2
|
Bian Y, Zheng Z, Fang X, Jiang H, Zhu M, Yu J, Zhao H, Zhang L, Yao J, Lu L, Lu J, Shao C. Artificial Intelligence to Predict Lymph Node Metastasis at CT in Pancreatic Ductal Adenocarcinoma. Radiology 2023; 306:160-169. [PMID: 36066369 DOI: 10.1148/radiol.220329] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Although deep learning has brought revolutionary changes in health care, reliance on manually selected cross-sectional images and segmentation remain methodological barriers. Purpose To develop and validate an automated preoperative artificial intelligence (AI) algorithm for tumor and lymph node (LN) segmentation with CT imaging for prediction of LN metastasis in patients with pancreatic ductal adenocarcinoma (PDAC). Materials and Methods In this retrospective study, patients with surgically resected, pathologically confirmed PDAC underwent multidetector CT from January 2015 to April 2020. Three models were developed, including an AI model, a clinical model, and a radiomics model. CT-determined LN metastasis was diagnosed by radiologists. Multivariable logistic regression analysis was conducted to develop the clinical and radiomics models. The performance of the models was determined on the basis of their discrimination and clinical utility. Kaplan-Meier curves, the log-rank test, or Cox regression were used for survival analysis. Results Overall, 734 patients (mean age, 62 years ± 9 [SD]; 453 men) were evaluated. All patients were split into training (n = 545) and validation (n = 189) sets. Patients who had LN metastasis (LN-positive group) accounted for 340 of 734 (46%) patients. In the training set, the AI model showed the highest performance (area under the receiver operating characteristic curve [AUC], 0.91) in the prediction of LN metastasis, whereas the radiologists and the clinical and radiomics models had AUCs of 0.58, 0.76, and 0.71, respectively. In the validation set, the AI model showed the highest performance (AUC, 0.92) in the prediction of LN metastasis, whereas the radiologists and the clinical and radiomics models had AUCs of 0.65, 0.77, and 0.68, respectively (P < .001). AI model-predicted positive LN metastasis was associated with worse survival (hazard ratio, 1.46; 95% CI: 1.13, 1.89; P = .004). Conclusion An artificial intelligence model outperformed radiologists and clinical and radiomics models for prediction of lymph node metastasis at CT in patients with pancreatic ductal adenocarcinoma. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Chu and Fishman in this issue.
Collapse
Affiliation(s)
- Yun Bian
- From the Departments of Radiology (Y.B., X.F., M.Z., J. Yu, H.Z., J.L., C.S.) and Pathology (H.J.), Changhai Hospital, 168 Changhai Road, Shanghai 200433, China; Ping An Technology, Shanghai, China (Z.Z.); and PAII Inc, Bethesda, Md (L.Z., J. Yao, L.L.)
| | - Zhilin Zheng
- From the Departments of Radiology (Y.B., X.F., M.Z., J. Yu, H.Z., J.L., C.S.) and Pathology (H.J.), Changhai Hospital, 168 Changhai Road, Shanghai 200433, China; Ping An Technology, Shanghai, China (Z.Z.); and PAII Inc, Bethesda, Md (L.Z., J. Yao, L.L.)
| | - Xu Fang
- From the Departments of Radiology (Y.B., X.F., M.Z., J. Yu, H.Z., J.L., C.S.) and Pathology (H.J.), Changhai Hospital, 168 Changhai Road, Shanghai 200433, China; Ping An Technology, Shanghai, China (Z.Z.); and PAII Inc, Bethesda, Md (L.Z., J. Yao, L.L.)
| | - Hui Jiang
- From the Departments of Radiology (Y.B., X.F., M.Z., J. Yu, H.Z., J.L., C.S.) and Pathology (H.J.), Changhai Hospital, 168 Changhai Road, Shanghai 200433, China; Ping An Technology, Shanghai, China (Z.Z.); and PAII Inc, Bethesda, Md (L.Z., J. Yao, L.L.)
