Christophe Paris | Université de Lorraine (original) (raw)
Papers by Christophe Paris
Lung Cancer, 2003
The objective of this study was to determine the factors associated with central airway versus pe... more The objective of this study was to determine the factors associated with central airway versus peripheral bronchial location of lung cancer. All patients diagnosed with lung cancer from 1997 through 2000 in the Respiratory Disease Department of Rouen University Hospital were prospectively interviewed about their smoking and occupational history using a standardized questionnaire. All patients underwent white-light bronchial endoscopy using a 4.5 mm flexible endoscope. Tumors were classified as central when they were accessible and visible using this technique. Out of 217 cases of lung cancer included in this study, 155 (71%) were central. Histological type of lung cancer was strongly associated with bronchial location as central location was observed in 48, 82 and 92% of Adenocarcinoma (AC), Squamous Cell (SqC), and Small Cell Carcinoma (SCC), respectively (P B/0.0001). Among non asbestos-exposed patients, location varied little with smoking status, with central location frequency ranging from 74 to 80%. In contrast, lung cancer was recorded central in 41% of long-term (]/10 years) ex-smokers, 67% of short-term (B/10 years) exsmokers and 75% of current smokers (P0/0.04) among patients exposed to asbestos, suggesting an interaction between duration of smoking cessation and occupational asbestos exposure with respect to lung cancer location. These findings were confirmed after adjustment for sex, age and histologic type in multivariate analysis. These results suggest that individually-tailored multimodality screening strategies relying on various combinations of low-dose CT scan, sputum analysis and fluorescence endoscopy according to each patient's profile may be more effective than standard strategies based on a single approach for all patients.
Occupational and environmental medicine, 2014
To investigate inter-reader agreement for the detection of pleural and parenchymal abnormalities ... more To investigate inter-reader agreement for the detection of pleural and parenchymal abnormalities using CT in a large cross-sectional study comprising information on individual cumulative exposure to asbestos. The project was approved by the hospital ethics committee, and all patients received information on the study and gave their written informed consent. In 5511 CT scans performed in a cohort of retired workers previously exposed to asbestos and volunteering to participate in a multiregional survey programme (Asbestos Related Diseases Cohort, ARDCO), double randomised standardised readings, triple in case of disagreement, were performed by seven trained expert radiologists specialised in thoracic imaging and blind to the initial interpretation. Inter-reader agreement was evaluated by calculating the κ-weighted coefficient between pairs of expert readers and results of routine practice and final diagnosis after expert reading. κ-Weighted coefficients between trained experts ranged...
The European respiratory journal, Jan 5, 2015
Lung cancer in never-smokers (LCINS) (fewer than 100 cigarettes in lifetime) is considered as a d... more Lung cancer in never-smokers (LCINS) (fewer than 100 cigarettes in lifetime) is considered as a distinct entity and harbours an original molecular profile. However, the epidemiological and molecular features of LCINS in Europe remain poorly understood. All consecutive newly diagnosed LCINS patients were included in this prospective observational study by 75 participating centres during a 14-month period. Each patient completed a detailed questionnaire about risk factor exposure. Biomarker and pathological analyses were also collected. We report the main descriptive overall results with a focus on sex differences. 384 patients were included: 65 men and 319 women. 66% had been exposed to passive smoking (significantly higher among women). Definite exposure to main occupational carcinogens was significantly higher in men (35% versus 8% in women). A targetable molecular alteration was found in 73% of patients (without any significant sex difference): EGFR in 51%, ALK in 8%, KRAS in 6%, ...
Environmental Health, 2008
Background: CT-Scan is currently under assessment for the screening of asbestos-related diseases.... more Background: CT-Scan is currently under assessment for the screening of asbestos-related diseases. However, to date no consensus exists as to how to select high-risk asbestos-exposed populations suitable for such screening programs. The objective of this study is to select the most relevant exposure variables for the prediction of pleural plaques and asbestosis in order to guide clinicians in their use of CT-Scan.
