{"id":2111,"date":"2018-10-20T18:40:32","date_gmt":"2018-10-20T16:40:32","guid":{"rendered":"https:\/\/angh.net\/abstracts\/resultats-a-trois-ans-de-la-cohorte-prospective-multicentrique-de-langh-sur-ladenocarcinome-du-pancreas-en-centre-hospitalier-apach\/"},"modified":"2018-11-29T11:04:11","modified_gmt":"2018-11-29T10:04:11","slug":"resultats-a-trois-ans-de-la-cohorte-prospective-multicentrique-de-langh-sur-ladenocarcinome-du-pancreas-en-centre-hospitalier-apach","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/resultats-a-trois-ans-de-la-cohorte-prospective-multicentrique-de-langh-sur-ladenocarcinome-du-pancreas-en-centre-hospitalier-apach\/","title":{"rendered":"R\u00e9sultats \u00e0 trois ans de la cohorte prospective multicentrique de l\u2019ANGH sur l\u2019Ad\u00e9nocarcinome du PAncr\u00e9as en Centre Hospitalier (APACH)."},"content":{"rendered":"

2018<\/strong><\/p>\n

R. FAROUX1, I. RAOTO2, R. YEUNG3, F. KHEMISSA4 , JL. LEGOUX5, C. LOCHER6, M. BACONNIER7,D. GRASSET8,C. POUPARDIN9,G MACAIGNE10, R COMBES11, I. BONNET12,C .BECKER13, V QUENTIN14, A. PELAQUIER15, RL. VITTE16, S. MANET-LACOMBE17, M. BLAZQUEZ18, K. ELRIZ19, I ROSA20, J. DIMET1 1LA ROCHE\/YON , 2AVIGNON, 3JOLIMONT, 4PERPIGNAN, 5ORLEANS, 6MEAUX, 7ANNECY, 8VANNES, 9MONTFERMEIL, 10LAGNY, 11NIORT, 12VALENCIENNES, 13LES SABLES D\u2019OLONNE, 14ST BRIEUC, 15MONTELIMAR, 16POISSY, 17PONTOISE, 18BRY sur MARNE, 19CORBEIL ESSONNES, 20CRETEIL<\/em><\/p>\n

Gastroent\u00e9rologie <\/strong>– \u00a02018-05-17 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Introduction : L\u2019incidence de l\u2019ad\u00e9nocarcinome du pancr\u00e9as (ADKP) qui est d\u2019environ 13 000 nouveaux cas par an en France, est en augmentation. La mortalit\u00e9 reste proche de l\u2019incidence. Cependant on dispose de peu de donn\u00e9es dans la vie r\u00e9elle en dehors des centres de r\u00e9f\u00e9rence.
\nObjectif principal : D\u00e9crire sur une large cohorte prospective multicentrique les caract\u00e9ristiques \u00e9pid\u00e9miologiques et cliniques actuelles des ADKP, ses modalit\u00e9s de prise en charge en Centre Hospitalier(CH) et connaitre les pratiques professionnelles.<\/p>\n

Patients et m\u00e9thodes : Entre octobre 2013 et novembre 2015, tous les nouveaux malades pr\u00e9sentant un ADKP prouv\u00e9 cytologiquement ou histologiquement ont \u00e9t\u00e9 inclus prospectivement et de fa\u00e7on exhaustive dans 50 centres ANGH (Association Nationale des gastroent\u00e9rologues des H\u00f4pitaux G\u00e9n\u00e9raux). Ils sont suivis pour une dur\u00e9e maximale de 5 ans. Les donn\u00e9es ont \u00e9t\u00e9 recueillies sur un cahier d\u2019observation \u00e9lectronique. Nous pr\u00e9sentons l\u2019ensemble des donn\u00e9es \u00e9pid\u00e9miologiques, cliniques ainsi que les r\u00e9sultats de survie trois ans apr\u00e8s la fin des inclusions.<\/p>\n

