to discover new infectious causes of cancer and refine the understanding of the mechanisms of carcinogenesis, for a better targeting of anticancer therapeutics.

La Presse Medicale - In Press.Proof corrected by the author Available online since vendredi 22 decembre 2017

International audience

Studies evaluating chemotherapy high dose chemotherapy with autologous haematopoietic stem cell transplantation (HDC-ACSH) in the treatment of metastatic (MBC), locally advanced (LABC) and inflammatory (IBC) breast cancer have in common lack of biomarker information, in particular the HER2 status.All consecutive female patients treated for breast cancer with HDC and AHSCT at Institut Paoli Calmettes between 2003 and 2012 were included. Patients were categorized in three subtypes based on hormonal receptor (HR) and HER2 status of the primary tumor: luminal, (HR+/HER2-), HER2 (HER2+, any HR) and triple negative (TN) (HER2- and HR-). The main objective was the analysis of overall survival (OS) according to the IHC subtypes.Three hundred and seventy-seven patients were included. For MBC, the TN subtype appeared to have the worst prognosis with a median OS of 19.68 months (95 % CI 11.76-44.4) compared to 44.64 months (95 % CI 40.32-67.56) for the luminal subtype and a median OS not reached for the HER2 subtype (P0.01). For IBC, HER2 subgroup appeared to have the best prognosis with a 5-year OS of 89 % (95 % CI 64-97) compared to 57 % (95 % CI 33-76) for the TN subgroup (HR 5.38, 95 % CI 1.14-25.44; P=0.034). For CSLA, luminal subgroup appeared to have the best prognosis with a 5-year OS of 92 % (95 % CI 71-98) against 75 % (95 % CI 46-90) for HER 2 subtype and 70 % (95 %CI 97-88) for TN subtype (P=0.301).The HDC-ACSH does not change the prognosis value of IHC subtype in breast cancer patients.

Breast cancer carrying BRCA mutation may be highly sensitive to DNA-damaging agents. We hypothesized a better outcome for BRCA-mutated (BRCA(mut)) metastatic breast cancer (MBC) patients receiving high-dose chemotherapy and autologous hematopoietic stem cell transplantation (HDC AHSCT) versus unaffected BRCA (BRCA wild type; (BRCA(wt))) or patients without documented BRCA mutation (BRCA untested (BRCA(ut))). All female patients treated for MBC with AHSCT at Institut Paoli-Calmettes between 2003 and 2012 were included. BRCA(mut) and BRCA(wt) patients were identified from our institutional genetic database. Overall survival (OS) was the primary end point. A total of 235 patients were included. In all, 15 patients were BRCA(mut), 62 BRCA(wt) and 149 BRCA(ut). In multivariate analyses, the BRCA(mut) status was an independent prognostic factor for OS (hazard ratio (HR): 3.08, 95% confidence interval (CI): 1.10-8.64, P=0.0326) and PFS (HR: 2.52, 95% CI :1.29-4.91, P=0.0069). In this large series of MBC receiving HDC AHSCT, we report a highly favorable survival outcome in the subset of patients with documented germline BRCA mutations.

La Presse Medicale - In Press.Proof corrected by the author Available online since mercredi 11 janvier 2017

La Presse Medicale - In Press.Proof corrected by the author Available online since vendredi 4 juillet 2014

The objective of this study was to evaluate the outcome of patients affected with different subtypes of metastatic breast cancer (MBC) following treatment with high-dose chemotherapy (HDC) and autologous haematopoietic progenitor cell transplantation (AHSCT).All consecutive female patients treated for MBC with HDC and AHSCT at the Institut Paoli-Calmettes between 2003 and 2012 were included. Patient, tumour and treatment characteristics were collected. Patients were categorised in three subtypes based on hormonal receptor (HR) and human epidermal growth factor receptor 2 (HER2) status of the primary tumour: luminal (L), (HR+/HER2-), HER2 (HER2+, any HR), and triple negative (TN) (HER2- and HR-). The main objective was the analysis of overall survival (OS) according to the immunohistochemical (IHC) subtypes.A total of 235 patients were included, median age was 46 (range 21-62). Median follow up was 53.28 months (95% confidence interval [CI] 45.12-57.6). The TN subtype appeared to have the worst prognosis with a median OS of 19.68 months (95% CI 11.76-44.4) compared to 44.64 months (95% CI 40.32-67.56) for the luminal subtype and a median OS not reached for the HER2 subtype (p0.01). In the multivariate analysis, the TN subtype retained an independent poor prognosis value compared to the luminal subtype, with a hazard ratio of 2.03 (95% CI 1.26-3.29, p = 0.037).HDC-AHSCT does not change the prognostic value of IHC subtypes in MBC patients. OS favourably compares with data available in the literature on similar groups of patients. These findings provide additional information and options for patients with MBC and who could potentially benefit of HDC-AHSCT.

