Importance of residual primary cancer after induction therapy for esophageal adenocarcinoma

Differences between sexes in patients who underwent total arch replacement and frozen elephant trunk procedures for acute dissection

OBJECTIVE

To analyze the effect of sex on the short-time prognosis in two different age subgroups (≤55 years old and >55 years old).

METHODS

From January 2009 to 2019, 1522 patients with DeBakey I acute aortic dissection (AAD) underwent frozen elephant trunk and total arch replacement at a Tertiary Center in China were divided into female group (n = 324) and male group (n = 1198). The demographic characteristics, clinical presentation, management, short-term outcomes were described in the different sex groups. The risk factors of 30-days mortality for females and males were identified by univariate and multivariable logistic regression analysis. Then, random Forest regression was used to analyze the association between age and 30-days mortality in the different sexes groups. The cut-off age for 30-days mortality in females was then identified as 55 years. The patients were divided into two subgroups: young patients (≤55 years old) and elderly patients (>55 years old). Clinical prognosis between different sex groups was further compared in the age subgroups.

RESULTS

Approximately four-fifths of the patients were males. Males with DeBakey I AAD were younger than females (47 vs 52 years; p < 0.01). The proportion of males gradually declined with age. The cut-off age for 30-days mortality in females and males was identified as 55 years old and 63 years old, respectively. In young patients (≤55 years old), the 30-days mortality rate for females was lower than males (hazard ratio [HR, 2.02, p < 0.05). Following adjustment using the multivariable Cox regression analysis, females were identified as an independent protective factor for 30-days mortality (HR, 2.24, p = 0.03).

CONCLUSIONS

Our study showed that females present with DeBakey I AAD less frequently than males and they tend to present with DeBakey AAD later in life. In young patients, females had better early outcomes despite similar time for symptom onset to diagnosis and surgical technique than males.

Effect of circumferential resection margin status on survival and recurrence in esophageal squamous cell carcinoma with neoadjuvant chemoradiotherapy

Background

The aim of this study was to investigate whether circumferential resection margin (CRM) status has an impact on survival and recurrence in esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy.

Methods

We screened patients with esophageal squamous cell carcinoma who underwent esophagectomy from January 2017 to December 2019. The CRM was reassessed. Patients were grouped into a CRM of 1 mm or less (0 &lt; CRM ≤ 1 mm) and a CRM greater than 1 mm (CRM&gt;1 mm). The impact of CRM on survival was investigated using Kaplan–Meier analysis and Cox regression modeling. The optimal CRM cut point was evaluated using restricted cubic spline curve.

Results

A total of 89 patients were enrolled in this study. The CRM status was an independent risk factor for the prognosis (HR: 0.35, 95% CI: 0.16-0.73). Compared with a CRM of 1 mm or less, a CRM greater than 1 mm had better overall survival (HR: 0.35, 95% CI: 0.16-0.73, log-rank P = 0.011), longer disease-free survival (HR: 0.51, 95% CI: 0.27-0.95, log-rank P = 0.040), and less recurrence (HR: 0.44, 95% CI: 0.23-0.85, log–rank P = 0.015). We visualized the association between CRM and the hazard ratio of survival and identified the optimal cut point at 1 mm.

Conclusions

A CRM greater than 1 mm had better survival and less recurrence compared to a CRM of 1 mm or less. A more radical resection with adequate CRM could benefit survival in patients with esophageal squamous cell carcinoma after neoadjuvant therapy.

A methodology for customizing clinical tests for esophageal cancer based on patient preferences

BACKGROUND

Clinical tests for diagnosis of any disease may be expensive, uncomfortable, time consuming and can have side effects e.g. barium swallow test for esophageal cancer. Although we can predict non-existence of esophageal cancer with near 100% certainty just using demographics, lifestyle, medical history information, and a few basic clinical tests but our objective is to devise a general methodology for customizing tests with user preferences to avoid expensive or uncomfortable tests.

METHOD

We propose to use classifiers trained from electronic medical records (EMR) for selection of tests. The key idea is to design classifiers with 100% false normal rates, possibly at the cost of higher false abnormal. We find kernel logistic regression to be most suitable for the task. We propose an algorithm for finding the best probability threshold for kernel LR, based on test set accuracy tuning with help of a validation data set. Using the proposed algorithm, we describe schemes for selecting tests, which appear as features in the automatic classification algorithm, using preferences on costs and discomfort of the users i.e the proposed method is able to detect almost all true patients in the population even with user preferred clinical tests.

RESULT

We test our methodology with EMRs collected for more than 3000 patients, as a part of project carried out by a reputed hospital in Mumbai, India. We found that kernel SVM and kernel LR with a polynomial kernel of degree 3, yields an accuracy of 99.18% and sensitivity 100% using only demographic, lifestyle, patient history, and basic clinical tests. We demonstrate our test selection algorithm using two case studies, one using cost of clinical tests, and other using "discomfort" values for clinical tests. We compute the test sets corresponding to the lowest false abnormals for each criterion described above, using exhaustive enumeration of 12 and 15 clinical tests respectively. The sets turn out to be different, substantiating our claim that one can customize test sets based on user preferences.