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Zhao Y, Li L, Han K, Li T, Duan J, Sun Q, Zhu C, Liang D, Chai N, Li ZC. A radio-pathologic integrated model for prediction of lymph node metastasis stage in patients with gastric cancer. Abdom Radiol (NY) 2023; 48:3332-3342. [PMID: 37716926 DOI: 10.1007/s00261-023-04037-2] [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: 05/11/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Accurate prediction of lymph node metastasis stage (LNMs) facilitates precision therapy for gastric cancer. We aimed to develop and validate a deep learning-based radio-pathologic model to predict the LNM stage in patients with gastric cancer by integrating CT images and histopathological whole-slide images (WSIs). METHODS A total of 252 patients were enrolled and randomly divided into a training set (n = 202) and a testing set (n = 50). Both pretreatment contrast-enhanced abdominal CT and WSI of biopsy specimens were collected for each patient. The deep radiologic and pathologic features were extracted from CT and WSI using ResNet-50 and Vision Transformer (ViT) network, respectively. By fusing both radiologic and pathologic features, a radio-pathologic integrated model was constructed to predict the five LNM stages. For comparison, four single-modality models using CT images or WSIs were also constructed, respectively. All models were trained on the training set and validated on the testing set. RESULTS The radio-pathologic integrated mode achieved an overall accuracy of 84.0% and a kappa coefficient of 0.795 on the testing set. The areas under the curves (AUCs) of the integrated model in predicting the five LNM stages were 0.978 (95% Confidence Interval (CI 0.917-1.000), 0.946 (95% CI 0.867-1.000), 0.890 (95% CI 0.718-1.000), 0.971 (95% CI 0.920-1.000), and 0.982 (95% CI 0.911-1.000), respectively. Moreover, the integrated model achieved an AUC of 0.978 (95% CI 0.912-1.000) in predicting the binary status of nodal metastasis. CONCLUSION Our study suggests that radio-pathologic integrated model that combined both macroscale radiologic image and microscale pathologic image can better predict lymph node metastasis stage in patients with gastric cancer.
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Affiliation(s)
- Yuanshen Zhao
- Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Longsong Li
- Department of Gastroenterology, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Ke Han
- Department of Gastroenterology, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Tao Li
- Department of Radiology, The First Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Jingxian Duan
- Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Qiuchang Sun
- Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Chaofan Zhu
- Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Dong Liang
- Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
- National Innovation Center for Advanced Medical Devices, Shenzhen, China
- Shenzhen United Imaging Research Institute of Innovative Medical Equipment, Shenzhen, China
| | - Ningli Chai
- Department of Gastroenterology, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China.
| | - Zhi-Cheng Li
- Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China.
- National Innovation Center for Advanced Medical Devices, Shenzhen, China.
- Shenzhen United Imaging Research Institute of Innovative Medical Equipment, Shenzhen, China.
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Wang Z, Li M, Xu Z, Jiang Y, Gu H, Yu Y, Zhu H, Zhang H, Lu P, Xin J, Xu H, Liu C. Improvements to the gastric cancer tumor-node-metastasis staging system based on computer-aided unsupervised clustering. BMC Cancer 2018; 18:706. [PMID: 29970022 PMCID: PMC6029135 DOI: 10.1186/s12885-018-4623-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/20/2018] [Indexed: 12/26/2022] Open
Abstract
Background The Union for International Cancer Control (UICC) tumor-node-metastasis (TNM) classification is a key gastric cancer prognosis system. This study aimed to create a new TNM system to provide a reference for the clinical diagnosis and treatment of gastric cancer. Methods A review of gastric cancer patients’ records was conducted in The First Hospital of China Medical University and the Liaoning Cancer Hospital and Institute. Based on patients’ prognoses data, computer-aided unsupervised clustering was performed for all possible TNM staging situations to create a new staging division system. Results The primary outcome measure was 5-year survival, analyzed according to TNM classifications. Computer-aided unsupervised clustering for all TNM staging situations was used to create TNM division criteria that were more consistent with clinical situations. Furthermore, unsupervised clustering for the number of lymph node metastasis in the N stage led to the formulation of a classification method that differs from the existing N stage criteria, and unsupervised clustering for tumor size provided an additional reference for prognosis estimates. Conclusions Finally, we developed a TNM staging system based on the computer-aided unsupervised clustering method; this system was more in line with clinical prognosis data when compared with the 7th edition of UICC gastric cancer TNM classification.
