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Oh HH, Kim JS, Lim JW, Lim CJ, Seo YE, You GR, Im CM, Kim KH, Kim DH, Kim HS, Joo YE. Clinical outcomes of colorectal neoplasm with positive resection margin after endoscopic submucosal dissection. Sci Rep 2024; 14:12353. [PMID: 38811758 PMCID: PMC11136969 DOI: 10.1038/s41598-024-63129-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/24/2024] [Indexed: 05/31/2024] Open
Abstract
A positive resection margin after colorectal endoscopic submucosal dissection (ESD) is associated with an increased risk of recurrence. We aimed to identify the clinical significance of positive resection margins in colorectal neoplasms after ESD. We reviewed 632 patients who had en bloc colorectal ESD at two hospitals between 2015 and 2020. The recurrence rates and presence of residual tumor after surgery were evaluated. The rate of additional surgery after ESD and recurrence rate were significantly higher in patients with incomplete resection (n = 75) compared to patients with complete resection (n = 557). When focusing solely on non-invasive lesions, no significant differences in recurrence rates were observed between the groups with complete and incomplete resection (0.2% vs. 1.9%, p = 0.057). Among 84 patients with submucosal invasive carcinoma, 39 patients underwent additional surgery due to non-curative resection. Positive vertical margin and lymphovascular invasion were associated with residual tumor. Lymphovascular invasion was associated with lymph node metastasis. However, no residual tumor nor lymph node metastases were found in patients with only one unfavorable histological factor. In conclusion, a positive resection margin in non-invasive colorectal lesions, did not significantly impact the recurrence rate. Also, in T1 colorectal cancer with a positive vertical resection margin, salvage surgery can be considered in selected patients with additional risk factors.
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Affiliation(s)
- Hyung-Hoon Oh
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea
| | - Je-Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea
| | - Jae-Woong Lim
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea
| | - Chae-June Lim
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea
| | - Young-Eun Seo
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea
| | - Ga-Ram You
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea
| | - Chan-Muk Im
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea
| | - Ki-Hyun Kim
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea
| | - Dong-Hyun Kim
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea
| | - Hyun-Soo Kim
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea
| | - Young-Eun Joo
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea.
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Song JH, Kim ER, Hong Y, Sohn I, Ahn S, Kim SH, Jang KT. Prediction of Lymph Node Metastasis in T1 Colorectal Cancer Using Artificial Intelligence with Hematoxylin and Eosin-Stained Whole-Slide-Images of Endoscopic and Surgical Resection Specimens. Cancers (Basel) 2024; 16:1900. [PMID: 38791978 PMCID: PMC11119228 DOI: 10.3390/cancers16101900] [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: 04/09/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
According to the current guidelines, additional surgery is performed for endoscopically resected specimens of early colorectal cancer (CRC) with a high risk of lymph node metastasis (LNM). However, the rate of LNM is 2.1-25.0% in cases treated endoscopically followed by surgery, indicating a high rate of unnecessary surgeries. Therefore, this study aimed to develop an artificial intelligence (AI) model using H&E-stained whole slide images (WSIs) without handcrafted features employing surgically and endoscopically resected specimens to predict LNM in T1 CRC. To validate with an independent cohort, we developed a model with four versions comprising various combinations of training and test sets using H&E-stained WSIs from endoscopically (400 patients) and surgically resected specimens (881 patients): Version 1, Train and Test: surgical specimens; Version 2, Train and Test: endoscopic and surgically resected specimens; Version 3, Train: endoscopic and surgical specimens and Test: surgical specimens; Version 4, Train: endoscopic and surgical specimens and Test: endoscopic specimens. The area under the curve (AUC) of the receiver operating characteristic curve was used to determine the accuracy of the AI model for predicting LNM with a 5-fold cross-validation in the training set. Our AI model with H&E-stained WSIs and without annotations showed good performance power with the validation of an independent cohort in a single center. The AUC of our model was 0.758-0.830 in the training set and 0.781-0.824 in the test set, higher than that of previous AI studies with only WSI. Moreover, the AI model with Version 4, which showed the highest sensitivity (92.9%), reduced unnecessary additional surgery by 14.2% more than using the current guidelines (68.3% vs. 82.5%). This revealed the feasibility of using an AI model with only H&E-stained WSIs to predict LNM in T1 CRC.
