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O'Shea R, Withey SJ, Owczarczyk K, Rookyard C, Gossage J, Godfrey E, Jobling C, Parsons SL, Skipworth RJE, Goh V. Multicentre validation of CT grey-level co-occurrence matrix features for overall survival in primary oesophageal adenocarcinoma. Eur Radiol 2024; 34:6919-6928. [PMID: 38526750 PMCID: PMC11399295 DOI: 10.1007/s00330-024-10666-y] [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: 08/29/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Personalising management of primary oesophageal adenocarcinoma requires better risk stratification. Lack of independent validation of proposed imaging biomarkers has hampered clinical translation. We aimed to prospectively validate previously identified prognostic grey-level co-occurrence matrix (GLCM) CT features for 3-year overall survival. METHODS Following ethical approval, clinical and contrast-enhanced CT data were acquired from participants from five institutions. Data from three institutions were used for training and two for testing. Survival classifiers were modelled on prespecified variables ('Clinical' model: age, clinical T-stage, clinical N-stage; 'ClinVol' model: clinical features + CT tumour volume; 'ClinRad' model: ClinVol features + GLCM_Correlation and GLCM_Contrast). To reflect current clinical practice, baseline stage was also modelled as a univariate predictor ('Stage'). Discrimination was assessed by area under the receiver operating curve (AUC) analysis; calibration by Brier scores; and clinical relevance by thresholding risk scores to achieve 90% sensitivity for 3-year mortality. RESULTS A total of 162 participants were included (144 male; median 67 years [IQR 59, 72]; training, 95 participants; testing, 67 participants). Median survival was 998 days [IQR 486, 1594]. The ClinRad model yielded the greatest test discrimination (AUC, 0.68 [95% CI 0.54, 0.81]) that outperformed Stage (ΔAUC, 0.12 [95% CI 0.01, 0.23]; p = .04). The Clinical and ClinVol models yielded comparable test discrimination (AUC, 0.66 [95% CI 0.51, 0.80] vs. 0.65 [95% CI 0.50, 0.79]; p > .05). Test sensitivity of 90% was achieved by ClinRad and Stage models only. CONCLUSIONS Compared to Stage, multivariable models of prespecified clinical and radiomic variables yielded improved prediction of 3-year overall survival. CLINICAL RELEVANCE STATEMENT Previously identified radiomic features are prognostic but may not substantially improve risk stratification on their own. KEY POINTS • Better risk stratification is needed in primary oesophageal cancer to personalise management. • Previously identified CT features-GLCM_Correlation and GLCM_Contrast-contain incremental prognostic information to age and clinical stage. • Compared to staging, multivariable clinicoradiomic models improve discrimination of 3-year overall survival.
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Affiliation(s)
- Robert O'Shea
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Samuel J Withey
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Radiology, Royal Marsden Hospital NHS Trust, Sutton, Surrey, UK
| | - Kasia Owczarczyk
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Clinical Oncology, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Christopher Rookyard
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - James Gossage
- Department of Surgery, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Edmund Godfrey
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Craig Jobling
- Department of Radiology, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Simon L Parsons
- Department of Surgery, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | | | - Vicky Goh
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Department of Radiology, Guy's & St Thomas' Hospitals NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EG, UK.
