Treatment response and survival in patients with pancreatic adenocarcinoma receiving neoadjuvant chemotherapy or chemoradiation.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15715-e15715
Author(s):  
Ahmed Khattab ◽  
Sunita Patruni ◽  
Stephen Abel ◽  
Shaakir Hasan ◽  
Gene Grant Finley ◽  
...  
Keyword(s):  
Overall Survival ◽  
Logistic Regression ◽  
Neoadjuvant Chemotherapy ◽  
Treatment Response ◽  
Pathologic Complete Response ◽  
Multivariable Analysis ◽  
Ductal Adenocarcinoma ◽  
Multivariable Logistic Regression ◽  
Predictors Of Response ◽  
Significant Difference

e15715 Background: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with a poor prognosis. Neoadjuvant chemotherapy (NeoChT) and chemoradiation (NeoCRT) have emerged as strategies to optimize resection, but data investigating predictors of treatment response and the overall survival (OS) impact are not well characterized. To investigate the effects of NeoChT/NeoCRT on primary tumor/nodal downstaging and OS, we analyzed the national cancer database (NCDB). Methods: We queried the NCDB for patients with PDAC receiving NeoChT/NeoCRT. Patients were classified as responders (T and/or N downstage), nonresponders (mixed/no response) and progressors (T and/or N upstage). Multivariable logistic regression identified predictors of response. Univariable and multivariable analyses identified characteristics predictive of OS. Results: 2,028 patients with PDAC receiving NeoChT/NeoCRT were analyzed. Univariable analysis of responders (n = 790) vs. nonresponders/progressors (n = 1,238) demonstrated a significant difference in median OS at 29.1 months vs. 25.3 months and 3-year overall survival of 40% vs. 34% [p = 0.006; HR: 0.95 (95% CI: 0.84-1.08)] respectively. When compared independently to both responders and nonresponders, progressors had a significantly decreased 3-year OS at 31% vs 40% and 37% respectively [p = 0.003; HR: 0.82 (95% CI: 0.70-0.96)]. Predictors of response on multivariable logistic regression included receipt of multiagent chemotherapy and receipt of NeoCRT. Only NeoCRT predicted for pathologic complete response (pCR). Multivariable analysis of patients with pCR demonstrated a trend towards increased OS (p = .08). Conclusions: Our results suggest that both response and progression following neoadjuvant therapy may predict for longer and shorter OS respectively. Randomized, prospective studies are needed to further validate these findings. [Table: see text]

scholarly journals Relationship Between Obesity and Pathologic Response to Neoadjuvant Chemotherapy Among Women With Operable Breast Cancer

2008 ◽  
Vol 26 (25) ◽  
pp. 4072-4077 ◽  
Author(s):  
Jennifer K. Litton ◽  
Ana M. Gonzalez-Angulo ◽  
Carla L. Warneke ◽  
Aman U. Buzdar ◽  
Shu-Wan Kau ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Pathologic Complete Response ◽  
Operable Breast Cancer ◽  
Obese Patients ◽  
Breast Cancer Patients ◽  
Significant Difference ◽  
Response To Neoadjuvant Chemotherapy

Purpose To understand the mechanism through which obesity in breast cancer patients is associated with poorer outcome, we evaluated body mass index (BMI) and response to neoadjuvant chemotherapy (NC) in women with operable breast cancer. Patients and Methods From May 1990 to July 2004, 1,169 patients were diagnosed with invasive breast cancer at M. D. Anderson Cancer Center and received NC before surgery. Patients were categorized as obese (BMI ≥ 30 kg/m2), overweight (BMI of 25 to < 30 kg/m2), or normal/underweight (BMI < 25 kg/m2). Logistic regression was used to examine associations between BMI and pathologic complete response (pCR). Breast cancer–specific, progression-free, and overall survival times were examined using the Kaplan-Meier method and Cox proportional hazards regression analysis. All statistical tests were two-sided. Results Median age was 50 years; 30% of patients were obese, 32% were overweight, and 38% were normal or underweight. In multivariate analysis, there was no significant difference in pCR for obese compared with normal weight patients (odds ratio [OR] = 0.78; 95% CI, 0.49 to 1.26). Overweight and the combination of overweight and obese patients were significantly less likely to have a pCR (OR = 0.59; 95% CI, 0.37 to 0.95; and OR = 0.67; 95% CI, 0.45 to 0.99, respectively). Obese patients were more likely to have hormone-negative tumors (P < .01), stage III tumors (P < .01), and worse overall survival (P = .006) at a median follow-up time of 4.1 years. Conclusion Higher BMI was associated with worse pCR to NC. In addition, its association with worse overall survival suggests that greater attention should be focused on this risk factor to optimize the care of breast cancer patients.