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Affiliation(s)
- Zhiqiong Wang
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, 110169, China
| | - Mo Li
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, 110169, China
| | - Zhen Xu
- Department of General, Visceral and Transplantation Surgery, Section Surgical Research, University Clinic Heidelberg, Im Neuenheimer Feld 365, 69120, Heidelberg, Germany
| | - Yanlin Jiang
- Department of Breast and Thyroid Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Huizi Gu
- Department of Internal Neurology, the Second Hospital of Dalian Medical University, Dalian, 116027, China
| | - Ying Yu
- Liaoning Medical Device Test Institute, Shenyang, 110179, China
| | - Haitao Zhu
- Department of Gastric Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, 110042, China
| | - Hao Zhang
- Department of Breast Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, No. 44, Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China.
| | - Ping Lu
- Department of Surgical Oncology, the first hospital of China Medical University, Shenyang, 110001, China
| | - Junchang Xin
- School of Computer Science and Engineering, Northeastern University, Shenyang, 110189, China.
| | - Hong Xu
- Department of Breast Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, No. 44, Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China.
| | - Caigang Liu
- Department of Breast Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
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Gu H, Li D, Zhu H, Zhang H, Yu Y, Qin D, Yi M, Li X, Lu P. The prognostic efficacy and improvements of the 7th edition Union for International Cancer Control tumor-node-metastasis classifications for Chinese patients with gastric cancer: Results based on a retrospective three-decade population study. Tumour Biol 2017; 39:1010428317694548. [PMID: 28351302 DOI: 10.1177/1010428317694548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
This study aimed to evaluate survival trends for patients with gastric cancer in northeast China in the most recent three decades and analyze the applicability of the UICC tumor-node-metastasis (TNM) classification 7th edition for Chinese patients with gastric cancer. A review of all inpatient and outpatient records of patients with gastric cancer was conducted in the first hospital of China Medical University and the Liaoning Cancer Hospital and Institute. All patients who met the inclusion criteria and were seen from January 1980 through December 2009 were included in the study. The primary outcome was 5-year survival, which was analyzed according to decade of diagnosis and TNM classifications. From 1980 through 2009, the 5-year survival rates for patients with gastric cancer (n=2414) increased from 39.1% to 57.3%. Decade of diagnosis was significantly associated with patient survival (p = 0.013), and the 5-year survival rate in the 2000s was remarkably higher than that in the 1980s and 1990s (p = 0.004 and 0.049, respectively). When classified according to the UICC TNM classification of gastric cancer 7th edition, the prognoses of stage IIIA and stage IIIB patients were not significantly different (p = 0.077). However, if stage T4b and stage N0 patients were classified as stage IIIA, the prognoses of stage IIIA and stage IIIB patients were significantly different (p < 0.001). Hence, there was a significant difference in survival during the three time periods in Northeast China. Classifying stage T4b and stage N0 patients as stage IIIA according to the 7th edition of UICC gastric cancer TNM classifications better stratified Chinese patients and predicted prognoses.
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Affiliation(s)
- Huizi Gu
- 1 Department of Internal Neurology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Dongmei Li
- 2 Department of Radiology, Dalian Hospital of Traditional Chinese Medicine, Dalian, China
| | - Haitao Zhu
- 3 Department of Gastric Surgery, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Hao Zhang
- 4 Breast Disease and Reconstruction Center, Breast Cancer Key Lab of Dalian, The Second Hospital of Dalian Medical University, Dalian, China
| | - Ying Yu
- 5 Liaoning Medical Device Test Institute, Shenyang, China
| | - Dongxue Qin
- 6 Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Mei Yi
- 6 Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Xiang Li
- 6 Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Ping Lu
- 7 Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang, China
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Zhang CD, Zeng YJ, Li Z, Chen J, Li HW, Zhang JK, Dai DQ. Extended antimicrobial prophylaxis after gastric cancer surgery: A systematic review and meta-analysis. World J Gastroenterol 2013; 19:2104-2109. [PMID: 23599632 PMCID: PMC3623990 DOI: 10.3748/wjg.v19.i13.2104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 02/06/2013] [Accepted: 03/07/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the efficacy of extended antimicrobial prophylaxis (EAP) after gastrectomy by systematic review of literature and meta-analysis.
