1
|
Watanabe J, Ichimasa K, Kudo SE, Mochizuki K, Tan KK, Kataoka Y, Tahara M, Kubota T, Takashina Y, Yeoh KG. Risk factors for lymph node metastasis in T2 colorectal cancer: a systematic review and meta-analysis. Int J Clin Oncol 2024:10.1007/s10147-024-02547-7. [PMID: 38709424 DOI: 10.1007/s10147-024-02547-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/30/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Lymph node metastasis (LNM) occurs in 20-25% of patients with T2 colorectal cancer (CRC). Identification of risk factors for LNM in T2 CRC may help identify patients who are at low risk and thereby potential candidates for endoscopic full-thickness resection. We examined risk factors for LNM in T2 CRC with the goal of establishing further criteria of the indications for endoscopic resection. METHODS MEDLINE, CENTRAL, and EMBASE were systematically searched from inception to November 2023. Studies that investigated the association between the presence of LNM and the clinical and pathological factors of T2 CRC were included. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Certainty of evidence (CoE) was assessed using the GRADE approach. RESULTS Fourteen studies (8349 patients) were included. Overall, the proportion of LNM was 22%. The meta-analysis revealed that the presence of lymphovascular invasion (OR, 5.5; 95% CI 3.7-8.3; high CoE), high-grade tumor budding (OR, 2.4; 95% CI 1.5-3.7; moderate CoE), poor differentiation (OR, 2.2; 95% CI 1.8-2.7; moderate CoE), and female sex (OR, 1.3; 95% CI 1.1-1.7; high CoE) were associated with LNM in T2 CRC. Lymphatic invasion (OR, 5.0; 95% CI 3.3-7.6) was a stronger predictor of LNM than vascular invasion (OR, 2.4; 95% CI 2.1-2.8). CONCLUSIONS Lymphovascular invasion, high-grade tumor budding, poor differentiation, and female sex were risk factors for LNM in T2 CRC. Endoscopic resection of T2 CRC in patients with very low risk for LNM may become an alternative to conventional surgical resection. TRIAL REGISTRATION PROSPERO, CRD42022316545.
Collapse
Affiliation(s)
- Jun Watanabe
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki, Yokohama, 224-8503, Japan.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Kenichi Mochizuki
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Ker-Kan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Surgery, National University Hospital, Singapore, Singapore
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Healthcare Epidemiology, Graduate School of Medicine / School of Public Health, Kyoto University, Kyoto, Japan
| | - Makiko Tahara
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takafumi Kubota
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yuki Takashina
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Khay Guan Yeoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore
| |
Collapse
|
2
|
Watanabe J, Ichimasa K, Kataoka Y, Miki A, Someko H, Honda M, Tahara M, Yamashina T, Yeoh KG, Kawai S, Kotani K, Sata N. Additional staining for lymphovascular invasion is associated with increased estimation of lymph node metastasis in patients with T1 colorectal cancer: Systematic review and meta-analysis. Dig Endosc 2024; 36:533-545. [PMID: 37746764 DOI: 10.1111/den.14691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/20/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES Lymphovascular invasion (LVI) is a critical risk factor for lymph node metastasis (LNM), which requires additional surgery after endoscopic resection of T1 colorectal cancer (CRC). However, the impact of additional staining on estimating LNM is unclear. This systematic review aimed to evaluate the impact of additional staining on determining LNM in T1 CRC. METHODS We searched five electronic databases. Outcomes were diagnostic odds ratio (DOR), assessed using hierarchical summary receiver operating characteristic curves, and interobserver agreement among pathologists for positive LVI, assessed using Kappa coefficients (κ). We performed a subgroup analysis of studies that simultaneously included a multivariable analysis for other risk factors (deep submucosal invasion, poor differentiation, and tumor budding). RESULTS Among the 64 studies (18,097 patients) identified, hematoxylin-eosin (HE) and additional staining for LVI had pooled sensitivities of 0.45 (95% confidence interval [CI] 0.32-0.58) and 0.68 (95% CI 0.44-0.86), specificities of 0.88 (95% CI 0.78-0.94) and 0.76 (95% CI 0.62-0.86), and DORs of 6.26 (95% CI 3.73-10.53) and 6.47 (95% CI 3.40-12.32) for determining LNM, respectively. In multivariable analysis, the DOR of additional staining for LNM (DOR 5.95; 95% CI 2.87-12.33) was higher than that of HE staining (DOR 1.89; 95% CI 1.13-3.16) (P = 0.01). Pooled κ values were 0.37 (95% CI 0.22-0.52) and 0.62 (95% CI 0.04-0.99) for HE and additional staining for LVI, respectively. CONCLUSION Additional staining for LVI may increase the DOR for LNM and interobserver agreement for positive LVI among pathologists.
Collapse
Affiliation(s)
- Jun Watanabe
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi, Japan
- Division of Community and Family Medicine, Jichi Medical University, Tochigi, Japan
| | - Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
- Department of Medicine, National University of Singapore, Singapore City, Singapore
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Kyoto, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/Public Health, Kyoto, Japan
- Scientific Research WorkS Peer Support Group, Osaka, Japan
| | - Atsushi Miki
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Hidehiro Someko
- Scientific Research WorkS Peer Support Group, Osaka, Japan
- General Internal Medicine, Asahi General Hospital, Chiba, Japan
| | - Munenori Honda
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Makiko Tahara
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Takeshi Yamashina
- Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Osaka, Japan
| | - Khay Guan Yeoh
- Department of Medicine, National University of Singapore, Singapore City, Singapore
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore City, Singapore
| | - Shigeo Kawai
- Department of Diagnostic Pathology, Tochigi Medical Center Shimotsuga, Tochigi, Japan
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Tochigi, Japan
| | - Naohiro Sata
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi, Japan
| |
Collapse
|
3
|
Saito Y, Sakamoto T, Dekker E, Pioche M, Probst A, Ponchon T, Messmann H, Dinis-Ribeiro M, Matsuda T, Ikematsu H, Saito S, Wada Y, Oka S, Sano Y, Fujishiro M, Murakami Y, Ishikawa H, Inoue H, Tanaka S, Tajiri H. First report from the International Evaluation of Endoscopic classification Japan NBI Expert Team: International multicenter web trial. Dig Endosc 2024; 36:591-599. [PMID: 37702082 DOI: 10.1111/den.14682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/10/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES Narrow-band imaging (NBI) contributes to real-time optical diagnosis and classification of colorectal lesions. The Japan NBI Expert Team (JNET) was introduced in 2011. The aim of this study was to explore the diagnostic accuracy of JNET when applied by European and Japanese endoscopists not familiar with this classification. METHODS This study was conducted by 36 European Society of Gastrointestinal Endoscopy (ESGE) and 49 Japan Gastroenterological Endoscopy Society (JGES) non-JNET endoscopists using still images of 150 lesions. For each lesion, nonmagnified white-light, nonmagnified NBI, and magnified NBI images were presented. In the magnified NBI, the evaluation area was designated by region of interest (ROI). The endoscopists scored histological prediction for each lesion. RESULTS In ESGE members, the sensitivity, specificity, and accuracy were respectively 73.3%, 94.7%, and 93.0% for JNET Type 1; 53.0%, 64.9%, and 62.1% for Type 2A; 43.9%, 67.7%, and 55.1% for Type 2B; and 38.1%, 93.7%, and 85.1% for Type 3. When Type 2B and 3 were considered as one category of cancer, the sensitivity, specificity, and accuracy for differentiating high-grade dysplasia and cancer from the others were 59.9%, 72.5%, and 63.8%, respectively. These trends were the same for JGES endoscopists. CONCLUSION The diagnostic accuracy of the JNET classification was similar between ESGE and JGES and considered to be sufficient for JNET Type 1. On the other hand, the accuracy for Types 2 and 3 is not sufficient; however, JNET 2B lesions should be resected en bloc due to the risk of cancers and JNET 3 can be treated by surgery due to its high specificity.
Collapse
Affiliation(s)
- Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
- University of Tsukuba, Ibaraki, Japan
| | - Evelien Dekker
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Andreas Probst
- RISE@CI-IPO, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Center, Porto, Portugal
| | | | - Helmut Messmann
- RISE@CI-IPO, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Center, Porto, Portugal
| | | | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
- Toho University, Tokyo, Japan
| | | | | | | | - Shiro Oka
- Hiroshima University, Hiroshima, Japan
| | | | | | | | | | | | - Shinji Tanaka
- Hiroshima University, Hiroshima, Japan
- JA Onomichi General Hospital, Hiroshima, Japan
| | | |
Collapse
|
4
|
Xu ZY, Li ZZ, Cao LM, Zhong NN, Liu XH, Wang GR, Xiao Y, Liu B, Bu LL. Seizing the fate of lymph nodes in immunotherapy: To preserve or not? Cancer Lett 2024; 588:216740. [PMID: 38423247 DOI: 10.1016/j.canlet.2024.216740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/07/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
Lymph node dissection has been a long-standing diagnostic and therapeutic strategy for metastatic cancers. However, questions over myriad related complications and survival outcomes are continuously debated. Immunotherapy, particularly neoadjuvant immunotherapy, has revolutionized the conventional paradigm of cancer treatment, yet has benefited only a fraction of patients. Emerging evidence has unveiled the role of lymph nodes as pivotal responders to immunotherapy, whose absence may contribute to drastic impairment in treatment efficacy, again posing challenges over excessive lymph node dissection. Hence, centering around this theme, we concentrate on the mechanisms of immune activation in lymph nodes and provide an overview of minimally invasive lymph node metastasis diagnosis, current best practices for activating lymph nodes, and the prognostic outcomes of omitting lymph node dissection. In particular, we discuss the potential for future comprehensive cancer treatment with effective activation of immunotherapy driven by lymph node preservation and highlight the challenges ahead to achieve this goal.
Collapse
Affiliation(s)
- Zhen-Yu Xu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Zi-Zhan Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Lei-Ming Cao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Nian-Nian Zhong
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Xuan-Hao Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Guang-Rui Wang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Yao Xiao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Bing Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China; Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China.
| | - Lin-Lin Bu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China; Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China.
| |
Collapse
|
5
|
Luțenco V, Țocu G, Guliciuc M, Moraru M, Candussi IL, Dănilă M, Luțenco V, Dimofte F, Mihailov OM, Mihailov R. New Horizons of Artificial Intelligence in Medicine and Surgery. J Clin Med 2024; 13:2532. [PMID: 38731061 DOI: 10.3390/jcm13092532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/06/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Ideas about Artificial intelligence appeared about half a century ago, but only now is it becoming an essential element of everyday life. The data provided are becoming a bigger pool and we need artificial intelligence that will help us with its superhuman powers. Its interaction with medicine is improving more and more, with medicine being a domain that continues to be perfected. Materials and Methods: The most important databases were used to perform this detailed search that addresses artificial intelligence in the medical and surgical fields. Discussion: Machine learning, deep learning, neural networks and computer vision are some of the mechanisms that are becoming a trend in healthcare worldwide. Developed countries such as Japan, France and Germany have already implemented artificial intelligence in their medical systems. The help it gives is in medical diagnosis, patient monitoring, personalized therapy and workflow optimization. Artificial intelligence will help surgeons to perfect their skills, to standardize techniques and to choose the best surgical techniques. Conclusions: The goal is to predict complications, reduce diagnostic times, diagnose complex pathologies, guide surgeons intraoperatively and reduce medical errors. We are at the beginning of this, and the potential is enormous, but we must not forget the impediments that may appear and slow down its implementation.
Collapse
Affiliation(s)
- Valerii Luțenco
- Surgery I Clinic, Emergency Hospital "Sf. Ap. Andrei", 800578 Galați, Romania
| | - George Țocu
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University of Galati, 800008 Galați, Romania
| | - Mădălin Guliciuc
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University of Galati, 800008 Galați, Romania
| | - Monica Moraru
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University of Galati, 800008 Galați, Romania
| | - Iuliana Laura Candussi
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University of Galati, 800008 Galați, Romania
- Clinical Children Emergency Hospital "Sf. Ioan", 060011 Galați, Romania
| | - Marius Dănilă
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University of Galati, 800008 Galați, Romania
- Clinical Children Emergency Hospital "Sf. Ioan", 060011 Galați, Romania
| | - Verginia Luțenco
- Clinical Children Emergency Hospital "Sf. Ioan", 060011 Galați, Romania
| | - Florentin Dimofte
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University of Galati, 800008 Galați, Romania
| | - Oana Mariana Mihailov
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University of Galati, 800008 Galați, Romania
| | - Raul Mihailov
- Surgery I Clinic, Emergency Hospital "Sf. Ap. Andrei", 800578 Galați, Romania
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University of Galati, 800008 Galați, Romania
| |
Collapse
|
6
|
Fábián A, Bor R, Vasas B, Szűcs M, Tóth T, Bősze Z, Szántó KJ, Bacsur P, Bálint A, Farkas B, Farkas K, Milassin Á, Rutka M, Resál T, Molnár T, Szepes Z. Long-term outcomes after endoscopic removal of malignant colorectal polyps: Results from a 10-year cohort. World J Gastrointest Endosc 2024; 16:193-205. [PMID: 38680198 PMCID: PMC11045354 DOI: 10.4253/wjge.v16.i4.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/28/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Choosing an optimal post-polypectomy management strategy of malignant colorectal polyps is challenging, and evidence regarding a surveillance-only strategy is limited. AIM To evaluate long-term outcomes after endoscopic removal of malignant colorectal polyps. METHODS A single-center retrospective cohort study was conducted to evaluate outcomes after endoscopic removal of malignant colorectal polyps between 2010 and 2020. Residual disease rate and nodal metastases after secondary surgery and local and distant recurrence rate for those with at least 1 year of follow-up were investigated. Event rates for categorical variables and means for continuous variables with 95% confidence intervals were calculated, and Fisher's exact test and Mann-Whitney test were performed. Potential risk factors of adverse outcomes were determined with univariate and multivariate logistic regression models. RESULTS In total, 135 lesions (mean size: 22.1 mm; location: 42% rectal) from 129 patients (mean age: 67.7 years; 56% male) were enrolled. The proportion of pedunculated and non-pedunculated lesions was similar, with en bloc resection in 82% and 47% of lesions, respectively. Tumor differentiation, distance from resection margins, depth of submucosal invasion, lymphovascular invasion, and budding were reported at 89.6%, 45.2%, 58.5%, 31.9%, and 25.2%, respectively. Residual tumor was found in 10 patients, and nodal metastasis was found in 4 of 41 patients who underwent secondary surgical resection. Univariate analysis identified piecemeal resection as a risk factor for residual malignancy (odds ratio: 1.74; P = 0.042). At least 1 year of follow-up was available for 117 lesions from 111 patients (mean follow-up period: 5.59 years). Overall, 54%, 30%, 30%, 11%, and 16% of patients presented at the 1-year, 3-year, 5-year, 7-year, and 9-10-year surveillance examinations. Adverse outcomes occurred in 9.0% (local recurrence and dissemination in 4 patients and 9 patients, respectively), with no difference between patients undergoing secondary surgery and surveillance only. CONCLUSION Reporting of histological features and adherence to surveillance colonoscopy needs improvement. Long-term adverse outcome rates might be higher than previously reported, irrespective of whether secondary surgery was performed.
