Ejso最新文献

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Optimized machine learning model for predicting unplanned reoperation after rectal cancer anterior resection 预测直肠癌前切除术后意外再次手术的优化机器学习模型

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-09-21 DOI: 10.1016/j.ejso.2024.108703

Background

Unplanned reoperation (URO) after surgery adversely affects the quality of life and prognosis of patients undergoing anterior resection for rectal cancer. This study aims to meet the urgent need for reliable predictive tools by developing an optimized machine learning model to estimate the risk of URO following anterior resection in rectal cancer patients.

Methods

This retrospective study collected multidimensional data from patients who underwent anterior resection for rectal cancer at Tongji Hospital of Huazhong University of Science and Technology from January 2012 to December 2022. Feature selection was conducted using both least absolute shrinkage and selection operator (LASSO) regression and the Boruta algorithm. Multiple machine learning models were developed, with parameter optimization via grid search and cross-validation. Performance metrics included accuracy, specificity, sensitivity, and area under curve (AUC). The optimal model was interpreted using SHapley Additive exPlanations (SHAP), and an online platform was created for real-time risk prediction.

Results

A total of 2384 patients who underwent anterior resection for rectal cancer were included in this study. Following rigorous selection, 14 variables were identified for constructing the machine learning model. The optimized model demonstrated high predictive accuracy, with the random forest (RF) model achieving the best overall performance. The model achieved an AUC of 0.889 and an accuracy of 0.842 on the test dataset. SHAP analysis revealed that the tumor location, previous abdominal surgery, and operative time were the most significant factors influencing the risk of URO.

Conclusion

This study developed an optimized machine learning-based online predictive system to assess the risk of URO after anterior resection in rectal cancer patients. Accessible at https://yangsu2023.shinyapps.io/UROrisk/, this system improves prediction accuracy and offers real-time risk assessment, providing a valuable tool that may support clinical decision-making and potentially improve the prognosis of rectal cancer patients.

背景术后计划内再次手术（URO）对直肠癌前路切除术患者的生活质量和预后产生不利影响。本研究旨在通过开发一种优化的机器学习模型来估计直肠癌患者前路切除术后的URO风险，从而满足对可靠预测工具的迫切需求。研究采用最小绝对收缩和选择算子（LASSO）回归和Boruta算法进行特征选择。开发了多个机器学习模型，并通过网格搜索和交叉验证对参数进行了优化。性能指标包括准确性、特异性、灵敏度和曲线下面积（AUC）。使用 SHapley Additive exPlanations（SHAP）对最佳模型进行解释，并创建了一个用于实时风险预测的在线平台。经过严格筛选，确定了 14 个变量用于构建机器学习模型。优化后的模型具有很高的预测准确性，其中随机森林（RF）模型的整体表现最佳。在测试数据集上，该模型的AUC为0.889，准确率为0.842。SHAP分析表明，肿瘤位置、既往腹部手术和手术时间是影响URO风险的最重要因素。结论这项研究开发了一种基于机器学习的优化在线预测系统，用于评估直肠癌患者前路切除术后的URO风险。该系统可通过 https://yangsu2023.shinyapps.io/UROrisk/ 访问，提高了预测准确性并提供了实时风险评估，为临床决策提供了有价值的工具，并有可能改善直肠癌患者的预后。

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引用次数: 0

Reply to: Comparison of the LiMAx test vs. the APRI+ALBI score - Incorrect comparison parameters lead to questionable results. 答复LiMAx测试与APRI+ALBI评分的比较--不正确的比较参数会导致可疑的结果。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-09-20 DOI: 10.1016/j.ejso.2024.108696

Jonas Santol, Markus Ammann, Tim Reese, Felix Oldhafer, Yawen Dong, Moritz Schmelzle, Karl J Oldhafer, Hubert Hackl, Thomas Gruenberger, Patrick Starlinger

引用次数: 0

Revolutionizing post-operative care: The role of novel cytokine monitoring in prompt detection of minimally invasive gastric surgery complications 革新术后护理：新型细胞因子监测在及时发现微创胃手术并发症中的作用

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-09-19 DOI: 10.1016/j.ejso.2024.108700

引用次数: 0

Preoperative prognostic stratification and prediction of long-term outcomes after pancreatoduodenectomy for distal cholangiocarcinoma 胰十二指肠切除术治疗远端胆管癌的术前预后分层和长期预后预测。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-09-18 DOI: 10.1016/j.ejso.2024.108691

Background

Patients with distal cholangiocarcinoma (DCC) frequently receive adjuvant chemotherapy in preoperative and postoperative settings, but prediction of prognostic risk at the time of treatment selection remains challenging.

Methods

This single-center retrospective study enrolled DCC patients who underwent initial pancreatoduodenectomy (PD) between 2009 and 2022. Preoperative clinical parameters were collected, and Cox regression analysis was used to identify risk factors for overall survival (OS).

