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Jiang W, Li M, Tan J, Feng M, Zheng J, Chen D, Liu Z, Yan B, Wang G, Xu S, Xiao W, Gao Y, Zhuo S, Yan J. A Nomogram Based on a Collagen Feature Support Vector Machine for Predicting the Treatment Response to Neoadjuvant Chemoradiotherapy in Rectal Cancer Patients. Ann Surg Oncol 2021; 28:6408-6421. [PMID: 34148136 DOI: 10.1245/s10434-021-10218-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/09/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The relationship between collagen features (CFs) in the tumor microenvironment and the treatment response to neoadjuvant chemoradiotherapy (nCRT) is still unknown. This study aimed to develop and validate a perdition model based on the CFs and clinicopathological characteristics to predict the treatment response to nCRT among locally advanced rectal cancer (LARC) patients. METHODS In this multicenter, retrospective analysis, 428 patients were included and randomly divided into a training cohort (299 patients) and validation cohort (129 patients) [7:3 ratio]. A total of 11 CFs were extracted from a multiphoton image of pretreatment biopsy, and a support vector machine (SVM) was then used to construct a CFs-SVM classifier. A prediction model was developed and presented with a nomogram using multivariable analysis. Further validation of the nomogram was performed in the validation cohort. RESULTS The CFs-SVM classifier, which integrated collagen area, straightness, and crosslink density, was significantly associated with treatment response. Predictors contained in the nomogram included the CFs-SVM classifier and clinicopathological characteristics by multivariable analysis. The CFs nomogram demonstrated good discrimination, with area under the receiver operating characteristic curves (AUROCs) of 0.834 in the training cohort and 0.854 in the validation cohort. Decision curve analysis indicated that the CFs nomogram was clinically useful. Moreover, compared with the traditional clinicopathological model, the CFs nomogram showed more powerful discrimination in determining the response to nCRT. CONCLUSIONS The CFs-SVM classifier based on CFs in the tumor microenvironment is associated with treatment response, and the CFs nomogram integrating the CFs-SVM classifier and clinicopathological characteristics is useful for individualized prediction of the treatment response to nCRT among LARC patients.
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Affiliation(s)
- Wei Jiang
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.,School of Science, Jimei University, Xiamen, Fujian, People's Republic of China
| | - Min Li
- Department of Radiation Oncology, Sun Yat sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Jie Tan
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Mingyuan Feng
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Jixiang Zheng
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Dexin Chen
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Zhangyuanzhu Liu
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Botao Yan
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Guangxing Wang
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou, Fujian, People's Republic of China
| | - Shuoyu Xu
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.,Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Weiwei Xiao
- Department of Radiation Oncology, Sun Yat sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Yuanhong Gao
- Department of Radiation Oncology, Sun Yat sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China.
| | - Shuangmu Zhuo
- School of Science, Jimei University, Xiamen, Fujian, People's Republic of China.
| | - Jun Yan
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
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Normalized spectral power of fetal heart rate variability is associated with fetal scalp blood pH. Early Hum Dev 2011; 87:259-63. [PMID: 21316165 DOI: 10.1016/j.earlhumdev.2011.01.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 01/16/2011] [Accepted: 01/18/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Spectral power of fetal heart rate variability is related to fetal condition. Previous studies found an increased normalized low frequency power in case of severe fetal acidosis. AIMS To analyze whether absolute or normalized low or high frequency power of fetal heart rate variability is associated with fetal scalp blood pH. STUDY DESIGN Prospective cohort study, performed in an obstetric unit of a tertiary care teaching hospital. SUBJECTS Consecutive singleton term fetuses in cephalic presentation that underwent one or more scalp blood samples, monitored during labour using ST-analysis of the fetal electrocardiogram. Ten-minute continuous beat-to-beat fetal heart rate segments, preceding the scalp blood measurement were used. OUTCOME MEASURES Absolute and normalized spectral power in the low frequency band (0.04-0.15 Hz) and in the high frequency band (0.4-1.5 Hz). RESULTS In total 39 fetal blood samples from 30 patients were studied. We found that normalized low frequency and normalized high frequency power of fetal heart rate variability is associated with fetal scalp blood pH. The estimated ß of normalized low frequency power was -0.37 (95% confidence interval -0.68 to -0.06) and the relative risk was 0.69 (95% confidence interval 0.51-0.94). The estimated ß of normalized high frequency power was 0.33 (95% confidence interval 0.01-0.65) and the relative risk was 1.39 (95% confidence interval 1.01-1.92). CONCLUSIONS Normalized low and normalized high frequency power of fetal heart rate variability is associated with fetal scalp blood pH.
