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Li J, Chen X, Xu S, Wang Y, Ma F, Wu Y, Qu J. Predicting pathologic response to neoadjuvant chemotherapy in locally advanced gastric cancer: The establishment of a spectral CT-based nomogram from prospective datasets. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108020. [PMID: 38367396 DOI: 10.1016/j.ejso.2024.108020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND To establish a spectral CT-based nomogram for predicting early neoadjuvant chemotherapy (NAC) response for locally advanced gastric cancer (LAGC). METHODS This study prospectively recruited 222 cases (177 male and 45 female patients, 9.59 ± 9.54 years) receiving NAC and radical gastrectomy. Triple enhanced spectral CT scans were performed before NAC initiation. According to post-operative tumor regression grade (TRG), patients were classified into responders (TRG = 0 + 1) or non-responders (TRG = 2 + 3), and split into a primary (156) and validation (66) dataset at 7:3 ratio chronologically. We compared clinicopathological data, follow-up information, iodine concentration (IC), normalized ICs (nICs) in arterial/venous/delayed phases (AP/VP/DP) between responders and non-responders. Independent risk factors of response were screened by multivariable logistic regression and adopted for model construction. Model was visualized by nomograms and its capability was determined through receiver operating characteristic (ROC) curves. Log-rank survival analysis was conducted to explore associations between TRG, nomogram and patients' survival. RESULTS This work identified Borrmann classification, ICDP, and nICDP were independent risk factors of response outcomes. A spectral CT-based nomogram was built accordingly and achieved an area under the curve (AUC) of 0.797 (0.692-0.879) and 0.741(0.661-0.811) for the primary and validation dataset, respectively, higher than AUC of individual parameters alone. The nomogram was related to disease-free survival in the validation dataset (Hazard ratio (HR): 5.19 [1.18-12.93], P = 0.02). CONCLUSIONS The spectral CT-based nomogram provides an efficient tool for predicting the pathologic response outcomes of GC after NAC and disease-free survival risk stratification.
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Affiliation(s)
- Jing Li
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China.
| | - Xuejun Chen
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China.
| | - Shuning Xu
- Department of Gastrointestinal Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China.
| | - Yi Wang
- Department of Pathology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China.
| | - Fei Ma
- Department of Gastrointestinal Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China.
| | - Yue Wu
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China.
| | - Jinrong Qu
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China.
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Sandø AD, Fougner R, Røyset ES, Dai HY, Grønbech JE, Bringeland EA. Response Evaluation after Neoadjuvant Chemotherapy for Resectable Gastric Cancer. Cancers (Basel) 2023; 15:cancers15082318. [PMID: 37190246 DOI: 10.3390/cancers15082318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/22/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND The method of response evaluation following neoadjuvant chemotherapy (NAC) in resectable gastric cancer has been widely debated. An essential prerequisite is the ability to stratify patients into subsets of different long-term survival rates based on the response mode. Histopathological measures of regression have their limitations, and interest resides in CT-based methods that can be used in everyday settings. METHODS We conducted a population-based study (2007-2016) on 171 consecutive patients with gastric adenocarcinoma who were receiving NAC. Two methods of response evaluation were investigated: a strict radiological procedure using RECIST (downsizing), and a composite radiological/pathological procedure comparing the initial radiological TNM stage to the pathological ypTNM stage (downstaging). Clinicopathological variables that could predict the response were searched for, and correlations between the response mode and long-term survival rates were assessed. RESULTS RECIST failed to identify half of the patients progressing to metastatic disease, and it was unable to assign patients to subsets with different long-term survival rates based on the response mode. However, the TNM stage response mode did achieve this objective. Following re-staging, 48% (78/164) were downstaged, 15% (25/164) had an unchanged stage, and 37% (61/164) were upstaged. A total of 9% (15/164) showed a histopathological complete response. The 5-year overall survival rate was 65.3% (95% CI 54.7-75.9%) for TNM downstaged cases, 40.0% (95% CI 20.8-59.2%) for stable disease, and 14.8% (95% CI 6.0-23.6%) for patients with TNM progression, p < 0.001. In a multivariable ordinal regression model, the Lauren classification and tumor site were the only significant determinants of the response mode. CONCLUSIONS Downsizing, as a method for evaluating the response to NAC in gastric cancer, is discouraged. TNM re-staging by comparing the baseline radiological CT stage to the pathological stage following NAC is suggested as a useful method that may be used in everyday situations.