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Affiliation(s)
- Joo Hye Song
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea;
| | - Eun Ran Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Yiyu Hong
- Department of R&D Center, Arontier Co., Ltd., Seoul 06735, Republic of Korea;
| | - Insuk Sohn
- Department of R&D Center, Arontier Co., Ltd., Seoul 06735, Republic of Korea;
| | - Soomin Ahn
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.A.); (S.-H.K.); (K.-T.J.)
| | - Seok-Hyung Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.A.); (S.-H.K.); (K.-T.J.)
| | - Kee-Taek Jang
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.A.); (S.-H.K.); (K.-T.J.)
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Yu L, Huang Z, Xiao Z, Tang X, Zeng Z, Tang X, Ouyang W. Unveiling the best predictive models for early‑onset metastatic cancer: Insights and innovations (Review). Oncol Rep 2024; 51:60. [PMID: 38456540 PMCID: PMC10940877 DOI: 10.3892/or.2024.8719] [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: 10/08/2023] [Accepted: 01/22/2024] [Indexed: 03/09/2024] Open
Abstract
Cancer metastasis is the primary cause of cancer deaths. Metastasis involves the spread of cancer cells from the primary tumors to other body parts, commonly through lymphatic and vascular pathways. Key aspects include the high mutation rate and the capability of metastatic cells to form invasive tumors even without a large initial tumor mass. Particular emphasis is given to early metastasis, occurring in initial cancer stages and often leading to misdiagnosis, which adversely affects survival and prognosis. The present review highlighted the need for improved understanding and detection methods for early metastasis, which has not been effectively identified clinically. The present review demonstrated the clinicopathological and molecular characteristics of early‑onset metastatic types of cancer, noting factors such as age, race, tumor size and location as well as the histological and pathological grade as significant predictors. In conclusion, the present review underscored the importance of early detection and management of metastatic types of cancer and called for improved predictive models, including advanced techniques such as nomograms and machine learning, so as to enhance patient outcomes, acknowledging the challenges and limitations of the current research as well as the necessity for further studies.
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Affiliation(s)
- Liqing Yu
- Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
- The Second Clinical Medical College, Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Zhenjun Huang
- Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Ziqi Xiao
- The Second Clinical Medical College, Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Xiaofu Tang
- The Second Clinical Medical College, Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Ziqiang Zeng
- Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, Jiangxi 330006, P.R. China
- School of Public Health, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Xiaoli Tang
- School of Basic Medicine, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Wenhao Ouyang
- Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
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Watanabe J, Ichimasa K, Kataoka Y, Miyahara S, Miki A, Yeoh KG, Kawai S, Martínez de Juan F, Machado I, Kotani K, Sata N. Diagnostic Accuracy of Highest-Grade or Predominant Histological Differentiation of T1 Colorectal Cancer in Predicting Lymph Node Metastasis: A Systematic Review and Meta-Analysis. Clin Transl Gastroenterol 2024; 15:e00673. [PMID: 38165075 PMCID: PMC10962900 DOI: 10.14309/ctg.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Treatment guidelines for colorectal cancer (CRC) suggest 2 classifications for histological differentiation-highest grade and predominant. However, the optimal predictor of lymph node metastasis (LNM) in T1 CRC remains unknown. This systematic review aimed to evaluate the impact of the use of highest-grade or predominant differentiation on LNM determination in T1 CRC. METHODS The study protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO, registration number: CRD42023416971) and was published in OSF ( https://osf.io/TMAUN/ ) on April 13, 2023. We searched 5 electronic databases for studies assessing the diagnostic accuracy of highest-grade or predominant differentiation to determine LNM in T1 CRC. The outcomes were sensitivity and specificity. We simulated 100 cases with T1 CRC, with an LNM incidence of 11.2%, to calculate the differences in false positives and negatives between the highest-grade and predominant differentiations using a bootstrap method. RESULTS In 42 studies involving 41,290 patients, the differentiation classification had a pooled sensitivity of 0.18 (95% confidence interval [CI] 0.13-0.24) and 0.06 (95% CI 0.04-0.09) ( P < 0.0001) and specificity of 0.95 (95% CI 0.93-0.96) and 0.98 (95% CI 0.97-0.99) ( P < 0.0001) for the highest-grade and predominant differentiations, respectively. In the simulation, the differences in false positives and negatives between the highest-grade and predominant differentiations were 3.0% (range 1.6-4.4) and -1.3% (range -2.0 to -0.7), respectively. DISCUSSION Highest-grade differentiation may reduce the risk of misclassifying cases with LNM as negative, whereas predominant differentiation may prevent unnecessary surgeries. Further studies should examine differentiation classification using other predictive factors.