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Partridge T, Wolfson P, Jiang J, Massimi L, Astolfo A, Djurabekova N, Savvidis S, Jones CJM, Hagen CK, Millard E, Shorrock W, Waltham RM, Haig IG, Bate D, Ho KMA, Mc Bain H, Wilson A, Hogan A, Delaney H, Liyadipita A, Levine AP, Dawas K, Mohammadi B, Qureshi YA, Chouhan MD, Taylor SA, Mughal M, Munro PRT, Endrizzi M, Novelli M, Lovat LB, Olivo A. T staging esophageal tumors with x rays. OPTICA 2024; 11:569-576. [PMID: 39006164 PMCID: PMC11239146 DOI: 10.1364/optica.501948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 03/05/2024] [Accepted: 04/07/2024] [Indexed: 07/16/2024]
Abstract
With histopathology results typically taking several days, the ability to stage tumors during interventions could provide a step change in various cancer interventions. X-ray technology has advanced significantly in recent years with the introduction of phase-based imaging methods. These have been adapted for use in standard labs rather than specialized facilities such as synchrotrons, and approaches that enable fast 3D scans with conventional x-ray sources have been developed. This opens the possibility to produce 3D images with enhanced soft tissue contrast at a level of detail comparable to histopathology, in times sufficiently short to be compatible with use during surgical interventions. In this paper we discuss the application of one such approach to human esophagi obtained from esophagectomy interventions. We demonstrate that the image quality is sufficiently high to enable tumor T staging based on the x-ray datasets alone. Alongside detection of involved margins with potentially life-saving implications, staging tumors intra-operatively has the potential to change patient pathways, facilitating optimization of therapeutic interventions during the procedure itself. Besides a prospective intra-operative use, the availability of high-quality 3D images of entire esophageal tumors can support histopathological characterization, from enabling "right slice first time" approaches to understanding the histopathology in the full 3D context of the surrounding tumor environment.
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Affiliation(s)
- T. Partridge
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
| | - P. Wolfson
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
- Division of Surgery and Interventional Science, UCL, London WC1E 6BT, UK
| | - J. Jiang
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
- Current address: Advanced Photon Source, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - L. Massimi
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
| | - A. Astolfo
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
- Nikon X-Tek Systems Ltd., Tring, Herts HP23 4JX, UK
| | - N. Djurabekova
- Department of Computer Science, UCL, London WC1E 6BT, UK
| | - S. Savvidis
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
| | - C. J. Maughan Jones
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
| | - C. K. Hagen
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
| | - E. Millard
- Nikon X-Tek Systems Ltd., Tring, Herts HP23 4JX, UK
| | - W. Shorrock
- Nikon X-Tek Systems Ltd., Tring, Herts HP23 4JX, UK
| | | | - I. G. Haig
- Nikon X-Tek Systems Ltd., Tring, Herts HP23 4JX, UK
| | - D. Bate
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
- Nikon X-Tek Systems Ltd., Tring, Herts HP23 4JX, UK
| | - K. M. A. Ho
- Division of Surgery and Interventional Science, UCL, London WC1E 6BT, UK
| | - H. Mc Bain
- Division of Surgery and Interventional Science, UCL, London WC1E 6BT, UK
| | - A. Wilson
- Division of Surgery and Interventional Science, UCL, London WC1E 6BT, UK
| | - A. Hogan
- Division of Surgery and Interventional Science, UCL, London WC1E 6BT, UK
| | - H. Delaney
- Department of Histopathology, UCL, London WC1E 6BT, UK
| | - A. Liyadipita
- Department of Histopathology, UCL, London WC1E 6BT, UK
| | - A. P. Levine
- Department of Histopathology, UCL, London WC1E 6BT, UK
| | - K. Dawas
- Department of Upper Gastro-Intestinal Surgery, UCLH, London NW1 2BU, UK
| | - B. Mohammadi
- Department of Upper Gastro-Intestinal Surgery, UCLH, London NW1 2BU, UK
| | - Y. A. Qureshi
- Department of Upper Gastro-Intestinal Surgery, UCLH, London NW1 2BU, UK
| | - M. D. Chouhan
- Center for Medical Imaging, Division of Medicine, UCL, London WC1E 6BT, UK
- Princess Alexandra Hospital Medical Imaging Department, Brisbane, Queensland, Australia