Collapse
Affiliation(s)
- Anna Fábián
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Renáta Bor
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Béla Vasas
- Department of Pathology, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Medical Informatics, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6720, Hungary
| | - Tibor Tóth
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Zsófia Bősze
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Kata Judit Szántó
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Péter Bacsur
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Anita Bálint
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Bernadett Farkas
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Klaudia Farkas
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
- USZ Translational Colorectal Research Group, Hungarian Centre of Excellence for Molecular Medicine, Szeged 6725, Hungary
| | - Ágnes Milassin
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Mariann Rutka
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Tamás Resál
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Tamás Molnár
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Zoltán Szepes
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| |
Collapse
|
7
|
Shiina O, Kudo S, Ichimasa K, Takashina Y, Kouyama Y, Mochizuki K, Morita Y, Kuroki T, Kato S, Nakamura H, Matsudaira S, Misawa M, Ogata N, Hayashi T, Wakamura K, Sawada N, Baba T, Nemoto T, Ishida F, Miyachi H. Differentiation grade as a risk factor for lymph node metastasis in T1 colorectal cancer. DEN Open 2024; 4:e324. [PMID: 38155928 PMCID: PMC10753631 DOI: 10.1002/deo2.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/26/2023] [Accepted: 12/06/2023] [Indexed: 12/30/2023]
Abstract
Objectives Japanese guidelines include high-grade (poorly differentiated) tumors as a risk factor for lymph node metastasis (LNM) in T1 colorectal cancer (CRC). However, whether the grading is based on the least or most predominant component when the lesion consists of two or more levels of differentiation varies among institutions. This study aimed to investigate which method is optimal for assessing the risk of LNM in T1 CRC. Methods We retrospectively evaluated 971 consecutive patients with T1 CRC who underwent initial or additional surgical resection from 2001 to 2021 at our institution. Tumor grading was divided into low-grade (well- to moderately differentiated) and high-grade based on the least or predominant differentiation analyses. We investigated the correlations between LNM and these two grading analyses. Results LNM was present in 9.8% of patients. High-grade tumors, as determined by least differentiation analysis, accounted for 17.0%, compared to 0.8% identified by predominant differentiation analysis. A significant association with LNM was noted for the least differentiation method (p < 0.05), while no such association was found for predominant differentiation (p = 0.18). In multivariate logistic regression, grading based on least differentiation was an independent predictor of LNM (p = 0.04, odds ratio 1.68, 95% confidence interval 1.00-2.83). Sensitivity and specificity for detecting LNM were 27.4% and 84.1% for least differentiation, and 2.1% and 99.3% for predominant differentiation, respectively. Conclusions Tumor grading via least differentiation analysis proved to be a more reliable measure for assessing LNM risk in T1 CRC compared to grading by predominant differentiation.
Collapse
Affiliation(s)
- Osamu Shiina
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Shin‐ei Kudo
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Katsuro Ichimasa
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
- Department of MedicineNational University of SingaporeSingaporeSingapore
| | - Yuki Takashina
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Yuta Kouyama
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Kenichi Mochizuki
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Yuriko Morita
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Takanori Kuroki
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Shun Kato
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Hiroki Nakamura
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Shingo Matsudaira
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Masashi Misawa
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Noriyuki Ogata
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Takemasa Hayashi
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Kunihiko Wakamura
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Naruhiko Sawada
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Toshiyuki Baba
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Tetsuo Nemoto
- Department of Diagnostic PathologyShowa University Northern Yokohama HospitalKanagawaJapan
| | - Fumio Ishida
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Hideyuki Miyachi
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| |
Collapse
|
8
|
罗 鑫, 陈 宇, 杨 锦, 邓 凯, 吴 俊, 甘 涛. [Prognosis Analysis of Additional Surgical Treatment for High-Risk T1 Colorectal Cancer Patients After Endoscopic Resection]. Sichuan Da Xue Xue Bao Yi Xue Ban 2024; 55:411-417. [PMID: 38645840 PMCID: PMC11026889 DOI: 10.12182/20240360502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Indexed: 04/23/2024]
Abstract
Objective To analyze the effect of additional surgery on the survival and prognosis of high-risk T1 colorectal cancer patients who have undergone endoscopic resection. Methods The clinical data of patients with high-risk T1 colorectal cancer were retrospectively collected. The patients were divided into the endoscopic resection (ER) plus additional surgical resection (SR) group, or the ER+SR group, and the ER group according to whether additional SR were performed after ER. Baseline data of the patients and information on the location, size, and postoperative pathology of the lesions were collected. Patient survival-related information was obtained through the medical record system and patient follow-up. The primary outcome indicators were the overall survival and the colorectal cancer-specific survival. Univariate Cox regression analysis was used to screen survival-related risk factors and hazard ratio (HR) was calculated. Multivariate Cox regression analysis was used to analyze the independent influencing factors. Results The data of 109 patients with T1 high-risk colorectal cancer were collected, with 52 patients in the ER group and 57 patients in the ER+SR group. The mean age of patients in the ER group was higher than that in the ER+SR group (65.21 years old vs. 60.54 years old, P=0.035), and the median endoscopic measurement of the size of lesions in the ER group was slightly lower than that in the ER+SR group (2.00 cm vs. 2.50 cm, P=0.026). The median follow-up time was 30.00 months, with the maximum follow-up time being 119 months, in the ER+SR group and there were 4 patients deaths, including one colorectal cancer-related death. Whereas the median follow-up time in the ER group was 28.50 months, with the maximum follow-up time being 78.00 months, and there were 4 patient deaths, including one caused by colorectal cancer. The overall 5-year cumulative survival rates in the ER+SR group and the ER group were 94.44% and 81.65%, respectively, and the cancer-specific 5-year cumulative survival rates in the ER+SR group and the ER group were 97.18% and 98.06%, respectively. The Kaplan-Meier analysis showed no significant difference in the overall cumulative survival or cancer-specific cumulative survival between the ER+SR and the ER groups. Univariate Cox regression analysis showed that age and the number of reviews were the risk factors of overall survival (HR=1.16 and HR=0.27, respectively), with age identified as an independent risk factor of overall survival in the multivariate Cox regression analysis (HR=1.10, P=0.045). Conclusion For T1 colorectal cancer patients with high risk factors after ER, factors such as patient age and their personal treatment decisions should not be overlooked. In clinical practice, additional caution should be exercised in decision-making concerning additional surgery.
Collapse
Affiliation(s)
- 鑫悦 罗
- 四川大学华西医院 消化内科 (成都 610041)Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 宇翔 陈
- 四川大学华西医院 消化内科 (成都 610041)Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 锦林 杨
- 四川大学华西医院 消化内科 (成都 610041)Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 凯 邓
- 四川大学华西医院 消化内科 (成都 610041)Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 俊超 吴
- 四川大学华西医院 消化内科 (成都 610041)Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 涛 甘
- 四川大学华西医院 消化内科 (成都 610041)Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu 610041, China
| |
Collapse
|
9
|
Campion JR, O'Connor DB, Lahiff C. Human-artificial intelligence interaction in gastrointestinal endoscopy. World J Gastrointest Endosc 2024; 16:126-135. [PMID: 38577646 PMCID: PMC10989254 DOI: 10.4253/wjge.v16.i3.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/18/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
The number and variety of applications of artificial intelligence (AI) in gastrointestinal (GI) endoscopy is growing rapidly. New technologies based on machine learning (ML) and convolutional neural networks (CNNs) are at various stages of development and deployment to assist patients and endoscopists in preparing for endoscopic procedures, in detection, diagnosis and classification of pathology during endoscopy and in confirmation of key performance indicators. Platforms based on ML and CNNs require regulatory approval as medical devices. Interactions between humans and the technologies we use are complex and are influenced by design, behavioural and psychological elements. Due to the substantial differences between AI and prior technologies, important differences may be expected in how we interact with advice from AI technologies. Human–AI interaction (HAII) may be optimised by developing AI algorithms to minimise false positives and designing platform interfaces to maximise usability. Human factors influencing HAII may include automation bias, alarm fatigue, algorithm aversion, learning effect and deskilling. Each of these areas merits further study in the specific setting of AI applications in GI endoscopy and professional societies should engage to ensure that sufficient emphasis is placed on human-centred design in development of new AI technologies.
Collapse
Affiliation(s)
- John R Campion
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin D07 AX57, Ireland
- School of Medicine, University College Dublin, Dublin D04 C7X2, Ireland
| | - Donal B O'Connor
- Department of Surgery, Trinity College Dublin, Dublin D02 R590, Ireland
| | - Conor Lahiff
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin D07 AX57, Ireland
- School of Medicine, University College Dublin, Dublin D04 C7X2, Ireland
| |
Collapse
|
10
|
Ichimasa K, Kudo SE, Tan KK, Lee JWJ, Yeoh KG. Challenges in Implementing Endoscopic Resection for T2 Colorectal Cancer. Gut Liver 2024; 18:218-221. [PMID: 37842729 PMCID: PMC10938148 DOI: 10.5009/gnl230125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/06/2023] [Accepted: 08/15/2023] [Indexed: 10/17/2023] Open
Abstract
The current standard treatment for muscularis propria-invasive (T2) colorectal cancer is surgical colectomy with lymph node dissection. With the advent of new endoscopic resection techniques, such as endoscopic full-thickness resection or endoscopic intermuscular dissection, T2 colorectal cancer, with metastasis to 20%-25% of the dissected lymph nodes, may be the next candidate for endoscopic resection following submucosal-invasive (T1) colorectal cancer. We present a novel endoscopic treatment strategy for T2 colorectal cancer and suggest further study to establish evidence on oncologic and endoscopic technical safety for its clinical implementation.
Collapse
Affiliation(s)
- Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shin-ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Ker-Kan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Surgery, National University Hospital, Singapore
| | - Jonathan Wei Jie Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Khay Guan Yeoh
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
11
|
Thompson N, Morley-Bunker A, McLauchlan J, Glyn T, Eglinton T. Use of artificial intelligence for the prediction of lymph node metastases in early-stage colorectal cancer: systematic review. BJS Open 2024; 8:zrae033. [PMID: 38637299 PMCID: PMC11026097 DOI: 10.1093/bjsopen/zrae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Risk evaluation of lymph node metastasis for early-stage (T1 and T2) colorectal cancers is critical for determining therapeutic strategies. Traditional methods of lymph node metastasis prediction have limited accuracy. This systematic review aimed to review the potential of artificial intelligence in predicting lymph node metastasis in early-stage colorectal cancers. METHODS A comprehensive search was performed of papers that evaluated the potential of artificial intelligence in predicting lymph node metastasis in early-stage colorectal cancers. Studies were appraised using the Joanna Briggs Institute tools. The primary outcome was summarizing artificial intelligence models and their accuracy. Secondary outcomes included influential variables and strategies to address challenges. RESULTS Of 3190 screened manuscripts, 11 were included, involving 8648 patients from 1996 to 2023. Due to diverse artificial intelligence models and varied metrics, no data synthesis was performed. Models included random forest algorithms, support vector machine, deep learning, artificial neural network, convolutional neural network and least absolute shrinkage and selection operator regression. Artificial intelligence models' area under the curve values ranged from 0.74 to 0.9993 (slide level) and 0.9476 to 0.9956 (single-node level), outperforming traditional clinical guidelines. CONCLUSION Artificial intelligence models show promise in predicting lymph node metastasis in early-stage colorectal cancers, potentially refining clinical decisions and improving outcomes. PROSPERO REGISTRATION NUMBER CRD42023409094.
