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P Grosclaude

Publications and source records attributed to P Grosclaude.

At least 37 records · Page 2Linked to original sources
PubMed2001

Survival of women with breast cancer in france: variation with age, stage and treatment.

This study examines survival of women with breast cancer using a sample of 1564 cases occurring in 1990 taken from all cases recorded in seven French cancer registries. Age at diagnosis pathological stage (pTNM) and treatment were the criteria selected for the study of the survival. We studied the 5-year observed survival and the relative survival. Tumors pT1 represented 46.7% cases, pT2: 31.6%, pT3 and pT4: 9.2%, and 52% of the tumors had no nodal involvement or metastasis. For cases without surgical treatment the prognosis was poor (observed survival 18.7%, relative survival 25.9%). For women benefiting from neoadjuvant treatment, observed survival rate was 65% after 5 years and relative survival rate 69.1%. For women who were treated first with surgery, the observed survival was 79.5% and the relative survival 86.7%. The survival rate for women under 40 years was slightly lower than for the 40-54-year-old. Using relative survival the youngest group had the worst prognosis and the oldest group the best. In older women, therapeutic strategy might have been more selective which leads to a better prognosis than in the younger age groups treated in a comparable way.

Adult↗
PubMed2001

A population-based study on radical prostatectomy in France.

There has as yet been no descriptive study of the practice of radical prostatectomy in the general population in France. The objective of this work was to investigate the use of radical prostatectomy (RP) in France and its determinants and geographic variations. A total of 175 radical prostatectomies was identified in a random sample of 798 cases of prostate cancer recorded in 1995 by four cancer registries, in the departments of Bas-Rhin, Calvados, Isère and Tarn. Tumour characteristics, diagnostic procedures and histopathological results were analysed. Multivariate analysis by logistic regression was used to take into account age, prostate specific antigen (PSA) levels and clinical stage in order to study variations between geographical departments and sectors of activity (private or public). The mean age of the patients at the time of diagnosis was 65.3 y (range 46-76). Median PSA level was 18.2 ng/ml (range 1-184). Diagnosis was made by randomised biopsies in 73.8% of cases or by transurethral resection (6.9%). Clinical stage was classified T(1) (22.3%), T(2) (64%), T(3) (8.6%), N(+) (0.6%) and unknown (4.5%). The histopathological result was pT(2)N0 in 46.3% of cases, pT(3)N0 in 40%, pT(4)N0 in 1.7%, pT(x)N(+) in 8.6% and unknown in 3.4%. Adjuvant therapy (radiotherapy 13.7%, hormonal treatment 13.7% or both 3%) was administered in 54 patients (31%). Logistic regression showed that the probability of undergoing RP was three times higher in one department than in the other departments, and was 2.6 times as high in the private sector. This study on the practice of RP is the first performed in the general population in France. It shows that practice differs according to geographical region and sector of activity, indicating that schools of thought and medical culture vary within the same country.Prostate Cnacer and Prostatic diseases (2001) 4, 118-123

Journal Article↗
PubMed2001

A population-based study on management of prostate cancer in four regions of France.

In France, as in other European countries, management of prostate cancer in the population is rather variable. The objective was to analyse diagnosis and treatment modalities of prostate cancer in patients from French cancer registries.A sample of 803 patients with prostate cancer diagnosed in 1995 was drawn at random from cases recorded in four cancer registries in the geographical regions of Bas-Rhin, Calvados, Isère and Tarn. Diagnosis, clinical staging and treatment were analysed by questionnaire. Multivariate analysis by logistic regression was used to describe medical determinants (age, PSA, clinical staging) of the various treatment choices.The mean age of the patients was 71.6 y (range 46-94 y). Clinical staging showed 60% T(1-2) tumours, 15% T(3-4) and 17% N+or metastases. PSA rate (median 18.2 ng/ml) was assessed in 92.4% of patients. Prostate cancer was diagnosed by prostate biopsy in 63% and by transurethral resection of the prostate (TURP) in 32% of patients. The main treatments were radical prostatectomy 22%, radiotherapy 19.4%, hormonal therapy 33%, TURP alone 17.7% and expectant management 6%. The method of treatment was unknown in 5.7% of cases. Adjuvant radiotherapy or hormonal therapy had been used in 31% of cases. Logistic regression analysis showed that radical prostatectomy was most often performed in patients aged <60 y, three times more frequently for T(2) tumour and for PSA between 4 and 20 ng/ml. Radiotherapy was the most frequently applied treatment for patients aged between 65 and 75 y, especially in T(3) tumours.Approximately 75% of the patients in the study underwent a specific treatment for prostate cancer with a curative intention in 40%. This study provides a baseline to clinicians and public health authorities on the management of prostate cancer in France with recent data. This survey will be useful to compare future descriptive analysis and to provide data regarding changing clinical practice.Prostate Cancer and Prostatic Diseases (2001) 4, 154-160.