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Affiliation(s)
- Jun Watanabe
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
| | - Katsuro Ichimasa
- Digestive Disease Center, Showa University, Northern Yokohama Hospital, Tsuzuki-ku, Yokohama, Japan
- Department of Medicine, National University of Singapore, Singapore
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Sakyo-ku, Kyoto, Japan
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/Public Health, Sakyo-ku, Kyoto, Japan
| | - Shoko Miyahara
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Atsushi Miki
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Khay Guan Yeoh
- Department of Medicine, National University of Singapore, Singapore
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore
| | - Shigeo Kawai
- Department of Diagnostic Pathology, Tochigi Medical Center Shimotsuga, Tochigi-City, Tochigi, Japan
| | - Fernando Martínez de Juan
- Department of Gastroenterology and Endoscopy Unit, Instituto Valenciano de Oncología, Valencia, Spain
- Endoscopy Unit, Hospital Quiron Salud, Valencia, Spain
- Medicine, Universidad Cardenal Herrrera-CEU, CEU Universities, Valencia, Spain
| | - Isidro Machado
- Pathology Department, Instituto Valenciano de Oncología, Patologika Laboratory Hospital Quiron Salud and Pathology Department University of Valencia, Valencia, Spain
- CIBERONC, Madrid, Spain
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Ichimasa K, Kudo SE, Yeoh KG. Commentary: An artificial intelligence prediction model outperforms conventional guidelines in predicting lymph node metastasis of T1 colorectal cancer. Front Oncol 2024; 14:1337576. [PMID: 38406818 PMCID: PMC10889107 DOI: 10.3389/fonc.2024.1337576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Affiliation(s)
- Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shin-ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Khay Guan Yeoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore, Singapore
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Hayashi T, Takasawa K, Yoshikawa T, Hashimoto T, Sekine S, Wada T, Yamagata Y, Suzuki H, Abe S, Yoshinaga S, Saito Y, Kouno N, Hamamoto R. A discrimination model by machine learning to avoid gastrectomy for early gastric cancer. Ann Gastroenterol Surg 2023; 7:913-921. [PMID: 37927931 PMCID: PMC10623978 DOI: 10.1002/ags3.12714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 11/07/2023] Open
Abstract
Aim Gastrectomy is recommended for patients with early gastric cancer (EGC) because the possibility of lymph node metastasis (LNM) cannot be completely denied. The aim of this study was to develop a discrimination model to select patients who do not require surgery using machine learning. Methods Data from 382 patients who received gastrectomy for gastric cancer and who were diagnosed with pT1b were extracted for developing a discrimination model. For the validation of this discrimination model, data from 140 consecutive patients who underwent endoscopic resection followed by gastrectomy, with a diagnosis of pT1b EGC, were extracted. We applied XGBoost to develop a discrimination model for clinical and pathological variables. The performance of the discrimination model was evaluated based on the number of cases classified as true negatives for LNM, with no false negatives for LNM allowed. Results Lymph node metastasis was observed in 95 patients (25%) in the development cohort and 11 patients (8%) in the validation cohort. The discrimination model was developed to identify 27 (7%) patients with no indications for additional surgery due to the prediction of an LNM-negative status with no false negatives. In the validation cohort, 13 (9%) patients were identified as having no indications for additional surgery and no patients with LNM were classified into this group. Conclusion The discrimination model using XGBoost algorithms could select patients with no risk of LNM from patients with pT1b EGC. This discrimination model was considered promising for clinical decision-making in relation to patients with EGC.