European Respiratory Journal, 2014
The aim of the study was to investigate the prognostic value of right heart catheterisation varia... more The aim of the study was to investigate the prognostic value of right heart catheterisation variables measured during exercise. 55 incident patients with idiopathic, familial or anorexigen-associated pulmonary arterial hypertension (PAH) underwent right heart catheterisation at rest and during exercise and 6-min walk testing before PAH treatment initiation. Patients were treated according to recommendations within the next 2 weeks. Right heart catheterisation was repeated 3-5 months into the PAH treatment in 20 patients. Exercise cardiac index decreased gradually as New York Heart Association (NYHA) functional class increased whereas cardiac index at rest was not significantly different across NYHA groups. Baseline 6-min walk distance correlated significantly with exercise and change in cardiac index from rest to exercise (r=0.414 and r=0.481, respectively; p<0.01). Change in 6-min walk distance from baseline to 3-5 months under PAH treatment was highly correlated with change in exercise cardiac index (r=0.746, p<0.001). The most significant baseline covariates associated with survival were change in systolic pulmonary artery pressure from rest to exercise and exercise cardiac index (hazard ratio 0.56 (95% CI 0.37-0.86) and 0.14 (95% CI 0.05-0.43), respectively). Change in pulmonary haemodynamics during exercise is an important tool for assessing disease severity and may help devise optimal treat-to-target strategies.
Lung Cancer, 2010
Clinical characteristics and risk factors of nonsmoker patients with lung cancer are still debate... more Clinical characteristics and risk factors of nonsmoker patients with lung cancer are still debated. The aim of this work is to describe the characteristics of never smoker patients with lung cancer, focusing on occupational and environmental exposures, Data collected were: age, gender, histological types, methods of diagnosis, TNM staging, smoking, and occupational data. Statistical analysis included descriptive analyses, Pearson's chi-square or nonparametric tests, and logistic regressions. All lung cancers diagnosed between January 1, 1997 and December 31, 2006, representing 1493 cases were included. Lung adenocarcinoma (ADC) [Odds Ratio (OR)=2.5 (1.5-4.3), p<0.0001] as well as clinical stage I cases at diagnosis [OR=2.4 (1.3-4.3)] were most frequent in nonsmokers relative to ever smokers. Comparison of clinical features among male and female nonsmoker patients did not reveal significant differences. Conversely, strong differences appeared when comparing environmental tobacco smoke (ETS) and occupational exposures in nonsmoker women vs men: ETS exposure (78.6% nonsmoker women vs 21.4% nonsmoker men, p<0.0001), occupational exposure (9.4% vs 48.6%, p<0.0005). Noteworthy, a sizeable number of nonsmoker male (40.0%), and nonsmoker female (31.2%) patients had no known exposure to major lung carcinogens. Main risk factors (ETS and occupational exposure) may only explain some cases.
Epidemiology, 2006
Aims and Methods: Long term effects of air pollution on mortality were studied in 14 284 adults w... more Aims and Methods: Long term effects of air pollution on mortality were studied in 14 284 adults who resided in 24 areas from seven French cities when enrolled in the PAARC survey (air pollution and chronic respiratory diseases) in 1974. Daily measurements of sulphur dioxide, total suspended particles, black smoke, nitrogen dioxide, and nitric oxide were made in 24 areas for three years . Cox proportional hazards models controlling for individual confounders (smoking, educational level, body mass index, occupational exposure) were applied, and frailty models used to take into account spatial correlation. Indicators of air pollution were the mean concentration. Results: Models were run before and after exclusion of six area monitors influenced by local traffic (NO/ NO 2 .3 in ppb). After exclusion of these areas, analyses showed that adjusted risk ratios (95% CI) for TSP, BS, NO 2 , and NO for non-accidental mortality were 1.05 (1.02 to 1.08), 1.07 (1.03 to 1.10), 1.14 (1.03 to 1.25), and 1.11 (1.05 to 1.17) for 10 mg/m 3 respectively. Consistent patterns for lung cancer and cardiopulmonary causes were observed. Conclusions: Urban air pollution assessed in the 1970s was associated with increased mortality over 25 years in France. S hort term associations between temporal day-to-day variations in outdoor air pollutants concentrations and day-to-day variations in total and cause specific mortality have been evidenced by many time series in the last decade. 1-3 Long term effects of air pollution on mortality have been evaluated in three American prospective cohort studies. The Harvard Six Cities study followed over 15 years a cohort of 8111 adults. 4 The American Cancer Society (ACS) study followed prospectively from 1982 to 1989 a cohort of 552 138 adults. 5 The Adventist Health Study of Smog (ASHMOG study) followed a cohort of 6338 non-smoking California Seventh-day Adventists (SDAs) since 1997. 6 After controlling for age, sex, cigarette smoking, educational level, body mass index, and other risk factors, results showed that relatively low concentrations of fine particles could be associated with reduced survival. Cardiopulmonary mortality was significantly associated with concentrations of particulate air pollution in the Six Cities study 4 and in the ACS, 5 but not in the ASHMOG study. A recent paper doubled the follow up time to more than 16 years for the ACS study and concluded that long term exposure to combustion related fine particulate air pollution is an important environmental factor for cardiopulmonary and lung cancer mortality. 7 However, these studies have been conducted in North America, and only one study has been published on long term effects from the Netherlands Cohort study on Diet and Cancer (NLCS) in Europe. The authors followed up 5000 adults aged 55-69 years over eight years; results showed that cardiopulmonary mortality was associated with living near a major road, with a relative risk of 1.95 (95% CI 1.09 to 3.52).