Surgical outcomes and rate of pathological response in resectable/borderline resectable pancreatic cancer patients undergoing neoadjuvant gemcitabine/nab-paclitaxel versus FOLFIRINOX: A retrospective institutional analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16247-e16247
Author(s):  
Abraham Attah Attah ◽  
Saleha Rizwan ◽  
Khaled Alhamad ◽  
Micheal Turk ◽  
Palash Asawa ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Treatment Response ◽  
Surgical Resection ◽  
Locally Advanced ◽  
Small Sample ◽  
Ductal Adenocarcinoma ◽  
Categorical Variables ◽  
Adjuvant Setting ◽  
Borderline Resectable ◽  
Significant Difference

e16247 Background: Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal solid tumors, predicted to become the second leading cause of cancer related death in some regions of the world. It often presents at an advanced stage, which contributes to poor five-year survival rates of 2%-9%, ranking firmly last amongst all cancer sites in terms of prognostic outcomes for patients. Only about 20% of the cases are diagnosed early enough to undergo surgical resection leading to complete remission. While chemotherapy has an established role in the setting of metastatic disease, utilizing it in the neo-adjuvant setting has been adopted by most institutes for resectable/ borderline resectable cases. Ongoing trials are exploring the use of different regimens in the neo-adjuvant setting. The aim of our study was to identify patients with resectable/borderline resectable PDAC undergoing neoadjuvant chemotherapy and differences in surgical outcome based on the regimen received i.e gemcitabine/ nab-Paclitaxel vs FOLFIRINOX. Methods: A retrospective review was conducted of all patients diagnosed with PDAC from 2017-2019 at Allegheny General Hospital. Data analysis was completed using IBM SPSS v23. Summary statistics were presented using percentages for categorical variables and medians with interquartile ranges for continuous variables. Results: Out of 121 patients who received and completed treatment in our institution, 30 underwent neoadjuvant chemotherapy treatment followed by surgical intervention. 21 (70%) patients were found to be borderline resectable, 8 (27%) patients were resectable and 1 patient had locally advanced PDAC. 16 (53%) patients received FOLFIRINOX compared to 13 (43%) patients received gem/nab-paclitaxel. Among patients who received neoadjuvant FOLFIRINOX, 5 out of 16 (31%) patients had moderate to significant treatment response at the time of surgery compared to 7 out of 13 (54%) patients who received gemcitabine/nab-paclitaxel. Conclusions: Our study revealed no significant difference (p=0.21) between the patients who received neoadjuvant gemcitabine/nab-paclitaxel vs FOLFIRINOX in terms of treatment response assessed pathologically at the time surgical resection. We recognize the limitations of our study in terms of it being a retrospective analysis with a small sample size and therefore further prospective and randomized controlled trials are needed to determine the most suitable and effective regimen in the neoadjuvant setting for resectable/borderline resectable PDAC patients. Response to treatment among different chemotherapy groups.[Table: see text]

scholarly journals Disease-free and overall survival after neoadjuvant chemotherapy in breast cancer: breast-conserving surgery compared to mastectomy in a large single-centre cohort study