- University of Queensland Medical School, Saint Lucia, Queensland, Australia
| | - S. A. Taylor
- Center for Medical Imaging, Division of Medicine, UCL, London WC1E 6BT, UK
| | - M. Mughal
- Department of Upper Gastro-Intestinal Surgery, UCLH, London NW1 2BU, UK
| | - P. R. T. Munro
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
| | - M. Endrizzi
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
| | - M. Novelli
- Research Department of Pathology, Cancer Institute, UCLH, London NW1 2BU, UK
| | - L. B. Lovat
- Division of Surgery and Interventional Science, UCL, London WC1E 6BT, UK
| | - A. Olivo
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
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Ebert MP, Fischbach W, Hollerbach S, Höppner J, Lorenz D, Stahl M, Stuschke M, Pech O, Vanhoefer U, Porschen R. S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:535-642. [PMID: 38599580 DOI: 10.1055/a-2239-9802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Matthias P Ebert
- II. Medizinische Klinik, Medizinische Fakultät Mannheim, Universitätsmedizin, Universität Heidelberg, Mannheim
- DKFZ-Hector Krebsinstitut an der Universitätsmedizin Mannheim, Mannheim
- Molecular Medicine Partnership Unit, EMBL, Heidelberg
| | - Wolfgang Fischbach
- Deutsche Gesellschaft zur Bekämpfung der Krankheiten von Magen, Darm und Leber sowie von Störungen des Stoffwechsels und der Ernährung (Gastro-Liga) e. V., Giessen
| | | | - Jens Höppner
- Klinik für Allgemeine Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck
| | - Dietmar Lorenz
- Chirurgische Klinik I, Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Darmstadt, Darmstadt
| | - Michael Stahl
- Klinik für Internistische Onkologie und onkologische Palliativmedizin, Evang. Huyssensstiftung, Evang. Kliniken Essen-Mitte, Essen
| | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Oliver Pech
- Klinik für Gastroenterologie und Interventionelle Endoskopie, Krankenhaus Barmherzige Brüder, Regensburg
| | - Udo Vanhoefer
- Klinik für Hämatologie und Onkologie, Katholisches Marienkrankenhaus, Hamburg
| | - Rainer Porschen
- Gastroenterologische Praxis am Kreiskrankenhaus Osterholz, Osterholz-Scharmbeck
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Veziant J, Bouché O, Aparicio T, Barret M, El Hajbi F, Lepilliez V, Lesueur P, Maingon P, Pannier D, Quero L, Raoul JL, Renaud F, Seitz JF, Serre AA, Vaillant E, Vermersch M, Voron T, Tougeron D, Piessen G. Esophageal cancer - French intergroup clinical practice guidelines for diagnosis, treatments and follow-up (TNCD, SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, SFP, RENAPE, SNFCP, AFEF, SFR). Dig Liver Dis 2023; 55:1583-1601. [PMID: 37635055 DOI: 10.1016/j.dld.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION This document is a summary of the French intergroup guidelines regarding the management of esophageal cancer (EC) published in July 2022, available on the website of the French Society of Gastroenterology (SNFGE) (www.tncd.org). METHODS This collaborative work was conducted under the auspices of several French medical and surgical societies involved in the management of EC. Recommendations were graded in three categories (A, B and C), according to the level of evidence found in the literature until April 2022. RESULTS EC diagnosis and staging evaluation are mainly based on patient's general condition assessment, endoscopy plus biopsies, TAP CT-scan and 18F FDG-PET. Surgery alone is recommended for early-stage EC, while locally advanced disease (N+ and/or T3-4) is treated with perioperative chemotherapy (FLOT) or preoperative chemoradiation (CROSS regimen) followed by immunotherapy for adenocarcinoma. Preoperative chemoradiation (CROSS regimen) followed by immunotherapy or definitive chemoradiation with the possibility of organ preservation are the two options for squamous cell carcinoma. Salvage surgery is recommended for incomplete response or recurrence after definitive chemoradiation and should be performed in an expert center. Treatment for metastatic disease is based on systemic therapy including chemotherapy, immunotherapy or combined targeted therapy according to biomarkers testing such as HER2 status, MMR status and PD-L1 expression. CONCLUSION These guidelines are intended to provide a personalised therapeutic strategy for daily clinical practice and are subject to ongoing optimization. Each individual case should be discussed by a multidisciplinary team.