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Affiliation(s)
- Alina Desiree Sandø
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7034 Trondheim, Norway
| | - Reidun Fougner
- Department of Radiology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
| | - Elin Synnøve Røyset
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7034 Trondheim, Norway
- Department of Pathology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Clinic of Laboratory Medicine, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
| | - Hong Yan Dai
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7034 Trondheim, Norway
- Department of Pathology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Clinic of Laboratory Medicine, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
| | - Jon Erik Grønbech
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7034 Trondheim, Norway
| | - Erling Audun Bringeland
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7034 Trondheim, Norway
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Li J, Xu S, Wang Y, Fang M, Ma F, Xu C, Hailiang L. Spectral CT-based nomogram for preoperative prediction of perineural invasion in locally advanced gastric cancer: a prospective study. Eur Radiol 2023:10.1007/s00330-023-09464-9. [PMID: 36826503 DOI: 10.1007/s00330-023-09464-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/15/2022] [Accepted: 01/22/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES This work focused on developing and validating the spectral CT-based nomogram to preoperatively predict perineural invasion (PNI) for locally advanced gastric cancer (LAGC). METHODS This work prospectively included 196 surgically resected LAGC patients (139 males, 57 females, 59.55 ± 11.97 years) undergoing triple enhanced spectral CT scans. Patients were labeled as perineural invasion (PNI) positive and negative according to pathologic reports, then further split into primary (n = 130) and validation cohort (n = 66). We extracted clinicopathological information, follow-up data, iodine concentration (IC), and normalized IC values against to aorta (nICs) at arterial/venous/delayed phases (AP/VP/DP). Clinicopathological features and IC values between PNI positive and negative groups were compared. Multivariable logistic regression was performed to screen independent risk factors of PNI. Then, a nomogram was established, and its capability was determined by ROC curves. Its clinical use was evaluated by decision curve analysis. The correlations of PNI and the nomogram with patients' survival were explored by log-rank survival analysis. RESULTS Borrmann classification, tumor thickness, and nICDP were independent predictors of PNI and used to build the nomogram. The nomogram yielded higher AUCs of 0.853 (0.744-0.928) and 0.782 (0.701-0.850) in primary and validation cohorts than any other parameters (p < 0.05). Both PNI and the nomogram were related to post-surgical treatment planning. Only PNI was associated with disease-free survival in the primary cohort (p < 0.05). CONCLUSION This work prospectively established a spectral CT-based nomogram, which can effectively predict PNI preoperatively and potentially guide post-surgical treatment strategy in LAGC. KEY POINTS • The present prospective study established a spectral CT-based nomogram for preoperative prediction of perineural invasion in LAGC. • The proposed nomogram, including morphological features and the quantitative iodine concentration values from spectral CT, had the potential to predict PNI for LAGC before surgery, along with guide post-surgical treatment planning. • Normalized iodine concentration at the delayed phase was the most valuable quantitative parameter, suggesting the importance of delayed enhancement in gastric CT.
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Affiliation(s)
- Jing Li
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Shuning Xu
- Department of Gastrointestinal Oncology, the Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, Henan, China
| | - Yi Wang
- Department of Pathology, the Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, Henan, China
| | - Mengjie Fang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Fei Ma
- Department of Gastrointestinal Surgery, the Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, Henan, China
| | - Chunmiao Xu
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Li Hailiang
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), No. 127 Dongming Road, Zhengzhou, 450008, Henan, China.
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Li J, Hou L, Zhang M. Diagnosis and treatment of stroke with Fe2O3 super nanoparticles and quality evaluation of nursing management in day medical department. APPLIED NANOSCIENCE 2022. [DOI: 10.1007/s13204-022-02728-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Dynamic contrast-enhanced and diffusion-weighted MR imaging in early prediction of pathologic response to neoadjuvant chemotherapy in locally advanced gastric cancer. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3394-3405. [PMID: 35916943 DOI: 10.1007/s00261-022-03623-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To investigate the efficacy of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the early prediction of the pathologic response to neoadjuvant chemotherapy (NAC) in patients with locally advanced gastric cancer (LAGC). METHODS Fifty patients with LAGC who were treated with NAC followed by radical gastrectomy were enrolled. Uncontrasted and DCE-MRI were performed within 1 week before NAC. According to tumor regression grading (TRG), patients were labeled as responders (TRG = 0 + 1) and non-responders (TRG = 2 + 3). Apparent diffusion coefficients (ADC) and DCE-MRI kinetics (Ktrans, Ve, and Kep) were compared between the two groups. Logistic regression analysis was performed to screen independent factors to predict the NAC efficacy. The relationship between MRI parameters and TRG was studied by Spearman's correlation analysis. Receiver-operating characteristic curve analyses were applied to evaluate the efficacy. RESULTS ADC, Ktrans, and Kep values were higher in responders than in non-responders (p < 0.05) and correlated with TRG (p < 0.05). The ADC and Kep values were independent markers for predicting TRG. The area under the curve, sensitivities, specificities of ADC, Ktrans, Kep, and ADC + Kep were 0.813, 0.699, 0.709, 0.886;73.64%, 65.54%, 63.21%, 70.37%; 86.47%, 54.97%, 79.47%, 95.65%; respectively. ADC + Kep demonstrated a higher efficacy than Ktrans and Kep (p = 0.012, 0.011), but without improvement compared with ADC (p > 0.05). CONCLUSION Both DWI and DCE-MRI can effectively predict the pathologic response to NAC in LAGC. A combination of ADC and Kep increased the efficacy, and ADC is the most valuable imaging parameter.