American Journal of Industrial Medicine, 2009
6 and the National Network of ''Asbestos Post-Exposure Survey'' (APEXS) and Christophe Paris, MD,... more 6 and the National Network of ''Asbestos Post-Exposure Survey'' (APEXS) and Christophe Paris, MD, PhD 2,7Ã
Background: Bronchial Hyperresponsiveness (BHR) is considered a hallmark of asthma. Other methods... more Background: Bronchial Hyperresponsiveness (BHR) is considered a hallmark of asthma. Other methods are helpful in epidemiological respiratory health studies including Fractional Exhaled Nitric Oxide (FENO) and Eosinophils Percentage (EP) in nasal lavage fluid measuring markers for airway inflammation along with the Forced Oscillatory Technique measuring Airway resistance (AR). Can their outcomes discriminate profiles of respiratory health in healthy subjects starting apprenticeship in occupations with a risk of asthma?
Occupational and environmental medicine, Jan 9, 2015
The European Union (EU) strategy for health and safety at work underlines the need to reduce the ... more The European Union (EU) strategy for health and safety at work underlines the need to reduce the incidence of occupational diseases (OD), but European statistics to evaluate this common goal are scarce. We aim to estimate and compare changes in incidence over time for occupational asthma, contact dermatitis, noise-induced hearing loss (NIHL), carpal tunnel syndrome (CTS) and upper limb musculoskeletal disorders across 10 European countries. OD surveillance systems that potentially reflected nationally representative trends in incidence within Belgium, the Czech Republic, Finland, France, Italy, the Netherlands, Norway, Spain, Switzerland and the UK provided data. Case counts were analysed using a negative binomial regression model with year as the main covariate. Many systems collected data from networks of 'centres', requiring the use of a multilevel negative binomial model. Some models made allowance for changes in compensation or reporting rules. Reports of contact dermat...
Lung Cancer, 2003
The objective of this study was to determine the factors associated with central airway versus pe... more The objective of this study was to determine the factors associated with central airway versus peripheral bronchial location of lung cancer. All patients diagnosed with lung cancer from 1997 through 2000 in the Respiratory Disease Department of Rouen University Hospital were prospectively interviewed about their smoking and occupational history using a standardized questionnaire. All patients underwent white-light bronchial endoscopy using a 4.5 mm flexible endoscope. Tumors were classified as central when they were accessible and visible using this technique. Out of 217 cases of lung cancer included in this study, 155 (71%) were central. Histological type of lung cancer was strongly associated with bronchial location as central location was observed in 48, 82 and 92% of Adenocarcinoma (AC), Squamous Cell (SqC), and Small Cell Carcinoma (SCC), respectively (P B/0.0001). Among non asbestos-exposed patients, location varied little with smoking status, with central location frequency ranging from 74 to 80%. In contrast, lung cancer was recorded central in 41% of long-term (]/10 years) ex-smokers, 67% of short-term (B/10 years) exsmokers and 75% of current smokers (P0/0.04) among patients exposed to asbestos, suggesting an interaction between duration of smoking cessation and occupational asbestos exposure with respect to lung cancer location. These findings were confirmed after adjustment for sex, age and histologic type in multivariate analysis. These results suggest that individually-tailored multimodality screening strategies relying on various combinations of low-dose CT scan, sputum analysis and fluorescence endoscopy according to each patient's profile may be more effective than standard strategies based on a single approach for all patients.
Occupational and environmental medicine, 2014
To investigate inter-reader agreement for the detection of pleural and parenchymal abnormalities ... more To investigate inter-reader agreement for the detection of pleural and parenchymal abnormalities using CT in a large cross-sectional study comprising information on individual cumulative exposure to asbestos. The project was approved by the hospital ethics committee, and all patients received information on the study and gave their written informed consent. In 5511 CT scans performed in a cohort of retired workers previously exposed to asbestos and volunteering to participate in a multiregional survey programme (Asbestos Related Diseases Cohort, ARDCO), double randomised standardised readings, triple in case of disagreement, were performed by seven trained expert radiologists specialised in thoracic imaging and blind to the initial interpretation. Inter-reader agreement was evaluated by calculating the κ-weighted coefficient between pairs of expert readers and results of routine practice and final diagnosis after expert reading. κ-Weighted coefficients between trained experts ranged...