2020 ◽  
Author(s):  
Janine M. Simons ◽  
Julien G. Jacobs ◽  
Joost P. Roijers ◽  
Maarten A. Beek ◽  
Leandra J. M. Boonman-de Winter ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Pathologic Complete Response ◽  
Multivariable Analysis ◽  
Disease Free Survival ◽  
Breast Conserving Surgery ◽  
Prognostic Indicators ◽  
Free Survival ◽  
Disease Free

Abstract Purpose The extended role of breast-conserving surgery (BCS) in the neoadjuvant setting may raise concerns on the oncologic safety of BCS compared to mastectomy. This study compared long-term outcomes after neoadjuvant chemotherapy (NAC) between patients treated with BCS and mastectomy. Methods All breast cancer patients treated with NAC from 2008 until 2017 at the Amphia Hospital (the Netherlands) were included. Disease-free and overall survival were compared between BCS and mastectomy with survival functions. Multivariable Cox proportional hazard regression was performed to determine prognostic variables for disease-free survival. Results 561 of 612 patients treated with NAC were eligible: 362 (64.5%) with BCS and 199 (35.5%) with mastectomy. Median follow-up was 6.8 years (0.9–11.9). Mastectomy patients had larger tumours and more frequently node-positive or lobular cancer. Unadjusted five-year disease-free survival was 90.9% for BCS versus 82.9% for mastectomy (p = .004). Unadjusted five-year overall survival was 95.3% and 85.9% (p < .001), respectively. In multivariable analysis, clinical T4 (cT4) (HR 3.336, 95% CI 1.214–9.165, p = .019) and triple negative disease (HR 5.946, 95% CI 2.703–13.081, p < .001) were negative predictors and pathologic complete response of the breast (HR 0.467, 95% CI 0.238–0.918, p = .027) and axilla (HR 0.332, 95% CI 0.193–0.572, p = .001) were positive predictors for disease-free survival. Mastectomy versus BCS was not a significant predictor for disease-free survival when adjusted for the former variables (unadjusted HR 2.13 (95%CI: 1.4–3.24), adjusted HR 1.31 (95%CI: 0.81–2.13)). In the BCS group, disease-free and overall survival did not differ significantly between cT1, cT2 or cT3 tumours. Conclusion BCS does not impair disease-free and overall survival in patients treated with NAC. Tumour biology and treatment response are significant prognostic indicators.

Prognostic significance of history of nonmuscle invasive bladder cancer in patients with muscle invasive bladder cancer treated with neoadjuvant chemotherapy followed by surgery.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 375-375
Author(s):  
Yongjune Lee ◽  
Young Seok Kim ◽  
Bumsik Hong ◽  
Yong Mee Cho ◽  
Jae-Lyun Lee
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Pathologic Complete Response ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
History Of ◽  
Muscle Invasive

375 Background: Efficacy of cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) for T2-4aN1M0 muscle-invasive bladder cancer (MIBC) was proved by randomize controlled trials. Recent retrospective studies suggested that MIBC patients who had a history of non-muscle invasive bladder cancer (NMIBC) had lower pathologic complete response and worse overall survival rate to NAC and RC. This study aimed to compare clinical outcomes between MIBC that progressed from NMIBC (secondary MIBC) and primary MIBC. Methods: A retrospective analysis of patients with urothelial carcinoma (cT2-4aN0-1M0) who received neoadjuvant chemotherapy from January 2011 and December 2017 in Asan Medical Center was conducted. Clinicopathologic outcomes were compared between 187 patients with primary MIBC and 38 patients with secondary MIBC. Results: Baseline characteristics are well balanced between the groups. Downstaging rate ( < ypT2 and no N upstaging) are 46.7% for secondary MIBC group, 55.6% for primary MIBC group (p = 0.390), and positive pathologic metastatic nodes (ypN1+) are observed in 23.3% for secondary MIBC group, 18.3% for primary MIBC group (p = 0.523). There were no differences in overall survival (OS) (3 year OS 69.3% for secondary MIBC, 70.3% for primary MIBC, p = 0.420), disease-free survival (DFS) (3 year DFS 57.7% vs 56.6%, p = 0.880) between the groups. History of NMIBC is not independent prognostic factor for OS on multivariable analysis. Conclusions: Patients with secondary MIBC treated with NAC showed no differences in NAC response, pathologic downstaging rate, OS, DFS compared to patients with primary MIBC. Prospective or larger cohort study are required in the future. Genomic analysis is ongoing to identify genetic differences between two groups.