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Sivanathan V, Utz C, Thomaidis T, Förster F, Stahl M, Lordick F, Ibach S, Kanzler S, Adler A, Mönig SP, Schimanski CC, Ignee A, Dietrich CF, Galle PR, Moehler M. Predictive Value of Preoperative Endoscopic Ultrasound (EUS) After Neoadjuvant Chemotherapy in Locally Advanced Esophagogastric Cancer - Data From a Randomized German Phase II Trial. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:514-521. [PMID: 35226933 DOI: 10.1055/a-1593-4401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The role of EUS before or after neoadjuvant chemotherapy (nCTX) in advanced esophagogastric cancer (EGC) is still unclear. The phase II NEOPECX trial evaluated perioperative chemotherapy with or without panitumumab in this setting. The aim of this sub-study was to investigate the prognostic value of EUS-guided preoperative staging before and after nCTX. MATERIALS AND METHODS Preoperative yuT/yuN stages by EUS were compared with histopathological ypT/ypN stages after curative resection. Reduction in T-stage from baseline to preoperative EUS was defined as downstaging (DS+) and compared to progression-free (PFS) and overall survival (OS) of patients without downstaging (DS-). In addition, preoperative EUS N-stages (positive N+ or negative N-) were correlated with clinical data. RESULTS The preoperative yuT-stage correlated with the ypT-stage in 48% of cases (sensitivity 48%, specificity 52%), while the preoperative yuN-stage correlated with the ypN-stage in 64% (sensitivity 76%, specificity 52%). Within DS+ patients who were downstaged by ≥ 2 T-categories, a trend towards improved OS was detected (median OS DS+: not reached (NR), median OS DS-: 38.5 months (M), p=0.21). Patients with yuN+ at preoperative EUS had a worse outcome than yuN- patients (median OS yuN-: NR, median OS yuN+: 38.5 M, p = 0.013). CONCLUSION The diagnostic accuracy of EUS to predict the response after nCTX in patients with advanced EGC is limited. In the current study the endosonographic detection of lymph node metastasis after nCTX indicates a poor prognosis. In the future, preoperative EUS with sectional imaging procedures may be used to tailor treatment for patients with advanced EGC.
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Affiliation(s)
- Visvakanth Sivanathan
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christoph Utz
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Thomaidis
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Friedrich Förster
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael Stahl
- Department of Medical Oncology, Hospitals Essen-Mitte Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - Florian Lordick
- University Cancer Center Leipzig (UCCL), University of Leipzig Faculty of Medicine, Leipzig, Germany
| | - Stefan Ibach
- Biostatistik, WiSP Wissenschaftlicher Service Pharma GmbH, Langenfeld, Germany
| | - Stephan Kanzler
- Department of Internal Medicine II,, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - Andreas Adler
- Medical Department, Division of Hepatology and Gastroenterology, Charite University Hospital Berlin, Berlin, Germany
| | - Stefan Paul Mönig
- Department of Visceral Surgery, University Hospitals Geneva, Geneve, Switzerland
| | - Carl C Schimanski
- Department of Internal Medicine II, Hospital Darmstadt GmbH, Darmstadt, Germany
| | - Andre Ignee
- Department of Internal Medicine II, Caritas Hospital Bad Mergentheim, Bad Mergentheim, Germany
| | - Christoph F Dietrich
- Department of General and Internal Medicine, Hirslanden Clinic Beau Site, Salem and Permanence, Bern, Switzerland
| | - Peter R Galle
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Markus Moehler
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
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64-Slice Spiral Computerized Tomography under Algebraic Reconstruction Algorithm in the Surgical Treatment of Acquired Immune Deficiency Syndrome Complicated with Gastric Cancer. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:8548760. [PMID: 35694588 PMCID: PMC9187453 DOI: 10.1155/2022/8548760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/25/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022]
Abstract
In order to deeply analyze the application of CT images based on artificial intelligence algorithm in clinical treatment of AIDS patients with gastric cancer, and to provide reference for intervention of AIDS patients with gastric cancer, a total of 100 AIDS patients with gastric cancer were included as the research objects. The patients with CD4+ T lymphocyte count less than 200 cells/µL were in the control group (50 cases), whereas those higher than 200 cells/µL were in the experimental group (50 cases). All the patients underwent 64-slice spiral CT scanning. An improved algebraic reconstruction technology (ART) under L0 algorithmic approach (L0-ART) was proposed, and compared with the total variation (TV), filtered back projection (FBP), and weighted total variation (WTV) models. The standard deviation (STD) and average processing time of the L0-ART algorithm were significantly lower than those of the TV, FBP, and WTV algorithms (P < 0.05). The operation time of the experimental group was longer than that of the control group; the intraoperative blood loss, the diameter of the surgical wound, the time of first farting, the length of hospital stays, and the incidence of adverse reactions were all greatly lower than those of the control group (P < 0.05). Postoperatively, the total adipose tissue (TAT), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) in the abdominal area were higher in the experimental group than those in the control group (P < 0.05). In conclusion, the improved L0-ART algorithm proposed in this study had an excellent processing effect on CT images with a clinical promotion value. Patients with CD4+ T lymphocytes over 200 cells/µL had better surgical outcomes and prognosis than those with less than 200 cells/µL.