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Affiliation(s)
- Tsutomu Hayashi
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Ken Takasawa
- Division of Medical AI Research and DevelopmentNational Cancer Center Research InstituteTokyoJapan
- Cancer Translational Research Team, RIKEN Center for Advanced Intelligence ProjectTokyoJapan
| | - Takaki Yoshikawa
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Taiki Hashimoto
- Department of Diagnostic PathologyNational Cancer Center HospitalTokyoJapan
| | - Shigeki Sekine
- Department of Diagnostic PathologyNational Cancer Center HospitalTokyoJapan
| | - Takeyuki Wada
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Yukinori Yamagata
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | | | - Seiichirou Abe
- Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | | | - Yutaka Saito
- Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | - Nobuji Kouno
- Division of Medical AI Research and DevelopmentNational Cancer Center Research InstituteTokyoJapan
| | - Ryuji Hamamoto
- Division of Medical AI Research and DevelopmentNational Cancer Center Research InstituteTokyoJapan
- Cancer Translational Research Team, RIKEN Center for Advanced Intelligence ProjectTokyoJapan
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Piao ZH, Ge R, Lu L. An artificial intelligence prediction model outperforms conventional guidelines in predicting lymph node metastasis of T1 colorectal cancer. Front Oncol 2023; 13:1229998. [PMID: 37941556 PMCID: PMC10628635 DOI: 10.3389/fonc.2023.1229998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
Background According to guidelines, a lot of patients with T1 colorectal cancers (CRCs) undergo additional surgery with lymph node dissection after being treated by endoscopic resection (ER) despite the low incidence of lymph node metastasis (LNM). Aim The aim of this study was to develop an artificial intelligence (AI) model to more effectively identify T1 CRCs at risk for LNM and reduce the rate of unnecessary additional surgery. Methods We retrospectively analyzed 651 patients with T1 CRCs. The patient cohort was randomly divided into a training set (546 patients) and a test set (105 patients) (ratio 5:1), and a classification and regression tree (CART) algorithm was trained on the training set to develop a predictive AI model for LNM. The model used 12 clinicopathological factors to predict positivity or negativity for LNM. To compare the performance of the AI model with the conventional guidelines, the test set was evaluated according to the Japanese Society for Cancer of the Colon and Rectum (JSCCR) and National Comprehensive Cancer Network (NCCN) guidelines. Finally, we tested the performance of the AI model using the test set and compared it with the JSCCR and NCCN guidelines. Results The AI model had better predictive performance (AUC=0.960) than the JSCCR (AUC=0.588) and NCCN guidelines (AUC=0.850). The specificity (85.8% vs. 17.5%, p<0.001), balanced accuracy (92.9% vs. 58.7%, p=0.001), and the positive predictive value (36.3% vs. 9.0%, p=0.001) of the AI model were significantly better than those of the JSCCR guidelines and reduced the percentage of the high-risk group for LNM from 83.8% (JSCCR) to 20.9%. The specificity of the AI model was higher than that of the NCCN guidelines (85.8% vs. 82.4%, p=0.557), but there was no significant difference between the two. The sensitivity of the NCCN guidelines was lower than that of our AI model (87.5% vs. 100%, p=0.301), and according to the NCCN guidelines, 1.2% of the 105 test set patients had missed diagnoses. Conclusion The AI model has better performance than conventional guidelines for predicting LNM in T1 CRCs and therefore could significantly reduce unnecessary additional surgery.