scholarly journals The Immunoscore in Localized Urothelial Carcinoma Treated with Neoadjuvant Chemotherapy: Clinical Significance for Pathologic Responses and Overall Survival

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 494
Author(s):  
Elise F. Nassif ◽  
Bernhard Mlecnik ◽  
Constance Thibault ◽  
Marie Auvray ◽  
Daniela Bruni ◽  
...  
Keyword(s):  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Pathologic Complete Response ◽  
Multivariable Analysis ◽  
Treatment Decision ◽  
Complete Response ◽  
P Value ◽  
Pre Treatment ◽  
Muscle Invasive ◽  
Response To Neoadjuvant Chemotherapy

(1) Background—The five-year overall survival (OS) of muscle-invasive bladder cancer (MIBC) with neoadjuvant chemotherapy and cystectomy is around 50%. There is no validated biomarker to guide the treatment decision. We investigated whether the Immunoscore (IS) could predict the pathologic response to neoadjuvant chemotherapy and survival outcomes. (2) Methods—This retrospective study evaluated the IS in 117 patients treated using neoadjuvant chemotherapy for localized MIBC from six centers (France and Greece). Pre-treatment tumor samples were immunostained for CD3+ and CD8+ T cells and quantified to determine the IS. The results were associated with the response to neoadjuvant chemotherapy, time to recurrence (TTR), and OS. (3) Results—Low (IS-0), intermediate (IS-1–2), and high (IS-3–4) ISs were observed in 36.5, 43.7, and 19.8% of the cohort, respectively. IS was positively associated with a pathologic complete response (pCR; p-value = 0.0096). A high IS was found in 35.7% of patients with a pCR, whereas it was found in 11.3% of patients without a pCR. A low IS was observed in 48.4% of patients with no pCR and in 21.4% of patients with a pCR. Low-, intermediate-, and high-IS patients had five-year recurrence-free rates of 37.2%, 36.5%, and 72.6%, respectively. In the multivariable analysis, a high IS was associated with a prolonged TTR (high vs. low: p = 0.0134) and OS (high vs. low: p = 0.011). (4) Conclusions—This study showed the significant prognostic and predictive roles of IS regarding localized MIBC.

scholarly journals Comparison of laparoscopic and hand-assisted laparoscopic nephrectomy for inflammatory renal disease: which is the preferred approach?

2021 ◽  
Vol 13 ◽  
pp. 175628722098404
Author(s):  
Xudong Guo ◽  
Hanbo Wang ◽  
Yuzhu Xiang ◽  
Xunbo Jin ◽  
Shaobo Jiang
Keyword(s):  
Logistic Regression ◽  
Renal Disease ◽  
Complication Rate ◽  
Adverse Outcomes ◽  
Laparoscopic Nephrectomy ◽  
Multivariable Logistic Regression Analysis ◽  
Invasive Approach ◽  
Intraoperative Complication ◽  
Multivariable Logistic Regression ◽  
Significant Difference

