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J Faivre

Publications and source records attributed to J Faivre.

At least 91 records · Page 5Linked to original sources
PubMed2000

Calcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomised intervention trial. European Cancer Prevention Organisation Study Group.

BACKGROUND: Some epidemiological studies have suggested that high dietary intake of calcium and fibre reduces colorectal carcinogenesis. Available data are not sufficient to serve as a basis for firm dietary advice. We undertook a multicentre randomised trial to test the effect of diet supplementation with calcium and fibre on adenoma recurrence. METHODS: We randomly assigned 665 patients with a history of colorectal adenomas to three treatment groups, in a parallel design: calcium gluconolactate and carbonate (2 g elemental calcium daily), fibre (3.5 g ispaghula husk), or placebo. Participants had colonoscopy after 3 years of follow-up. The primary endpoint was adenoma recurrence. Analyses were by intention to treat. FINDINGS: 23 patients died, 15 were lost to follow-up, 45 refused repeat colonoscopy, and five developed severe contraindications to colonoscopy. Among the 552 participants who completed the follow-up examination, 94 stopped treatment early. At least one adenoma developed in 28 (15.9%) of 176 patients in the calcium group, 58 (29.3%) of 198 in the fibre group, and 36 (20.2%) of 178 in the placebo group. The adjusted odds ratio for recurrence was 0.66 (95% CI 0.38-1.17; p=0.16) for calcium treatment and 1.67 (1.01-2.76, p=0.042) for the fibre treatment. The odds ratio associated with the fibre treatment was significantly higher in participants with baseline dietary calcium intake above the median than in those with intake below the median (interaction test, p=0.028) INTERPRETATION: Supplementation with fibre as ispaghula husk may have adverse effects on colorectal adenoma recurrence, especially in patients with high dietary calcium intake. Calcium supplementation was associated with a modest but not significant reduction in the risk of adenoma recurrence.

Adenoma↗
PubMed2000

Trends in incidence and management of gallbladder carcinoma: a population-based study in France.

BACKGROUND: Little is known, at a population level, about the incidence and management of gallbladder carcinoma. The objective of this study was to determine trends in incidence, treatment, stage at diagnosis, and prognosis of gallbladder carcinoma in a well defined population. METHODS: A series of 484 patients diagnosed over a 20-year period (1976-1995) in a French well defined population was used. Incidence rates were calculated by gender, age groups, and 5-year periods. Prognosis was determined using crude and relative survival rates. A multivariate relative survival analysis was performed. RESULTS: Age-standardized incidence rates were 0.8 per 100,000 inhabitants for men and 1.5 per 100,000 inhabitants for women. There were no significant time trends in incidence in both genders. The proportion of cases resected for cure increased from 18. 1% (1976-1980) to 42.4% (1991-1995) (P < 0.001) as well as the proportion of cases limited to the gallbladder wall, respectively from 15.7% to 27.8% (P < 0.001). Relative survival rates were 16.6% at 1 year and 6.2% at 5 years. Age, stage at diagnosis, and period of diagnosis significantly influenced the prognosis of gallbladder carcinoma. The 5-year relative survival rate rose from 2.7% (1976-1985) to 10.2% (1986-1995). The multivariate analysis showed that age and stage at diagnosis were independent prognostic factors. CONCLUSIONS: This study demonstrated that gallbladder carcinoma incidence is stable in France and that substantial advances in its management have been achieved, but there is evidence that further improvements are necessary to increase survival.

Adult↗
PubMed2000

National cancer prevalence estimation in France.

In France, as in several other European countries, prevalence has to be estimated from the modelling of 2 of the 3 basic epidemiological measures of incidence, mortality, and survival. Since, in these countries, follow-up of cancer patients is only made in a few registries, we explored the feasibility of estimating prevalence in the absence of follow-up data. The method, which used only incidence and mortality, was validated on Danish data and applied to France. For this latter country, the estimation procedure is based on the recorded mortality data and an estimate of incidence for the entire country. It is applied to selected sites of cancer, which account for 80% of the estimated incidence. In 1992, the prevalence of patients who had such a diagnosis amounts to 538,000 women and 424, 000 men. The most frequent cancer sites are head and neck, breast, and large bowel. Most of the cancer sites present an increase in prevalence proportion between 1987 and 1992. The larger increases concern breast and prostate cancer.

Adult↗
PubMed2000

Improvement of operative mortality after curative resection for gastric cancer: population-based study.