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Tang CT, Li J, Wang P, Chen YX, Zeng CY. Prediction model for lymph node metastasis in superficial colorectal cancer: a better choice than computed tomography. Surg Endosc 2023; 37:7444-7454. [PMID: 37400690 DOI: 10.1007/s00464-023-10222-7] [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: 02/27/2023] [Accepted: 06/16/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Risk evaluation of lymph node metastasis (LNM) in superficial colorectal cancer resected by endoscopic surgery is critical for determining subsequent therapeutic strategies, but the role of existing clinical methods, including computed tomography, remains limited. METHODS Features of the nomogram were determined by logistic regression analysis, and the performance was validated by calibration plots, ROC curves and DCA curves in both the training set and the validation set. RESULTS A total of 608 consecutive superficial CRC cases were randomly divided into 426 training and 182 validation cases. Univariate and multivariate logistic regression analyses revealed that age < 50, tumour budding, lymphatic invasion and lower HDL levels were risk factors for LNM. Stepwise regression and the Hosmer‒Lemeshow goodness of fit test showed that the nomogram had good performance and discrimination, which was validated by ROC curves and calibration plots. Internal and external validation demonstrated that the nomogram had a higher C-index (training group, 0.749, validation group, 0.693). DCA and clinical impact curves graphically show that the use of the nomogram to predict LNM had remarkable predictive power. Finally, in comparison with CT diagnosis, the nomogram also visually showed higher superiority, as demonstrated by ROC, DCA and clinical impact curves. CONCLUSION Using common clinicopathologic factors, a noninvasive nomogram for individualized prediction of LNM after endoscopic surgery was conveniently established. Nomograms have great superiority in the risk stratification of LNM compared with traditional CT imaging.
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Affiliation(s)
- Chao-Tao Tang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Jun Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Peng Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - You-Xiang Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Chun-Yan Zeng
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China.
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Sharma A, Kumar R, Yadav G, Garg P. Artificial intelligence in intestinal polyp and colorectal cancer prediction. Cancer Lett 2023; 565:216238. [PMID: 37211068 DOI: 10.1016/j.canlet.2023.216238] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/23/2023]
Abstract
Artificial intelligence (AI) algorithms and their application to disease detection and decision support for healthcare professions have greatly evolved in the recent decade. AI has been widely applied and explored in gastroenterology for endoscopic analysis to diagnose intestinal cancers, premalignant polyps, gastrointestinal inflammatory lesions, and bleeding. Patients' responses to treatments and prognoses have both been predicted using AI by combining multiple algorithms. In this review, we explored the recent applications of AI algorithms in the identification and characterization of intestinal polyps and colorectal cancer predictions. AI-based prediction models have the potential to help medical practitioners diagnose, establish prognoses, and find accurate conclusions for the treatment of patients. With the understanding that rigorous validation of AI approaches using randomized controlled studies is solicited before widespread clinical use by health authorities, the article also discusses the limitations and challenges associated with deploying AI systems to diagnose intestinal malignancies and premalignant lesions.
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Affiliation(s)
- Anju Sharma
- Department of Pharmacoinformatics, National Institute of Pharmaceutical Education and Research, S.A.S Nagar, 160062, Punjab, India
| | - Rajnish Kumar
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow Campus, Uttar Pradesh, 226010, India; Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
| | - Garima Yadav
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow Campus, Uttar Pradesh, 226010, India
| | - Prabha Garg
- Department of Pharmacoinformatics, National Institute of Pharmaceutical Education and Research, S.A.S Nagar, 160062, Punjab, India.