Aims: Management of inflammatory renal disease (IRD) can still be technically challenging for laparoscopic procedures. The aim of the present study was to compare the safety and feasibility of laparoscopic and hand-assisted laparoscopic nephrectomy in patients with IRD. Patients and methods: We retrospectively analyzed the data of 107 patients who underwent laparoscopic nephrectomy (LN) and hand-assisted laparoscopic nephrectomy (HALN) for IRD from January 2008 to March 2020, including pyonephrosis, renal tuberculosis, hydronephrosis, and xanthogranulomatous pyelonephritis. Patient demographics, operative outcomes, and postoperative recovery and complications were compared between the LN and HALN groups. Multivariable logistic regression analysis was conducted to identify the independent predictors of adverse outcomes. Results: Fifty-five subjects in the LN group and 52 subjects in the HALN group were enrolled in this study. In the LN group, laparoscopic nephrectomy was successfully performed in 50 patients (90.9%), while four (7.3%) patients were converted to HALN and one (1.8%) case was converted to open procedure. In HALN group, operations were completed in 51 (98.1%) patients and conversion to open surgery was necessary in one patient (1.9%). The LN group had a shorter median incision length (5 cm versus 7 cm, p < 0.01) but a longer median operative duration (140 min versus 105 min, p < 0.01) than the HALN group. There was no significant difference in blood loss, intraoperative complication rate, postoperative complication rate, recovery of bowel function, and hospital stay between the two groups. Multivariable logistic regression revealed that severe perinephric adhesions was an independent predictor of adverse outcomes. Conclusion: Both LN and HALN appear to be safe and feasible for IRD. As a still minimally invasive approach, HALN provided an alternative to IRD or when conversion was needed in LN.

scholarly journals Development of a new sternal dehiscence prediction scale for decision making in sternal closure techniques after cardiac surgery

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ehab Nooh ◽  
Colin Griesbach ◽  
Johannes Rösch ◽  
Michael Weyand ◽  
Frank Harig
Keyword(s):  
Logistic Regression ◽  
Risk Score ◽  
Characteristic Curve ◽  
Multivariable Analysis ◽  
Individual Risk ◽  
Dependent Diabetes Mellitus ◽  
Analysis Model ◽  
Multivariable Logistic Regression Model ◽  
Sternal Dehiscence ◽  
Multivariable Logistic Regression

Abstract Background After sternotomy, the spectrum for sternal osteosynthesis comprises standard wiring and more complex techniques, like titanium plating. The aim of this study is to develop a predictive risk score that evaluates the risk of sternum instability individually. The surgeon may then choose an appropriate sternal osteosynthesis technique that is risk- adjusted as well as cost-effective. Methods Data from 7.173 patients operated via sternotomy for all cardiovascular indications from 2008 until 2017 were retrospectively analyzed. Sternal dehiscence occurred in 2.5% of patients (n = 176). A multivariable analysis model examined pre- and intraoperative factors. A multivariable logistic regression model and a backward elimination based on the Akaike Information Criterion (AIC) a logistic model were selected. Results The model showed good sensitivity and specificity (area under the receiver-operating characteristic curve, AUC: 0.76) and several predictors of sternal instability could be evaluated. Multivariable logistic regression showed the highest Odds Ratios (OR) for reexploration (OR 6.6, confidence interval, CI [4.5–9.5], p < 0.001), obesity (body mass index, BMI > 35 kg/m2) (OR 4.23, [CI 2.4–7.3], p < 0.001), insulin-dependent diabetes mellitus (IDDM) (OR 2.2, CI [1.5–3.2], p = 0.01), smoking (OR 2.03, [CI 1.3–3.08], p = 0.001). After weighting the probability of sternum dehiscence with each factor, a risk score model was proposed scaling from − 1 to 5 points. This resulted in a risk score ranging up to 18 points, with an estimated risk for sternum complication up to 74%. Conclusions A weighted scoring system based on individual risk factors was specifically created to predict sternal dehiscence. High-scoring patients should receive additive closure techniques.

scholarly journals Preoperative Score to Stratify Recurrence Risk After Curative Resection of Resectable Pancreatic Ductal Adenocarcinoma: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Yu Jiang ◽  
SIYI Zou ◽  
Weishen Wang ◽  
Haoda Chen ◽  
Qian Zhan ◽  
...  
Keyword(s):  
High Risk ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Prognostic Score ◽  
Multidisciplinary Treatment ◽  
Multivariable Analysis ◽  
Disease Free Survival ◽  
Ductal Adenocarcinoma ◽  
Final Model ◽  
Significant Difference ◽  
Risk Patients