Journal Article↗
PubMed2001

[Variations of the practice of radical prostatectomy in France].

OBJECTIVE: A description of radical prostatectomy (PR) practice in the general population in France has never been reported. The objective of this study was to analyse RP practice in France, and its determinants and geographical variations based on the CCAFU-Francim survey on prostate cancer (PC) diagnosed in 1995. MATERIAL AND METHOD: 175 PR were performed on the sample of 798 patients selected at random from the cases of PC identified in 1995 by four cancer registries (Bas-Rhin, Calvados, Isère and Tarn). Analysis was based on tumour characteristics, diagnostic methods and histopathological results. Multivariate analysis by logistic regression taking into account age, PSA and clinical stage studied variations between departments and types of urology practice (private or public). RESULTS: The mean age of the patients at the time of the diagnosis was 65.3 years (46-76). The median PSA was 18.3 ng/ml (1-184). The diagnosis was made by biopsies (91%) which were systematized in 74% of cases or by transurethral resection (7%). The clinical stage was T1 (22.3%), T2 (64%), T3 (8.6%), N+ (0.611) and unknown (4.5%). The pathological stage was pT2N0 (46.3%), pT3N0 (40%), pT4N0 (1.7%), pTxN0 (8.6%) and unknown (3.4%). Adjuvant treatment (radiotherapy: 13.7%, endocrine therapy: 13.7% or both: 31%) was performed in 54 patients (31%). Multivariate analysis showed that the adjusted probability to be treated by RP was 3 times higher in one department compared to others and 2.6 times higher in the private sector. CONCLUSION: This study of RP practice in the general population shows a concordance with the 1995 recommendations, but it also shows practice variations according to the region and the type of practice, reflecting different schools of thought and medical education within the same country.

Adult↗
PubMed2001

[A case of canine angiostrongylosis].

A six-month old bitch presenting a sub-lingual mucocele and hematoma associated with coagulation disorders died four days after the surgical treatment of the mucocele. The necropsy revealed a canine angiostrongylosis, a disease rarely seen in Switzerland. This article summarizes the biology of Angiostrongylus vasorum and describes the lesions and symptoms caused by this cardio-pulmonary helminthosis, as well as its diagnosis and treatment. The connections between angiostrongylosis and coagulation disorders are also discussed.

Angiostrongylus↗
PubMed2001

[Cancer of the prostate in France: results of the survey CCAFU-FRANCIM].

OBJECTIVE: The management, diagnosis and treatment of prostate cancer (PC) in the general population are poorly defined in France. The objective of this survey was to analyse the diagnostic and therapeutic modalities of prostate cancer in 1995, on the basis of a population derived from 4 French cancer registries. MATERIAL AND METHOD: A sample of 803 PCs diagnosed in 1995 were selected at random from the cases listed in the 4 registries (Bas-Rhin, Calvados, Isère and Tarn). Analysis by questionnaire concerned the modalities of diagnosis, clinical tumour stage and the treatment performed. Clinical stage (TNM 1992) was submitted to centralized coding. Logistic regression was used to quantify the various practices, taking into account the patient's age, PSA level and clinical stage. The probability of receiving each treatment modality was studied by using the same clinical determinants. RESULTS: The mean age of the patients was 71.6 years (range: 46-94). The clinical stage was T1 or T2 in 60% of cases, T3 or T4 in 14% of cases and N+ or M+ in 17% of cases. PSA (median: 18.2 ng/ml) was assayed in 92.4% of cases. The diagnosis was established by biopsy in 63% of cases and by endoscopic resection (TURP) in 32% (5% unknown). The main treatments were: radical prostatectomy (RP): 21.9%, radiotherapy: 19.4%, endocrine therapy: 33%, isolated TURP: 16.3%, conservative management: 6% and unspecified treatment: 5.6% of cases. 31% of cases received combinations of various treatment modalities. RP was performed more frequently in patients over the age of 60 years, for T2 tumours (OR: 3.3) and for 4 < PSA < 20 ng/ml. Radiotherapy tended to be reserved for older patients with T3-T4 tumours and 20 < PSA < 50 ng/ml. The frequency of endocrine therapy increased with age and PSA (> 50 ng/ml). The frequency of TURP and surveillance also increased with age, decreased with high PSA and essentially concerned T1 tumours. CONCLUSION: PC was diagnosed relatively early in France in 1995 with clinically localized tumours in 60% of cases. In this survey, 94% of patients received treatment during the year following diagnosis, with 40% of curative treatments and 31% of combined treatments.