Collapse
Affiliation(s)
- Nasya Thompson
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Arthur Morley-Bunker
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Jared McLauchlan
- Department of Surgery, Te Whatu Ora – Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| | - Tamara Glyn
- Department of Surgery, University of Otago, Christchurch, New Zealand
- Department of Surgery, Te Whatu Ora – Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| | - Tim Eglinton
- Department of Surgery, University of Otago, Christchurch, New Zealand
- Department of Surgery, Te Whatu Ora – Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| |
Collapse
|
12
|
Watanabe J, Ichimasa K, Kataoka Y, Miyahara S, Miki A, Yeoh KG, Kawai S, Martínez de Juan F, Machado I, Kotani K, Sata N. Diagnostic Accuracy of Highest-Grade or Predominant Histological Differentiation of T1 Colorectal Cancer in Predicting Lymph Node Metastasis: A Systematic Review and Meta-Analysis. Clin Transl Gastroenterol 2024; 15:e00673. [PMID: 38165075 PMCID: PMC10962900 DOI: 10.14309/ctg.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Treatment guidelines for colorectal cancer (CRC) suggest 2 classifications for histological differentiation-highest grade and predominant. However, the optimal predictor of lymph node metastasis (LNM) in T1 CRC remains unknown. This systematic review aimed to evaluate the impact of the use of highest-grade or predominant differentiation on LNM determination in T1 CRC. METHODS The study protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO, registration number: CRD42023416971) and was published in OSF ( https://osf.io/TMAUN/ ) on April 13, 2023. We searched 5 electronic databases for studies assessing the diagnostic accuracy of highest-grade or predominant differentiation to determine LNM in T1 CRC. The outcomes were sensitivity and specificity. We simulated 100 cases with T1 CRC, with an LNM incidence of 11.2%, to calculate the differences in false positives and negatives between the highest-grade and predominant differentiations using a bootstrap method. RESULTS In 42 studies involving 41,290 patients, the differentiation classification had a pooled sensitivity of 0.18 (95% confidence interval [CI] 0.13-0.24) and 0.06 (95% CI 0.04-0.09) ( P < 0.0001) and specificity of 0.95 (95% CI 0.93-0.96) and 0.98 (95% CI 0.97-0.99) ( P < 0.0001) for the highest-grade and predominant differentiations, respectively. In the simulation, the differences in false positives and negatives between the highest-grade and predominant differentiations were 3.0% (range 1.6-4.4) and -1.3% (range -2.0 to -0.7), respectively. DISCUSSION Highest-grade differentiation may reduce the risk of misclassifying cases with LNM as negative, whereas predominant differentiation may prevent unnecessary surgeries. Further studies should examine differentiation classification using other predictive factors.
Collapse
Affiliation(s)
- Jun Watanabe
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
| | - Katsuro Ichimasa
- Digestive Disease Center, Showa University, Northern Yokohama Hospital, Tsuzuki-ku, Yokohama, Japan
- Department of Medicine, National University of Singapore, Singapore
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Sakyo-ku, Kyoto, Japan
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/Public Health, Sakyo-ku, Kyoto, Japan
| | - Shoko Miyahara
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Atsushi Miki
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Khay Guan Yeoh
- Department of Medicine, National University of Singapore, Singapore
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore
| | - Shigeo Kawai
- Department of Diagnostic Pathology, Tochigi Medical Center Shimotsuga, Tochigi-City, Tochigi, Japan
| | - Fernando Martínez de Juan
- Department of Gastroenterology and Endoscopy Unit, Instituto Valenciano de Oncología, Valencia, Spain
- Endoscopy Unit, Hospital Quiron Salud, Valencia, Spain
- Medicine, Universidad Cardenal Herrrera-CEU, CEU Universities, Valencia, Spain
| | - Isidro Machado
- Pathology Department, Instituto Valenciano de Oncología, Patologika Laboratory Hospital Quiron Salud and Pathology Department University of Valencia, Valencia, Spain
- CIBERONC, Madrid, Spain
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| |
Collapse
|
13
|
Huang X, Yang Z, Qin W, Li X, Su S, Huang J. Construction of machine learning models based on transrectal ultrasound combined with contrast-enhanced ultrasound to predict preoperative regional lymph node metastasis of rectal cancer. Heliyon 2024; 10:e26433. [PMID: 38390137 PMCID: PMC10882134 DOI: 10.1016/j.heliyon.2024.e26433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
Purpose Constructing a machine learning model based on transrectal ultrasound (TRUS) combined with contrast-enhanced ultrasound (CEUS) to predict preoperative regional lymph node metastasis (RLNM) of rectal cancer and provide new references for decision-making. Materials and methods 233 patients with rectal cancer were enrolled and underwent TRUS and CEUS prior to surgery. Clinicopathological and ultrasound data were collected to analyze the correlation of RLNM status, clinical features and ultrasound parameters. A 75% training set and 25% test set were utilized to construct seven machine learning algorithms. The DeLong test was used to assess the model's diagnostic performance, then chose the best one to predict RLNM of rectal cancer. Results The diagnostic performance was most dependent on the following: MMT difference (36), length (30), location (29), AUC ratio (27), and PI ratio (24). The prediction accuracy, sensitivity, specificity, precision, and F1 score range of KNN, Bayes, MLP, LR, SVM, RF, and LightGBM were (0.553-0.857), (0.000-0.935), (0.600-1.000), (0.557-0.952), and (0.617-0.852), respectively. The LightGBM model exhibited the optimal accuracy (0.857) and F1 score (0.852). The AUC for machine learning analytics were (0.517-0.941, 95% CI: 0.380-0.986). The LightGBM model exhibited the highest AUC (0.941, 95% CI: 0.843-0.986), though no statistic significant showed in comparison with the SVM, LR, RF, and MLP models (P > 0.05), it was significantly higher than that of the KNN and Bayes models (P < 0.05). Conclusion The LightGBM machine learning model based on TRUS combined with CEUS may help predict RLNM prior to surgery and provide new references for clinical treatment in rectal cancer.
Collapse
Affiliation(s)
- Xuanzhang Huang
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, PR China
| | - Zhendong Yang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, PR China
| | - Wanyue Qin
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, PR China
| | - Xigui Li
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, PR China
| | - Shitao Su
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, PR China
| | - Jianyuan Huang
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, PR China
| |
Collapse
|
14
|
Ichimasa K, Kudo SE, Yeoh KG. Commentary: An artificial intelligence prediction model outperforms conventional guidelines in predicting lymph node metastasis of T1 colorectal cancer. Front Oncol 2024; 14:1337576. [PMID: 38406818 PMCID: PMC10889107 DOI: 10.3389/fonc.2024.1337576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Affiliation(s)
- Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shin-ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Khay Guan Yeoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore, Singapore
| |
Collapse
|
15
|
Ichimasa K, Kudo SE, Misawa M, Takashina Y, Yeoh KG, Miyachi H. Role of the artificial intelligence in the management of T1 colorectal cancer. Dig Liver Dis 2024:S1590-8658(24)00250-0. [PMID: 38311532 DOI: 10.1016/j.dld.2024.01.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/24/2024] [Indexed: 02/06/2024]
Abstract
Approximately 10% of submucosal invasive (T1) colorectal cancers demonstrate extraintestinal lymph node metastasis, necessitating surgical intervention with lymph node dissection. The ability to identify T1b (submucosal invasion depth ≥ 1000 µm) as a risk factor for lymph node metastasis via pre-treatment endoscopy is crucial in guiding treatment strategies. Accurately distinguishing T1b from T1a (submucosal invasion depth < 1000 µm) or dysplasia remains a significant challenge for artificial intelligence (AI) systems, which require high and consistent diagnostic capabilities. Moreover, as endoscopic therapies like endoscopic full-thickness resection and endoscopic intermuscular dissection evolve, and the focus on reducing unnecessary surgeries intensifies, the initial management of T1 colorectal cancers via endoscopic treatment is anticipated to increase. Consequently, the development of highly accurate and reliable AI systems is essential, not only for pre-treatment depth assessment but also for post-treatment risk stratification of lymph node metastasis. While such AI diagnostic systems are still under development, significant advancements are expected in the near future to improve decision-making in T1 colorectal cancer management.
Collapse
Affiliation(s)
- Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama, Kanagawa 224-8503, Japan; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama, Kanagawa 224-8503, Japan
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama, Kanagawa 224-8503, Japan
| | - Yuki Takashina
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama, Kanagawa 224-8503, Japan
| | - Khay Guan Yeoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hideyuki Miyachi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama, Kanagawa 224-8503, Japan
| |
Collapse
|
16
|
Bernklev L, Nilsen JA, Augestad KM, Holme Ø, Pilonis ND. Management of non-curative endoscopic resection of T1 colon cancer. Best Pract Res Clin Gastroenterol 2024; 68:101891. [PMID: 38522886 DOI: 10.1016/j.bpg.2024.101891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/07/2024] [Indexed: 03/26/2024]
Abstract
Endoscopic resection techniques enable en-bloc resection of T1 colon cancers. A complete removal of T1 colon cancer can be considered curative when histologic examination of the specimens shows none of the high-risk factors for lymph nodes metastases. Criteria predicting lymph nodes metastases include deep submucosal invasion, poor differentiation, lymphovascular invasion, and high-grade tumor budding. In these cases, complete (R0), local endoscopic resection is considered sufficient as negligible risk of lymph nodes metastases does not outweigh morbidity and mortality associated with surgical resection. Challenges arise when endoscopic resection is incomplete (RX/R1) or high-risk histological features are present. The risk of lymph node metastasis in T1 CRC ranges from 1% to 36.4%, depending on histologic risk factors. Presence of any risk factor labels the patient "high risk," warranting oncologic surgery with mesocolic lymphadenectomy. However, even if 70%-80% of T1-CRC patients are classified as high-risk, more than 90% are without lymph node involvement after oncological surgery. Surgical overtreatment in T1 CRC is a challenge, requiring a balance between oncologic safety and minimizing morbidity/mortality. This narrative review explores the landscape of managing non-curative T1 colon cancer, focusing on the choice between advanced endoscopic resection techniques and surgical interventions. We discuss surveillance strategies and shared decision-making, emphasizing the importance of a multidisciplinary approach.
Collapse
Affiliation(s)
- Linn Bernklev
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway; Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway.
| | - Jens Aksel Nilsen
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway; Vestre Viken Hospital Trust, Bærum Hospital, Norway
| | - Knut Magne Augestad
- Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway; Division of Surgery Campus Ahus, University of Oslo, Oslo, Norway
| | - Øyvind Holme
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway; Department of Research, Sorlandet Hospital Trust, Kristiansand, Norway
| | - Nastazja Dagny Pilonis
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway; Medical Center of Postgraduate Education, Warsaw, Poland; Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|
17
|
Dang H, Verhoeven DA, Boonstra JJ, van Leerdam ME. Management after non-curative endoscopic resection of T1 rectal cancer. Best Pract Res Clin Gastroenterol 2024; 68:101895. [PMID: 38522888 DOI: 10.1016/j.bpg.2024.101895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/03/2024] [Accepted: 02/15/2024] [Indexed: 03/26/2024]
Abstract
Since the introduction of population-based screening, increasing numbers of T1 rectal cancers are detected and removed by local endoscopic resection. Patients can be cured with endoscopic resection alone, but there is a possibility of residual tumor cells remaining after the initial resection. These can be located intraluminally at the resection site or extraluminally in the form of (lymph node) metastases. To decrease the risk of residual cells progressing towards more advanced disease, additional treatment is usually needed. However, with the currently available risk stratification models, it remains challenging to determine who should and should not be further treated after non-curative endoscopic resection. In this review, the different management strategies for patients with non-curatively treated T1 rectal cancers are discussed, along with the available evidence for each strategy and relevant considerations for clinical decision making. Furthermore, we provide practical guidance on the management and surveillance following non-curative endoscopic resection of T1 rectal cancer.
Collapse
Affiliation(s)
- Hao Dang
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Daan A Verhoeven
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jurjen J Boonstra
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
18
|
Galadima H, Anson-Dwamena R, Johnson A, Bello G, Adunlin G, Blando J. Machine Learning as a Tool for Early Detection: A Focus on Late-Stage Colorectal Cancer across Socioeconomic Spectrums. Cancers (Basel) 2024; 16:540. [PMID: 38339293 PMCID: PMC10854986 DOI: 10.3390/cancers16030540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE To assess the efficacy of various machine learning (ML) algorithms in predicting late-stage colorectal cancer (CRC) diagnoses against the backdrop of socio-economic and regional healthcare disparities. METHODS An innovative theoretical framework was developed to integrate individual- and census tract-level social determinants of health (SDOH) with sociodemographic factors. A comparative analysis of the ML models was conducted using key performance metrics such as AUC-ROC to evaluate their predictive accuracy. Spatio-temporal analysis was used to identify disparities in late-stage CRC diagnosis probabilities. RESULTS Gradient boosting emerged as the superior model, with the top predictors for late-stage CRC diagnosis being anatomic site, year of diagnosis, age, proximity to superfund sites, and primary payer. Spatio-temporal clusters highlighted geographic areas with a statistically significant high probability of late-stage diagnoses, emphasizing the need for targeted healthcare interventions. CONCLUSIONS This research underlines the potential of ML in enhancing the prognostic predictions in oncology, particularly in CRC. The gradient boosting model, with its robust performance, holds promise for deployment in healthcare systems to aid early detection and formulate localized cancer prevention strategies. The study's methodology demonstrates a significant step toward utilizing AI in public health to mitigate disparities and improve cancer care outcomes.