It is not well known if the improvement in operative mortality after surgery for gastric cancer reported in hospital series can be extrapolated to the whole population. The aim of this study was to determine trends in operative mortality over a 20-year period in a nonselected community-based series of patients. A database of 648 patients with gastric cancer resected with curative intent between 1976 and 1995 in a region with a half-million population was divided into two periods: 1976-1983 and 1984-1995. Nonconditional logistic regression was performed to estimate the independent effects of the studied factors. Operative mortality was higher during the 1976-1983 period than during the 1984-1995 period (17.1% vs. 7.1%; p < 0.0001). When comparing the two study periods, operative mortality decreased dramatically from 26.2% to 10.0% in patients over age 70, from 31.8% to 7.9% after total gastrectomy, and from 30.7% to 6.3% after proximal esophagogastrectomy. Operative mortality after total gastrectomy was nearly the same as that after distal gastrectomy (7.9% vs 5.9%) during the second study period. During the first study period, operative mortality was independently associated with age at diagnosis, type of gastrectomy, and to a lesser degree stage at diagnosis; during the second study period, only age and stage at diagnosis were associated with the risk of operative mortality. This study indicates that in this well defined population operative mortality after curative resection for gastric cancer has decreased during the last 20 years. The results should encourage aggressive management of patients with gastric cancer, even in patients over 70 years of age.

Aged↗
PubMed2000

Changes in the practice of adjuvant radiotherapy in resectable rectal cancer within a French well-defined population.

BACKGROUND AND PURPOSE: To assess the use of adjuvant radiotherapy in treating rectal cancers at a population level. MATERIALS AND METHODS: From 1976 to 1996, the influence of the period of diagnosis, sex, age, type of surgical resection, place of surgical resection on the use of radiotherapy was studied. A non-conditional logistic regression was performed to obtain the odds radio for each studied period adjusted for the other variables. RESULTS: The use of adjuvant radiotherapy increased over time from 14.3% in 1976-1978 to 61.7% in 1994-1996 (odds ratio (OR): 28.0 for the 1994-1996 period compared with 1976-1978). It was also influenced by age (OR: 0.26 for patients >74 years compared with those <65 years), type of resection (OR: 3.42 for abdominoperineal resection compared with anterior resection) and place of surgery (OR: 0.39 for non-university hospitals compared with university hospitals). The nature of adjuvant radiotherapy altered over time: most adjuvant radiotherapy being done postoperatively before 1988, then preoperatively subsequently. CONCLUSIONS: Substantial changes have occurred in both the degree of use of adjuvant radiotherapy and in its timing. Some progress is still possible, in particular in older patients and in patients treated in non-university hospitals.

Adult↗
PubMed2000

Hepatocellular carcinoma in patients with acute hepatic porphyria: frequency of occurrence and related factors.

BACKGROUND/AIMS: Previous retrospective studies have suggested an association between hepatocellular carcinoma and acute hepatic porphyrias. The incidence, the relative risk, the characteristics and the outcome of primary liver cancer were prospectively evaluated in patients with acute hepatic porphyrias; the molecular mechanism of carcinogenesis in these patients was also pointed out. METHODS: A cohort of 650 patients with acute hepatic porphyria was followed over 7 years. Standardized rate ratio was used to measure the relative risk of primary liver cancer after indirect standardization. Morphological and clinical aspects of primary liver cancer were investigated, and survival rates were calculated using the Kaplan-Meier method. Common etiological factors involved in liver carcinogenesis were screened. Excretion rates of porphyrin precursors, serum melatonin levels and mutations in the genes encoding for heme biosynthetic enzymes were studied. RESULTS: Hepatocellular carcinoma was found in four symptomatic and three asymptomatic patients (four female, three male). The overall standardized rate ratio was 36 (95% CI: 14-74). The 5-year disease-free survival was 43% in patients with hepatocellular carcinoma. Usual risk factors for primary liver cancer were not confounding factors. Hepatocellular carcinoma was not related to specific heme biosynthesis gene mutations. Heme precursors were significantly increased in porphyric patients with hepatocellular carcinoma, and serum melatonin levels were low. CONCLUSIONS: Acute hepatic porphyrias are risk factors for hepatocellular carcinoma. Hepatic porphyrias should be sought in patients with hepatocellular cancer without obvious etiology, and a periodic screening for hepatocellular carcinoma should be evaluated in these patients. Genes encoding for heme biosynthetic pathway may not act as tumor suppressor genes. Chronic increased levels of delta aminolevulinic acid could lead to the generation of free radicals and subsequently to hepatic carcinogenesis.