Aged↗
PubMed2001

[Competitive morbidity ant its impact on life expectancy: evaluation and inclusion in the therapeutic decision regarding localized prostatic cancer].

OBJECTIVES: The treatment decision taken by a multidisciplinary meeting for patients with localized prostate cancer must take into account the clinical stage of the cancer and its histological characteristics, but also the patient's age, general state and any concomitant diseases, as treatment is only beneficial when it induces a reduction of morbidity and specific mortality. The specific survival with or without recurrence after treatment for localized prostate cancer is long, at least more than 10 years. Curative treatment is generally not proposed to men with localized prostate cancer when his probability of survival related to a competitive morbidity (intercurrent medical disease) is estimated to be less than 10 years. The objective of this study was to measure the increase or reduction of the survival probability of a patient with localized prostate cancer according to his competitive morbidity, based on the mean life expectancy of the general population. METHODS: Review of the literature. RESULTS: Studies describing the natural history of prostate cancer show that the impact of treatment on morbidity of the cancer (local and/or metastatic) requires a life expectancy of about 8 to 10 years. The impact of a treatment on specific survival requires a life expectancy of about 13 to 15 years. The exact prevalence of diseases coexisting with prostate cancer is unknown. In the USA, The Index of Coexisting Disease (ICD), which takes into account 14 diseases, appears to be the most reliable tool to measure the competitive morbidity in patients with localized prostate cancer. Each disease is classified into 4 levels of severity (score 0 to 3). A table indicates estimated life expectancies by age-group and by ICD score. All men with a high score (2 to 3) die within 10 years after diagnosis, men with a score of 0 have a better estimated life expectancy according to age than that of the general population. CONCLUSION: The upper age limit, theoretically set at 70 years, in order to propose curative treatment for localized prostate cancer needs to be reviewed (the mean life expectancy for a 70-year-old man is 12.9 years in France). According to the ICD, the life expectancy at 70 years is 14.8 years in the case of a score of 0 and 8.4 years in the case of a score of 2. In the case of a score of 2, the impact of curative treatment on localized prostate cancer would be real on morbidity, but not on specific mortality.

Humans↗
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↗
PubMed1999

Second non-germ cell malignancies in patients treated for stage I-II testicular seminoma.

PURPOSE: To measure the incidence of second non-germ cell malignancies (SNGCM) in patients treated for a stage I-II testicular seminoma. MATERIALS AND METHODS: From 1970 to 1992, 131 evaluable patients received in the Institut Claudius Regaud a post-orchiectomy treatment for a stage I-II testicular seminoma. The therapeutic modalities, including salvage treatment for six recurrences, were as follows: infradiaphragmatic radiotherapy (IDRT) (n = 55); infra- and supradiaphragmatic radiotherapy (IDRT + SDRT) (n = 64); IDRT + SDRT with chemotherapy (n = 12). The mean follow-up was 11 years. The cumulative incidence of SNGCM was compared to the overall cancer incidence in the general male population on the basis of the Tarn Cancer Registry; the relative risk was expressed as a standardized incidence ratio (SIR). RESULTS: Overall, the cumulative incidence of SNGCM was 10.7% (14/131 cases). The SIR was equal to 2.81 (95% confidence interval (CI) 1.54-4.72; P < 0.001) and increased with follow-up duration. The SIR was significantly increased in 64 patients treated with IDRT + SDRT (SIR = 3.08; 95% CI 1.47-5.66; P = 0.002) but not in 55 patients treated with IDRT alone (SIR = 0.62; 95% CI 0.01-3.43; P = 0.8). The 12 patients who received chemotherapy had an SIR of 26.2 (95% CI 5.48-77.69; P < 0.001), while the SIR was 2.26 in the 119 patients who did not receive any chemotherapy (95% CI 1.13-4.04; P = 0.01 ). Of four hematologic malignancies, three appeared in the 12 patients who received chemotherapy. CONCLUSIONS: An increased risk of SNGCM after SDRT + IDRT has been demonstrated. After IDRT alone, the risk of second cancer is not incremented after a median follow-up of 6 years, but further observation of the patients is necessary to achieve final conclusions. Our results suggest that the risk of second cancer and especially of hematologic malignancy is increased by the association of chemotherapy and radiation.