| | - Mengmeng Zhu
- From the Departments of Radiology (Y.B., X.F., M.Z., J. Yu, H.Z., J.L., C.S.) and Pathology (H.J.), Changhai Hospital, 168 Changhai Road, Shanghai 200433, China; Ping An Technology, Shanghai, China (Z.Z.); and PAII Inc, Bethesda, Md (L.Z., J. Yao, L.L.)
| | - Jieyu Yu
- From the Departments of Radiology (Y.B., X.F., M.Z., J. Yu, H.Z., J.L., C.S.) and Pathology (H.J.), Changhai Hospital, 168 Changhai Road, Shanghai 200433, China; Ping An Technology, Shanghai, China (Z.Z.); and PAII Inc, Bethesda, Md (L.Z., J. Yao, L.L.)
| | - Haiyan Zhao
- From the Departments of Radiology (Y.B., X.F., M.Z., J. Yu, H.Z., J.L., C.S.) and Pathology (H.J.), Changhai Hospital, 168 Changhai Road, Shanghai 200433, China; Ping An Technology, Shanghai, China (Z.Z.); and PAII Inc, Bethesda, Md (L.Z., J. Yao, L.L.)
| | - Ling Zhang
- From the Departments of Radiology (Y.B., X.F., M.Z., J. Yu, H.Z., J.L., C.S.) and Pathology (H.J.), Changhai Hospital, 168 Changhai Road, Shanghai 200433, China; Ping An Technology, Shanghai, China (Z.Z.); and PAII Inc, Bethesda, Md (L.Z., J. Yao, L.L.)
| | - Jiawen Yao
- From the Departments of Radiology (Y.B., X.F., M.Z., J. Yu, H.Z., J.L., C.S.) and Pathology (H.J.), Changhai Hospital, 168 Changhai Road, Shanghai 200433, China; Ping An Technology, Shanghai, China (Z.Z.); and PAII Inc, Bethesda, Md (L.Z., J. Yao, L.L.)
| | - Le Lu
- From the Departments of Radiology (Y.B., X.F., M.Z., J. Yu, H.Z., J.L., C.S.) and Pathology (H.J.), Changhai Hospital, 168 Changhai Road, Shanghai 200433, China; Ping An Technology, Shanghai, China (Z.Z.); and PAII Inc, Bethesda, Md (L.Z., J. Yao, L.L.)
| | - Jianping Lu
- From the Departments of Radiology (Y.B., X.F., M.Z., J. Yu, H.Z., J.L., C.S.) and Pathology (H.J.), Changhai Hospital, 168 Changhai Road, Shanghai 200433, China; Ping An Technology, Shanghai, China (Z.Z.); and PAII Inc, Bethesda, Md (L.Z., J. Yao, L.L.)
| | - Chengwei Shao
- From the Departments of Radiology (Y.B., X.F., M.Z., J. Yu, H.Z., J.L., C.S.) and Pathology (H.J.), Changhai Hospital, 168 Changhai Road, Shanghai 200433, China; Ping An Technology, Shanghai, China (Z.Z.); and PAII Inc, Bethesda, Md (L.Z., J. Yao, L.L.)
