scholarly journals A radiomics-based nomogram for preoperative T staging prediction of rectal cancer

2021 ◽  
Author(s):  
Xue Lin ◽  
Sheng Zhao ◽  
Huijie Jiang ◽  
Fucang Jia ◽  
Guisheng Wang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Goodness Of Fit ◽  
Clinical Decision Making ◽  
Early Stage ◽  
Locally Advanced ◽  
Area Under The Curve ◽  
Training Dataset ◽  
Validation Dataset ◽  
Prospective Analysis ◽  
Clinical Value

Abstract Purpose To investigate the value of a radiomics-based nomogram in predicting preoperative T staging of rectal cancer. Methods A total of 268 eligible rectal cancer patients from August 2012 to December 2018 were enrolled and allocated into two datasets: training (n = 188) and validation datasets (n = 80). Another set of 32 patients from January 2019 to July 2019 was included in a prospective analysis. Pretreatment T2-weighted images were used to radiomics features extraction. Feature selection and radiomics score (Rad-score) construction were performed through a least absolute shrinkage and selection operator regression analysis. The nomogram, which included Rad-scores and clinical factors, was built using multivariate logistic regression. Discrimination, calibration, and clinical utility were used to evaluate the performance of the nomogram. Results The Rad-score containing nine selected features was significantly related to T staging. Patients who had locally advanced rectal cancer (LARC) generally had higher Rad-scores than patients with early-stage rectal cancer. The nomogram incorporated Rad-scores and carcinoembryonic antigen levels and showed good discrimination, with an area under the curve (AUC) of 0.882 (95% confidence interval [CI] 0.835–0.930) in the training dataset and 0.846 (95% CI 0.757–0.936) in the validation dataset. The calibration curves confirmed high goodness of fit, and the decision curve analysis revealed the clinical value. A prospective analysis demonstrated that the AUC of the nomogram to predict LARC was 0.859 (95% CI 0.730–0.987). Conclusion A radiomics-based nomogram is a novel method for predicting LARC and can provide support in clinical decision making.

Monocyte distribution width (MDW): a useful biomarker to improve sepsis management in Emergency Department

2022 ◽  
Vol 0 (0) ◽  
Author(s):  
Donatella Poz ◽  
Danila Crobu ◽  
Elena Sukhacheva ◽  
Marco Bruno Luigi Rocchi ◽  
Maria Chiara Anelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Decision Making ◽  
Area Under The Curve ◽  
Sepsis Group ◽  
Differential Analysis ◽  
Clinical Value ◽  
Sepsis Management ◽  
Distribution Width ◽  
Standard Clinical Practice

Abstract Objectives Sepsis is a time-dependent and life-threating condition. Despite several biomarkers are available, none of them is completely reliable for the diagnosis. This study aimed to evaluate the diagnostic utility of monocyte distribution width (MDW) to early detect sepsis in adult patients admitted in the Emergency Department (ED) with a five part differential analysis as part of the standard clinical practice. Methods A prospective cohort study was conducted on 985 patients aged from 18 to 96 and included in the study between November 2019 and December 2019. Enrolled subjects were classified into four groups based on sepsis-2 diagnostic criteria: control, Systemic Inflammatory Response Syndrome (SIRS), infection and sepsis. The hematology analyzer DxH 900 (Beckman Coulter Inc.) provides the new reportable parameter MDW, included in the leukocyte 5 part differential analysis, cleared by Food and Drug administration (FDA) and European Community In-Vitro-Diagnostic Medical Device (CE IVD) marked as early sepsis indicator (ESId). Results MDW was able to differentiate the sepsis group from all other groups with Area Under the Curve (AUC) of 0.849, sensitivity of 87.3% and specificity of 71.7% at cut-off of 20.1. MDW in combination with white blood cell (WBC) improves the performance for sepsis detection with a sensitivity increased up to 96.8% when at least one of the two biomarkers are abnormal, and a specificity increased up to 94.6% when both biomarkers are abnormal. Conclusions MDW can predict sepsis increasing the clinical value of Leukocyte 5 Part Differential analysis and supporting the clinical decision making in sepsis management at the admission to the ED.

scholarly journals The Role of Micro-RNAs and Circulating Tumor Markers as Predictors of Response to Neoadjuvant Therapy in Locally Advanced Rectal Cancer