Adult↗
PubMed1999

Cancer registry data based estimation of regional cancer incidence: application to breast and colorectal cancer in French administrative regions.

STUDY OBJECTIVE: In many countries, cancer registries cover only a small part of the national population. Cancer incidence for the rest of the country has therefore to be estimated. This can be done from mortality data using the relation between incidence and mortality observed in the cancer registry areas. Such an approach was used to study geographical variation and trend of colorectal and breast cancer incidence in France where 10% of the national population is covered by cancer registries. DESIGN: This study applies the incidence/mortality ratios of cancer registry areas to regional mortality data to obtain an estimation of cancer incidence at a given point in time. Age and period effects are included in the statistical models. MAIN RESULTS: The incidence estimations are given for 21 administrative regions and three time points (1985, 1990, 1995). The European standardised incidence rates for breast cancer ranged from 86.8 to 128.8. For colorectal cancer, these rates ranged from 48.2 to 79.6 for men, and from 32.5 to 48.8 for women. Breast cancer incidence has increased considerably between 1985 and 1995 with a higher increase in the north than in the south of France. The incidence of colorectal cancer has also increased, albeit to a lesser extent. CONCLUSION: The incidence estimation method proposed leads to regional incidence rates that are useful for planning health care services on a regional basis and may also be used to study regional differences in incidence. This method is useful when only partial incidence data are available.

Adult↗
PubMed1999

[Risk of second non-germ cell cancer after treatment of stage I-II testicular seminoma].

OBJECTIVE: To determine the incidence of second non-germ-cell cancers (SNGC) in patients treated for stage I-II testicular seminoma. MATERIAL AND METHODS: This study is based on 131 evaluable patients treated at the Institut Claudius Regaud between 1970 and 1990. Treatment modalities, including salvage therapy for 6 patients developing recurrence, were as follows: infradiaphragmatic irradiation (infraDI) only in 55 cases, infra- and supradiaphragmatic irradiation (infraDI + supraDI) in 64 cases, and irradiation and chemotherapy (IC) in 12 cases. Five patients were lost to follow-up 4 months to 14 years after primary treatment (mean follow-up: 11 years). The cumulative incidence of SNGC was compared to the overall cancer incidence in the age-matched male population reported in the Tarn Cancer Registry. The relative risk was expressed as the Standardized Incidence Ratio (SIR). RESULTS: The cumulative incidence of SNGC was 10.7% (14/131 patients). SIR was equal to 2.81 (p < 0.001) and increased with the duration of follow-up. SIR was significantly increased in 64 patients treated with infraDI + supraDI (SIR) = 3.25; p = 0.002), but not in the 55 patients treated with infraDI only (SIR = 0.62; p = 0.8). The 12 treated patients with IC had an SIR of 26.2 (p < 0.001). Three of the 4 patients who developed a haematological malignancy belonged to the IC group. CONCLUSIONS: The risk of SNGC is increased after infraDI + supraDI. The risk of SNGC after infraDI only is not increased with a median follow-up of 6 years, but this follow-up is too short to allow any definitive conclusions. The risk of SNGC and particularly haematological malignancy appears to be increased by the combination of radiotherapy and chemotherapy.

Adult↗
PubMed1999

[Reporting of resected colonic carcinomas. Assessment of practices in 8 French counties in 1995].