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Santos-Antunes J, Pioche M, Ramos-Zabala F, Cecinato P, Gallego Rojo FJ, Barreiro P, Félix C, Sferrazza S, Berr F, Wagner A, Lemmers A, Figueiredo Ferreira M, Albéniz E, Uchima H, Küttner-Magalhães R, Fernandes C, Morais R, Gupta S, Martinho-Dias D, Rios E, Faria-Ramos I, Marques M, Bourke MJ, Macedo G. Risk of residual neoplasia after a noncurative colorectal endoscopic submucosal dissection for malignant lesions: a multinational study. Endoscopy 2023; 55:235-244. [PMID: 35863354 DOI: 10.1055/a-1906-8000] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND : Endoscopic submucosal dissection (ESD) in colorectal lesions is technically demanding and a significant rate of noncurative procedures is expected. We aimed to assess the rate of residual lesions after a noncurative ESD for colorectal cancer (CRC) and to establish predictive scores to be applied in the clinical setting. METHODS : Retrospective multicenter analysis of consecutive colorectal ESDs. Patients with noncurative ESDs performed for the treatment of CRC lesions submitted to complementary surgery or with at least one follow-up endoscopy were included. RESULTS : From 2255 colorectal ESDs, 381 (17 %) were noncurative, and 135 of these were performed in CRC lesions. A residual lesion was observed in 24 patients (18 %). Surgery was performed in 96 patients and 76 (79 %) had no residual lesion in the colorectal wall or in the lymph nodes. The residual lesion rate for sm1 cancers was 0 %, and for > sm1 cancers was also 0 % if no other risk factors were present. Independent risk factors for lymph node metastasis were poor differentiation and lymphatic permeation (NC-Lymph score). Risk factors for the presence of a residual lesion in the wall were piecemeal resection, poor differentiation, and positive/indeterminate vertical margin (NC-Wall score). CONCLUSIONS : Lymphatic permeation or poor differentiation warrant surgery owing to their high risk of lymph node metastasis, mainly in > sm1 cancers. In the remaining cases, en bloc and R0 resections resulted in a low risk of residual lesions in the wall. Our scores can be a useful tool for the management of patients who undergo noncurative colorectal ESDs.
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Affiliation(s)
- João Santos-Antunes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
- Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
| | - Mathieu Pioche
- Department of Hepatology and Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Felipe Ramos-Zabala
- Department of Gastroenterology, Department of Clinical Medical Sciences, Hospital Universitario HM Montepríncipe, HM Hospitales, Universidad San Pablo-CEU, CEU Universities Madrid, Madrid, Spain
| | - Paolo Cecinato
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Pedro Barreiro
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental EPE, Lisbon, Portugal
- Lisbon Advanced Endoscopic Center, Hospital Lusíadas, Lisbon, Portugal
| | - Catarina Félix
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental EPE, Lisbon, Portugal
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento, Italy
| | - Frieder Berr
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Andrej Wagner
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Mariana Figueiredo Ferreira
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Eduardo Albéniz
- Navarrabiomed Research Institute, Complejo Hospitalario de Navarra, Public University of Navarra, IdiSNA, Pamplona, Spain
| | - Hugo Uchima
- Digestive Endoscopy Service, Centro Médico Teknon, Barcelona, Spain
- Gastroenterology Service, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | - Ricardo Küttner-Magalhães
- Gastroenterology Department, Hospital Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Carlos Fernandes
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Rui Morais
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Sunil Gupta
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Daniel Martinho-Dias
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Elisabete Rios
- Pathology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Isabel Faria-Ramos
- Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
| | - Margarida Marques
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Guilherme Macedo
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
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11
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Qiu B, Su XH, Qin X, Wang Q. Application of machine learning techniques in real-world research to predict the risk of liver metastasis in rectal cancer. Front Oncol 2022; 12:1065468. [PMID: 36605425 PMCID: PMC9807609 DOI: 10.3389/fonc.2022.1065468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background The liver is the most common site of distant metastasis in rectal cancer, and liver metastasis dramatically affects the treatment strategy of patients. This study aimed to develop and validate a clinical prediction model based on machine learning algorithms to predict the risk of liver metastasis in patients with rectal cancer. Methods We integrated two rectal cancer cohorts from Surveillance, Epidemiology, and End Results (SEER) and Chinese multicenter hospitals from 2010-2017. We also built and validated liver metastasis prediction models for rectal cancer using six machine learning algorithms, including random forest (RF), light gradient boosting (LGBM), extreme gradient boosting (XGB), multilayer perceptron (MLP), logistic regression (LR), and K-nearest neighbor (KNN). The models were evaluated by combining several metrics, such as the area under the curve (AUC), accuracy score, sensitivity, specificity and F1 score. Finally, we created a network calculator using the best model. Results The study cohort consisted of 19,958 patients from the SEER database and 924 patients from two hospitals in China. The AUC values of the six prediction models ranged from 0.70 to 0.95. The XGB model showed the best predictive power, with the following metrics assessed in the internal test set: AUC (0.918), accuracy (0.884), sensitivity (0.721), and specificity (0.787). The XGB model was assessed in the outer test set with the following metrics: AUC (0.926), accuracy (0.919), sensitivity (0.740), and specificity (0.765). The XGB algorithm also shows a good fit on the calibration decision curves for both the internal test set and the external validation set. Finally, we constructed an online web calculator using the XGB model to help generalize the model and to assist physicians in their decision-making better. Conclusion We successfully developed an XGB-based machine learning model to predict liver metastasis from rectal cancer, which was also validated with a real-world dataset. Finally, we developed a web-based predictor to guide clinical diagnosis and treatment strategies better.