METHODS: Electronic databases of PubMed, Embase, CINAHL, the Cochrane Database of Systematic Reviews, the Cochrane Controlled Trials Register and the China National Knowledge Infrastructure were searched systematically from January 1980 to October 2012. Strict literature retrieval and data extraction were carried out independently by two reviewers and meta-analyses were conducted using RevMan 5.0.2 with statistics tools risk ratios (RRs) and intention-to-treat analyses to evaluate the items of total complications, surgical site infection, incision infection, organ (or space) infection, remote site infection, anastomotic leakage (or dehiscence) and mortality. Fixed model or random model was selected accordingly and forest plot was conducted to display RR. Likewise, Cochrane Risk of Bias Tool was applied to evaluate the quality of randomized controlled trials (RCTs) included in this meta-analysis.
RESULTS: A total of 1095 patients with gastric cancer were enrolled in four RCTs. No statistically significant differences were detected between EAP and intraoperative antimicrobial prophylaxis (IAP) in total complications (RR of 0.86, 95%CI: 0.63-1.16, P = 0.32), surgical site infection (RR of 1.97, 95%CI: 0.86-4.48, P = 0.11), incision infection (RR of 4.92, 95%CI: 0.58-41.66, P = 0.14), organ or space infection (RR of 1.55, 95%CI: 0.61-3.89, P = 0.36), anastomotic leakage or dehiscence (RR of 3.85, 95%CI: 0.64-23.17, P = 0.14) and mortality (RR of 1.14, 95%CI: 0.10-13.12; P = 0.92). Likewise, multiple-dose antimicrobial prophylaxis showed no difference compared with single-dose antimicrobial prophylaxis in surgical site infection (RR of 1.10, 95%CI: 0.62-1.93, P = 0.75). Nevertheless, EAP showed a decreased remote site infection rate compared with IAP alone (RR of 0.54, 95%CI: 0.34-0.86, P = 0.01), which is the only significant finding. Unfortunately, EAP did not decrease the incidence of surgical site infections after gastrectomy; likewise, multiple-dose antimicrobial prophylaxis failed to decrease the incidence of surgical site infection compared with single-dose antimicrobial prophylaxis.
CONCLUSION: We recommend that EAP should not be used routinely after gastrectomy until more high-quality RCTs are available.
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Nelson R, Ko EB, Arrington A, Lee W, Kim J, Garcia-Aguilar J, Kim J. Race and correlations between lymph node number and survival for patients with gastric cancer. J Gastrointest Surg 2013; 17:471-81. [PMID: 23288716 DOI: 10.1007/s11605-012-2125-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 12/10/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is ongoing debate whether extended lymphadenectomy improves survival in gastric cancer patients who undergo surgical resection. We previously observed that Korean-American patients had the highest overall survival in Los Angeles County. Our objective was to assess lymph node (LN) number and its impact on survival for Korean-American gastric cancer patients. METHODS We utilized the National Cancer Institute's Surveillance, Epidemiology, and End Results registry to identify Korean-Americans with gastric adenocarcinoma treated with curative-intent gastrectomy between 1988 and 2008. We grouped patients according to examined LN number (1-15 and 16+) and compared characteristics. We performed similar analysis for white patients. RESULTS Out of 982 Korean-American patients with gastric adenocarcinoma, most patients had 1-15 examined LNs (60 %). When we compared LN groups, we observed higher overall survival in the 1-15 group than the 16+ group (5-year survival, 59 % vs 52 %, respectively; p = 0.04). However, LN number was not prognostic of overall survival on stepwise Cox proportional hazards analysis. In contrast, LN number was prognostic for white patients. CONCLUSIONS Although examined LN number may impact survival for white patients, outcomes of Korean-American gastric cancer patients were independent of LN number. Our data suggest that survival of Korean-American gastric cancer patients are comparable with outcomes from East Asian hospitals and may be independent of surgical technique.
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Affiliation(s)
- Rebecca Nelson
- Departments of Biostatistics (RN) and Surgery (EBK, AA, WL, JK, JK), City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
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