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Yu W, Li X, Zhou H, Zhang Y, Sun Z. Efficacy Evaluation of 64-Slice Spiral Computed Tomography Images in Laparoscopic-Assisted Distal Gastrectomy for Gastric Cancer under the Reconstruction Algorithm. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:2464640. [PMID: 36017021 PMCID: PMC9368136 DOI: 10.1155/2022/2464640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 11/18/2022]
Abstract
This study was aimed to analyze the application value of the filtered back-projection (FBP) reconstruction algorithm of computed tomography (CT) images in laparoscopic-assisted distal gastrectomy. In this study, 56 patients with gastric cancer were selected as research subjects and randomly divided into the control group (CT-guided laparoscopic radical gastrectomy) and the observation group (CT-guided laparoscopic radical gastrectomy with the FBP reconstruction algorithm), with 28 patients in each group. Fourier transform and iterative reconstruction were introduced for comparison, and finally, the postoperative curative effect and adverse events were compared between the two groups. The results showed that the CT image quality score processed by the FBP reconstruction algorithm (4.31 ± 0.31) was significantly higher than that of the iterative reconstruction method (3.5 ± 0.29) and the Fourier transform method (3.97 ± 0.38) (P < 0.05). The incidences of postoperative wound infection and gastric motility disorder (5.88% and 8.16%, respectively) in the observation group were significantly lower than those in the control group (8.21% and 10.82%, respectively) (P < 0.05). The levels of serum interleukin-6 (IL-6) (280.35 ± 15.08 ng/L) and tumor necrosis factor-α (TNF-α) (144.32 ± 10.32 ng/L) in the observation group after the treatment were significantly lower than those in the control group, which were 399.71 ± 14.19 ng/L and 165.33 ± 10.08 ng/L, respectively (P < 0.05). In conclusion, the FBP reconstruction algorithm was better than other algorithms in the processing of gastric cancer CT images. The FBP reconstruction algorithm showed a good reconstruction effect on CT images of gastric cancer; CT images based on this algorithm helped to formulate targeted surgical treatment plans for gastric cancer, showing a high clinical application value.
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Affiliation(s)
- Weiguang Yu
- Department of General Surgery, Affiliated Hongqi Hospital of Mudanjiang Medical
University, Mudanjiang 157011, Heilongjiang, China
| | - Xing Li
- Department of General Surgery, Affiliated Hongqi Hospital of Mudanjiang Medical
University, Mudanjiang 157011, Heilongjiang, China
| | - Hongbo Zhou
- Internal Medicine Oncology, Affiliated Hongqi Hospital of Mudanjiang Medical
University, Mudanjiang 157011, Heilongjiang, China
| | - Yang Zhang
- Department of Anatomy, Mudanjiang Medical University, Mudanjiang 157011,
Heilongjiang, China
| | - Zhiguo Sun
- Department of General Surgery, Affiliated Hongqi Hospital of Mudanjiang Medical
University, Mudanjiang 157011, Heilongjiang, China
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Acem I, Schultze BT, Schoonbeek A, van Houdt WJ, van de Sande MA, Visser JJ, Grünhagen DJ, Verhoef C. The added value of chest imaging after neoadjuvant radiotherapy for soft tissue sarcoma of the extremities and trunk wall: A retrospective cohort study. Eur J Surg Oncol 2022; 48:1543-1549. [DOI: 10.1016/j.ejso.2022.03.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022] Open
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Ge Z, Wang M, Liu Q. Segmentation of Gastric Computerized Tomography Images under Intelligent Algorithms in Evaluation of Efficacy of Decitabine Combined with Paclitaxel in Treatment of Gastric Cancer. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:8023490. [PMID: 34745511 PMCID: PMC8566038 DOI: 10.1155/2021/8023490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022]
Abstract