Acute Disease↗
PubMed2000

Prognostic factors after curative resection for gastric cancer. A population-based study.

The aim of this study was to document patterns of survival after resection for cure for gastric cancer in a well-defined population. A population-based series of 649 gastric cancers resected for cure between 1976 and 1995 in a 494000 population, was used. Resection for cure was performed in 44.4% of the diagnosed cases. This proportion increased from 36.8% (1976-1979) to 45.0% (1992-1995) (P=0.03) whilst operative mortality decreased from 18.3 to 12.7% (P=0.003). The overall crude 5-year survival rate (excluding operative mortality) was 32.6% (95% confidence interval (CI) 28.7-36. 5) and the corresponding relative survival rate was 40.9%. Prognosis did not improve during the study period. Stage at diagnosis was the most important prognostic factor, the 5-year relative survival rate being 81.2% (+/-5.9) in TNM stage IA, 76.9% (+/-8.0) in stage IB, 50. 4% (+/-4.6) in stage II, 24.4% (+/-3.7) in stage IIIA, 5.6% (+/-3.2) in stage IIIB and 5.2% (+/- 2.2) in stage IV. Stage at diagnosis, age, subsite and macroscopic type of growth were independent prognostic factors, in a multivariate relative survival model. Earlier detection or development of an effective adjuvant therapy could contribute to improvement in prognosis.

Adolescent↗
PubMed2000

Intracerebral hemorrhage survival: French register data.

Cerebral hemorrhages are subject to a heavy short- and long-term case fatality. A study of prognostic factors and of relative survival based on the data of a population registry is of great value to study patients having a hematoma of all ages, irrespective of the method of care. We have listed 183 patients having a cerebral hemorrhage between 1 January 1985 and 31 December 1996 and living in the city of Dijon, France. Eighteen clinical and CT-scanning variables have been studied. We have found four predictive factors of death at one month from cerebral hemorrhages. These are, in decreasing order: the existence of consciousness disorders at the initial clinical examination (OR = 5.80, p < 0.0001); an intraventricular hemorrhage (OR = 5.60, p < 0.0001); a hematoma volume over 11 cubic centimeters (OR = 3.53, p = 0.027); lastly, in male patients an age over 70 years (OR = 4.90, p = 0.039). With regard to long-term survival, the existence of consciousness disorders remains the principal predictive factor of case fatality in both crude and relative survival (OR = 5.52, p < 0.0001, in crude survival versus OR = 22.2 in relative survival, p < 0.0001), followed by age over 70 years (OR = 3.71, p < 0.0001 in crude survival and OR = 2.41 in relative survival, p = 0.086). The existence of consciousness disorders at the initial examination following a cerebral hemorrhage would seem to be the principal worst prognostic factor of short- and long-term survival and of relative survival, age and sex having less importance. Moreover, intraventricular hemorrhage and hematoma volume are short-term, pejorative factors. These data, based on a population-based registry, are an important consideration in the acute management of hemorrhagic therapy, and for the design of further therapeutic trials on this severe pathology.

Adolescent↗
PubMed2000

Tobacco type and risk of squamous cell cancer of the oesophagus in males: a French multicentre case-control study.

BACKGROUND: The association between tobacco smoking and oesophageal cancer is well established. However, some major questions remain unanswered such as the importance of kind of tobacco and smoke inhalation. The aim of this study was to investigate the effect of each kind of tobacco on the risk of squamous cell cancer of the oesophagus in men and to test whether the effect of kind of tobacco is similar whatever the sub-site of cancer. Tobacco consumption was assessed by the number of years of consumption and time since quitting. METHODS: We conducted a multicentre case-control study in three university hospitals in France (Caen, Dijon, and Toulouse). From 1991 to 1994, 208 cases and 399 controls, all male, were selected. During the interview, the subject's entire tobacco history was recalled, noting each type of tobacco consumed throughout life. RESULTS: Strong tobacco, dark tobacco and non-filter-tipped cigarettes were associated with an increase in risk whatever the adjustments, whilst light, filter-tipped cigarettes and mild tobacco were not. Hand-rolled cigarettes were more strongly associated with risk than manufactured cigarettes. The effect of hand-rolled cigarettes appeared stronger for the lower third whilst those of strong cigarettes and dark tobacco appeared stronger for the upper third of the oesophagus. The effect of inhaling was confined to the upper third. CONCLUSIONS: Our results, emphasizing the role of dark tobacco, hand-rolled cigarettes, strong cigarettes and non-filter-tipped cigarettes are in line with previous publications. Moreover, they suggest that the mechanism underlying the tobacco effect could be different according to the sub-site of cancer.