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Ojala K, Vääräsmäki M, Mäkikallio K, Valkama M, Tekay A. A comparison of intrapartum automated fetal electrocardiography and conventional cardiotocography-a randomised controlled study. BJOG 2006; 113:419-23. [PMID: 16553653 DOI: 10.1111/j.1471-0528.2006.00886.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine whether intrapartum monitoring by means of automatic ST analysis (STAN) of fetal electrocardiography could reduce the rate of neonatal acidemia and the rate of operative intervention during labour, compared with monitoring by means of cardiotocography (CTG). DESIGN Randomised controlled trial. SETTING Labour ward in tertiary-level university hospital. SAMPLE A total of 1483 women in active labour with singleton term fetus in cephalic presentation. METHODS Women were randomly assigned to be monitored either by STAN or by CTG. Fetal blood sampling (FBS) was optional in both groups. MAIN OUTCOME MEASURES Neonatal acidemia (umbilical artery pH <7.10), neonatal metabolic acidosis (umbilical artery pH <7.05 and base excess <-12 mmol/l) and operative interventions: caesarean section rate, vacuum outlet (VO) rate and FBS rate. RESULTS There were no statistically significant differences between the STAN group and CTG group in the incidence of neonatal acidemia (5.8 versus 4.7%) or metabolic acidosis (1.7 versus 0.7%). The caesarean section rate (6.4 versus 4.7%) and the VO rate (9.5 versus 10.7%) were also similar in the STAN and CTG groups. The incidence of FBS was lower (P < 0.001) in the STAN group (7.0%) than in the CTG group (15.6%). CONCLUSIONS Intrapartum fetal monitoring by means of automatic STAN did not improve the neonatal outcome or decrease the caesarean section rate. However, the need for FBS during labour was lower in the STAN group.
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Affiliation(s)
- K Ojala
- Department of Obstetrics and Gynaecology, Oulu University Hospital, Oulu, Finland.
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Abstract
Both VAS and scalp stimulation are useful in the evaluation of fetal compromise by decreasing the number of falsely abnormal FHR tests and limiting the number of unnecessary interventions, thus improving the efficiency of antepartum and intrapartum FHR monitoring. As is true for all types of fetal assessment using FHR monitoring, VAS and scalp stimulation have limitations, and a lack of response to these methodologies does not necessarily indicate fetal acidemia. When either VAS or scalp stimulation is employed, one must take into consideration their respective predictive values (see Table 1). Fetal VAS or scalp stimulation should be considered as one facet of comprehensive fetal evaluation. When these techniques are used in this manner, the clinician evaluating the fetus in the antepartum or intrapartum period may prevent unnecessary intervention and improve maternal and neonatal outcome.
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Affiliation(s)
- T F Porter
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City.
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Irion O, Stuckelberger P, Moutquin JM, Morabia A, Extermann P, Béguin F. Is intrapartum vibratory acoustic stimulation a valid alternative to fetal scalp pH determination? BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1996; 103:642-7. [PMID: 8688389 DOI: 10.1111/j.1471-0528.1996.tb09831.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To determine the association between fetal heart rate accelerations, whether spontaneous or induced by vibratory acoustic stimulation, and subsequent scalp pH values in presence of a suspicious intrapartum fetal heart rate tracing, and thereby assess the ability of accelerations to predict a concurrent normal fetal scalp blood pH. DESIGN Prospective observational study of 253 labours involving 421 pH samples. SETTING Tertiary care university hospital of Genoeva. INTERVENTION Vibratory acoustic stimulation through the maternal abdominal wall for five seconds prior to fetal blood sampling. MAIN OUTCOME MEASURES Spontaneous fetal heart rate reactivity (accelerations) in the 10 min preceding vibratory acoustic stimulation, vibratory acoustic-induced reactivity prior to fetal blood sampling, and scalp pH value. RESULTS The positive predictive value of a reactive fetal heart rate response after vibratory acoustic stimulation was 78% (95% CI 73-84%) and 97% (95% CI 94-99%) for scalp pH values of > 7.25 and > or = 7.20, respectively. Similar observations occurred with spontaneous reactivity. Of concern, 7 out of 31 (23%) occasions where the scalp blood pH was less than 7.20 appeared to be associated with a normal fetal heart rate response to vibratory acoustic stimulation. CONCLUSION Fetal heart rate acceleration induced by vibratory acoustic stimulation was significantly associated with a normal scalp blood pH higher than 7.25. However, vibratory acoustic stimulation offers no advantage over observation of spontaneous fetal heart rate tracings and cannot safely replace fetal blood sampling during labour.