The European respiratory journal, Jan 5, 2015
Lung cancer in never-smokers (LCINS) (fewer than 100 cigarettes in lifetime) is considered as a d... more Lung cancer in never-smokers (LCINS) (fewer than 100 cigarettes in lifetime) is considered as a distinct entity and harbours an original molecular profile. However, the epidemiological and molecular features of LCINS in Europe remain poorly understood. All consecutive newly diagnosed LCINS patients were included in this prospective observational study by 75 participating centres during a 14-month period. Each patient completed a detailed questionnaire about risk factor exposure. Biomarker and pathological analyses were also collected. We report the main descriptive overall results with a focus on sex differences. 384 patients were included: 65 men and 319 women. 66% had been exposed to passive smoking (significantly higher among women). Definite exposure to main occupational carcinogens was significantly higher in men (35% versus 8% in women). A targetable molecular alteration was found in 73% of patients (without any significant sex difference): EGFR in 51%, ALK in 8%, KRAS in 6%, ...
Environmental Health, 2008
Background: CT-Scan is currently under assessment for the screening of asbestos-related diseases.... more Background: CT-Scan is currently under assessment for the screening of asbestos-related diseases. However, to date no consensus exists as to how to select high-risk asbestos-exposed populations suitable for such screening programs. The objective of this study is to select the most relevant exposure variables for the prediction of pleural plaques and asbestosis in order to guide clinicians in their use of CT-Scan.
European Respiratory Journal, 2014
The aim of the study was to investigate the prognostic value of right heart catheterisation varia... more The aim of the study was to investigate the prognostic value of right heart catheterisation variables measured during exercise. 55 incident patients with idiopathic, familial or anorexigen-associated pulmonary arterial hypertension (PAH) underwent right heart catheterisation at rest and during exercise and 6-min walk testing before PAH treatment initiation. Patients were treated according to recommendations within the next 2 weeks. Right heart catheterisation was repeated 3-5 months into the PAH treatment in 20 patients. Exercise cardiac index decreased gradually as New York Heart Association (NYHA) functional class increased whereas cardiac index at rest was not significantly different across NYHA groups. Baseline 6-min walk distance correlated significantly with exercise and change in cardiac index from rest to exercise (r=0.414 and r=0.481, respectively; p<0.01). Change in 6-min walk distance from baseline to 3-5 months under PAH treatment was highly correlated with change in exercise cardiac index (r=0.746, p<0.001). The most significant baseline covariates associated with survival were change in systolic pulmonary artery pressure from rest to exercise and exercise cardiac index (hazard ratio 0.56 (95% CI 0.37-0.86) and 0.14 (95% CI 0.05-0.43), respectively). Change in pulmonary haemodynamics during exercise is an important tool for assessing disease severity and may help devise optimal treat-to-target strategies.
Lung Cancer, 2010
Clinical characteristics and risk factors of nonsmoker patients with lung cancer are still debate... more Clinical characteristics and risk factors of nonsmoker patients with lung cancer are still debated. The aim of this work is to describe the characteristics of never smoker patients with lung cancer, focusing on occupational and environmental exposures, Data collected were: age, gender, histological types, methods of diagnosis, TNM staging, smoking, and occupational data. Statistical analysis included descriptive analyses, Pearson's chi-square or nonparametric tests, and logistic regressions. All lung cancers diagnosed between January 1, 1997 and December 31, 2006, representing 1493 cases were included. Lung adenocarcinoma (ADC) [Odds Ratio (OR)=2.5 (1.5-4.3), p<0.0001] as well as clinical stage I cases at diagnosis [OR=2.4 (1.3-4.3)] were most frequent in nonsmokers relative to ever smokers. Comparison of clinical features among male and female nonsmoker patients did not reveal significant differences. Conversely, strong differences appeared when comparing environmental tobacco smoke (ETS) and occupational exposures in nonsmoker women vs men: ETS exposure (78.6% nonsmoker women vs 21.4% nonsmoker men, p<0.0001), occupational exposure (9.4% vs 48.6%, p<0.0005). Noteworthy, a sizeable number of nonsmoker male (40.0%), and nonsmoker female (31.2%) patients had no known exposure to major lung carcinogens. Main risk factors (ETS and occupational exposure) may only explain some cases.