Adult↗
PubMed2000

Colorectal cancer prevalence in France.

Cancer prevalence is a crucial indicator that allows the magnitude of the problem of colorectal cancer to be monitored. Population-based cancer registries with long-standing activity are the most appropriate tools for providing prevalence data. All colorectal cases registered between 1976 and 1995 in the Côte d'Or Cancer Registry have been considered in this study. Total prevalence (20 years) was the number of patients with a previously diagnosed colorectal cancer, alive on 31 December 1995. Cumulative recurrence rates up to 5 years after diagnosis were calculated and applied to the number of prevalent cases to estimate the number of recurrences by one-year intervals up to 5 years. The overall age-standardized prevalence rate was 170.8/100000, which yielded an estimated 185857 French people alive with a history of colorectal cancer. The 5-year prevalence rates were 149.4/100000, which represented 46.4% of prevalent cases. Five-year prevalence rates regularly increased with periods of diagnosis. These results represent useful indicators for monitoring the colorectal cancer problem and for health care planning.

Aged↗
PubMed2000

Cancer of the ampulla of Vater: results of a 20-year population-based study.

BACKGROUND: Relatively little attention has been given to the epidemiology and management of cancer of the ampulla of Vater. SETTING: A series of 111 patients with a cancer of the ampulla of Vater diagnosed over a 20-year period (1976-1995) in a well-defined French population was used to analyse its incidence, management and prognosis as well as to determine time trends. Prognosis was determined by using crude and relative survival rates. Factors predictive of survival were also identified using a relative survival model in a multivariate analysis. RESULTS: Age-standardized incidence rates were 3.8 per 1000000 inhabitants in men and 2.7 per 1000000 inhabitants in women. Incidence increased over time in men from 1.9 during the first period (1976-1980) to 5.9 during the last period (1991-1995). In women, incidence rates remained stable. A resection for cure was performed in 52 cases (48.1%). Overall, 9.9% of these cancers were classified TNM stage I and 54.1% stage IV. There was no significant variation in treatment modalities and in stage at diagnosis over the study period. The overall operative mortality rate was 7.5%. Relative survival rates were 58.9% at 1 year, 30.9% at 3 years and 20.9% at 5 years. Five-year relative survival rates varied from 72.8% in TNM stage I cancers to 6.6% in TNM stage IV cancers. Age, treatment procedure and stage at diagnosis significantly influenced the prognosis of cancer of the ampulla of Vater. In a multivariate analysis, stage at diagnosis remained the major prognostic factor (P<0.01). CONCLUSIONS: Although its incidence is increasing in men, cancer of the ampulla of Vater remains a rare tumour in both sexes. No improvements in the management and care of patients have been achieved. Further studies are needed to enhance the understanding of this cancer.

Adenocarcinoma↗
PubMed2000

Understanding variations in survival for colorectal cancer in Europe: a EUROCARE high resolution study.

BACKGROUND: Marked differences in population based survival across Europe were found for colorectal cancers diagnosed in 1985-1989. AIMS: To understand the reasons for these differences in survival in a new analysis of colorectal cancers diagnosed between 1988 and 1991. SUBJECTS: A total of 2720 patients with adenocarcinoma of the large bowel from 11 European cancer registries (CRs). METHODS: We obtained information on stage at diagnosis, diagnostic determinants, and surgical treatment (not routinely collected by CRs) and analysed the data in relation to three year observed survival, calculating relative risks (RRs) of death and adjusting for age, sex, site, stage, and determinants of stage. RESULTS: Three year observed survival rates ranged from 25% (Cracow) to 59% (Modena), and were low in the Thames area (UK) (38%). Survival rates between registries for "resected" patients varied less than those for all patients. When age, sex, and site were considered, RRs ranged from 0.7 (95% confidence intervals (CI) 0.6-0.9) (Modena) to 2.3 (95% CI 1.9-2.9) (Cracow). After further adjustment by stage, between registry RR variation was between 0.8 (95% CI 0.6-0.9) and 1.8 (95% CI 1.5-2.2). Inter-registry RR differences were slightly reduced when the determinants of stage (number of nodes examined and liver imaging) were included in the model. The reduction was marked for the UK registries. CONCLUSIONS: The wide differences across Europe in colorectal cancer survival depend to a large extent on differences in stage at diagnosis. There are wide variations in diagnostic and surgical practices. There was a twofold range in the risk of death from colorectal cancer even after adjustment for surgery and disease stage.