To analyze the evaluation of artificial intelligence algorithm combined with gastric computed tomography (CT) image in clinical chemotherapy for advanced gastric cancer, 112 patients with advanced gastric cancer were selected as the research object. Among which, 56 patients in the experimental group received paclitaxel (PTX) combined with decitabine sequential decitabine maintenance therapy. Fifty-six patients in the control group received first-line treatment with decitabine combined with cisplatin. The image segmentation algorithm based on fast interactive dictionary selection was used to process gastric CT images. Complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD), response rate (RR), disease control rate (DCR), and overall survival (OS) after treatment were recorded. The true-positive rate (TPR) and coincidence ratio (CR) of the proposed algorithm for image segmentation were significantly higher than those of the mean shift algorithm and the iCoseg algorithm. The mean edge distance (MED) and edge distance variance (EDV) were significantly lower than the mean shift algorithm and the iCoseg algorithm, and the differences were considerable (P < 0.05). The number of CR (5 cases), PR (13 cases), RR (18 cases), and DCR (44 cases) in the experimental group was significantly higher than that in the control group, while the number of PD (12 cases) was significantly lower than that in the control group (P < 0.05). The number of patients complicated with hematological toxicity, leucopenia, thrombocytopenia, and digestive tract reaction in the experimental group was less than that in the control group (P < 0.05). From the comparison of long-term efficacy, the survival rate of patients in both groups showed a decreasing trend within 24 months, but the decreasing trend of survival rate of patients in the experimental group was better than that in the control group. In short, the proposed algorithm had better segmentation performance than traditional algorithms. Compared with first-line treatment with decitabine and cisplatin, PTX in combination with decitabine sequential citabine maintenance regimens had better disease control rates, lower toxicity, and more effective improvements in patient quality of life and longer survival in patients with advanced gastric cancer.
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Affiliation(s)
- Zhenghui Ge
- Department of Gastroenterology, The People's Hospital of Danyang, Affiliated Danyang Hospital of Nantong University, Danyang 212300, Jiangsu, China
| | - Mengyun Wang
- Department of Imaging, Huai'an Second People's Hospital, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an 223002, Jiangsu, China
| | - Qun Liu
- Department of Neurology, Lianshui County People's Hospital, Lianshui 223400, Jiangsu, China
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Chen Q, Wang X, Ding R, Wang Z. Intelligent Algorithm-Based CT Imaging for Evaluation of Efficacy of Docetaxel Combined with Fluorouracil on Patients with Gastric Cancer. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:1040374. [PMID: 34659676 PMCID: PMC8514889 DOI: 10.1155/2021/1040374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022]
Abstract
The study focused on the dual-source computed tomography (CT) images segmented by the decision tree algorithm, to explore the efficacy of docetaxel combined with fluorouracil therapy on gastric patients undergoing chemotherapy. In this study, 98 patients with gastric cancer who were treated in the hospital were selected as the research subjects. The decision tree algorithm was applied to segment dual-source CT images of gastric cancer patients. The decision tree is established according to the feature ring and the segmentation position. The machine inductively learns from the decision tree to extract the features of the CT image to obtain the optimal segmentation boundary. The observation group was treated with docetaxel combined with fluorouracil, and the control group was treated with docetaxel combined with tegafur gimeracil oteracil potassium capsules. The general data of the two groups of patients were comparable and not statistically significant (P > 0.05). The two groups were compared for clinical efficacy, physical status, KPS score, improvement rate, and adverse drug reactions after treatment. The results showed that the improvement rate of physical fitness in the observation group was 38.78%, and the improvement rate in the control group was 18.37%. The total effective rate in the observation group was 42.85%, and the total effective rate in the control group was 36.73%. Obviously, the curative effect and improvement rate of physical fitness in the observation group were significantly better than those in the control group (P < 0.05). In conclusion, the decision tree algorithm proposed in this study demonstrates superb capabilities in feature extraction of CT images. The machine inductively learns from the decision tree to extract the features of the CT image to obtain the optimal segmentation boundary. The effect of docetaxel combined with fluorouracil is better than that of docetaxel combined with tegafur gimeracil oteracil potassium capsules.