OBJECTIVES: The objective of this work was to study the reporting of resected colonic carcinomas and to compare them with Consensus Guidelines published in January 1998. METHODS: The study included 535 colonic carcinomas collected in 8 French registries in 1995, and chosen by drawing lots. For each report, the presence of the information requested by the Guidelines was looked for. Three synthetic variables were built: 2 scores and one qualitative at 2 classes. The influence of patients, tumour and health care system's characteristics was analysed on the 3 dependent variables. RESULTS: Some important variations were observed for information's percents in reporting. In monovariate analysis, scores were significantly influenced by cancer's sub-location, area of patient's residence, surgical center, type of laboratories and pathologist case volume. In multivariate analysis, significant heterogeneity in practices remained between geographical areas. Types of laboratories and pathologist case volume affected differently dependent variables. CONCLUSION: This study shows the necessity to assess the practices before consensus because of the impact of pathological forms in therapeutic decisions and variations observed.

Aged↗
PubMed1999

[Participation factors in a occupational health colorectal cancer screening program].

A colorectal cancer screening campaign by Hemoccult test was carried out from January 1993 to December 1994 in collaboration with the company doctors of employees ages 45 and older in the companies of the Lot department of France. Of the 1311 employees to whom the test was offered, 811 actually had the test done, representing a rate of participation of 61.9%. Participation varied from 48.1% to 72.7% depending on the company doctor, and was higher for large companies. Managers participated less than other employees. People who never visit a dentist, who had not seen their doctor for over a year or who never give blood participated less than others. Thus, even though company doctors can play a true role by favouring the participation of general employees, their action is limited by the weak participation of people who already have little contact with the health care system.

Aged↗
PubMed1998

Lymph node harvest reporting in patients with carcinoma of the large bowel: a French population-based study.

BACKGROUND: In patients with resected colorectal carcinoma, lymph node involvement has particular importance for patient prognosis and adjuvant therapy. The network of French cancer registries (FRANCIM) established a study aimed at analyzing the validity of lymph node harvest reporting in a population-based sample. METHODS: The study population was comprised of 1081 resected tumors without distant visceral metastasis and classified using the TNM system. Correlation between the number of examined lymph nodes and the staging of the tumor was examined by logistic regression analysis to establish an estimate of the minimum number of lymph nodes required to determine whether a tumor is lymph node negative. RESULTS: An average of 7.7 +/- 0.2 lymph nodes were examined per specimen in the 851 patients for whom the number of lymph nodes examined was known. The proportion of cases classified as N+ increased significantly with the number of examined lymph nodes (chi-square trend = 24.6; P < 0.0001). If the probability of correct lymph node status assessment is 1 in the reference group (comprised of pathology reports of specimens with > or = 16 examined lymph nodes), the probability of correct N+/N- dichotomization was significantly < 1 for the 1 to 3 lymph nodes group and the 4 to 7 lymph nodes group (i.e., 53.7% of cases). CONCLUSIONS: To comply with current rules for adjuvant chemotherapy, surgeons must provide pathologists with at least eight lymph nodes for optimal N+/N- dichotomization to reduce the risk of misclassification and understaging.

Aged↗
PubMed1998

[Prostate cancer in Isère and Tarn (France) between 1985 and 1995: evolution of therapeutic indications].

The objective is to describe the evolution of therapeutic practices of prostate carcinoma in the departements of Tarn and Isère in France for the 1985-1995 period. This retrospective study is based on patient folders for whom a prostate carcinoma has been diagnosed between 1985 and 1995. A sample of 871 patients have been included after randomisation stratified on the year and the department of the diagnostic in the files of the cancer registries of Tarn and Isère. Therapeutic practices of the prostate cancer have significantly evolved between 1985 and 1989. The rate of radical prostatectomies increased from 1986 whereas the rate of radiotherapy remained stable. This evolution has been made to the detriment of non curative treatments with the decrease of the rate of hormonotherapies. This is due to the important development of diagnostic technics which led to an earlier diagnostic of these cancers; but, the evolution of therapeutic technics and particularly of the radical prostatectomy allowed the evolution of indications for the treatment of this cancer, with the increase of the rate of radical prostatectomies and the decrease of the rate of radiotherapies at the same stage of disease evolution. For 1990 to 1995, there was no major evolution. Some indications are discussed in this disease touching old man, with a slow evolution.

Adenocarcinoma↗