2020 ◽  
Vol 21 (19) ◽  
pp. 7040 ◽  
Author(s):  
Fatima Domenica Elisa De Palma ◽  
Gaetano Luglio ◽  
Francesca Paola Tropeano ◽  
Gianluca Pagano ◽  
Maria D’Armiento ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Clinical Decision Making ◽  
Locally Advanced ◽  
Therapy Response ◽  
Predictive Biomarkers ◽  
Advanced Rectal Cancer ◽  
Clinical Decision ◽  
Locally Advanced Rectal Cancer ◽  
Specific Expression ◽  
Micro Rnas

The response to neoadjuvant chemoradiation (nCRT) is a critical step in the management of locally advanced rectal cancer (LARC) patients. Only a minority of LARC patients responds completely to neoadjuvant treatments, thus avoiding invasive radical surgical resection. Moreover, toxic side effects can adversely affect patients’ survival. The difficulty in separating in advances responder from non-responder patients affected by LARC highlights the need for valid biomarkers that guide clinical decision-making. In this context, microRNAs (miRNAs) seem to be promising candidates for predicting LARC prognosis and/or therapy response, particularly due to their stability, facile detection, and disease-specific expression in human tissues, blood, serum, or urine. Although a considerable number of studies involving potential miRNA predictors to nCRT have been conducted over the years, to date, the identification of the perfect miRNA signatures or single miRNA, as well as their use in the clinical practice, is still representing a challenge for the management of LARC patients. In this review, we will first introduce LARC and its difficult management. Then, we will trace the scientific history and the key obstacles for the identification of specific miRNAs that predict responsiveness to nCRT. There is a high potential to identify non-invasive biomarkers that circulate in the human bloodstream and that might indicate the LARC patients who benefit from the watch-and-wait approach. For this, we will critically evaluate recent advances dealing with cell-free nucleic acids including miRNAs and circulating tumor cells as prognostic or predictive biomarkers.

The prognostic value of an early response in chemoradiation of locally advanced rectal cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14134-e14134
Author(s):  
John Ploeen ◽  
Jan Lindebjerg ◽  
Jens Christian Riis Joergensen ◽  
Anders Kristian Moeller Jakobsen
Keyword(s):  
Rectal Cancer ◽  
Clinical Examination ◽  
Anal Verge ◽  
Locally Advanced ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Clinical Value ◽  
Cancer Specific Survival ◽  
End Of Treatment

e14134 Background: Preoperative chemoradiation is standard treatment of locally advanced rectal cancer, and there is an obvious need for new methods of assessing the effect. Evaluation by clinical examination with endoscopy is controversial. In most papers the assessment of effect has been performed after the end of treatment. The aim of the present study was to investigate the clinical value of an examination during chemoradiation. Methods: The study included 128 patients with histopathologically verified rectal cancer. Further inclusion criteria were a T3 tumor with a circumferential margin ≤ 5 mm by MRI or a T4 tumor, a distance of < 10 cm from the anal verge and localized diseased only by abdominal and chest CT scan. The treatment was 50.4 Gy/28 fractions or the same treatment with the addition of endorectal brachytherapy 10 Gy/2 fractions in a randomized trial. The concomitant chemotherapy was UFT 300 mg/m2 and L-leucovorin 22.5 mg daily. Both drugs were given five days a week. Clinical examination with endoscopy was performed week 4 during treatment. The clinical effect was classified into complete response (CR) or not complete response with clinical residual tumor (NCR). The patients were operated eight weeks after end of treatment and the pathological tumor response was classified according to Mandard (TRG). Results: CR was found in 14% of the patients. Comparison with TRG showed that 82% with CR had TRG1 as compared to the NCR group where only 9% had TRG1 (p<10-4). The risk of lymph node metastasis was also different with 94% pN0 in the group with CR compared to 57% in the NCR group (p=0.02). The rate of CR translated to a major difference in the risk of recurrence (local and distant). No patients with CR experienced recurrence as compared to 19% in the NCR group (p<0.05). The CR also correlated with cancer specific survival. None of the patients with CR died from rectal cancer with a median observation time of 36 months compared to 30% in the NCR group. Conclusions: CR is a major prognostic parameter in locally advanced rectal cancer treated with chemoradiation. Early CR should be considered in the selection of patients for Watchful Waiting.

scholarly journals Development and Validation of a Score for Prediction of Postoperative Respiratory Complications