Collapse
Affiliation(s)
- Hadiza Galadima
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (R.A.-D.); (A.J.); (J.B.)
| | - Rexford Anson-Dwamena
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (R.A.-D.); (A.J.); (J.B.)
| | - Ashley Johnson
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (R.A.-D.); (A.J.); (J.B.)
| | - Ghalib Bello
- Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Georges Adunlin
- Department of Pharmaceutical, Social and Administrative Sciences, Samford University, Birmingham, AL 35229, USA;
| | - James Blando
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (R.A.-D.); (A.J.); (J.B.)
| |
Collapse
|
19
|
Ueno Y, Oda M, Yamaguchi T, Fukuoka H, Nejima R, Kitaguchi Y, Miyake M, Akiyama M, Miyata K, Kashiwagi K, Maeda N, Shimazaki J, Noma H, Mori K, Oshika T. Deep learning model for extensive smartphone-based diagnosis and triage of cataracts and multiple corneal diseases. Br J Ophthalmol 2024:bjo-2023-324488. [PMID: 38242700 DOI: 10.1136/bjo-2023-324488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/17/2023] [Indexed: 01/21/2024]
Abstract
AIM To develop an artificial intelligence (AI) algorithm that diagnoses cataracts/corneal diseases from multiple conditions using smartphone images. METHODS This study included 6442 images that were captured using a slit-lamp microscope (6106 images) and smartphone (336 images). An AI algorithm was developed based on slit-lamp images to differentiate 36 major diseases (cataracts and corneal diseases) into 9 categories. To validate the AI model, smartphone images were used for the testing dataset. We evaluated AI performance that included sensitivity, specificity and receiver operating characteristic (ROC) curve for the diagnosis and triage of the diseases. RESULTS The AI algorithm achieved an area under the ROC curve of 0.998 (95% CI, 0.992 to 0.999) for normal eyes, 0.986 (95% CI, 0.978 to 0.997) for infectious keratitis, 0.960 (95% CI, 0.925 to 0.994) for immunological keratitis, 0.987 (95% CI, 0.978 to 0.996) for cornea scars, 0.997 (95% CI, 0.992 to 1.000) for ocular surface tumours, 0.993 (95% CI, 0.984 to 1.000) for corneal deposits, 1.000 (95% CI, 1.000 to 1.000) for acute angle-closure glaucoma, 0.992 (95% CI, 0.985 to 0.999) for cataracts and 0.993 (95% CI, 0.985 to 1.000) for bullous keratopathy. The triage of referral suggestion using the smartphone images exhibited high performance, in which the sensitivity and specificity were 1.00 (95% CI, 0.478 to 1.00) and 1.00 (95% CI, 0.976 to 1.000) for 'urgent', 0.867 (95% CI, 0.683 to 0.962) and 1.00 (95% CI, 0.971 to 1.000) for 'semi-urgent', 0.853 (95% CI, 0.689 to 0.950) and 0.983 (95% CI, 0.942 to 0.998) for 'routine' and 1.00 (95% CI, 0.958 to 1.00) and 0.896 (95% CI, 0.797 to 0.957) for 'observation', respectively. CONCLUSIONS The AI system achieved promising performance in the diagnosis of cataracts and corneal diseases.
Collapse
Affiliation(s)
- Yuta Ueno
- Department of Ophthalmology, University of Tsukuba, Tsukuba, Japan
| | - Masahiro Oda
- Information Technology Center, Nagoya University, Nagoya, Japan
- Graduate School of Informatics, Nagoya University, Nagoya, Japan
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Hideki Fukuoka
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Yoshiyuki Kitaguchi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Vusual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masato Akiyama
- Department of Ocular Pathology and Imaging Science, Kyushu University, Fukuoka, Japan
| | | | - Kenji Kashiwagi
- Department of Ophthalmology, University of Yamanashi, Kofu, Japan
| | - Naoyuki Maeda
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Hisashi Noma
- Department of Data Science, Institute of Statistical Mathematics, Tokyo, Japan
| | - Kensaku Mori
- Information Technology Center, Nagoya University, Nagoya, Japan
- Graduate School of Informatics, Nagoya University, Nagoya, Japan
- National Institute of Informatics, Tokyo, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
20
|
Ajithkumar P, Vasantharajan SS, Pattison S, McCall JL, Rodger EJ, Chatterjee A. Exploring Potential Epigenetic Biomarkers for Colorectal Cancer Metastasis. Int J Mol Sci 2024; 25:874. [PMID: 38255946 PMCID: PMC10815915 DOI: 10.3390/ijms25020874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Metastatic progression is a complex, multistep process and the leading cause of cancer mortality. There is growing evidence that emphasises the significance of epigenetic modification, specifically DNA methylation and histone modifications, in influencing colorectal (CRC) metastasis. Epigenetic modifications influence the expression of genes involved in various cellular processes, including the pathways associated with metastasis. These modifications could contribute to metastatic progression by enhancing oncogenes and silencing tumour suppressor genes. Moreover, specific epigenetic alterations enable cancer cells to acquire invasive and metastatic characteristics by altering cell adhesion, migration, and invasion-related pathways. Exploring the involvement of DNA methylation and histone modification is crucial for identifying biomarkers that impact cancer prediction for metastasis in CRC. This review provides a summary of the potential epigenetic biomarkers associated with metastasis in CRC, particularly DNA methylation and histone modifications, and examines the pathways associated with these biomarkers.
Collapse
Affiliation(s)
- Priyadarshana Ajithkumar
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin 9016, New Zealand; (P.A.)
| | - Sai Shyam Vasantharajan
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin 9016, New Zealand; (P.A.)
| | - Sharon Pattison
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9016, New Zealand
| | - John L. McCall
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin 9016, New Zealand
| | - Euan J. Rodger
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin 9016, New Zealand; (P.A.)
| | - Aniruddha Chatterjee
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin 9016, New Zealand; (P.A.)
- School of Health Sciences and Technology, UPES University, Dehradun 248007, India
| |
Collapse
|
21
|
Li JW, Wang LM, Ichimasa K, Lin KW, Ngu JCY, Ang TL. Use of artificial intelligence in the management of T1 colorectal cancer: a new tool in the arsenal or is deep learning out of its depth? Clin Endosc 2024; 57:24-35. [PMID: 37743068 PMCID: PMC10834280 DOI: 10.5946/ce.2023.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/11/2023] [Indexed: 09/26/2023] Open
Abstract
The field of artificial intelligence is rapidly evolving, and there has been an interest in its use to predict the risk of lymph node metastasis in T1 colorectal cancer. Accurately predicting lymph node invasion may result in fewer patients undergoing unnecessary surgeries; conversely, inadequate assessments will result in suboptimal oncological outcomes. This narrative review aims to summarize the current literature on deep learning for predicting the probability of lymph node metastasis in T1 colorectal cancer, highlighting areas of potential application and barriers that may limit its generalizability and clinical utility.
Collapse
Affiliation(s)
- James Weiquan Li
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore
- Academic Medicine Center, Duke-NUS Medical School, Singapore
| | - Lai Mun Wang
- Department of Laboratory Medicine, Changi General Hospital, Singapore Health Services, Singapore
| | - Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kenneth Weicong Lin
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore
- Academic Medicine Center, Duke-NUS Medical School, Singapore
| | - James Chi-Yong Ngu
- Department of General Surgery, Changi General Hospital, Singapore Health Services, Singapore
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore
- Academic Medicine Center, Duke-NUS Medical School, Singapore
| |
Collapse
|
22
|
Haze T, Kawano R, Takase H, Suzuki S, Hirawa N, Tamura K. Influence on the accuracy in ChatGPT: Differences in the amount of information per medical field. Int J Med Inform 2023; 180:105283. [PMID: 37931432 DOI: 10.1016/j.ijmedinf.2023.105283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES Although ChatGPT was not developed for medical use, there is growing interest in its use in medical fields. Understanding its capabilities and precautions for its use in the medical field is an urgent matter. We hypothesized that differences in the amounts of information published in different medical fields would be proportionate to the amounts of training ChatGPT receives in those fields, and hence its accuracy in providing answers. STUDY DESIGN A non-clinical experimental study. METHODS We administered the Japanese National Medical Examination to GPT-3.5 and GPT-4 to examine the rates of accuracy and consistency in their responses. We counted the total number of documents in the Web of Science Core Collection per medical field and assessed the relationship with ChatGPT's accuracy. We also performed multivariate-adjusted models to investigate the risk factors for incorrect answers. RESULTS For GPT-4, we confirmed an accuracy rate of 81.0 % and a consistency rate of 88.8 % on the exam; both showed improvement compared to those for GPT-3.5. A positive correlation was observed between the accuracy rate and consistency rate (R = 0.51, P < 0.001). The number of documents per medical field was significantly correlated with the accuracy rate in that medical field (R = 0.44, P < 0.05), with relatively few publications being an independent risk factor for incorrect answers. CONCLUSIONS Checking consistency may help identify incorrect answers when using ChatGPT. Users should be aware that the accuracy of the answers by ChatGPT may decrease when it is asked about topics with limited published information, such as new drugs and diseases.
Collapse
Affiliation(s)
- Tatsuya Haze
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan; Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan; YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama, Japan.
| | - Rina Kawano
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan; Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan
| | - Hajime Takase
- YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama, Japan; Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shota Suzuki
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan; Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan
| | - Nobuhito Hirawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan; Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan; Clinical Education and Training Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| |
Collapse
|
23
|
Zhang C, Xu J, Tang R, Yang J, Wang W, Yu X, Shi S. Novel research and future prospects of artificial intelligence in cancer diagnosis and treatment. J Hematol Oncol 2023; 16:114. [PMID: 38012673 PMCID: PMC10680201 DOI: 10.1186/s13045-023-01514-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
Research into the potential benefits of artificial intelligence for comprehending the intricate biology of cancer has grown as a result of the widespread use of deep learning and machine learning in the healthcare sector and the availability of highly specialized cancer datasets. Here, we review new artificial intelligence approaches and how they are being used in oncology. We describe how artificial intelligence might be used in the detection, prognosis, and administration of cancer treatments and introduce the use of the latest large language models such as ChatGPT in oncology clinics. We highlight artificial intelligence applications for omics data types, and we offer perspectives on how the various data types might be combined to create decision-support tools. We also evaluate the present constraints and challenges to applying artificial intelligence in precision oncology. Finally, we discuss how current challenges may be surmounted to make artificial intelligence useful in clinical settings in the future.
Collapse
Affiliation(s)
- Chaoyi Zhang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, No. 270 Dong'An Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
- Shanghai Pancreatic Cancer Institute, No. 399 Lingling Road, Shanghai, 200032, People's Republic of China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jin Xu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, No. 270 Dong'An Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
- Shanghai Pancreatic Cancer Institute, No. 399 Lingling Road, Shanghai, 200032, People's Republic of China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, People's Republic of China
| | - Rong Tang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, No. 270 Dong'An Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
- Shanghai Pancreatic Cancer Institute, No. 399 Lingling Road, Shanghai, 200032, People's Republic of China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jianhui Yang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, No. 270 Dong'An Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
- Shanghai Pancreatic Cancer Institute, No. 399 Lingling Road, Shanghai, 200032, People's Republic of China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, People's Republic of China
| | - Wei Wang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, No. 270 Dong'An Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
- Shanghai Pancreatic Cancer Institute, No. 399 Lingling Road, Shanghai, 200032, People's Republic of China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, People's Republic of China
| | - Xianjun Yu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, No. 270 Dong'An Road, Shanghai, 200032, People's Republic of China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
- Shanghai Pancreatic Cancer Institute, No. 399 Lingling Road, Shanghai, 200032, People's Republic of China.
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Si Shi
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, No. 270 Dong'An Road, Shanghai, 200032, People's Republic of China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
- Shanghai Pancreatic Cancer Institute, No. 399 Lingling Road, Shanghai, 200032, People's Republic of China.
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, People's Republic of China.
| |
Collapse
|
24
|
Saez de Gordoa K, Rodrigo-Calvo MT, Archilla I, Lopez-Prades S, Diaz A, Tarragona J, Machado I, Ruiz Martín J, Zaffalon D, Daca-Alvarez M, Pellisé M, Camps J, Cuatrecasas M. Lymph Node Molecular Analysis with OSNA Enables the Identification of pT1 CRC Patients at Risk of Recurrence: A Multicentre Study. Cancers (Basel) 2023; 15:5481. [PMID: 38001742 PMCID: PMC10670609 DOI: 10.3390/cancers15225481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Early-stage colorectal carcinoma (CRC)-pT1-is a therapeutic challenge and presents some histological features related to lymph node metastasis (LNM). A significant proportion of pT1 CRCs are treated surgically, resulting in a non-negligible surgical-associated mortality rate of 1.5-2%. Among these cases, approximately 6-16% exhibit LNM, but the impact on survival is unclear. Therefore, there is an unmet need to establish an objective and reliable lymph node (LN) staging method to optimise the therapeutic management of pT1 CRC patients and to avoid overtreating or undertreating them. In this multicentre study, 89 patients with pT1 CRC were included. All histological features associated with LNM were evaluated. LNs were assessed using two methods, One-Step Nucleic Acid Amplification (OSNA) and the conventional FFPE plus haematoxylin and eosin (H&E) staining. OSNA is an RT-PCR-based method for amplifying CK19 mRNA. Our aim was to assess the performance of OSNA and H&E in evaluating LNs to identify patients at risk of recurrence and to optimise their clinical management. We observed an 80.9% concordance in LN assessment using the two methods. In 9% of cases, LNs were found to be positive using H&E, and in 24.7% of cases, LNs were found to be positive using OSNA. The OSNA results are provided as the total tumour load (TTL), defined as the total tumour burden present in all the LNs of a surgical specimen. In CRC, a TTL ≥ 6000 CK19 m-RNA copies/µL is associated with poor prognosis. Three patients had TTL > 6000 copies/μL, which was associated with higher tumour budding. The discrepancies observed between the OSNA and H&E results were mostly attributed to tumour allocation bias. We concluded that LN assessment with OSNA enables the identification of pT1 CRC patients at some risk of recurrence and helps to optimise their clinical management.
Collapse
Affiliation(s)
- Karmele Saez de Gordoa
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clinic, 08036 Barcelona, Spain; (K.S.d.G.); (M.T.R.-C.); (I.A.); (S.L.-P.); (A.D.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (M.P.); (J.C.)
| | - Maria Teresa Rodrigo-Calvo
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clinic, 08036 Barcelona, Spain; (K.S.d.G.); (M.T.R.-C.); (I.A.); (S.L.-P.); (A.D.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (M.P.); (J.C.)
| | - Ivan Archilla
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clinic, 08036 Barcelona, Spain; (K.S.d.G.); (M.T.R.-C.); (I.A.); (S.L.-P.); (A.D.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (M.P.); (J.C.)
| | - Sandra Lopez-Prades
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clinic, 08036 Barcelona, Spain; (K.S.d.G.); (M.T.R.-C.); (I.A.); (S.L.-P.); (A.D.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (M.P.); (J.C.)
| | - Alba Diaz
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clinic, 08036 Barcelona, Spain; (K.S.d.G.); (M.T.R.-C.); (I.A.); (S.L.-P.); (A.D.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (M.P.); (J.C.)