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Affiliation(s)
- Binxu Qiu
- Department of Gastric and Colorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Xiao hu Su
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinxin Qin
- Department of Gastric and Colorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Quan Wang
- Department of Gastric and Colorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China,*Correspondence: Quan Wang,
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Müller F, Lugli A, Dawson H. [Tumor budding in colorectal cancer-Information for clinical use and instructions for practical evaluation]. DER PATHOLOGE 2022; 43:45-50. [PMID: 34724116 PMCID: PMC8789725 DOI: 10.1007/s00292-021-01016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Some patients with high-risk colorectal cancer show a worse prognosis within the same UICC stage. Therefore, the identification of additional risk factors is necessary to find the best treatment for these patients. OBJECTIVE In which settings can tumor budding help the clinical decision-making process for treatment planning and how should scoring be performed? MATERIAL AND METHODS Evaluation of current publications on tumor budding with an emphasis on practical grading and potential problems in the determination of tumor budding. RESULTS Tumor budding is a significant risk factor for worse clinical outcome of colorectal cancer and can influence clinical decision-making in pT1 and stage II colorectal cancer. A scoring method was standardized by the ITBCC 2016 and is feasible in everyday practice. Challenges in assessment can be addressed by increasing awareness of potential problem cases.
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Affiliation(s)
- Felix Müller
- Institut für Pathologie, Universität Bern, Murtenstraße 31, 3008, Bern, Schweiz.
| | - Alessandro Lugli
- Institut für Pathologie, Universität Bern, Murtenstraße 31, 3008, Bern, Schweiz
| | - Heather Dawson
- Institut für Pathologie, Universität Bern, Murtenstraße 31, 3008, Bern, Schweiz
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Prior endoscopic resection does not affect the outcome of secondary surgery for T1 colorectal cancer, a systematic review and meta-analysis. Int J Colorectal Dis 2022; 37:273-281. [PMID: 34716475 DOI: 10.1007/s00384-021-04049-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND It remains unclear the effect of prior endoscopic resection (ER) on the secondary surgery (SS) for T1 colorectal cancer (CRC). This study aimed to compare the short- and long-term outcomes between primary surgery (PS) and ER followed by SS for T1 CRC. METHODS A systematic literature search was performed in PubMed and Ovid for studies comparing PS with ER followed by SS for T1 colorectal cancer. The last search was performed on 18 May 2021. The primary outcomes were surgical parameters and the secondary outcomes were survival indicators. The meta-analysis was performed with Review Manager Software (version 5.3). RESULTS A total of fifteen studies published between 2013 and 2021 with 4349 patients were included in this meta-analysis finally. No significant difference was observed between the two groups for operative time (P = 0.75, WMD = 3.16, 95%CI [-15.88, 22.19], I2 = 64%), blood loss (P = 0.86, WMD = 12.33, 95%CI [-122.99, 147.65], I2 = 95%), and postoperative complications (P = 0.59, OR = 0.93, 95%CI [0.71, 1.22], I2 = 0%). Besides, the two groups showed comparable survival outcomes, including overall recurrence rate (P = 0.15, OR = 0.78, 95%CI [0.56, 1.09], I2 = 23%) and 5-year overall survival (P = 0.76, OR = 0.86, 95%CI [0.33, 2.25], I2 = 0%). In the subgroup analysis for studies with propensity matching score or lesions located in the rectum, the results were not changed. CONCLUSION ER followed by SS is feasible for T1 CRC with high-risk factors. The prior ER would not bring additional adverse effects to the SS. More advanced tools should be developed to improve the diagnostic accuracy for the high-risk factors before treatment for T1 CRC.