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Affiliation(s)
- O Irion
- Hôpital Saint-François d' Assise, Département de Gynécologie et d' Obstétrique, Université Laval, Quèbec, Canada
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Abstract
Twenty years after its widespread introduction, the role of continuous fetal heart rate and contraction monitoring in labour (cardiotocography, CTG) remains uncertain. Although a normal pattern is very reassuring about fetal condition, the predictive value of an abnormal pattern is low. In most studies the use of CTG has been associated with an increase in intervention in labour, particularly caesarean section, without clear evidence of benefit. Fetal blood sampling is the most useful associated technique for minimizing unnecessary intervention. The relationship between fetal heart rate, fetal blood pH changes and long-term outcome remains obscure and further work to clarify this relationship is urgently needed.
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Affiliation(s)
- J A Spencer
- Department of Obstetrics and Gynaecology, University College Hospital, London, UK
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Maclachlan NA, Spencer JA, Harding K, Arulkumaran S. Fetal acidaemia, the cardiotocograph and the T/QRS ratio of the fetal ECG in labour. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1992; 99:26-31. [PMID: 1547167 DOI: 10.1111/j.1471-0528.1992.tb14387.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To relate the T/QRS ratio of the fetal electrocardiogram (ECG) to the cardiotocogram (CTG) and fetal pH during labour. DESIGN Prospective data collection from selected monitored labours. SETTING A postgraduate teaching hospital delivery suite. SUBJECTS 113 women in labour at term. MAIN OUTCOME MEASURES Correlation of fetal T/QRS ratio values with pH values at the time of fetal blood sampling and at birth (umbilical artery blood). Comparison of the predictive values of raised T/QRS ratio and a pathological CTG for fetal acidemia. RESULTS Complete data sufficient for analysis was available for 51 fetal scalp blood samples and 93 umbilical artery pH samples. The median (range) of T/QRS ratio values before birth of 88 babies not requiring admission to the neonatal unit was 0.13 (0.00-0.32) with a 97.5th centile value of 0.28. T/QRS ratios did not correlate with fetal scalp pH values. Fetal scalp acidaemia (pH less than 7.20) was detected with rates of 50 and 13% respectively by a pathological CTG and by a T/QRS ratio above 0.28, the positive predictive values being 40% and 50%, respectively. There was a significant correlation between increasing T/QRS ratio and falling pH. Detection rates (sensitivities) for umbilical artery acidaemia (pH less than 7.12) were 76% and 29% whereas positive predictive values were 38% and 71% respectively for a pathological CTG and a T/QRS ratio above 0.28. CONCLUSION A raised T/QRS ratio (greater than 0.28) had a considerably lower detection rate for fetal acidaemia during labour than a pathological CTG.
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Affiliation(s)
- N A Maclachlan
- Institute of Obstetrics and Gynaecology, Royal Postgraduate Medical School, University of London
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Ingemarsson E, Ingemarsson I, Svenningsen NW. Impact of routine fetal monitoring during labor on fetal outcome with long-term follow-up. Am J Obstet Gynecol 1981; 141:29-38. [PMID: 7270619 DOI: 10.1016/0002-9378(81)90671-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A computerized system for the storage of antenatal, intrapartal, and neonatal data has been used since 1973. The present study evaluated the influence of changed neonatal and obstetric practices, with special regard to routine fetal monitoring. Three periods were studied: 1973-1974 (6,542 deliveries, only selected high-risk patients monitored); 1975-1976 (6,857 deliveries, high-risk patients monitored); 1977-1979 (9,638 deliveries, 90% monitored). The numbers of infants with an Apgar score less than 7 at 1 and 5 min were similar in 1973-1974 and 1975-1976, but the number was significantly reduced in 1977-1979. During the years studied, all but eight infants with an Apgar score less than 7 at 5 min participated in a scheduled long-term follow-up (at least 14 mo). In 1973-1974, 25 infants (35.2%) demonstrated neurological handicaps. In 1975-1976, 14 infants (19.2%) had sequelae; in 1977-1979, only three infants (4.6%) were damaged. Trend analysis showed a significant reduction in the number of infants with neurological sequelae through the years; the reduction was significant for premature and low-risk infants but not for mature high-risk infants. The improved short-term and long-term fetal outcomes seem to be largely a result of routine fetal monitoring with all its implications for obstetric and neonatal management; the significant reduction in neurological sequelae, even after correction for other changes in obstetric routines, supports this suggestion.
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