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Department of Clinical Foundations, University of Barcelona (UB), 08036 Barcelona, Spain
| | - Jordi Tarragona
- Pathology Department, Hospital Arnau de Vilanova, 25198 Lleida, Spain;
| | - Isidro Machado
- Pathology Department, Instituto Valenciano de Oncología, Hospital Quirón-Salud Valencia, University of Valencia, 46010 Valencia, Spain;
- Centro de Investigación Biomédica en Red en Cancer (CIBERONC), 28029 Madrid, Spain
| | - Juan Ruiz Martín
- Pathology Department, Virgen de la Salud Hospital, 45071 Toledo, Spain;
| | - Diana Zaffalon
- Gastroenterology Department, Consorci Sanitari de Terrassa, 08227 Terrassa, Spain;
| | - Maria Daca-Alvarez
- Gastroenterology Department, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain;
| | - Maria Pellisé
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (M.P.); (J.C.)
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Gastroenterology Department, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain;
| | - Jordi Camps
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (M.P.); (J.C.)
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Cell Biology and Medical Genetics Unit, Department of Cell Biology, Physiology and Immunology, Faculty of Medicine, Autonomous University of Barcelona (UAB), 08193 Bellaterra, Spain
| | - Miriam Cuatrecasas
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clinic, 08036 Barcelona, Spain; (K.S.d.G.); (M.T.R.-C.); (I.A.); (S.L.-P.); (A.D.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (M.P.); (J.C.)
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Department of Clinical Foundations, University of Barcelona (UB), 08036 Barcelona, Spain
| |
Collapse
|
25
|
Takashina Y, Kudo SE, Kouyama Y, Ichimasa K, Miyachi H, Mori Y, Kudo T, Maeda Y, Ogawa Y, Hayashi T, Wakamura K, Enami Y, Sawada N, Baba T, Nemoto T, Ishida F, Misawa M. Whole slide image-based prediction of lymph node metastasis in T1 colorectal cancer using unsupervised artificial intelligence. Dig Endosc 2023; 35:902-908. [PMID: 36905308 DOI: 10.1111/den.14547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/08/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVES Lymph node metastasis (LNM) prediction for T1 colorectal cancer (CRC) is critical for determining the need for surgery after endoscopic resection because LNM occurs in 10%. We aimed to develop a novel artificial intelligence (AI) system using whole slide images (WSIs) to predict LNM. METHODS We conducted a retrospective single center study. To train and test the AI model, we included LNM status-confirmed T1 and T2 CRC between April 2001 and October 2021. These lesions were divided into two cohorts: training (T1 and T2) and testing (T1). WSIs were cropped into small patches and clustered by unsupervised K-means. The percentage of patches belonging to each cluster was calculated from each WSI. Each cluster's percentage, sex, and tumor location were extracted and learned using the random forest algorithm. We calculated the areas under the receiver operating characteristic curves (AUCs) to identify the LNM and the rate of over-surgery of the AI model and the guidelines. RESULTS The training cohort contained 217 T1 and 268 T2 CRCs, while 100 T1 cases (LNM-positivity 15%) were the test cohort. The AUC of the AI system for the test cohort was 0.74 (95% confidence interval [CI] 0.58-0.86), and 0.52 (95% CI 0.50-0.55) using the guidelines criteria (P = 0.0028). This AI model could reduce the 21% of over-surgery compared to the guidelines. CONCLUSION We developed a pathologist-independent predictive model for LNM in T1 CRC using WSI for determination of the need for surgery after endoscopic resection. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN000046992, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000053590).
Collapse
Affiliation(s)
- Yuki Takashina
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yuta Kouyama
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore City, Singapore
| | - Hideyuki Miyachi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yuichi Mori
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Toyoki Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yasuharu Maeda
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yushi Ogawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Takemasa Hayashi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Kunihiko Wakamura
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yuta Enami
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Naruhiko Sawada
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Toshiyuki Baba
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Tetsuo Nemoto
- Department of Diagnostic Pathology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| |
Collapse
|
26
|
Piao ZH, Ge R, Lu L. An artificial intelligence prediction model outperforms conventional guidelines in predicting lymph node metastasis of T1 colorectal cancer. Front Oncol 2023; 13:1229998. [PMID: 37941556 PMCID: PMC10628635 DOI: 10.3389/fonc.2023.1229998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
Background According to guidelines, a lot of patients with T1 colorectal cancers (CRCs) undergo additional surgery with lymph node dissection after being treated by endoscopic resection (ER) despite the low incidence of lymph node metastasis (LNM). Aim The aim of this study was to develop an artificial intelligence (AI) model to more effectively identify T1 CRCs at risk for LNM and reduce the rate of unnecessary additional surgery. Methods We retrospectively analyzed 651 patients with T1 CRCs. The patient cohort was randomly divided into a training set (546 patients) and a test set (105 patients) (ratio 5:1), and a classification and regression tree (CART) algorithm was trained on the training set to develop a predictive AI model for LNM. The model used 12 clinicopathological factors to predict positivity or negativity for LNM. To compare the performance of the AI model with the conventional guidelines, the test set was evaluated according to the Japanese Society for Cancer of the Colon and Rectum (JSCCR) and National Comprehensive Cancer Network (NCCN) guidelines. Finally, we tested the performance of the AI model using the test set and compared it with the JSCCR and NCCN guidelines. Results The AI model had better predictive performance (AUC=0.960) than the JSCCR (AUC=0.588) and NCCN guidelines (AUC=0.850). The specificity (85.8% vs. 17.5%, p<0.001), balanced accuracy (92.9% vs. 58.7%, p=0.001), and the positive predictive value (36.3% vs. 9.0%, p=0.001) of the AI model were significantly better than those of the JSCCR guidelines and reduced the percentage of the high-risk group for LNM from 83.8% (JSCCR) to 20.9%. The specificity of the AI model was higher than that of the NCCN guidelines (85.8% vs. 82.4%, p=0.557), but there was no significant difference between the two. The sensitivity of the NCCN guidelines was lower than that of our AI model (87.5% vs. 100%, p=0.301), and according to the NCCN guidelines, 1.2% of the 105 test set patients had missed diagnoses. Conclusion The AI model has better performance than conventional guidelines for predicting LNM in T1 CRCs and therefore could significantly reduce unnecessary additional surgery.
Collapse
|
27
|
Shi K, Yang Z, Leng K. Treatment for T1 colorectal cancers substratified by site and size: "horses for courses". Front Med (Lausanne) 2023; 10:1230844. [PMID: 37901402 PMCID: PMC10602675 DOI: 10.3389/fmed.2023.1230844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/21/2023] [Indexed: 10/31/2023] Open
Abstract
Background Owing to advances in diagnostic technology, the diagnosis of T1 colorectal cancers (CRCs) continues to increase. However, the optimal management of T1 CRCs in the Western Hemisphere remains unclear due to limited population-based data directly comparing the efficacy of endoscopic therapy (ET) and surgical resection (SR). The purpose of this study was to report outcome data from a large Western cohort of patients who underwent ET or SR for early CRCs. Methods The SEER-18 database was used to identify patients with T1 CRCs diagnosed from 2004 to 2018 treated with ET or SR. Multivariable logistic regression models were employed to identify variables related to lymph node metastasis (LNM). Rates of ET and 1-year relative survival were calculated for each year. Effect of ET or SR on overall survival and cancer-specific survival was compared using Kaplan-Meier method stratified by tumor size and site. Results A total of 28,430 T1 CRCs patients were identified from 2004 to 2018 in US, with 22.7% undergoing ET and 77.3% undergoing SR. The incidence of T1 CRCs was 6.15 per 100,000 person-years, with male patients having a higher incidence. Left-sided colon was the most frequent location of tumors. The utilization of ET increased significantly from 2004 to 2018, with no significant change in 1-year relative survival rate. Predictors of LNM were age at diagnosis, sex, race, tumor size, histology, grade, and location. The 5-year relative survival rates were 91.4 and 95.4% for ET and SR, respectively. Subgroup analysis showed that OS and CSS were similar between ET and SR in T1N0M0 left-sided colon cancers with tumors 2 cm or less and in rectal cancers with tumors 1 cm or less. Conclusion Our study showed that ET was feasible and safe for patients with left-sided T1N0M0 colon cancers and tumors of 2 cm or less, as well as T1N0M0 rectal cancers and tumors of 1 cm or less. Therefore, the over- and under-use of ET should be avoided by carefully selecting patients based on tumor size and site.
Collapse
Affiliation(s)
- Kexin Shi
- The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Zhen Yang
- Department of Hepatopancreatobiliary Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
- Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
| | - Kaiming Leng
- Department of Hepatopancreatobiliary Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
- Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
| |
Collapse
|
28
|
Jurescu A, Văduva A, Vița O, Gheju A, Cornea R, Lăzureanu C, Mureșan A, Cornianu M, Tăban S, Dema A. Colorectal Carcinomas: Searching for New Histological Parameters Associated with Lymph Node Metastases. Medicina (Kaunas) 2023; 59:1761. [PMID: 37893479 PMCID: PMC10608479 DOI: 10.3390/medicina59101761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/21/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Colorectal cancer (CRC) continues to be an essential public health problem. Our study aimed to evaluate the prognostic significance of classic prognostic factors and some less-studied histopathological parameters in CRC. Materials and Methods: We performed a retrospective study on 71 colorectal carcinoma patients who underwent surgery at the "Pius Brînzeu" County Clinical Emergency Hospital in Timișoara, Romania. We analyzed the classic parameters but also tumor budding (TB), poorly differentiated clusters (PDCs) of cells, tumor-infiltrating lymphocytes (TILs), and the configuration of the tumor border on hematoxylin-eosin slides. Results: A high degree of malignancy (p = 0.006), deep invasion of the intestinal wall (p = 0.003), an advanced stage of the disease (p < 0.0001), lymphovascular invasion (p < 0.0001), perineural invasion (p < 0.0001), high-grade TB (p < 0.0001), high-grade PDCs (p < 0.0001), infiltrative tumor border configuration (p < 0.0001) showed a positive correlation with lymph node metastases. Conclusions: The analyzed parameters positively correlate with unfavorable prognostic factors in CRC. We highlight the value of classic prognostic factors along with a series of less-known parameters that are more accessible and easier to evaluate using standard staining techniques and that could predict the risk of relapse or aggressive evolution in patients with CRC.
Collapse
Affiliation(s)
- Aura Jurescu
- Department of Microscopic Morphology-Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Adrian Văduva
- Department of Microscopic Morphology-Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, “Pius Brînzeu” County Clinical Emergency Hospital, 300723 Timişoara, Romania
| | - Octavia Vița
- Department of Microscopic Morphology-Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Adelina Gheju
- Emergency County Hospital Deva, 330032 Deva, Romania
| | - Remus Cornea
- Department of Microscopic Morphology-Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, “Pius Brînzeu” County Clinical Emergency Hospital, 300723 Timişoara, Romania
| | - Codruța Lăzureanu
- Department of Microscopic Morphology-Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, “Pius Brînzeu” County Clinical Emergency Hospital, 300723 Timişoara, Romania
| | - Anca Mureșan
- Department of Microscopic Morphology-Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, “Pius Brînzeu” County Clinical Emergency Hospital, 300723 Timişoara, Romania
| | - Marioara Cornianu
- Department of Microscopic Morphology-Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, “Pius Brînzeu” County Clinical Emergency Hospital, 300723 Timişoara, Romania
| | - Sorina Tăban
- Department of Microscopic Morphology-Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, “Pius Brînzeu” County Clinical Emergency Hospital, 300723 Timişoara, Romania
| | - Alis Dema
- Department of Microscopic Morphology-Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, “Pius Brînzeu” County Clinical Emergency Hospital, 300723 Timişoara, Romania
| |
Collapse
|
29
|
Li S, Li Z, Wang L, Wu M, Chen X, He C, Xu Y, Dong M, Liang Y, Chen X, Liu Z. CT morphological features for predicting the risk of lymph node metastasis in T1 colorectal cancer. Eur Radiol 2023; 33:6861-6871. [PMID: 37171490 DOI: 10.1007/s00330-023-09688-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES The aim of this study is to evaluate the feasibility of clinicopathological characteristics and computed tomography (CT) morphological features in predicting lymph node metastasis (LNM) for patients with T1 colorectal cancer (CRC). METHODS A total of 144 patients with T1 CRC who underwent CT scans and surgical resection were retrospectively included in our study. The clinicopathological characteristics and CT morphological features were assessed by two observers. Univariate and multiple logistic regression analyses were used to identify significant LNM predictive variables. Then a model was developed using the independent predictive factors. The predictive model was subjected to bootstrapping validation (1000 bootstrap resamples) to calculate the calibration curve and relative C-index. RESULTS LNM were found in 30/144 patients (20.83%). Four independent risk factors were determined in the multiple logistic regression analysis, including presence of necrosis (adjusted odds ratio [OR] = 10.32, 95% confidence interval [CI] 1.96-54.3, p = 0.004), irregular outer border (adjusted OR = 5.94, 95% CI 1.39-25.45, p = 0.035), and heterogeneity enhancement (adjusted OR = 7.35, 95% CI 3.11-17.38, p = 0.007), as well as tumor location (adjusted ORright-sided colon = 0.05 [0.01-0.60], p = 0.018; adjusted ORrectum = 0.22 [0.06-0.83], p = 0.026). In the internal validation cohort, the model showed good calibration and good discrimination with a C-index of 0.89. CONCLUSIONS There are significant associations between lymphatic metastasis status and tumor location as well as CT morphologic features in T1 CRC, which could help the doctor make decisions for additional surgery after endoscopic resection. KEY POINTS • LNM more frequently occurs in left-sided T1 colon cancer than in right-sided T1 colon and rectal cancer. • CT morphologic features are risk factors for LNM of T1 CRC, which may be related to fundamental biological behaviors. • The combination of tumor location and CT morphologic features can more effectively assist in predicting LNM in patients with T1 CRC, and decrease the rate of unnecessary extra surgeries after endoscopic resection.