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Affiliation(s)
- Qianqian Chen
- Department of Gastroenterology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an 223002, Jiangsu, China
| | - Xiaohong Wang
- Department of CT, The First Affiliated Hospital of Xiamen University, Xiamen 361003, Fujian, China
| | - Rong Ding
- Blood Rheumatology and Immunology, Lianshui County People's Hospital, Lianshui County 223400, Jiangsu, China
| | - Ziyao Wang
- Department of Pharmacy, People's Hospital of Hongze District, Huai'an 223100, Jiangsu, China
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12
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Wang J, Zhong L, Zhou X, Chen D, Li R. Value of multiphase contrast-enhanced CT with three-dimensional reconstruction in detecting depth of infiltration, lymph node metastasis, and extramural vascular invasion of gastric cancer. J Gastrointest Oncol 2021; 12:1351-1362. [PMID: 34532093 DOI: 10.21037/jgo-21-276] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/29/2021] [Indexed: 12/13/2022] Open
Abstract
Background Multiphase contrast-enhanced computed tomography (CECT) can reveal the location, morphology, size, and enhancement pattern of gastric cancer (GC), whereas the three-dimensional reconstruction (3DR) technique can better display the relationships of the lesions with surrounding structures, the feeding vessels, and lymph node metastasis. Here, we investigated the value of multi-phase CECT with 3DR in detecting depth of infiltration, lymph node metastasis, and extramural vascular invasion (EMVI) of GC. Methods The clinical and imaging data of 132 GC patients admitted to the Chongqing Hospital of Traditional Chinese Medicine and the Third Affiliated Hospital of Chongqing Medical University during the period from January 2012 to October 2019 were collected. All patients received plain and multiphase contrast-enhanced CT scans. The agreement between the results of preoperative CT evaluation and the surgical/pathological findings was compared. Results (I) CT findings of GC of 3 differentiation levels: on the multiphase CECT, the peak enhancement percentage was highest in the portal venous phase. The CT values significantly differed among the arterial, portal venous, and equilibrium phases (P<0.05); the differences in the arterial, portal venous, and equilibrium phases were statistically significant among the well-, moderately, and poorly differentiated groups (all P<0.05); finally, the difference in the equilibrium phase was statistically significant between the well- and moderately differentiated groups (P<0.05). (II) Preoperative CT and postoperative pathology had good consistency in T staging (Kappa =0.667). (III) The Kappa values between the preoperative CT-diagnosed lymph node metastasis and postoperative pathologically showing an increasing consistency with the increase of CT enhancement differences. (IV) Preoperative CT and postoperative pathology had good consistency in N staging (Kappa =0.779). (V) Preoperative CT in displaying arterial supply to the stomach. The rate of positive EMVI was 32.6% (43/132) on preoperative CT. The positive EMVI diagnosed by preoperative CT was correlated with tumor size, growth pattern, tissue differentiation degree, T stage, and N stage (all P<0.05). Conclusions Multiphase CECT combined with 3DR has high diagnostic performance in detecting the depth of infiltration, lymph node metastasis, and EMVI of GC.
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Affiliation(s)
- Junda Wang
- Department of Ultrasound, The Third Affiliated Hospital, Chongqing Medical University, Chongqing, China.,Department of Radiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Lijuan Zhong
- Department of Radiology, Leshan People's Hospital, Leshan, China
| | - Xinjie Zhou
- Department of Ultrasound, The Third Affiliated Hospital, Chongqing Medical University, Chongqing, China.,Department of Radiology, The Third Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Demei Chen
- Department of Ultrasound, The Third Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Rui Li
- Department of Ultrasound, The Third Affiliated Hospital, Chongqing Medical University, Chongqing, China
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13
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Computed Tomography Angiography under Deep Learning in the Treatment of Atherosclerosis with Rapamycin. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:4543702. [PMID: 34336152 PMCID: PMC8321726 DOI: 10.1155/2021/4543702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/30/2021] [Accepted: 07/15/2021] [Indexed: 12/24/2022]
Abstract
The clinical characteristics and vascular computed tomography (CT) imaging characteristics of patients were explored so as to assist clinicians in diagnosing patients with atherosclerosis. 316 patients with atherosclerosis who were hospitalized for emergency treatment were treated with rapamycin (RAPA) in the hospital. A group of manually delineated left ventricular myocardia (LVM) on the patient's coronary computed tomography angiography (CCTA) were selected as the region of interest for imaging features extracted. The CCTA images of 80% of patients were randomly selected for training, and those of 20% of patients were used for verification. The correlation matrix method was used to remove redundant image omics features under different correlation thresholds. In the validation set, CCTA diagnostic parameters were about 40 times higher than the manually segmented data. The average dice similarity coefficient was 91.6%. The proposed method also produced a very small centroid distance (mean 1.058 mm, standard deviation 1.245 mm) and volume difference (mean 1.640), with a segmentation time of about 1.45 ± 0.51 s, compared to about 744.8 ± 117.49 s for physician manual segmentation. Therefore, the deep learning model effectively segmented the atherosclerotic lesion area, measured and assisted the diagnosis of future atherosclerosis clinical cases, improved medical efficiency, and accurately identified the patient's lesion area. It had great application potential in helping diagnosis and curative effect analysis of atherosclerosis.