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Han T, Zhu J, Chen X, Chen R, Jiang Y, Wang S, Xu D, Shen G, Zheng J, Xu C. Application of artificial intelligence in a real-world research for predicting the risk of liver metastasis in T1 colorectal cancer. Cancer Cell Int 2022; 22:28. [PMID: 35033083 PMCID: PMC8761313 DOI: 10.1186/s12935-021-02424-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/23/2021] [Indexed: 12/11/2022] Open
Abstract
Background Liver is the most common metastatic site of colorectal cancer (CRC) and liver metastasis (LM) determines subsequent treatment as well as prognosis of patients, especially in T1 patients. T1 CRC patients with LM are recommended to adopt surgery and systematic treatments rather than endoscopic therapy alone. Nevertheless, there is still no effective model to predict the risk of LM in T1 CRC patients. Hence, we aim to construct an accurate predictive model and an easy-to-use tool clinically. Methods We integrated two independent CRC cohorts from Surveillance Epidemiology and End Results database (SEER, training dataset) and Xijing hospital (testing dataset). Artificial intelligence (AI) and machine learning (ML) methods were adopted to establish the predictive model. Results A total of 16,785 and 326 T1 CRC patients from SEER database and Xijing hospital were incorporated respectively into the study. Every single ML model demonstrated great predictive capability, with an area under the curve (AUC) close to 0.95 and a stacking bagging model displaying the best performance (AUC = 0.9631). Expectedly, the stacking model exhibited a favorable discriminative ability and precisely screened out all eight LM cases from 326 T1 patients in the outer validation cohort. In the subgroup analysis, the stacking model also demonstrated a splendid predictive ability for patients with tumor size ranging from one to50mm (AUC = 0.956). Conclusion We successfully established an innovative and convenient AI model for predicting LM in T1 CRC patients, which was further verified in the external dataset. Ultimately, we designed a novel and easy-to-use decision tree, which only incorporated four fundamental parameters and could be successfully applied in clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12935-021-02424-7.
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Affiliation(s)
- Tenghui Han
- Xijing Hospital, Airforce Medical University, Xi'an, China
| | - Jun Zhu
- State Key Laboratory of Cancer Biology, Institute of Digestive Diseases, Xijing Hospital, Airforce Medical University, Xi'an, China.,Department of General Surgery, The Southern Theater Air Force Hospital, Guangzhou, China
| | - Xiaoping Chen
- Department of General Surgery, The Southern Theater Air Force Hospital, Guangzhou, China
| | - Rujie Chen
- State Key Laboratory of Cancer Biology, Institute of Digestive Diseases, Xijing Hospital, Airforce Medical University, Xi'an, China
| | - Yu Jiang
- State Key Laboratory of Cancer Biology, Institute of Digestive Diseases, Xijing Hospital, Airforce Medical University, Xi'an, China
| | - Shuai Wang
- Ming Gang Station Hospital, Xi'an Institute of Flight of the Air Force, Minggang, China
| | - Dong Xu
- School of Clinical Medicine, Xi'an Medical University, Xi'an, China
| | - Gang Shen
- Ming Gang Station Hospital, Xi'an Institute of Flight of the Air Force, Minggang, China
| | - Jianyong Zheng
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Airforce Medical University, Xi'an, China.
| | - Chunsheng Xu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Airforce Medical University, Xi'an, China.
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