2013 ◽  
Vol 118 (6) ◽  
pp. 1276-1285 ◽  
Author(s):  
Britta Brueckmann ◽  
Jose L. Villa-Uribe ◽  
Brian T. Bateman ◽  
Martina Grosse-Sundrup ◽  
Dean R. Hess ◽  
...  
Keyword(s):  
Area Under The Curve ◽  
Training Dataset ◽  
Validation Dataset ◽  
Multivariable Logistic Regression Analysis ◽  
Respiratory Complications ◽  
Billing Data ◽  
Entire Cohort ◽  
Postoperative Respiratory Complications ◽  
History Of ◽  
American Society

Abstract Background: Postoperative respiratory failure is associated with increased morbidity and mortality, as well as high costs of hospital care. Methods: Using electronic anesthesia records, billing data, and chart review, the authors developed and validated a score predicting reintubation in the hospital after primary extubation in the operating room, leading to unplanned mechanical ventilation within the first 3 postoperative days. Using multivariable logistic regression analysis, independent predictors were determined and a score postulated and validated. Results: In the entire cohort (n = 33,769 surgical cases within 29,924 patients), reintubation occurred in 137 cases (0.41%). Of those, 16%, (n = 22) died subsequently, whereas the mortality in patients who were not reintubated was 0.26% (P &lt; 0.0001). Independent predictors for reintubation were: American Society of Anesthesiologist Score 3 or more, emergency surgery, high-risk surgical service, history of congestive heart failure, and chronic pulmonary disease. A point value of 3, 3, 2, 2, and 1 were assigned to these predictors, respectively, based on their β coefficient in the predictive model. The score yielded a calculated area under the curve of 0.81, whereas each point increment was associated with a 1.7-fold (odds ratio: 1.72 [95% CI, 1.55–1.91]) increase in the odds for reintubation in the training dataset. Using the validation dataset (n = 16,884), the score had an area under the curve of 0.80 and similar estimated probabilities for reintubation. Conclusion: The authors developed and validated a score for the prediction of postoperative respiratory complications, a simple, 11-point score that can be used preoperatively by anesthesiologists to predict severe postoperative respiratory complications.

scholarly journals Histopathological, Radiological and Demographic Factors Predicting the Response to Neoadjuvant Therapy for Rectal Cancer

2021 ◽  
Author(s):  
Emine YILDIRIM ◽  
Sibel Bektas ◽  
Zekeriya Pelen ◽  
Irem Yanik ◽  
Ahmet Muzaffer Er ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymphovascular Invasion ◽  
Perineural Invasion ◽  
Early Stage ◽  
Anal Verge ◽  
Demographic Data ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Stage

Abstract Background/aimWhile the treatment for early stage rectal cancer is surgery, when a diagnosis is made at a locally advanced stage, it is recommended to start treatment with neoadjuvant chemoradiotherapy. Therefore, it is important to determine which patients will respond best to neoadjuvant treatment. The aim of this study was to investigate which hematological, histopathological, and radiological parameters can predict the response to chemoradiotherapy. Methods and materialsA retrospective examination was made of 43 patients who underwent surgery following neoadjuvant chemoradiotherapy because of locally advanced stage rectal cancer. Demographic data were collected from the patient files, and the radiological, histopathological and laboratory findings before neoadjuvant chemoradiotherapy were compared with the findings after treatment. ResultsIn the postoperative evaluation, a pathological complete response was determined in 25.50% of the patients. Lymphovascular invasion, perineural invasion and absence of necrosisis were seen to be statistically related to major response (p<0.05), and in patients where the tumor was closer than 6cm to the anal verge, the response was betterConclusionWhen the findings were examined, histopathological lymphovascular invasion, perineural invasion, the presence of necrosis, and the anal verge distance were evaluated as parameters predicting the response to neoadjuvant chemoradiotherapy in rectal cancer.

scholarly journals Establishment of a clinical nomogram model to predict the progression of COVID-19 to severe disease

2020 ◽  
Author(s):  
changli tu ◽  
Guojie Wang ◽  
Cuiyan Tan ◽  
Meizhu Chen ◽  
Zijun Xiang ◽  
...  
Keyword(s):  
Disease Progression ◽  
Selection Process ◽  
Severe Disease ◽  
Area Under The Curve ◽  
Training Dataset ◽  
Validation Dataset ◽  
Efficient Manner ◽  
And Performance ◽  
Sensitivity Specificity ◽  
D Dimer