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14
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Sandø AD, Fougner R, Grønbech JE, Bringeland EA. The value of restaging CT following neoadjuvant chemotherapy for resectable gastric cancer. A population-based study. World J Surg Oncol 2021; 19:212. [PMID: 34256790 PMCID: PMC8278640 DOI: 10.1186/s12957-021-02313-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background Response evaluation following neoadjuvant chemotherapy (NAC) in gastric cancer is debated. The aim of this study was to investigate the value of UICC-downstaging as mode of response evaluation following a MAGIC-style regimen of NAC. Methods Retrospective, population-based study on consecutive patients with resectable gastric adenocarcinoma receiving NAC from 2007 to 2016. CT-scan was obtained at diagnosis (rTNM) and repeated following NAC (yrTNM) to evaluate response in terms of downstaging. Further, yrTNM stage was crosstabulated to pathologic stage (ypTNM) to depict correlation between radiologic and pathologic assessment. Results Of 171 patients receiving NAC, 169 were available for response evaluation. For TNM-stages, 43% responded, 50% had stable disease and 7% progressed at CT. Crosstabulating yrTNM stage to ypTNM stage, 24% had concordant stages, with CT overstaging 38% and understaging 38% of the tumours, Cohen kappa ƙ = 0,06 (95%CI 0.004–0.12). Similar patterns of discordance were found for T-stages and N-stages separately. For M-category, restaging CT detected 12 patients with carcinomatosis, with an additional 14 diagnosed with carcinomatosis only at operation. No patient developed parenchymal or extra abdominal metastases, and none developed locally non-resectable tumour during delivery of NAC. Restaging CT with response evaluation was not able to stratify patients into groups of different long-term survival rates based on response mode. Conclusions Routine CT-scan following NAC is of limited value. Accuracy of CT staging compared to final pathologic stage is poor, and radiologic downstaging as measure of response evaluation is unreliable and unable to discriminate long-term survival rates based on response mode.
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Affiliation(s)
- Alina Desiree Sandø
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway. .,Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Reidun Fougner
- Department of Radiology St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jon Erik Grønbech
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway.,Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erling Audun Bringeland
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway.,Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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15
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Lymph Node Involvement in Advanced Gastric Cancer in the Era of Multimodal Treatment-Oncological and Surgical Perspective. Cancers (Basel) 2021; 13:cancers13102509. [PMID: 34065596 PMCID: PMC8160868 DOI: 10.3390/cancers13102509] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Gastric cancer (GC) continues to be one of the major oncological challenges on a global scale. The role of neoadjuvant chemotherapy (NAC) in GC is to downstage primary tumour, eliminate potential micrometastases, and increase the chance for radical resection. Although systemic treatment prolongs the survival in advanced GC, persistent lymph node (LN) metastases indicate poor prognosis. Therefore, further identification of prognostic factors after NAC is urgent and could positively influence clinical outcomes. This article aimed to review the actual trends and future perspectives in multimodal therapy of advanced GC, with a particular interest in the post-neoadjuvant pathological nodal stage. Since downstaged and primarily node-negative patients show a similar prognosis, the main target for NAC in advanced GC should be nodal clearance. Adequate staging and personalised perioperative therapy seem to be of great importance in the multimodal treatment of GC. Abstract Gastric cancer (GC) continues to be one of the major oncological challenges on a global scale. The role of neoadjuvant chemotherapy (NAC) in GC is to downstage primary tumour, eliminate potential micrometastases, and increase the chance for radical resection. Although systemic treatment prolongs the survival in advanced GC, persistent lymph node (LN) metastases indicate poor prognosis. Further identification of prognostic factors after NAC is urgent and could positively influence clinical outcomes. This article aimed to review the actual trends and future perspectives in multimodal therapy of advanced GC, with a particular interest in the post-neoadjuvant pathological nodal stage. A favourable prognostic impact for ypN0 patients is observed, either due to truly negative LN before the start of therapy or because preoperative therapy achieved a pathologically complete nodal response. Ongoing trials investigating the extent of lymphadenectomy after neoadjuvant therapy will standardise the LN dissection from the multimodal therapy perspective. Since downstaged and primarily node-negative patients show a similar prognosis, the main target for NAC in advanced GC should be nodal clearance. Adequate staging and personalised perioperative therapy seem to be of great importance in the multimodal treatment of GC.