| |
Collapse
|
3
|
Zhang X, Sun C, Li Z, Wang T, Zhao L, Niu P, Guo C, Chen Y, Che X, Zhao D. Development and Validation of a New Lymph Node Ratio-Based Staging System for Ampullary Carcinoma After Curative Pancreaticoduodenectomy. Front Oncol 2022; 11:811595. [PMID: 35127524 PMCID: PMC8810493 DOI: 10.3389/fonc.2021.811595] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/15/2021] [Indexed: 01/03/2023] Open
Abstract
Background Lymph node metastasis (LNM) is closely associated with the prognosis of ampullary carcinoma (AC). The purpose of this study is to explore the relationship between lymph node ratio (LNR) and the prognosis of patients with AC after curative pancreaticoduodenectomy and to establish a new LNR-based staging system. Methods AC patients in the Cancer Hospital, Chinese Academy of Medical Sciences, between 1998 and 2020 were retrospectively reviewed as the training cohort; and AC patients in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2018 were obtained as the validation cohort. Within the training group, Kaplan–Meier survival analyses and Cox proportional hazards regression were conducted to assess the prognostic value of LNR and establish a new LNR-based staging system. Then, the new staging system was compared with the 8th American Joint Committee on Cancer (AJCC) TNM staging system in both the training and validation cohorts. Results A total of 264 patients in the training cohort and 199 patients in the validation cohort were enrolled. Significant overall survival (OS) difference was observed between LNR-low stage and LNR-high stage in both training (p = 0.001) and validation cohorts (p < 0.001). Then a new LNR-based staging system was developed. Under the new system, the number of patients in the training cohort and validation cohort of stage I, stage II, and stage III was 30 (11%) vs. 18 (9%), 190 (72%) vs. 96 (48%), and 44 (17%) vs. 85 (43%), respectively. The new staging system classified patients with respect to survival better than did the 8th AJCC TNM staging system. Conclusions The new LNR-based staging system had better discriminability for predicting survival in AC patients after curative pancreaticoduodenectomy. More data are needed for further validation.
Collapse
Affiliation(s)
- Xiaojie Zhang
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chongyuan Sun
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zefeng Li
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tongbo Wang
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lulu Zhao
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Penghui Niu
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunguang Guo
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingtai Chen
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Che
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
- *Correspondence: Xu Che, ; Dongbing Zhao,
| | - Dongbing Zhao
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Xu Che, ; Dongbing Zhao,
| |
Collapse
|
6
|
Lee JW, Choi SB, Lim TW, Kim WJ, Park P, Kim WB. Prognostic value of the lymph node metastasis in patients with ampulla of Vater cancer after surgical resection. Ann Hepatobiliary Pancreat Surg 2021; 25:90-96. [PMID: 33649260 PMCID: PMC7952676 DOI: 10.14701/ahbps.2021.25.1.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 12/19/2022] Open
Abstract
Backgrounds/Aims Patients with Ampulla of Vater cancer have a better prognosis than those with other periampullary cancers. This study aimed to determine the prognostic impact of lymph node metastasis on survival in patients with ampulla of Vater cancer after surgical resection. Methods From 1991 to 2016, we retrospectively reviewed data on 104 patients with ampulla of Vater cancer who had received pancreaticoduodenectomy. Clinicopathologic factors such as lymph node ratio (LNR) and number of metastatic lymph nodes that influence survival were statistically analyzed. Results 5-year survival rate after resection was 57.8%. Mean number of retrieved and metastatic lymph nodes was 13 and 0.95, respectively. In patients with lymph node metastasis, the median number of metastatic lymph nodes and was 1, and the mean LNR was 0.18. LNR >0.2 was a significant prognostic factor for overall survival. Patients with 0 or 1 metastatic lymph nodes had better survival than those with ≥2 metastatic lymph nodes. Univariate analysis revealed that histologic differentiation of tumor, lymph node metastasis, and T stage were significant prognostic factors for overall survival. Multivariate analysis revealed that tumor differentiation and number of metastatic lymph nodes were independent prognostic factors for survival. Conclusions Pancreaticoduodenectomy is an appropriate surgical procedure with acceptable long-term survival for ampulla of Vater cancer. Patients with LNR >0.2 and ≥2 positive lymph node metastasis had a poor survival. Tumor differentiation and ≥2 metastatic lymph nodes were independent significant prognostic factors for overall survival. Curative resection with lymph node dissection might control lymph node spread and enhance survival outcomes.
Collapse
Affiliation(s)
- Jeong Woo Lee
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Sae Byeol Choi
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Tae Wan Lim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Wan Joon Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Pyoungjae Park
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Wan Bae Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|