Results

Among 170 patients examined, the median tumor depth was 10 mm, and 37 % of the patients were diagnosed with pT3. Overall, 46 % of patients had lymph node metastasis. The median and 5-year OS was 58.2 months and 50 %, respectively. Multivariate analysis revealed tumor size on computed tomography (CT) ≥15 mm and main pancreatic duct (MPD) dilatation (≥3 mm) as independent risk factors for OS among various preoperative parameters; the prognosis was stratified based on these two parameters. Patients with one risk factor had similar outcomes (5-year OS: 39 %) to pStage IIB DCC (pT2N1 or pT3), while those with two risk factors had a prognosis akin to pStage IIIA (pN2), with a high early recurrence rate of 64 % (5-year OS: 8 %). Among non-risk group patients with low carbohydrate antigen (CA)19-9 levels (<37 U/mL), the prognosis was comparable (5-year OS: 72 %) to those with pStage I DCC.

Conclusion

A simple stratification approach was developed to predict long-term postoperative outcomes. To improve poor prognosis, intensive therapy, including neoadjuvant chemotherapy, should be considered for patients with two risk factors.

背景：远端胆管癌（DCC）患者经常在术前和术后接受辅助化疗，但在选择治疗方法时预测预后风险仍具有挑战性：这项单中心回顾性研究纳入了2009年至2022年间接受初次胰十二指肠切除术（PD）的DCC患者。收集术前临床参数，采用Cox回归分析确定总生存率（OS）的风险因素：在接受检查的170名患者中，肿瘤中位深度为10毫米，37%的患者被诊断为pT3。46%的患者有淋巴结转移。中位和5年生存期分别为58.2个月和50%。多变量分析显示，在各种术前参数中，计算机断层扫描（CT）显示的肿瘤大小≥15毫米和主胰管（MPD）扩张（≥3毫米）是影响患者生存期的独立危险因素；根据这两个参数对预后进行了分层。有一个风险因素的患者的预后（5 年 OS：39%）与 pStage IIB DCC（pT2N1 或 pT3）相似，而有两个风险因素的患者的预后与 pStage IIIA（pN2）相似，早期复发率高达 64%（5 年 OS：8%）。在碳水化合物抗原（CA）19-9水平较低的非风险组患者中（结论：CA19-9水平较低的患者预后较差），其早期复发率高达64%（5年生存率：8%）：我们开发了一种简单的分层方法来预测术后的长期预后。为了改善预后不良的情况，有两个危险因素的患者应考虑接受强化治疗，包括新辅助化疗。

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引用次数: 0

Redefining melanoma surveillance: The controversial utility of serum S100B and the potential of liquid biopsy 重新定义黑色素瘤监测：血清 S100B 的争议性用途和液体活检的潜力

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-09-18 DOI: 10.1016/j.ejso.2024.108695

引用次数: 0

IFC: Filler advert_sciencedirect_210x280.pdf 国际金融公司：填料广告_sciencedirect_210x280.pdf

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-09-17 DOI: 10.1016/S0748-7983(24)00730-3

引用次数: 0

Comparison of the LiMAx test vs. the APRI+ALBI score – Incorrect comparison parameters lead to questionable results LiMAx测试与APRI+ALBI评分的比较--不正确的比较参数导致可疑的结果

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-09-17 DOI: 10.1016/j.ejso.2024.108697

引用次数: 0

Factors associated with leakage after reversal of protective stoma in patients with locally advanced rectal cancer following curative resection and anastomosis. 局部晚期直肠癌患者治愈性切除和吻合术后逆转保护性造口后发生渗漏的相关因素。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-09-17 DOI: 10.1016/j.ejso.2024.108698

Miao-Ling Tsai, Ji-Shiang Hung, John Huang, Been-Ren Lin

Introduction: Anastomotic leakage (AL) is a significant complication in colorectal surgery with numerous general and specific risk factors. The determinants of colorectal AL following the reversal of a protective defunctioning ileostomy remain unclear and warrant further investigation.

Material and methods: Data from April 2008 to December 2014 were collected and retrospectively reviewed for 361 consecutive patients who underwent protective ileostomy reversal following curative resection with anastomosis for rectal cancer. The baseline, treatment, and oncological variables of patients associated with post-reversal AL were evaluated using univariate and multivariate logistic regression analysis. The impact of AL on long-term survival outcomes was assessed using Kaplan-Meier survival analyses.

Results: In a study of 361 patients, 52 (14.4 %) experienced leakage following stoma reversal, manifesting at a median of 5.7 months. Multivariable logistic regression analysis revealed that an anastomosis located less than 7 cm from the anal verge (OR 2.82, p = 0.008), a side-to-end anastomotic configuration (OR 2.02, p = 0.036), involvement of the circumferential resection margin (OR 6.46, p = 0.043), and adjuvant radiotherapy (OR 4.69, p = 0.003) significantly predicted post-reversal AL. Notably, five-year overall survival (63.4 % vs. 90.3 %, p < 0.0001) and disease-free survival (46.9 % vs. 71.1 %, p = 0.001) were significantly lower in patients with post-reversal AL.