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16
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Jiang L, Wang W, Li Z, Zhao Y, Qin Z. NUPR1 participates in YAP-mediate gastric cancer malignancy and drug resistance via AKT and p21 activation. J Pharm Pharmacol 2021; 73:740-748. [PMID: 33793788 DOI: 10.1093/jpp/rgab010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/19/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To assess nuclear protein 1 (NUPR1) level in human gastric cancer (GC) cells, explore the effects of NUPR1 on GC progression, and investigate the possible regulatory mechanism. METHODS Immunohistochemistry (IHC), Immunoblot and quantitative PCR assays were conducted to detect the NUPR1 level in human GC tissues and corresponding normal tissues. Also, NUPR1 expression level correlates with clinical features of GC patients. 3-(4,5-Dimethylthiazol-2-Yl)-2,5-Diphenyltetrazolium Bromide (MTT), transwell assays, Immunoblot assays, and flow cytometry (FCM) assays were used to evaluate the effects of NUPR1 on the proliferation, invasion, epithelial-mesenchymal transformation (EMT) and apoptosis of GC cells in vitro. Immunoblot assays were performed to detect the potential mechanism in NUPR1-mediated drug resistance. KEY FINDINGS We found the expression of NUPR1 was upregulated in human gastric cancer tissues and correlated with the clinical features including tumour size, tumour stage and, lymph node metastasis. We further noticed that the depletion of NUPR1 inhibited the invasion and EMT of gastric cancer cells and stimulated the apoptosis. In doxorubicin-resistant gastric cancer cells, yes-associated protein (YAP) activation was up-regulated, and YAP could regulate the expression of NUPR1 to affect drug-resistance. We further provided the evidence that overexpression of NUPR1 reversed the effect of YAP knockdown on cell malignancy and drug resistance via regulating AKT and p21 pathway. CONCLUSIONS Our findings indicated the involvement of NUPR1 in the progression of gastric cancer and elucidated its molecular mechanism in regulating drug resistance.
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Affiliation(s)
- Lei Jiang
- Acute Abdominal Surgery Ward, Affiliated ZhongShan Hospital Dalian University, Dalian City, Liaoning Province, China
| | - Wenjun Wang
- Acute Abdominal Surgery Ward, Affiliated ZhongShan Hospital Dalian University, Dalian City, Liaoning Province, China
| | - Zhanwu Li
- Acute Abdominal Surgery Ward, Affiliated ZhongShan Hospital Dalian University, Dalian City, Liaoning Province, China
| | - Yao Zhao
- General Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an City, Jiangsu Province, China
| | - Zhensheng Qin
- General Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an City, Jiangsu Province, China
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17
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Gertsen EC, Brenkman HJF, Brosens LAA, Luijten JCHBM, Mohammad NH, Verhoeven RHA, van Hillegersberg R, Ruurda JP. Refraining from resection in patients with potentially curable gastric carcinoma. Eur J Surg Oncol 2020; 47:1062-1068. [PMID: 33129631 DOI: 10.1016/j.ejso.2020.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/05/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Surgical resection is the cornerstone of curative treatment for gastric cancer. The aim of this study was to evaluate reasons for and patient- and tumor characteristics that are associated with refraining from surgical resection in patients with potentially curable gastric cancer. MATERIALS AND METHODS Between 2015 and 2017, all patients with potentially curable gastric adenocarcinoma (cT1-4a-x, cN0-3-x, cM0) were included from the Netherlands Cancer Registry (NCR). Patients were divided into a resection (RG) and a no-resection group (nRG). Reasons for not undergoing resection as registered by the NCR were evaluated. Using multivariable logistic regression analyses, patient and tumor characteristics associated with refraining from resection were assessed. RESULTS Of the 1679 analyzed patients with potentially curable disease, 1127 patients (67%) underwent resection, and 552 patients (33%) did not. Most common registered reasons for refraining from surgery were patient refusal (25%), low performance status (23%), comorbidity and extent of disease (both 10%). Factors associated with not undergoing resection were: age ≥80 years (OR 4.77, [95%CI 2.27-10.06], p < 0.001), low Social-Economic-Status (SES) (OR 2.68 [95%CI 1.31-5.46], p = 0.007), WHO performance status 3-4 (OR 10.48 [95%CI 2.41-45.73], p = 0.002) with several accompanying comorbidities, unclassified Lauren classification (OR 3.93 [95%CI 1.61-9.56], p = 0.003) and overlapping/diffuse tumors (OR 3.51, [95%CI 1.54-8.05], p = 0.003). CONCLUSION A third of patients with potentially curable gastric cancer did not undergo resection. Most frequent registered reasons for refraining from surgery were patient refusal, performance status, comorbidity and extent of disease. Additionally, multivariable analyses identified higher age, lower SES, and poor tumor characteristics as associated factors.
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Affiliation(s)
- Emma C Gertsen
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Hylke J F Brenkman
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - L A A Brosens
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Josianne C H B M Luijten
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - Nadia Haj Mohammad
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Rob H A Verhoeven
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands; Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
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