Collapse
Affiliation(s)
- Suyun Li
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
- School of Medicine, South China University of Technology, Guangzhou, 510006, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Zhenhui Li
- Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, 650118, China
| | - Li Wang
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, 511400, China
| | - Mimi Wu
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Xiaobo Chen
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Chutong He
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1 Panfu Road, Guangzhou, 510180, China
| | - Yao Xu
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
- School of Medicine, South China University of Technology, Guangzhou, 510006, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Mengyi Dong
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, 511400, China
| | - Yanting Liang
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Xin Chen
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1 Panfu Road, Guangzhou, 510180, China.
| | - Zaiyi Liu
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China.
- School of Medicine, South China University of Technology, Guangzhou, 510006, China.
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
| |
Collapse
|
30
|
Kuo LJ, Fang CY, Su RY, Lin YK, Wei PL, Kung CH, Chen CL. Tn as a potential predictor for regional lymph node metastasis in T1 colorectal cancer. Asian J Surg 2023; 46:4302-4307. [PMID: 37173248 DOI: 10.1016/j.asjsur.2023.04.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Approximately 10 percent of T1 colorectal cancer (CRC) has lymph node metastasis. In this study, we aimed to determine possible predictors for nodal involvement in order to aid selection of appropriate patients for organ-preserving strategies. METHODS We retrospectively reviewed CRC patients underwent radical surgery from January 2009 to December 2016, with final pathology report disclosed as T1 lesion. The paraffin-embedded samples were achieved for glycosylated proteins expression analysis by immunohistochemistry. RESULTS Totally, 111 CRC patients with T1 lesion were enrolled in this study. Of these patients, seventeen patients had nodal metastases, with the lymph node positive rate of 15.3%. Semiquantitative analysis of immunohistochemical results indicated that mean value of Tn protein expression in T1 CRC specimens was significantly different between patients with and without lymph node metastasis (63.6 vs. 27.4; p = 0.018). CONCLUSIONS Our data shown that Tn expression may be applied as a molecular predictor for regional lymph node metastasis in T1 CRC. Moreover, the organ-preserving strategy could be improved by proper classification of patients. The mechanism involved in expression of Tn glycosylation protein and CRC metastasis need further investigation.
Collapse
Affiliation(s)
- Li-Jen Kuo
- Division of Colorectal Surgery, Taipei Medical University Hospital, Taipei, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Yeu Fang
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan Town, Taiwan
| | - Ruei-Yu Su
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Pathology and Laboratory Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, 33301, Taiwan
| | - Po-Li Wei
- Division of Colorectal Surgery, Taipei Medical University Hospital, Taipei, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ching-Huei Kung
- Department of Diagnostic Radiology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chi-Long Chen
- Department of Pathology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
31
|
Lee HD, Nam KH, Shin CM, Lee HS, Chang YH, Yoon H, Park YS, Kim N, Lee DH, Ahn SH, Kim HH. Development and Validation of Models to Predict Lymph Node Metastasis in Early Gastric Cancer Using Logistic Regression and Gradient Boosting Machine Methods. Cancer Res Treat 2023; 55:1240-1249. [PMID: 36960625 PMCID: PMC10582533 DOI: 10.4143/crt.2022.1330] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/20/2023] [Indexed: 03/25/2023] Open
Abstract
PURPOSE To identify important features of lymph node metastasis (LNM) and develop a prediction model for early gastric cancer (EGC) using a gradient boosting machine (GBM) method. MATERIALS AND METHODS The clinicopathologic data of 2556 patients with EGC who underwent gastrectomy were used as training set and the internal validation set (set 1) at a ratio of 8:2. Additionally, 548 patients with EGC who underwent endoscopic submucosal dissection (ESD) as the initial treatment were included in the external validation set (set 2). The GBM model was constructed, and its performance was compared with that of the Japanese guidelines. RESULTS LNM was identified in 12.6% (321/2556) of the gastrectomy group (training set & set 1) and 4.3% (24/548) of the ESD group (set 2). In the GBM analysis, the top five features that most affected LNM were lymphovascular invasion, depth, differentiation, size, and location. The accuracy, sensitivity, specificity, and the area under the receiver operating characteristics of set 1 were 0.566, 0.922, 0.516, and 0.867, while those of set 2 were 0.810, 0.958, 0.803, and 0.944, respectively. When the sensitivity of GBM was adjusted to that of Japanese guidelines (beyond the expanded criteria in set 1 [0.922] and eCuraC-2 in set 2 [0.958]), the specificities of GBM in sets 1 and 2 were 0.516 (95% confidence interval, 0.502-0.523) and 0.803 (0.795-0.805), while those of the Japanese guidelines were 0.502 (0.488-0.509) and 0.788 (0.780-0.790), respectively. CONCLUSION The GBM model showed good performance comparable with the eCura system in predicting LNM risk in EGCs.
Collapse
Affiliation(s)
- Hae Dong Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Kyung Han Nam
- Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan,
Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul,
Korea
| | - Young Hoon Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam,
Korea
| |
Collapse
|
32
|
Tee CHN, Ravi R, Ang TL, Li JW. Role of artificial intelligence in Barrett’s esophagus. Artif Intell Gastroenterol 2023; 4:28-35. [DOI: 10.35712/aig.v4.i2.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/17/2023] [Accepted: 06/12/2023] [Indexed: 09/07/2023] Open
Abstract
The application of artificial intelligence (AI) in gastrointestinal endoscopy has gained significant traction over the last decade. One of the more recent applications of AI in this field includes the detection of dysplasia and cancer in Barrett’s esophagus (BE). AI using deep learning methods has shown promise as an adjunct to the endoscopist in detecting dysplasia and cancer. Apart from visual detection and diagnosis, AI may also aid in reducing the considerable interobserver variability in identifying and distinguishing dysplasia on whole slide images from digitized BE histology slides. This review aims to provide a comprehensive summary of the key studies thus far as well as providing an insight into the future role of AI in Barrett’s esophagus.
Collapse
Affiliation(s)
- Chin Hock Nicholas Tee
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore 529889, Singapore
| | - Rajesh Ravi
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore 529889, Singapore
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore 529889, Singapore
| | - James Weiquan Li
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore 529889, Singapore
| |
Collapse
|
33
|
Alaimo L, Lima HA, Moazzam Z, Endo Y, Yang J, Ruzzenente A, Guglielmi A, Aldrighetti L, Weiss M, Bauer TW, Alexandrescu S, Poultsides GA, Maithel SK, Marques HP, Martel G, Pulitano C, Shen F, Cauchy F, Koerkamp BG, Endo I, Kitago M, Pawlik TM. Development and Validation of a Machine-Learning Model to Predict Early Recurrence of Intrahepatic Cholangiocarcinoma. Ann Surg Oncol 2023; 30:5406-5415. [PMID: 37210452 DOI: 10.1245/s10434-023-13636-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/26/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND The high incidence of early recurrence after hepatectomy for intrahepatic cholangiocarcinoma (ICC) has a detrimental effect on overall survival (OS). Machine-learning models may improve the accuracy of outcome prediction for malignancies. METHODS Patients who underwent curative-intent hepatectomy for ICC were identified using an international database. Three machine-learning models were trained to predict early recurrence (< 12 months after hepatectomy) using 14 clinicopathologic characteristics. The area under the receiver operating curve (AUC) was used to assess their discrimination ability. RESULTS In this study, 536 patients were randomly assigned to training (n = 376, 70.1%) and testing (n = 160, 29.9%) cohorts. Overall, 270 (50.4%) patients experienced early recurrence (training: n = 150 [50.3%] vs testing: n = 81 [50.6%]), with a median tumor burden score (TBS) of 5.6 (training: 5.8 [interquartile range {IQR}, 4.1-8.1] vs testing: 5.5 [IQR, 3.7-7.9]) and metastatic/undetermined nodes (N1/NX) in the majority of the patients (training: n = 282 [75.0%] vs testing n = 118 [73.8%]). Among the three different machine-learning algorithms, random forest (RF) demonstrated the highest discrimination in the training/testing cohorts (RF [AUC, 0.904/0.779] vs support vector machine [AUC, 0.671/0.746] vs logistic regression [AUC, 0.668/0.745]). The five most influential variables in the final model were TBS, perineural invasion, microvascular invasion, CA 19-9 lower than 200 U/mL, and N1/NX disease. The RF model successfully stratified OS relative to the risk of early recurrence. CONCLUSIONS Machine-learning prediction of early recurrence after ICC resection may inform tailored counseling, treatment, and recommendations. An easy-to-use calculator based on the RF model was developed and made available online.
Collapse
Affiliation(s)
- Laura Alaimo
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
- Department of Surgery, University of Verona, Verona, Italy
| | - Henrique A Lima
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Zorays Moazzam
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jason Yang
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | | | | | | | - Matthew Weiss
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Todd W Bauer
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | | | | | | | - Hugo P Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | | | - Carlo Pulitano
- Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Feng Shen
- Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - François Cauchy
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University, Tokyo, Japan
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
| |
Collapse
|
34
|
van Bokhorst QNE, Houwen BBSL, Hazewinkel Y, Fockens P, Dekker E. Advances in artificial intelligence and computer science for computer-aided diagnosis of colorectal polyps: current status. Endosc Int Open 2023; 11:E752-E767. [PMID: 37593158 PMCID: PMC10431975 DOI: 10.1055/a-2098-1999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/08/2023] [Indexed: 08/19/2023] Open
Affiliation(s)
- Querijn N E van Bokhorst
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Britt B S L Houwen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Yark Hazewinkel
- Department of Gastroenterology and Hepatology, Tergooi Medical Center, Hilversum, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| |
Collapse
|
35
|
Metter K, Weißinger SE, Várnai-Händel A, Grund KE, Dumoulin FL. Endoscopic Treatment of T1 Colorectal Cancer. Cancers (Basel) 2023; 15:3875. [PMID: 37568691 PMCID: PMC10417475 DOI: 10.3390/cancers15153875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Commonly accepted criteria for curative resection of T1 colorectal cancer include R0 resection with horizontal and vertical clear margins (R0), absence of lympho-vascular or vessel infiltration (L0, V0), a low to moderate histological grading (G1/2), low tumor cell budding, and limited (<1000 µm) infiltration into the submucosa. However, submucosal infiltration depth in the absence of other high-risk features has recently been questioned as a high-risk situation for lymph-node metastasis. Consequently, endoscopic resection techniques should focus on the acquisition of qualitatively and quantitively sufficient submucosal tissue. Here, we summarize the current literature on lymph-node metastasis risk after endoscopic resection of T1 colorectal cancer. Moreover, we discuss different endoscopic resection techniques with respect to the quality of the resected specimen.
Collapse
Affiliation(s)
- Klaus Metter
- Klinik für Gastroenterologie, Hepatologie und Diabetologie, Alb Fils Kliniken, Klinik am Eichert, Eichertstraße 3, D-73035 Göppingen, Germany
| | - Stephanie Ellen Weißinger
- Institut für Pathologie, Alb Fils Kliniken, Klinik am Eichert, Eichertstraße 3, D-73035 Göppingen, Germany;
| | | | - Karl-Ernst Grund
- Experimentelle Chirurgische Endoskopie (CETEX), Universitätsklinikum Tübingen, Waldhörnlestraße 22, D-72072 Tübingen, Germany;
| | - Franz Ludwig Dumoulin
- Innere Medizin/Gastroenterologie, Gemeinschaftskrankenhaus Bonn, Prinz Albert Str. 40, D-53113 Bonn, Germany;
| |
Collapse
|
36
|
Peng W, Qiao H, Mo L, Guo Y. Progress in the diagnosis of lymph node metastasis in rectal cancer: a review. Front Oncol 2023; 13:1167289. [PMID: 37519802 PMCID: PMC10374255 DOI: 10.3389/fonc.2023.1167289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Historically, the chief focus of lymph node metastasis research has been molecular and clinical studies of a few essential pathways and genes. Recent years have seen a rapid accumulation of massive omics and imaging data catalyzed by the rapid development of advanced technologies. This rapid increase in data has driven improvements in the accuracy of diagnosis of lymph node metastasis, and its analysis further demands new methods and the opportunity to provide novel insights for basic research. In fact, the combination of omics data, imaging data, clinical medicine, and diagnostic methods has led to notable advances in our basic understanding and transformation of lymph node metastases in rectal cancer. Higher levels of integration will require a concerted effort among data scientists and clinicians. Herein, we review the current state and future challenges to advance the diagnosis of lymph node metastases in rectal cancer.
Collapse
Affiliation(s)
- Wei Peng
- Medical Big Data and Bioinformatics Research Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Huimin Qiao
- Medical Big Data and Bioinformatics Research Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Linfeng Mo
- School of Health and Medicine, Guangzhou Huashang Vocational College, Guangzhou, Guangdong, China
| | - You Guo
- Medical Big Data and Bioinformatics Research Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| |
Collapse
|
37
|
Zaffalon D, Daca-Alvarez M, Saez de Gordoa K, Pellisé M. Dilemmas in the Clinical Management of pT1 Colorectal Cancer. Cancers (Basel) 2023; 15:3511. [PMID: 37444621 DOI: 10.3390/cancers15133511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
Implementation of population-based colorectal cancer screening programs has led to increases in the incidence of pT1 colorectal cancer. These incipient invasive cancers have a very good prognosis and can be treated locally, but more than half of these cases are treated with surgery due to the presence of histological high-risk criteria. These high-risk criteria are suboptimal, with no consensus among clinical guidelines, heterogeneity in definitions and assessment, and poor concordance in evaluation, and recent evidence suggests that some of these criteria considered high risk might not necessarily affect individual prognosis. Current criteria classify most patients as high risk with an indication for additional surgery, but only 2-10.5% have lymph node metastasis, and the residual tumor is present in less than 20%, leading to overtreatment. Patients with pT1 colorectal cancer have excellent disease-free survival, and recent evidence indicates that the type of treatment, whether endoscopic or surgical, does not significantly impact prognosis. As a result, the protective role of surgery is questionable. Moreover, surgery is a more aggressive treatment option, with the potential for higher morbidity and mortality rates. This article presents a comprehensive review of recent evidence on the clinical management of pT1 colorectal cancer. The review analyzes the limitations of histological evaluation, the prognostic implications of histological risk status and the treatment performed, the adverse effects associated with both endoscopic and surgical treatments, and new advances in endoscopic treatment.