Abstract Background Coronavirus disease 2019 (COVID-19) is a worldwide public health pandemic with a high mortality rate, among severe cases. The disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. It is important to ensure early detection of the virus to curb disease progression to severe COVID-19. This study aimed to establish a clinical-nomogram model to predict the progression to severe COVID-19 in a timely, efficient manner. Methods This retrospective study included 202 patients with COVID-19 who were admitted to the Fifth Affiliated Hospital of Sun Yat-sen University and Shiyan Taihe Hospital from January 17 to April 30, 2020. The patients were randomly assigned to the training dataset (n = 163, with 43 progressing to severe COVID-19) or the validation dataset (n = 39, with 10 progressing to severe COVID-19) at a ratio of 8:2. The optimal subset algorithm was applied to filter for the clinical factors most relevant to the disease progression. Based on these factors, the logistic regression model was fit to distinguish severe (including severe and critical cases) from non-severe (including mild and moderate cases) COVID-19. Sensitivity, specificity, and area under the curve (AUC) were calculated using the R software package to evaluate prediction performance. A clinical nomogram was established and performance assessed with the discrimination curve. Results Risk factors, including demographics data, symptoms, laboratory and image findings were recorded for the 202 patients. Eight of the 52 variables that were entered into the selection process were selected via the best subset algorithm to establish the predictive model; they included gender, age, BMI, CRP, D-dimer, TP, ALB, and involved-lobe. Sensitivity, specificity and AUC were 0.91, 0.84 and 0.86 for the training dataset, and 0.87, 0.66, and 0.80 for the validation dataset. Conclusions We established an efficient and reliable clinical nomogram model which showed that gender, age, and initial indexes including BMI, CRP, D-dimer, involved-lobe, TP, and ALB could predict the risk of progression to severe COVID-19.

scholarly journals A Nomogram-Based Model to Predict Neoplastic Risk For Patients With Gallbladder Polyps

2021 ◽  
Author(s):  
Xudong Zhang ◽  
Jin-Cheng Wang ◽  
Baoqiang Wu ◽  
Tao Li ◽  
Lei Jin ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Early Stage ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Training Group ◽  
Clinical Decision ◽  
Polyp Size ◽  
Training Cohort ◽  
Discrimination Ability ◽  
Gallbladder Polyps

Abstract Background: Gallbladder polyps (GBPs) assessment seeks to identify early-stage gallbladder carcinoma (GBC). Many studies have analyzed the risk factors for malignant GBPs, and we try to establish a more accurate predictive model for potential neoplastic polyps in patients with GBPs.Methods: This retrospective study developed a nomogram-based model in a training cohort of 233 GBP patients. Clinical information, ultrasonographic findings, and blood tests were retrospectively analyzed. Spearman correlation and logistic regression analysis were used to identify independent predictors and establish a nomogram model. An internal validation was conducted in 225 consecutive patients. Performance of models was evaluated through the receiver operating characteristic curve (ROC) and decision curve analysis (DCA). Results: Age, cholelithiasis, CEA, polyp size and sessile were confirmed as independent predictors for neoplastic potential of GBPs in the training group. Compared with other proposed prediction methods, the established nomogram model presented good discrimination ability in the training cohort (area under the curve [AUC]: 0.845) and the validation cohort (AUC: 0.836). DCA demonstrated the most clinical benefits can be provided by the nomogram. Conclusions: Our developed preoperative nomogram model can successfully evaluate the neoplastic potential of GBPs based on simple clinical variables, that maybe useful for clinical decision-making.

The potential of circulating tumor DNA (ctDNA) to guide adjuvant chemotherapy decision making in locally advanced rectal cancer (LARC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 3521-3521 ◽  
Author(s):  
Jeanne Tie ◽  
Joshua Cohen ◽  
Yuxuan Wang ◽  
Lu Li ◽  
Isaac Kinde ◽  
...  
Keyword(s):  
Decision Making ◽  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Clinical Decision Making ◽  
Locally Advanced ◽  
Recurrence Risk ◽  
Routine Practice ◽  
Plasma Samples ◽  
Multi Centre Study ◽  
Ctdna Analysis