Synovial sarcoma (SVS) of the thyroid gland is exceedingly rare. We report the case of a 55-year-old man with a rapidly growing 7-cm neck mass. Because of suspicion of anaplastic thyroid carcinoma, a total thyroidectomy was planned, without preoperative cytology. During surgery, the tumor ruptured, leading to fragmented and incomplete resection. The morphological and immunohistochemical aspects suggested thyroid SVS, which was confirmed by fluorescent in situ hybridization (SYT gene rearrangement). The patient experienced immediate local relapse in close contact with large vessels and the thyroid cartilage and was referred to our institution. Doxorubicin-ifosfamide chemotherapy led to a minor response that authorized secondary conservative surgery. Because of microscopically incomplete resection, adjuvant radiotherapy was chosen and is ongoing 10 months after initial surgery. The prognosis of thyroid SVS is associated with a high risk for local and metastatic relapses. Pretreatment diagnosis is fundamental and may benefit from molecular analysis. Margin-free monobloc surgical excision is the best chance for cure, but adjuvant chemotherapy and radiotherapy deserve to be discussed.

325 Background: Our aim was to investigate outcome of patients (pts) treated with AC or NC for organ-confined UC, or with NC for clinical lymph node involvement (cN+). Methods: We retrospectively analyzed 482 pts treated in 22 French hospitals between 2000 and 2013 in 3 settings: 226 pts with radical cystectomy (RC) and AC (AC group), 193 cN0 (NC group), and 63 cN+ (cN+ group) pts received NC before a planned RC for cT2-T4, M0 UC. The primary outcome was overall survival (OS). Cancer-related survival (CRS) was also evaluated. Multivariate Cox proportional hazards regression was used to estimate adjusted hazard ratios with 95% confidence interval. Results: Median age was 62, 61.7, and 62.1 in AC, NC, and cN+, respectively. Median time between diagnosis and first treatment (RC or NC) was 2.1, 1.4 and 1.6 months, respectively (p

4550 Background: The benefit of NC on survival in UC has been shown with SD and is most evident in patients (pts) who achieve a pathological complete response (ypT0). In the last decade, physicians...

Introduction : les médecins généralistes sont essentiels dans la prise en charge des patients atteints de cancer. La pratique de la médecine générale militaire diffère du civil par une expertise sur la condition physique et la patientèle. Nous souhaitons identifier les difficultés rencontrées lors de la prise en charge des patients militaires pendant ou après cancer. Notre deuxième étude évalue l'impact du cancer sur leur carrière professionnelle, celui-ci n’ayant jamais été étudié. Matériels et méthode : premièrement, ont été inclus tous les patients en congé longue durée pour maladie pour cancer entre janvier 2012 et décembre 2021, à l’hôpital Sainte Anne. Les patients ayant repris le travail ont été contactés par téléphone afin de répondre à un questionnaire d'auto-évaluation sur leur satisfaction après leur reprise (RTWSE-11). Deuxièmement, a été réalisée une étude descriptive transversale multicentrique de juillet 2021 à septembre 2022, ciblant les médecins généralistes militaires. Il s’agit d’un questionnaire anonyme décrivant la population des médecins d'unité et leurs patients, l’exploration des difficultés rencontrées dans le suivi des militaires et les réseaux d'informations accessibles. Résultats : 132 patients ont été inclus dans la première étude. Le taux de retour à l’emploi était de 67%. Une chimiothérapie (p=0,008), une tumeur localisée (p=0,02), un cancer hématologique ou gynécologique (p=0,01) et un arrêt de travail inférieur à un an (p