Collapse
Affiliation(s)
- Diana Zaffalon
- Gastroenterology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain
- Gastroenterology Department, Consorci Sanitari de Terrassa, Torrebonica, s/n, 08227 Terrassa, Spain
| | - Maria Daca-Alvarez
- Gastroenterology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Karmele Saez de Gordoa
- Pathology Department, Centre de Diagnostic Biomèdic, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - María Pellisé
- Gastroenterology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain
| |
Collapse
|
38
|
Smits LJH, van Lieshout AS, Bosker RJI, Crobach S, de Graaf EJR, Hage M, Laclé MM, Moll FCP, Moons LMG, Peeters KCMJ, van Westreenen HL, van Grieken NCT, Tuynman JB. Clinical consequences of diagnostic variability in the histopathological evaluation of early rectal cancer. Eur J Surg Oncol 2023; 49:1291-1297. [PMID: 36841695 DOI: 10.1016/j.ejso.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/14/2023] [Indexed: 02/19/2023]
Abstract
INTRODUCTION In early rectal cancer, organ sparing treatment strategies such as local excision have gained popularity. The necessity of radical surgery is based on the histopathological evaluation of the local excision specimen. This study aimed to describe diagnostic variability between pathologists, and its impact on treatment allocation in patients with locally excised early rectal cancer. MATERIALS AND METHODS Patients with locally excised pT1-2 rectal cancer were included in this prospective cohort study. Both quantitative measures and histopathological risk factors (i.e. poor differentiation, deep submucosal invasion, and lymphatic- or venous invasion) were evaluated. Interobserver variability was reported by both percentages and Fleiss' Kappa- (ĸ) or intra-class correlation coefficients. RESULTS A total of 126 patients were included. Ninety-four percent of the original histopathological reports contained all required parameters. In 73 of the 126 (57.9%) patients, at least one discordant parameter was observed, which regarded histopathological risk factors for lymph node metastases in 36 patients (28.6%). Interobserver agreement among different variables varied between 74% and 95% or ĸ 0.530-0.962. The assessment of lymphovascular invasion showed discordances in 26% (ĸ = 0.530, 95% CI 0.375-0.684) of the cases. In fourteen (11%) patients, discordances led to a change in treatment strategy. CONCLUSION This study demonstrated that there is substantial interobserver variability between pathologists, especially in the assessment of lymphovascular invasion. Pathologists play a key role in treatment allocation after local excision of early rectal cancer, therefore interobserver variability needs to be reduced to decrease the number of patients that are over- or undertreated.
Collapse
Affiliation(s)
- Lisanne J H Smits
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Annabel S van Lieshout
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | - Stijn Crobach
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Eelco J R de Graaf
- Department of Surgery, IJsselland Hospital, Cappelle aan de IJssel, the Netherlands
| | - Mariska Hage
- Department of Pathology, Deventer Hospital, Deventer, the Netherlands
| | - Miangela M Laclé
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Freek C P Moll
- Department of Pathology, Isala Clinics, Zwolle, the Netherlands
| | - Leon M G Moons
- Department of Gastroenterology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Nicole C T van Grieken
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
| |
Collapse
|
39
|
Li K, Chen C, Cao W, Wang H, Han S, Wang R, Ye Z, Wu Z, Wang W, Cai L, Ding D, Yuan Z. DeAF: A multimodal deep learning framework for disease prediction. Comput Biol Med 2023; 156:106715. [PMID: 36867898 DOI: 10.1016/j.compbiomed.2023.106715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/05/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023]
Abstract
Multimodal deep learning models have been applied for disease prediction tasks, but difficulties exist in training due to the conflict between sub-models and fusion modules. To alleviate this issue, we propose a framework for decoupling feature alignment and fusion (DeAF), which separates the multimodal model training into two stages. In the first stage, unsupervised representation learning is conducted, and the modality adaptation (MA) module is used to align the features from various modalities. In the second stage, the self-attention fusion (SAF) module combines the medical image features and clinical data using supervised learning. Moreover, we apply the DeAF framework to predict the postoperative efficacy of CRS for colorectal cancer and whether the MCI patients change to Alzheimer's disease. The DeAF framework achieves a significant improvement in comparison to the previous methods. Furthermore, extensive ablation experiments are conducted to demonstrate the rationality and effectiveness of our framework. In conclusion, our framework enhances the interaction between the local medical image features and clinical data, and derive more discriminative multimodal features for disease prediction. The framework implementation is available at https://github.com/cchencan/DeAF.
Collapse
Affiliation(s)
- Kangshun Li
- College of Mathematics and Informatics, South China Agricultural University, Guangzhou, 510000, China.
| | - Can Chen
- College of Mathematics and Informatics, South China Agricultural University, Guangzhou, 510000, China
| | - Wuteng Cao
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510000, China
| | - Hui Wang
- Department of Colorectal Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Shuai Han
- General Surgery Center, Department of Gastrointestinal Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510000, China
| | - Renjie Wang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200000, China
| | - Zaisheng Ye
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, 350000, China
| | - Zhijie Wu
- Department of Colorectal Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Wenxiang Wang
- College of Mathematics and Informatics, South China Agricultural University, Guangzhou, 510000, China
| | - Leng Cai
- College of Mathematics and Informatics, South China Agricultural University, Guangzhou, 510000, China
| | - Deyu Ding
- Department of Economics, University of Konstanz, Konstanz, 350000, Germany
| | - Zixu Yuan
- Department of Colorectal Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China.
| |
Collapse
|
40
|
Diaconu C, State M, Birligea M, Ifrim M, Bajdechi G, Georgescu T, Mateescu B, Voiosu T. The Role of Artificial Intelligence in Monitoring Inflammatory Bowel Disease-The Future Is Now. Diagnostics (Basel) 2023; 13. [PMID: 36832222 DOI: 10.3390/diagnostics13040735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
Crohn's disease and ulcerative colitis remain debilitating disorders, characterized by progressive bowel damage and possible lethal complications. The growing number of applications for artificial intelligence in gastrointestinal endoscopy has already shown great potential, especially in the field of neoplastic and pre-neoplastic lesion detection and characterization, and is currently under evaluation in the field of inflammatory bowel disease management. The application of artificial intelligence in inflammatory bowel diseases can range from genomic dataset analysis and risk prediction model construction to the disease grading severity and assessment of the response to treatment using machine learning. We aimed to assess the current and future role of artificial intelligence in assessing the key outcomes in inflammatory bowel disease patients: endoscopic activity, mucosal healing, response to treatment, and neoplasia surveillance.
Collapse
|
41
|
Huang P, Feng Z, Shu X, Wu A, Wang Z, Hu T, Cao Y, Tu Y, Li Z. A bibliometric and visual analysis of publications on artificial intelligence in colorectal cancer (2002-2022). Front Oncol 2023; 13:1077539. [PMID: 36824138 PMCID: PMC9941644 DOI: 10.3389/fonc.2023.1077539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
Background Colorectal cancer (CRC) has the third-highest incidence and second-highest mortality rate of all cancers worldwide. Early diagnosis and screening of CRC have been the focus of research in this field. With the continuous development of artificial intelligence (AI) technology, AI has advantages in many aspects of CRC, such as adenoma screening, genetic testing, and prediction of tumor metastasis. Objective This study uses bibliometrics to analyze research in AI in CRC, summarize the field's history and current status of research, and predict future research directions. Method We searched the SCIE database for all literature on CRC and AI. The documents span the period 2002-2022. we used bibliometrics to analyze the data of these papers, such as authors, countries, institutions, and references. Co-authorship, co-citation, and co-occurrence analysis were the main methods of analysis. Citespace, VOSviewer, and SCImago Graphica were used to visualize the results. Result This study selected 1,531 articles on AI in CRC. China has published a maximum number of 580 such articles in this field. The U.S. had the most quality publications, boasting an average citation per article of 46.13. Mori Y and Ding K were the two authors with the highest number of articles. Scientific Reports, Cancers, and Frontiers in Oncology are this field's most widely published journals. Institutions from China occupy the top 9 positions among the most published institutions. We found that research on AI in this field mainly focuses on colonoscopy-assisted diagnosis, imaging histology, and pathology examination. Conclusion AI in CRC is currently in the development stage with good prospects. AI is currently widely used in colonoscopy, imageomics, and pathology. However, the scope of AI applications is still limited, and there is a lack of inter-institutional collaboration. The pervasiveness of AI technology is the main direction of future housing development in this field.
Collapse
Affiliation(s)
- Pan Huang
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China,Department of Digestive Surgery, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China,Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zongfeng Feng
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China,Department of Digestive Surgery, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China,Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xufeng Shu
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China,Department of Digestive Surgery, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China,Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ahao Wu
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China,Department of Digestive Surgery, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China,Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhonghao Wang
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China,Department of Digestive Surgery, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China,Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tengcheng Hu
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China,Department of Digestive Surgery, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China,Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi Cao
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China,Department of Digestive Surgery, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China,Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi Tu
- Department of Pathology, The First Affiliated Hospital of Nanchang University, Nanchang, China,*Correspondence: Yi Tu, ; Zhengrong Li,
| | - Zhengrong Li
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China,Department of Digestive Surgery, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China,Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China,*Correspondence: Yi Tu, ; Zhengrong Li,
| |
Collapse
|
42
|
Shao S, Zhao Y, Lu Q, Liu L, Mu L, Qin J. Artificial intelligence assists surgeons' decision-making of temporary ileostomy in patients with rectal cancer who have received anterior resection. Eur J Surg Oncol 2023; 49:433-439. [PMID: 36244844 DOI: 10.1016/j.ejso.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/27/2022] [Accepted: 09/28/2022] [Indexed: 10/07/2022]
Abstract
BACKGROUND Due to the difficult evaluation of the risk of anastomotic leakage (AL) after rectal cancer resection, the decision to perform a temporary ileostomy is not easily distinguishable. The aim of the present study was to develop an artificial intelligence (AI) model for identifying the risk of AL to assist surgeons in the selective implementation of a temporary ileostomy. MATERIALS AND METHODS The data from 2240 patients with rectal cancer who received anterior resection were collected, and these patients were divided into one training and two test cohorts. Five AI algorithms, such as support vector machine (SVM), logistic regression (LR), Naive Bayes (NB), stochastic gradient descent (SGD) and random forest (RF) were employed to develop predictive models using clinical variables and were assessed using the two test cohorts. RESULTS The SVM model indicated good discernment of AL, and might have increased the implementation of temporary ileostomy in patients with AL in the training cohort (p < 0.001). Following the assessment of the two test cohorts, the SVM model could identify AL in a favorable manner, which performed with positive predictive values of 0.150 (0.091-0.234) and 0.151 (0.091-0.237), and negative predictive values of 0.977 (0.958-0.988) and 0.986 (0.969-0.994), respectively. It is important to note that the implementation of temporary ileostomy in patients without AL would have been significantly reduced (p < 0.001) and which would have been significantly increased in patients with AL (p < 0.05). CONCLUSION The model (https://alrisk.21cloudbox.com/) indicated good discernment of AL, which may be used to assist the surgeon's decision-making of performing temporary ileostomy.
Collapse
Affiliation(s)
- Shengli Shao
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China; Molecular Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Yufeng Zhao
- Department of Vascular Surgery, First Hospital of Lanzhou University, 730030, Lanzhou, China
| | - Qiyi Lu
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China; Molecular Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Lu Liu
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China; Molecular Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Lei Mu
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China; Molecular Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Jichao Qin
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China; Molecular Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China.
| |
Collapse
|
43
|
Yinhang W, Jing Z, Jie Z, Yin J, Xinyue W, Yifei S, Zhiqing F, Wei W, Shuwen H. Prediction model of colorectal cancer (CRC) lymph node metastasis based on intestinal bacteria. Clin Transl Oncol 2023; 25:1661-1672. [PMID: 36633831 DOI: 10.1007/s12094-022-03061-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Lymph node metastasis is the main metastatic mode of CRC. Lymph node metastasis affects patient prognosis. OBJECTIVE To screen differential intestinal bacteria for CRC lymph node metastasis and construct a prediction model. METHODS First, fecal samples of 119 CRC patients with lymph node metastasis and 110 CRC patients without lymph node metastasis were included for the detection of intestinal bacterial 16S rRNA. Then, bioinformatics analysis of the sequencing data was performed. Community structure and composition analysis, difference analysis, and intragroup and intergroup correlation analysis were conducted between the two groups. Finally, six machine learning models were used to construct a prediction model for CRC lymph node metastasis. RESULTS The community richness and the community diversity at the genus level of the two groups were basically consistent. A total of 12 differential bacteria (Agathobacter, Catenibacterium, norank_f__Oscillospiraceae, Lachnospiraceae_FCS020_group, Lachnospiraceae_UCG-004, etc.) were screened at the genus level. Differential bacteria, such as Agathobacter, Catenibacterium, norank_f__Oscillospiraceae, and Lachnospiraceae_FCS020_group, were more associated with no lymph node metastasis in CRC. In the discovery set, the RF model had the highest prediction accuracy (AUC = 1.00, 98.89% correct, specificity = 55.21%, sensitivity = 55.95%). In the test set, SVM model had the highest prediction accuracy (AUC = 0.73, 72.92% correct, specificity = 69.23%, sensitivity = 88.89%). Lachnospiraceae_FCS020_group was the most important variable in the RF model. Lachnospiraceae_UCG - 004 was the most important variable in the SVM model. CONCLUSION CRC lymph node metastasis is closely related to intestinal bacteria. The prediction model based on intestinal bacteria can provide a new evaluation method for CRC lymph node metastasis.
