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Venkatesulu B, Giridhar P. With regards to Ellsworth et al. on "Lymphocyte sparing normal tissue effects in the clinic LymphoTEC): A systematic review of dose constraint considerations to mitigate radiation-related lymphopenia in the era of immunotherapy". Radiother Oncol 2023; 181:109496. [PMID: 36736587 DOI: 10.1016/j.radonc.2023.109496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 01/17/2023] [Indexed: 02/05/2023]
Affiliation(s)
- BhanuPrasad Venkatesulu
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, IL 60153, USA; Edward Hines Veteran Affairs Hospital, Chicago, IL, USA.
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Ladbury C, Li R, Shiao J, Liu J, Cristea M, Han E, Dellinger T, Lee S, Wang E, Fisher C, Chen YJ, Amini A, Robin T, Glaser S. Characterizing impact of positive lymph node number in endometrial cancer using machine-learning: A better prognostic indicator than FIGO staging? Gynecol Oncol 2021; 164:39-45. [PMID: 34794840 DOI: 10.1016/j.ygyno.2021.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/16/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Number of involved lymph nodes (LNs) is a crucial stratification factor in staging of numerous disease sites, but has not been incorporated for endometrial cancer. We evaluated whether number of involved LNs provide improved prognostic value. PATIENTS AND METHODS Patients diagnosed with node-positive endometrial adenocarcinoma without distant metastasis were identified in the National Cancer Database. We trained a machine-learning based model of overall survival. Shapley additive explanation values (SHAP) based on the model were used to identify cutoffs of number of LNs involved. Results were validated using a Cox proportional hazards regression model. RESULTS We identified 11,381 patients with endometrial cancer meeting the inclusion criteria. Using the SHAP values, we selected the following thresholds: 1-3 LNs, 4-5 LNs, and 6+ LNs. The 3-year OS was 82.0% for 1-3 LNs, 74.3% for 4-5 LNs (hazard ratio [HR] 1.38; p < 0.001), and 59.9% for 6+ LNs (HR 2.23; p < 0.001). On univariate Cox regression, PA nodal involvement was a significant predictor of OS (HR 1.20; p < 0.001) but was not significant on multivariate analysis when number of LNs was included (HR 1.05; p = 0.273). Additionally, we identified an interaction between adjuvant therapy and number of involved LNs. Patients with 1-3 involved LNs had 3-year OS of 85.2%, 78.7% and 74.2% with chemoradiation (CRT), chemotherapy, and radiation, respectively. Patients with 6+ involved LNs had 3-yr OS of 67.8%, 49.6%, and 48.9% with CRT, chemotherapy, and radiation, respectively (p < 0.001). CONCLUSION Number of involved LNs is a stronger prognostic and predictive factor compared to PA node involvement.
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Affiliation(s)
- Colton Ladbury
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Richard Li
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Jay Shiao
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jason Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Mihaela Cristea
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Ernest Han
- Department of Gynecologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Thanh Dellinger
- Department of Gynecologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Stephen Lee
- Department of Gynecologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Edward Wang
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Christine Fisher
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Yi-Jen Chen
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Tyler Robin
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Scott Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA.
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