Epidemiology, 2006
Aims and Methods: Long term effects of air pollution on mortality were studied in 14 284 adults w... more Aims and Methods: Long term effects of air pollution on mortality were studied in 14 284 adults who resided in 24 areas from seven French cities when enrolled in the PAARC survey (air pollution and chronic respiratory diseases) in 1974. Daily measurements of sulphur dioxide, total suspended particles, black smoke, nitrogen dioxide, and nitric oxide were made in 24 areas for three years . Cox proportional hazards models controlling for individual confounders (smoking, educational level, body mass index, occupational exposure) were applied, and frailty models used to take into account spatial correlation. Indicators of air pollution were the mean concentration. Results: Models were run before and after exclusion of six area monitors influenced by local traffic (NO/ NO 2 .3 in ppb). After exclusion of these areas, analyses showed that adjusted risk ratios (95% CI) for TSP, BS, NO 2 , and NO for non-accidental mortality were 1.05 (1.02 to 1.08), 1.07 (1.03 to 1.10), 1.14 (1.03 to 1.25), and 1.11 (1.05 to 1.17) for 10 mg/m 3 respectively. Consistent patterns for lung cancer and cardiopulmonary causes were observed. Conclusions: Urban air pollution assessed in the 1970s was associated with increased mortality over 25 years in France. S hort term associations between temporal day-to-day variations in outdoor air pollutants concentrations and day-to-day variations in total and cause specific mortality have been evidenced by many time series in the last decade. 1-3 Long term effects of air pollution on mortality have been evaluated in three American prospective cohort studies. The Harvard Six Cities study followed over 15 years a cohort of 8111 adults. 4 The American Cancer Society (ACS) study followed prospectively from 1982 to 1989 a cohort of 552 138 adults. 5 The Adventist Health Study of Smog (ASHMOG study) followed a cohort of 6338 non-smoking California Seventh-day Adventists (SDAs) since 1997. 6 After controlling for age, sex, cigarette smoking, educational level, body mass index, and other risk factors, results showed that relatively low concentrations of fine particles could be associated with reduced survival. Cardiopulmonary mortality was significantly associated with concentrations of particulate air pollution in the Six Cities study 4 and in the ACS, 5 but not in the ASHMOG study. A recent paper doubled the follow up time to more than 16 years for the ACS study and concluded that long term exposure to combustion related fine particulate air pollution is an important environmental factor for cardiopulmonary and lung cancer mortality. 7 However, these studies have been conducted in North America, and only one study has been published on long term effects from the Netherlands Cohort study on Diet and Cancer (NLCS) in Europe. The authors followed up 5000 adults aged 55-69 years over eight years; results showed that cardiopulmonary mortality was associated with living near a major road, with a relative risk of 1.95 (95% CI 1.09 to 3.52).
American Journal of Industrial Medicine, 2009
6 and the National Network of ''Asbestos Post-Exposure Survey'' (APEXS) and Christophe Paris, MD,... more 6 and the National Network of ''Asbestos Post-Exposure Survey'' (APEXS) and Christophe Paris, MD, PhD 2,7Ã
Background: Bronchial Hyperresponsiveness (BHR) is considered a hallmark of asthma. Other methods... more Background: Bronchial Hyperresponsiveness (BHR) is considered a hallmark of asthma. Other methods are helpful in epidemiological respiratory health studies including Fractional Exhaled Nitric Oxide (FENO) and Eosinophils Percentage (EP) in nasal lavage fluid measuring markers for airway inflammation along with the Forced Oscillatory Technique measuring Airway resistance (AR). Can their outcomes discriminate profiles of respiratory health in healthy subjects starting apprenticeship in occupations with a risk of asthma?
Occupational and environmental medicine, Jan 9, 2015
The European Union (EU) strategy for health and safety at work underlines the need to reduce the ... more The European Union (EU) strategy for health and safety at work underlines the need to reduce the incidence of occupational diseases (OD), but European statistics to evaluate this common goal are scarce. We aim to estimate and compare changes in incidence over time for occupational asthma, contact dermatitis, noise-induced hearing loss (NIHL), carpal tunnel syndrome (CTS) and upper limb musculoskeletal disorders across 10 European countries. OD surveillance systems that potentially reflected nationally representative trends in incidence within Belgium, the Czech Republic, Finland, France, Italy, the Netherlands, Norway, Spain, Switzerland and the UK provided data. Case counts were analysed using a negative binomial regression model with year as the main covariate. Many systems collected data from networks of 'centres', requiring the use of a multilevel negative binomial model. Some models made allowance for changes in compensation or reporting rules. Reports of contact dermat...