Collapse
Affiliation(s)
- Wu Yinhang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China
- Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
- Key Laboratory of Multiomics Research and Clinical Transformation of Digestive Cancer of Huzhou, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Zhuang Jing
- Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
- Key Laboratory of Multiomics Research and Clinical Transformation of Digestive Cancer of Huzhou, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Zhou Jie
- Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Jin Yin
- Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
- Key Laboratory of Multiomics Research and Clinical Transformation of Digestive Cancer of Huzhou, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Wu Xinyue
- Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Song Yifei
- Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Fan Zhiqing
- Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Wu Wei
- Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China.
- Key Laboratory of Multiomics Research and Clinical Transformation of Digestive Cancer of Huzhou, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China.
| | - Han Shuwen
- Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China.
- Key Laboratory of Multiomics Research and Clinical Transformation of Digestive Cancer of Huzhou, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China.
| |
Collapse
|
44
|
Liu X, Sha L, Huang C, Kong X, Yan F, Shi X, Tang X. A nomogram prediction model for lymph node metastasis risk after neoadjuvant chemoradiotherapy in rectal cancer patients based on SEER database. Front Oncol 2023; 13:1098087. [PMID: 36923430 PMCID: PMC10009107 DOI: 10.3389/fonc.2023.1098087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/14/2023] [Indexed: 03/02/2023] Open
Abstract
Background Rectal cancer patients who received neoadjuvant chemoradiotherapy (CRT) may have a lower cancer stage and a better prognosis. Some patients may be able to avoid invasive surgery. It is critical to accurately assess lymph node metastases (LNM) after neoadjuvant chemoradiotherapy. The goal of this study is to identify clinical variables associated with LNM and to develop a nomogram for LNM prediction in rectal cancer patients following nCRT. Methods From 2010 to 2015, patients were drawn from the Surveillance, Epidemiology, and End Results (SEER) database. To identify clinical factors associated with LNM, the least absolute shrinkage and selection operator (LASSO) aggression and multivariate logistic regression analyses were used. To predict the likelihood of LNM, a nomogram based on multivariate logistic regression was created using decision curve analyses. Reslut The total number of patients included in this study was 6,388. The proportion of patients with pCR was 17.50% (n=1118), and the proportion of patients with primary tumor pCR was 20.84% (n = 1,331). The primary tumor was pCR in 16.00% (n=213) of the patients. Age, clinical T stage, clinical N stage, and histology were found to be significant independent clinical predictors of LNM using LASSO and multivariate logistic regression analysis. The nomogram was developed based on four clinical factors. The 5-year overall survival rate was 78.9 percent for those with ypN- and 66.3 percent for those with ypN+, respectively (P<0.001). Conclusion Patients over 60 years old, with clinical T1-2, clinical N0, and adenocarcinoma may be more likely to achieve ypN0. The watch-and-wait (WW) strategy may be considered. Patients who had ypN0 or pCR had a better prognosis.
Collapse
Affiliation(s)
- Xiaoshuang Liu
- Department of General Surgery, Shuguang Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China.,Department of Colorectal Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Li Sha
- Department of General Surgery, Shuguang Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
| | - Cheng Huang
- Department of Colorectal Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Xiancheng Kong
- Department of General Surgery, Shuguang Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
| | - Feihu Yan
- Department of Colorectal Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Xiaohui Shi
- Department of Colorectal Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Xuefeng Tang
- Department of General Surgery, Shuguang Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
45
|
Baker K. SCIENCE AND KNOWLEDGE DEVELOPMENT IN THE GASTROENTEROLOGY NURSING SPECIALTY: MORE THAN WE COULD HAVE IMAGINED. Gastroenterol Nurs 2023; 46:11-3. [PMID: 36706137 DOI: 10.1097/SGA.0000000000000724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
|
46
|
Luo Y, Hong CQ, Huang BL, Ding TY, Chu LY, Zhang B, Qu QQ, Li XH, Liu CT, Peng YH, Guo HP, Xu YW. Serum insulin-like growth factor binding protein-3 as a potential biomarker for diagnosis and prognosis of oesophageal squamous cell carcinoma. Ann Med 2022; 54:2153-2166. [PMID: 35930383 PMCID: PMC9359171 DOI: 10.1080/07853890.2022.2104921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Insulin-like growth factor binding protein-3 (IGFBP3) has been reported to be related to the risk of some cancers. Here we focussed on serum IGFBP3 as a possible biomarker of diagnosis and prognosis for oesophageal squamous carcinoma (ESCC). METHODS Enzyme-linked immunosorbent assay (ELISA) was used to measure the serum IGFBP3 level in the training cohort including 136 ESCC patients and 119 normal controls and the validation cohort with 55 ESCC patients and 42 normal controls. The receiver operating characteristics curve (ROC) was used to assess the diagnosis value. Cox proportional hazards model was applied to select factors for survival nomogram construction. RESULTS Serum IGFBP3 levels were significantly lower in early-stage ESCC or ESCC patients than those in normal controls (p < .05). The specificity and sensitivity of serum IGFBP3 for the diagnosis of ESCC were 95.80% and 50.00%, respectively, with the area under the ROC curve (AUC) of 0.788 in the training cohort. Similar results were observed in the validation cohort (88.10%, 38.18%, and 0.710). Importantly, serum IGFBP3 could also differentiate early-stage ESCC from controls (95.80%, 52.54%, 0.777 and 88.10%, 36.36%, 0.695 in training and validation cohorts, respectively). Furthermore, Cox multivariate analysis revealed that serum IGFBP3 was an independent prognostic risk factor (HR = 2.599, p = .002). Lower serum IGFBP3 level was correlated with reduced overall survival (p < .05). Nomogram based on serum IGFBP3, TNM stage, and tumour size improved the prognostic prediction of ESCC with a concordance index of 0.715. CONCLUSION We demonstrated that serum IGFBP3 was a potential biomarker of diagnosis and prognosis for ESCC. Meanwhile, the nomogram might help predict the prognosis of ESCC. Key MessageSerum IGFBP3 showed early diagnostic value in oesophageal squamous cell carcinoma with independent cohort validation. Moreover, serum IGFBP3 was identified as an independent prognostic risk factor, which was used to construct a nomogram with improved prognosis ability in oesophageal squamous cell carcinoma.
Collapse
Affiliation(s)
- Yun Luo
- Department of Clinical Laboratory Medicine, the Cancer Hospital of Shantou University Medical College, Shantou, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, China
| | - Chao-Qun Hong
- Department of Oncological Laboratory Research, the Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Bin-Liang Huang
- Department of Clinical Laboratory Medicine, the Cancer Hospital of Shantou University Medical College, Shantou, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
| | - Tian-Yan Ding
- Department of Clinical Laboratory Medicine, the Cancer Hospital of Shantou University Medical College, Shantou, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, China
| | - Ling-Yu Chu
- Department of Clinical Laboratory Medicine, the Cancer Hospital of Shantou University Medical College, Shantou, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, China
| | - Biao Zhang
- Department of Clinical Laboratory Medicine, the Cancer Hospital of Shantou University Medical College, Shantou, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, China
| | - Qi-Qi Qu
- Department of Clinical Laboratory Medicine, the Cancer Hospital of Shantou University Medical College, Shantou, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, China
| | - Xin-Hao Li
- Department of Clinical Laboratory Medicine, the Cancer Hospital of Shantou University Medical College, Shantou, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, China
| | - Can-Tong Liu
- Department of Clinical Laboratory Medicine, the Cancer Hospital of Shantou University Medical College, Shantou, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
| | - Yu-Hui Peng
- Department of Clinical Laboratory Medicine, the Cancer Hospital of Shantou University Medical College, Shantou, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
| | - Hai-Peng Guo
- Department of Head and Neck Surgery, the Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Yi-Wei Xu
- Department of Clinical Laboratory Medicine, the Cancer Hospital of Shantou University Medical College, Shantou, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
| |
Collapse
|
47
|
Ichimasa K, Kudo SE, Yeoh KG. Which variable better predicts the risk of lymph node metastasis in T1 colorectal cancer: Highest grade or predominant histological differentiation? Dig Endosc 2022; 34:1494. [PMID: 35979736 DOI: 10.1111/den.14422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/16/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan.,Department of Gastroenterology and Hepatology, National University Hospital, Singapore City, Singapore.,Department of Medicine, National University of Singapore, Singapore City, Singapore
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Khay Guan Yeoh
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore City, Singapore.,Department of Medicine, National University of Singapore, Singapore City, Singapore
| |
Collapse
|
48
|
Mochizuki K, Kudo SE, Kato K, Kudo K, Ogawa Y, Kouyama Y, Takashina Y, Ichimasa K, Tobo T, Toshima T, Hisamatsu Y, Yonemura Y, Masuda T, Miyachi H, Ishida F, Nemoto T, Mimori K. Molecular and clinicopathological differences between depressed and protruded T2 colorectal cancer. PLoS One 2022; 17:e0273566. [PMID: 36264865 PMCID: PMC9584453 DOI: 10.1371/journal.pone.0273566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/11/2022] [Indexed: 11/05/2022] Open
Abstract
Background Colorectal cancer (CRC) can be classified into four consensus molecular subtypes (CMS) according to genomic aberrations and gene expression profiles. CMS is expected to be useful in predicting prognosis and selecting chemotherapy regimens. However, there are still no reports on the relationship between the morphology and CMS. Methods This retrospective study included 55 subjects with T2 CRC undergoing surgical resection, of whom 30 had the depressed type and 25 the protruded type. In the classification of the CMS, we first defined cases with deficient mismatch repair as CMS1. And then, CMS2/3 and CMS4 were classified using an online classifier developed by Trinh et al. The staining intensity of CDX2, HTR2B, FRMD6, ZEB1, and KER and the percentage contents of CDX2, FRMD6, and KER are input into the classifier to obtain automatic output classifying the specimen as CMS2/3 or CMS4. Results According to the results yielded by the online classifier, of the 30 depressed-type cases, 15 (50%) were classified as CMS2/3 and 15 (50%) as CMS4. Of the 25 protruded-type cases, 3 (12%) were classified as CMS1 and 22 (88%) as CMS2/3. All of the T2 CRCs classified as CMS4 were depressed CRCs. More malignant pathological findings such as lymphatic invasion were associated with the depressed rather than protruded T2 CRC cases. Conclusions Depressed-type T2 CRC had a significant association with CMS4, showing more malignant pathological findings such as lymphatic invasion than the protruded-type, which could explain the reported association between CMS4 CRC and poor prognosis.
Collapse
Affiliation(s)
- Kenichi Mochizuki
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Shin-ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Kazuki Kato
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Koki Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yushi Ogawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yuta Kouyama
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yuki Takashina
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore
| | - Taro Tobo
- Department of Clinical Laboratory, Kyushu University Beppu Hospital, Beppu, Japan
| | - Takeo Toshima
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Yuichi Hisamatsu
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Yusuke Yonemura
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Takaaki Masuda
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Hideyuki Miyachi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Tetsuo Nemoto
- Department of Diagnostic Pathology, School of Medicine, Showa University, Yokohama Northern Hospital, Kanagawa, Japan
| | - Koshi Mimori
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
- * E-mail:
| |
Collapse
|
49
|
Jawaid S, Othman MO. Artificial intelligence: an innovative approach to prognisticate the outcome of colonic resection. Gastrointest Endosc 2022; 96:673-674. [PMID: 35985860 DOI: 10.1016/j.gie.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Salmaan Jawaid
- Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas, USA
| | - Mohamed O Othman
- Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
50
|
Ichimasa K, Nakahara K, Kudo SE, Misawa M, Bretthauer M, Shimada S, Takehara Y, Mukai S, Kouyama Y, Miyachi H, Sawada N, Mori K, Ishida F, Mori Y. Novel "resect and analysis" approach for T2 colorectal cancer with use of artificial intelligence. Gastrointest Endosc 2022; 96:665-672.e1. [PMID: 35500659 DOI: 10.1016/j.gie.2022.04.1305] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/21/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Because of a lack of reliable preoperative prediction of lymph node involvement in early-stage T2 colorectal cancer (CRC), surgical resection is the current standard treatment. This leads to overtreatment because only 25% of T2 CRC patients turn out to have lymph node metastasis (LNM). We assessed a novel artificial intelligence (AI) system to predict LNM in T2 CRC to ascertain patients who can be safely treated with less-invasive endoscopic resection such as endoscopic full-thickness resection and do not need surgery. METHODS We included 511 consecutive patients who had surgical resection with T2 CRC from 2001 to 2016; 411 patients (2001-2014) were used as a training set for the random forest-based AI prediction tool, and 100 patients (2014-2016) were used to validate the AI tool performance. The AI algorithm included 8 clinicopathologic variables (patient age and sex, tumor size and location, lymphatic invasion, vascular invasion, histologic differentiation, and serum carcinoembryonic antigen level) and predicted the likelihood of LNM by receiver-operating characteristics using area under the curve (AUC) estimates. RESULTS Rates of LNM in the training and validation datasets were 26% (106/411) and 28% (28/100), respectively. The AUC of the AI algorithm for the validation cohort was .93. With 96% sensitivity (95% confidence interval, 90%-99%), specificity was 88% (95% confidence interval, 80%-94%). In this case, 64% of patients could avoid surgery, whereas 1.6% of patients with LNM would lose a chance to receive surgery. CONCLUSIONS Our proposed AI prediction model has a potential to reduce unnecessary surgery for patients with T2 CRC with very little risk. (Clinical trial registration number: UMIN 000038257.).
Collapse
Affiliation(s)
- Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Kenta Nakahara
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Shoji Shimada
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yusuke Takehara
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Shunpei Mukai
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yuta Kouyama
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Hideyuki Miyachi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Naruhiko Sawada
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Kensaku Mori
- Graduate School of Informatics, Nagoya University, Nagoya, Japan
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yuichi Mori
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan; Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| |
Collapse
|