3521 Background: The optimal approach to adjuvant chemotherapy for rectal cancer is keenly debated. Routine practice and clinical guidelines vary widely. After pre-operative chemoradiation (CRT), a pathologic complete response (pCR) or nodal involvement (pN+) are prognostic markers that can guide clinical decision-making, but markers that better define the patients (pts) that are likely or unlikely to benefit from chemotherapy are urgently needed. We investigated the potential role of ctDNA as a biomarker to guide therapy. Methods: We conducted a prospective, multi-centre study in pts with LARC (T3/T4 and/or N+) planned for CRT and curative resection. Serial plasma samples were collected pre-CRT, post-CRT, and 4-10 weeks after surgery. Somatic mutations in individual pts’ tumor were identified via sequencing of 15 genes commonly mutated in colorectal cancers. We then designed personalized assays to quantify ctDNA in plasma samples. Pts received adjuvant therapy at clinician discretion. Results: 200 pts were enrolled between Apr-2012 and Dec-2015. Median age was 62 years (range 28-86), 67% were male and 159 pts had pre-CRT and post-op ctDNA samples available for analysis. Of these, 122 (77%) pts had detectable ctDNA prior to therapy. After surgery, 19 pts had detectable ctDNA and 11 of these 19 (58%) have recurred during a median follow up of 22 months. Recurrence occurred in only 12 of 140 (8.6%) with negative ctDNA (HR 12, p < 0.001). One hundred and two (64%) pts received adjuvant chemotherapy. Post-op ctDNA detection was predictive of recurrence irrespective of adjuvant chemotherapy (chemo: HR 10, p < 0.001; no chemo: HR 16, p < 0.001). Thirty-four pts (21%) achieved a pCR, 43 (27%) had pN+ disease. pCR (vs non-pCR) was associated with a trend for lower recurrence risk (HR 0.31, p = 0.089) and pN+ (vs pN0) with a higher recurrence risk (HR 4.2, p < 0.001). ctDNA detection remained predictive of recurrence among pts with a pCR (HR 14, p = 0.014) or with pN+ disease (HR 11, p < 0.001). Conclusions: Post-op ctDNA analysis stratifies pts with LARC into very high and low risk groups. ctDNA analysis remains strongly predictive of recurrence among pts with both lower risk (pCR) and higher risk (pN+) disease.

Rectal cancer in the elderly: A review of treatment variances between younger and older patients.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 839-839
Author(s):  
Lynda Corrigan ◽  
Connor Gerard O'Leary ◽  
Jeska Kroes ◽  
Paula Calvert ◽  
Miriam O'Connor ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Older Patients ◽  
Early Stage ◽  
Average Length ◽  
Clinical Stage ◽  
Locally Advanced ◽  
Length Of Hospital Stay ◽  
Rectal Polyp ◽  
Categorical Variables ◽  
Operative Recovery

839 Background: Rectal cancer (RC) treatment involves multiple modalities with tolerability a concern for some older patients (pts). However, fit older pts have outcomes similar to those of younger pts. We examined the treatment of RC in older pts compared to younger counterparts. Methods: Pts diagnosed with early stage and locally advanced RC from January 2014 to January 2016 were identified from a prospectively maintained electronic database. Characteristics were ascertained through retrospective analysis of pt records. Associations between categorical variables was tested using chi- square. Results: 116 pts diagnosed with RC were identified. Median age was 67 (range 36- 95). 47 (41%) were ≥ 70 years old. Stage distribution is summarised in the Table. Eight pts with stage I disease had rectal polyp cancers, fully resected at endoscopy. 108 were discussed at multidisciplinary meeting (MDM). Treatment (tx) recommendations based on clinical stage and ultimate tx received are outlined in the Table. Clinical Stage and MDM Outcomes Older pts were less likely to receive recommended NACRT than those < 70 (52% and 85% respectively). All pts ≥ 70 who received NACRT completed a full course successfully. Older pts were less likely to proceed to curative resection than younger pts (76% and 94% respectively). Average length of hospital stay was longer in pts ≥ 70: 22.9 vs. 16.6 days in pts < 70. Hospital readmission within 30 days in ≥ 70 vs. < 70 was 9% and 3% respectively. There was no statistical difference in the likelihood of receiving AC based on age. 25% of older pts required dose reductions of AC; 38% did not complete the planned number of cycles. Conclusions: While most older pts tolerated NACRT without significant toxicity, post- operative recovery and tolerability of AC varies widely. Comprehensive geriatric assessment may be useful in guiding tx decisions, and ensuring best outcomes, in this heterogeneous group.[Table: see text]

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