Adenocarcinoma↗
PubMed2000

Family history and risk of colorectal cancer: implications for screening programmes.

OBJECTIVE: To estimate the lifetime risk of colorectal cancer in the general population and in first degree relatives of patients with sporadic colorectal cancer or adenoma. MAIN OUTCOMES MEASURES: The cumulative risk of colorectal cancer (0-74) in the general population combined with the relative risk of colorectal cancer and the prevalence of different groups of subjects with family history of colorectal tumour allows the calculation of cumulative risks in these groups. RESULTS: The lifetime risk of colorectal cancer was 1 in 23 in men and 1 in 40 in women. In males, 0.5% in the 55-59 age group and 4.5% in the 70-74 age group will develop a colorectal cancer. The corresponding values in females were 0.4% and 2.5%. The cumulative risk at age 74 varied between 7.7% (one family member affected) and 25.6% (two affected) in males, and 4.3% and 14.3% respectively in females. The risk in the 40-44 year age group for individuals with one first degree relative affected before 45 years of age was 0.5%, similar to that of those aged 45-49 with one first degree relative affected with a colorectal cancer or a large adenoma (> 1 cm). CONCLUSIONS: These results suggest that screening in the general population should start at 50 or 55. The lifetime risk is high enough (over 10%) among individuals with one affected first degree relative before age 45, or with at least two affected first degree relatives, to warrant colonoscopic screening. The data provide a basis for recommendations that relatives of these patients should enter screening programmes at age 40 to 44.

Adult↗
PubMed2000

[The characteristics of patients with hepatitis C virus antibodies followed in specialized university hospital units are different from those of patients in the general population. The Research Group of the REBOHC].

OBJECTIVES: To compare the characteristics of patients with anti-hepatitis C virus antibodies followed in a University Hospital Department of Hepatogastroenterology with those in patients who received medical care elsewhere. METHODS: Since 1994, a specialized viral hepatitis register has recorded since 1994 all new cases of anti-hepatitis C virus antibodies diagnosed in inhabitants of the French department of Côte-d'Or (493931). The factors correlated with the type of medical care in patients followed in the University Department were studied by logistical regression. RESULTS: One hundred of the 498 new patients with anti-hepatitis C virus antibodies diagnosed in the Côte-d'Or between 1994 and 1996 were followed in a University Hospital Department. Multivariate analysis showed that age (<60), contamination due to transfusion, elevated ALT levels and no excessive alcohol consumption were factors significantly correlated with follow-up at the University Department. Liver biopsy was more often performed (66%) and a treatment was more often prescribed (34%) in patients followed in a University Department of Hepatogastroenterology patients than in other patients (20.4%; P <0.0001 et 7.5%; P <0.0001 respectively). CONCLUSIONS: This study shows that patients with anti-hepatitis C virus antibodies who are followed by a specialised University Department are a selected group; these patients are more likely to be treated than others. This study emphasizes that the greatest care must be taken when extending the extension of results of hospital series to a non-selected population.

Biopsy↗
PubMed1999

Variation over time of the effects of prognostic factors in a population-based study of colon cancer: comparison of statistical models.

The authors compare the performance of different regression models for censored survival data in modeling the impact of prognostic factors on all-cause mortality in colon cancer. The data were for 1,951 patients, who were diagnosed in 1977-1991, recorded by the Registry of Digestive Tumors of Côte d'Or, France, and followed for up to 15 years. Models include the Cox proportional hazards model and its three generalizations that allow for hazard ratio to change over time: 1) the piecewise model where hazard ratio is a step function; 2) the model with interaction between a predictor and a parametric function of time; and 3) the non-parametric regression spline model. Results illustrate the importance of accounting for non-proportionality of hazards, and some advantages of flexible non-parametric modeling of time-dependent effects. The authors provide empirical evidence for the dependence of the results of piecewise and parametric models on arbitrary a priori choices, regarding the number of time intervals and specific parametric function, which may lead to biased estimates and low statistical power. The authors demonstrate that a single, a priori selected spline model recovers a variety of patterns of changes in hazard ratio and fits better than other models, especially when the changes are non-monotonic, as in the case of cancer stages.

Aged↗