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Affiliation(s)
- Julie Veziant
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, CHU Lille, University of Lille, Lille F-59000, France.
| | - Olivier Bouché
- Department of Digestive Oncology, CHU Reims, Reims, France
| | - T Aparicio
- Department of Gastroenterology and Digestive Oncology, AP-HP, Saint-Louis Hospital, Paris, France
| | - M Barret
- Gastroenterology Department, Cochin Hospital, APHP, Paris, France
| | - F El Hajbi
- Department of Oncology, Centre Oscar Lambret, Lille, France
| | - V Lepilliez
- Gastroenterology Department, Jean Mermoz Private Hospital, Ramsay Santé, Lyon, France
| | - P Lesueur
- Department of Radiation Oncology, Centre Guillaume le Conquérant, Le Havre, France
| | - P Maingon
- Department of Radiation Oncology, La Pitié-Salpêtrière, APHP, Sorbonne University, Paris, France
| | - D Pannier
- Department of Oncology, Centre Oscar Lambret, Lille, France
| | - L Quero
- Department of Radiation Oncology, Saint-Louis Hospital, APHP, Paris, France
| | - J L Raoul
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - F Renaud
- Department of Pathology, La Pitié-Salpêtrière, APHP, Sorbonne University, Paris, France
| | - J F Seitz
- Department of Digestive Oncology, La Timone, Aix Marseille Université, Marseille, France
| | - A A Serre
- Department of Radiotherapy, Centre Léon Bérard, Lyon, France
| | | | - M Vermersch
- Medical Imaging Department, Valencienne Hospital Centre, Valencienne 59300, France
| | - T Voron
- Department of General and Digestive Surgery, Sorbonne Université, AP-HP, Hôpital Saint Antoine, 184 rue du faubourg Saint-Antoine, Paris 75012, France
| | - D Tougeron
- Department of Gastro-Enterology and Hepatology, Poitiers University Hospital, Poitiers, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, CHU Lille, University of Lille, Lille F-59000, France
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Wong LY, Elliott IA, Liou DZ, Backhus LM, Lui NS, Shrager JB, Berry MF. The impact of refusing esophagectomy for treatment of locally advanced esophageal adenocarcinoma. JTCVS OPEN 2023; 16:987-995. [PMID: 38204633 PMCID: PMC10775062 DOI: 10.1016/j.xjon.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 01/12/2024]
Abstract
Objective Patients with esophageal cancer may be reluctant to proceed with surgery due to high complication rates. This study aims to compare outcomes between eligible surgical candidates who proceeded with surgery versus those who refused surgery. Methods Characteristics and survival of patients with locally advanced (cT3N0M0, cT1-3N+M0) mid-/distal esophageal adenocarcinoma in the National Cancer Database (2006-2019) who either proceeded with or refused surgery after chemoradiotherapy were evaluated with logistic regression, Kaplan-Meier curves, and Cox proportional hazards methods. Results Of the 13,594 patients included in the analysis, 595 (4.4%) patients refused esophagectomy. Patients who refused surgery were older, had less distance to travel to their treatment facility, were more likely to have cN0 disease, and were more likely to be treated at a community rather than academic or integrated network program, but did not have significantly different comorbid disease distributions. On multivariable analysis, refusing surgery was independently associated with older age, uninsured, lower income, less distance to a hospital, and treatment in a community program versus an academic/research or integrated network program. Esophagectomy was associated with better survival (5-year survival 40.1% [39.2-41] vs 23.6% [19.9-27.9], P < .001) and was also independently associated with better survival in the Cox model (hazard rate, 0.78 [95% confidence interval, 0.7-0.87], P < .001). Conclusions The results of this study can inform selected patients with resectable esophageal adenocarcinoma that their survival will be significantly diminished if surgery is not pursued. Many factors associated with refusing surgery are non-clinical and suggest that access to or support for care could influence patient decisions.
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Affiliation(s)
- Lye-Yeng Wong
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, Calif
| | - Irmina A. Elliott
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, Calif
- VA Palo Alto Health Care System, Palo Alto, Calif
| | - Douglas Z. Liou
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, Calif
| | - Leah M. Backhus
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, Calif
- VA Palo Alto Health Care System, Palo Alto, Calif
| | - Natalie S. Lui
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, Calif
| | - Joseph B. Shrager
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, Calif
- VA Palo Alto Health Care System, Palo Alto, Calif
| | - Mark F. Berry
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, Calif
- VA Palo Alto Health Care System, Palo Alto, Calif
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