Conclusions: Our analysis identified several clinicopathological factors associated with post-reversal AL, which is linked to a significant decrease in long-term survival and oncological outcomes. Alleviating these adverse effects necessitates ensuring early detection and effective management of leaks among high-risk patients.

介绍：吻合口漏（AL）是结直肠手术中的一个重要并发症，具有许多一般和特殊的风险因素。逆转保护性失功能回肠造口术后发生结直肠AL的决定因素仍不清楚，值得进一步研究：收集并回顾性审查了 2008 年 4 月至 2014 年 12 月期间连续接受保护性回肠造口逆转术的 361 例直肠癌根治性切除吻合术患者的数据。采用单变量和多变量逻辑回归分析评估了与逆转术后AL相关的患者基线、治疗和肿瘤学变量。采用 Kaplan-Meier 生存分析评估了 AL 对长期生存结果的影响：在对 361 名患者进行的研究中，52 人（14.4%）在造口翻转术后出现渗漏，中位时间为 5.7 个月。多变量逻辑回归分析显示，吻合口距离肛门边缘小于 7 厘米（OR 2.82，p = 0.008）、侧对端吻合口结构（OR 2.02，p = 0.036）、周缘切除边缘受累（OR 6.46，p = 0.043）和辅助放疗（OR 4.69，p = 0.003）可显著预测造口翻转术后 AL。值得注意的是，五年总生存率（63.4% vs. 90.3%，P=0.043我们的分析确定了与逆转后 AL 相关的几个临床病理因素，而逆转后 AL 与长期生存率和肿瘤预后的显著下降有关。要减轻这些不良影响，就必须确保早期发现并有效管理高危患者的漏诊。

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引用次数: 0

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IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-09-17 DOI: 10.1016/S0748-7983(24)00733-9

引用次数: 0

Timeline of surgery in localized angiosarcoma of the breast: Improving outcome following multidisciplinary treatment optimization 乳腺局部血管肉瘤的手术时间表：多学科治疗优化后提高疗效

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2024-09-17 DOI: 10.1016/j.ejso.2024.108699

Introduction

Primary (PAS) and radiation-associated angiosarcomas (RAAS) of the breast are rare tumors of vascular origin with poor survival. In this retrospective cohort study, we aimed to assess the impact of multidisciplinary treatment optimization on the prognosis of patients who underwent surgery at a national referral center.

Materials and methods

Cases of operable angiosarcoma of the breast evaluated by a multidisciplinary team including surgeons, medical oncologists and radiation oncologists expert in the field and treated from January 2012 to January 2023 were retrieved from a prospectively maintained database. The outcomes of three treatment groups, defined by the timing of surgery in relation to adjuvant and neoadjuvant therapies, were compared.

Results

Fifty-nine patients with operable angiosarcomas of the breast (49 RAAS and 10 PAS) were retrospectively identified. The five-year overall survival was 85.2 % (95 % CI 73.9–98.2) and event-free survival was significantly better in patients with grade 1 than those with grade 2 or 3 tumors. Patients receiving neoadjuvant chemotherapy had significantly better outcomes than those treated with primary surgery. Pathological complete response was significantly higher in patients receiving neoadjuvant radiotherapy after neoadjuvant chemotherapy, and a trend towards better distant–disease-free survival was found for patients with complete response at time of surgery.

Conclusions

Optimization of angiosarcoma treatment based on specialized, multidisciplinary assessment regarding the type and timing of surgery and the use of neoadjuvant chemoradiotherapy can improve outcomes. The findings of this study support the use of neoadjuvant chemotherapy as well as adjuvant and neoadjuvant radiotherapy in clinical practice.

导言乳腺原发性血管肉瘤（PAS）和放射相关血管肉瘤（RAAS）是罕见的血管性肿瘤，生存率很低。在这项回顾性队列研究中，我们旨在评估多学科治疗优化对在一家国家转诊中心接受手术治疗的患者预后的影响。材料和方法从一个前瞻性维护的数据库中检索了2012年1月至2023年1月期间由包括外科医生、肿瘤内科医生和放射肿瘤专家在内的多学科团队评估的可手术乳腺血管肉瘤病例。结果回顾性鉴定了59例乳腺可手术血管肉瘤患者（49例RAAS和10例PAS）。五年总生存率为 85.2%（95 % CI 73.9-98.2），1 级肿瘤患者的无事件生存率明显高于 2 级或 3 级肿瘤患者。接受新辅助化疗的患者的疗效明显优于接受初次手术治疗的患者。病理完全反应在新辅助化疗后接受新辅助放疗的患者中明显较高，而且发现手术时有完全反应的患者的远处无病生存率有提高的趋势。结论基于对手术类型和时机以及新辅助化放疗的使用进行专业化、多学科评估，优化血管肉瘤的治疗可改善预后。本研究结果支持在临床实践中使用新辅助化疗以及辅助和新辅助放疗。

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引用次数: 0

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全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

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