Correspondence
cancer than expected in the registry. Additionally, a subgroup of patients aged 44–61 years, with a BMI of 16–22 (underweight) had a 1·7 times higher frequency of rectosigmoid cancer than expected. These results suggest an association between abnormal BMI and colorectal cancer, especially for distal bowel segment and young age. To the best of our knowledge, no national or international guidelines currently propose earlier or more frequent screening for people with obesity;2 we postulate that national cancer screening programmes could be more efficient if they included BMI as a risk factor. On the basis of our data, we suggest that screening for colorectal cancer in obese and underweight people is intensified by giving them a short rectosigmoidoscopy at the age of 45 years. Obviously, the costs and effectiveness of such a practice will need to be validated prospectively. YP declares funding from Eumedica, Olympus, Sanofi, and Brothier, outside the scope of this work. The other authors declare no competing interests. The analysis of data from the COINCIDE database presented here was done by Alexandre Templier and Alexandre Civet (Quinten, Paris, France), paid for by industrial funding from Roche France. Roche France did not have access to the COINCIDE database, and were not involved in the analysis or development of the question addressed here.
Clarisse Eveno, Yann Parc, Alexis Laurent, Michel Ducreux, *Marc Pocard [email protected] Surgical Oncologic and Digestive Unit, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Université Paris-Diderot, 75010 Paris, France (CE, MP); Department of Digestive Surgery, Hôpital Saint-Antoine Assistance publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France (YP); Department of Hepato-Biliary Surgery and Liver Transplantation, Assistance publique-Hôpitaux de Paris, Université Paris XII-Créteil, Paris, France (AL); and Department of Medical Oncology, Gustave Roussy, Villejuif, France (MD) 1
2
Arnold M, Pandeya N, Byrnes G, et al. Global burden of cancer attributable to high bodymass index in 2012: a population-based study. Lancet Oncol 2015; 16: 36–46. Laiyemo AO. The risk of colonic adenomas and colonic cancer in obesity. Best Pract Res Clin Gastroenterol 2014; 28: 655–63.
www.thelancet.com/oncology Vol 16 March 2015
Adjuvant chemotherapy in locally advanced bladder cancer The natural history of muscle-invasive bladder cancer suggests that aggressive management with both local and systemic therapy is needed, in view of the incidence of distant recurrence (20–50%) and locoregional recurrence (5–15%) after cystectomy. Perioperative chemotherapy, either neoadjuvant or adjuvant, has been used in an effort to improve survival, and although level 1 evidence for a survival benefit is less robust for adjuvant therapy, several surveys suggest that urologists prefer to use adjuvant therapy more frequently than neoadjuvant treatment.1,2 Indeed, adjuvant chemotherapy enables accurate pathological staging before systemic chemotherapy, potentially limiting the possibility of toxic effects to those high-risk patients who are most likely to benefit from the treatment, and averting delays in possibly curative surgery. However, whether immediate adjuvant and deferred adjuvant chemotherapy are equally effective with respect to overall survival is still unclear. The establishment of an acceptable trade-off between benefit and harm is essential to the decision-making process in clinical practice. In the recent Article by Cora Sternberg and colleagues,3 284 patients were randomly assigned to either immediate adjuvant or to deferred adjuvant chemotherapy at the time of relapse. 5-year progression-free survival was 47·6% (95% CI 38·8–55·9) with immediate adjuvant therapy versus 31·8% (24·2–39·6) with deferred adjuvant (p
cancer than expected in the registry. Additionally, a subgroup of patients aged 44–61 years, with a BMI of 16–22 (underweight) had a 1·7 times higher frequency of rectosigmoid cancer than expected. These results suggest an association between abnormal BMI and colorectal cancer, especially for distal bowel segment and young age. To the best of our knowledge, no national or international guidelines currently propose earlier or more frequent screening for people with obesity;2 we postulate that national cancer screening programmes could be more efficient if they included BMI as a risk factor. On the basis of our data, we suggest that screening for colorectal cancer in obese and underweight people is intensified by giving them a short rectosigmoidoscopy at the age of 45 years. Obviously, the costs and effectiveness of such a practice will need to be validated prospectively. YP declares funding from Eumedica, Olympus, Sanofi, and Brothier, outside the scope of this work. The other authors declare no competing interests. The analysis of data from the COINCIDE database presented here was done by Alexandre Templier and Alexandre Civet (Quinten, Paris, France), paid for by industrial funding from Roche France. Roche France did not have access to the COINCIDE database, and were not involved in the analysis or development of the question addressed here.
Clarisse Eveno, Yann Parc, Alexis Laurent, Michel Ducreux, *Marc Pocard [email protected] Surgical Oncologic and Digestive Unit, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Université Paris-Diderot, 75010 Paris, France (CE, MP); Department of Digestive Surgery, Hôpital Saint-Antoine Assistance publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France (YP); Department of Hepato-Biliary Surgery and Liver Transplantation, Assistance publique-Hôpitaux de Paris, Université Paris XII-Créteil, Paris, France (AL); and Department of Medical Oncology, Gustave Roussy, Villejuif, France (MD) 1
2
Arnold M, Pandeya N, Byrnes G, et al. Global burden of cancer attributable to high bodymass index in 2012: a population-based study. Lancet Oncol 2015; 16: 36–46. Laiyemo AO. The risk of colonic adenomas and colonic cancer in obesity. Best Pract Res Clin Gastroenterol 2014; 28: 655–63.
www.thelancet.com/oncology Vol 16 March 2015
Adjuvant chemotherapy in locally advanced bladder cancer The natural history of muscle-invasive bladder cancer suggests that aggressive management with both local and systemic therapy is needed, in view of the incidence of distant recurrence (20–50%) and locoregional recurrence (5–15%) after cystectomy. Perioperative chemotherapy, either neoadjuvant or adjuvant, has been used in an effort to improve survival, and although level 1 evidence for a survival benefit is less robust for adjuvant therapy, several surveys suggest that urologists prefer to use adjuvant therapy more frequently than neoadjuvant treatment.1,2 Indeed, adjuvant chemotherapy enables accurate pathological staging before systemic chemotherapy, potentially limiting the possibility of toxic effects to those high-risk patients who are most likely to benefit from the treatment, and averting delays in possibly curative surgery. However, whether immediate adjuvant and deferred adjuvant chemotherapy are equally effective with respect to overall survival is still unclear. The establishment of an acceptable trade-off between benefit and harm is essential to the decision-making process in clinical practice. In the recent Article by Cora Sternberg and colleagues,3 284 patients were randomly assigned to either immediate adjuvant or to deferred adjuvant chemotherapy at the time of relapse. 5-year progression-free survival was 47·6% (95% CI 38·8–55·9) with immediate adjuvant therapy versus 31·8% (24·2–39·6) with deferred adjuvant (p