R\u00e9sultats : 1087 patients, de sexe masculin 56%, d\u2019\u00e2ge moyen 68,2ans (minimum-maximum 30-97) \u00e9taient analysables sur les 1133 inclus. Les ant\u00e9c\u00e9dents d\u2019int\u00e9r\u00eat \u00e9taient : un diab\u00e8te (30%), un ant\u00e9c\u00e9dent personnel de cancer (15,6%), un ant\u00e9c\u00e9dent familial au 1er degr\u00e9 d\u2019ADKP (4,1%), Une TIPMP (2,8%) et une cirrhose (1,2%). On retrouvait les facteurs de risque suivant : un tabagisme (39%), une consommation excessive d\u2019alcool (26%) et un IMC>25 (40%). Une preuve histo-cytologique \u00e9tait obtenue par la biopsie de la tumeur primitive dans 75% des cas, dont 70% par cytoponction sous \u00e9choendoscopie, et\/ou de ses m\u00e9tastases (29%). La tumeur primitive \u00e9tait de localisation c\u00e9phalique (64,8%) corpor\u00e9ale (20,6%)caudale (14,6%). Il existait des m\u00e9tastases synchrones dans 50% des cas, de localisation : h\u00e9patiques (79%), pulmonaires (20%) et\/ou p\u00e9riton\u00e9ales (28%).
\nCent quatre-vingt-seize (18%) patients ont \u00e9t\u00e9 op\u00e9r\u00e9s \u00e0 vis\u00e9e curative (chirurgie suivie d\u2019une chimioth\u00e9rapie adjuvante dans 93% des cas) dont duod\u00e9nopancr\u00e9atectomie c\u00e9phalique DPC (79%) et pancr\u00e9atectomie gauche (17%). La r\u00e9section \u00e9tait R0 dans 67% des cas et R1 dans 33% des cas. La chirurgie \u00e9tait r\u00e9alis\u00e9e dans 63% des cas en h\u00f4pital g\u00e9n\u00e9ral. La mortalit\u00e9 post op\u00e9ratoire \u00e0 30 jours \u00e9tait de1,4% et \u00e0 90 jours de 3%.
\nUne chimioth\u00e9rapie de premi\u00e8re ligne \u00e9tait initi\u00e9e pour 75% des patients m\u00e9tastatiques selon : Folfirinox (43%), Gemcitabine (42%), Nab-paclitaxel (0,8%). Les patients du groupe Folfirinox \u00e9taient significativement plus jeunes et plus souvent de performans status 0 ou 1. Une seconde ligne \u00e9tait administr\u00e9e \u00e0 66% des patients apr\u00e8s Folfirinox et 30% apr\u00e8s Gemcitabine. La survie m\u00e9diane des patients m\u00e9tastatiques ne recevant pas de chimioth\u00e9rapie \u00e9tait de 1mois [0,59-2,10] contre 8,2 mois [3,9-14,9] pour ceux trait\u00e9s par au moins une ligne.
\nLe taux de survie global \u00e0 2 ans \u00e9tait de 18,6% % pour l\u2019ensemble de la population. La m\u00e9diane de survie \u00e9tait de 10,5 mois [4,1-19,8] : 15,3 mois [8,4-non atteint] en l\u2019absence de m\u00e9tastase et 6,1 mois [2,1-12,9] en cas de maladie m\u00e9tastatique d\u2019embl\u00e9e.
\nLes patients op\u00e9r\u00e9s \u00e0 vis\u00e9e curative, (18% de la population initiale) ont une survie m\u00e9diane \u00e0 29,5 mois en cas de r\u00e9section R0 et de 23,4 mois en cas de r\u00e9section R1 ( NS). En analyse multivari\u00e9e, sur un mod\u00e8le de base comprenant l\u2019\u00e2ge, la perte de poids, l\u2019OMS,le tx de bilirubine, de leucocytes la nutrition pr\u00e9op\u00e9ratoire, les transfusions, le type de r\u00e9section, le T et le N, seuls l\u2019OMS <2, le N0, et une chimioth\u00e9rapie adjuvante influencent la survie.<\/p>\n

Conclusion :
\nDans cette large cohorte prospective de patients non s\u00e9lectionn\u00e9s suivis pour un ADKP en CH, pour les 18% de patients ayant pu \u00eatre op\u00e9r\u00e9s \u00e0 vis\u00e9e curative, la survie m\u00e9diane est de 29 mois en cas de r\u00e9section R0 et de 23,4 mois si R1. Cependant sur l\u2019ensemble de la population, le pronostic reste mauvais avec une m\u00e9diane de survie de 10 mois. la survie sans progression \u00e0 3 ans est inf\u00e9rieure \u00e0 7%. En analyse multivari\u00e9e les facteurs pronostics ind\u00e9pendants sont l\u2019OMS < 2, la localisation c\u00e9phalique de la tumeur, une chirurgie \u00e0 vis\u00e9e curative et un taux bas de leucocytes . Le caract\u00e8re multicentrique national de cette cohorte de patients non s\u00e9lectionn\u00e9s permet d\u2019avoir une photographie de la pr\u00e9sentation actuelle de la maladie en France. Malgr\u00e9 les ind\u00e9niables progr\u00e8s de la chirurgie et de la chimioth\u00e9rapie adjuvante et m\u00e9tastatique, la survie sans progression \u00e0 trois ans reste exceptionnelle.<\/p>\n

Les donn\u00e9es seront actualis\u00e9es lors du congr\u00e8s<\/p>\n

Financement : CRC La Roche sur Yon, Laboratoire MERCK<\/p>\n[download id=\u00a0\u00bb2219″]\n","protected":false},"excerpt":{"rendered":"

2018 R. FAROUX1, I. RAOTO2, R. YEUNG3, F. KHEMISSA4 , JL. LEGOUX5, C. LOCHER6, M. BACONNIER7,D. GRASSET8,C. POUPARDIN9,G MACAIGNE10, R COMBES11, I. BONNET12,C .BECKER13, V QUENTIN14, A. PELAQUIER15, RL. VITTE16, S. MANET-LACOMBE17, M. BLAZQUEZ18, K. ELRIZ19, I ROSA20, J. DIMET1 1LA ROCHE\/YON , 2AVIGNON, 3JOLIMONT, 4PERPIGNAN, 5ORLEANS, 6MEAUX, 7ANNECY, 8VANNES, 9MONTFERMEIL, 10LAGNY, 11NIORT, 12VALENCIENNES, 13LES […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[29],"class_list":["post-2111","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-29"],"yoast_head":"\nR\u00e9sultats \u00e0 trois ans de la cohorte prospective multicentrique de l\u2019ANGH sur l\u2019Ad\u00e9nocarcinome du PAncr\u00e9as en Centre Hospitalier (APACH). - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/resultats-a-trois-ans-de-la-cohorte-prospective-multicentrique-de-langh-sur-ladenocarcinome-du-pancreas-en-centre-hospitalier-apach\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"R\u00e9sultats \u00e0 trois ans de la cohorte prospective multicentrique de l\u2019ANGH sur l\u2019Ad\u00e9nocarcinome du PAncr\u00e9as en Centre Hospitalier (APACH). - 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