Abstract Background: Oncological survival after operation of resectable pancreatic ductal adenocarcinoma (R-PDAC) is variable depending on various factors. Preoperative risk stratification could guide decision-making in multidisciplinary treatment concepts. We develop and validate a prognostic score for disease-free survival (DFS) in R-PDAC to solve this issue.Methods: 421 R-PDAC patients between January 2012 and December 2015 were enrolled. Performance of the final model was evaluated with respect to discrimination, calibration and clinical usefulness. A prognostic score based on the final model was developed, and external validated in 290 patients.Results: On multivariable analysis, age, tumor size, carbohydrate antigen (CA)19-9, CA125, lymphocyte-monocyte ratio, and systemic-immune-inflammation index were independently associated with DFS. Final model had acceptable calibration, discrimination and internal validity. The prognostic score could delineate low- and high-risk groups with median DFS of 19.6 and 10.1 months (P<0.0001). Tumors in high-risk group exhibited more aggressive pathobiological behaviors. Additionally, at 1-year follow-up, the restricted mean survival time was longer with adjuvant chemotherapy than those without in low-risk patients. However, no significant difference was detected in high-risk patients.Discussion: The prognostic score could accurately predict DFS preoperatively in R-PDAC patients and provide reference for risk-adapted strategies formulation for R-PDAC management in the future.

scholarly journals THE MODERN ASPECTS OF THE BREAST CONSERVING SURGERY AFTER NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH BREAST CANCER CT1-3N0-3M0

2020 ◽  
Vol 66 (4) ◽  
pp. 376-380
Author(s):  
Nadezhda Volchenko ◽  
A. Bosieva ◽  
A. Zikiryakhodzhayev ◽  
M. Ermoshchenkova
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Breast Conserving Surgery ◽  
Point Of View ◽  
Medical Documentation ◽  
Oncological Safety ◽  
Lobular Cancer ◽  
Significant Difference ◽  
Disease Free

Introduction. While the “no tumor on ink” approach is generally accepted for breast-conserving surgery (BCS) in patient with breast cancer, it remains unclear whether it is oncologically safe for BCS after neoadjuvant chemotherapy therapy (NACT). The aim of the study is to investigate the optimal width of the resection edges in BCS after NALT and the influence on disease-free and overall survival in patients with breast cancer. Materials and methods. Retrospectively, the medical documentation of 76 patients with breast cancer, who were performed BCS after NACT, was studied. The distribution by stage of breast cancer was as follows: I St. -5 patients, II St. - 55, III St. - 16 (excluded IIIB St.). Invasive cancer of non-specific type was diagnosed in 81.6% of cases, in 6.5% - lobular cancer, in 1.3% - combined breast cancer. Radical breast resections in the classic version were performed in 28 cases, and oncoplastic resections in various modifications were performed in 48 Cases. Results. We present the retrospective data of 76 patients with breast cancer who underwent OSA after NALT in the Department of breast and skin cancer OF the Moscow Institute of medical research. P. A. Herzen. The results of our study demonstrated the oncological safety of OSO with respect to new sizes of tumor nodes after NALT followed by remote radiotherapy. The method of “absence of tumor cells” at the edges of resection demonstrated a high percentage of 1, 3, 5-year relapse - free and overall survival, the frequency of relapse was 2.6%. There was no statistically significant difference in 1, 3, 5-year relapse-free and overall survival when the width of the resection edges was more or less than 1 mm. Conclusion. The results of numerous studies have demonstrated that the breast- conserving surgery is the safe method of surgical treatment from an oncological point of view and is an alternative for radical mastectomies for patients with the breast cancer after neoadjuvant chemotherapy.

Development and Validation of CT-based Radiomics Scores for Prediction of Response to Neoadjuvant Chemotherapy and Survival in Gastric Cancer

2019 ◽  
Author(s):  
Kai-Yu Sun ◽  
Hang-Tong Hu ◽  
Shu-Ling Chen ◽  
Jin-Ning Ye ◽  
Guang-Hua Li ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Treatment Response ◽  
Validation Cohort ◽  
Clinical Score ◽  
Feature Reduction ◽  
Portal Venous Phase ◽  
Clinical Variables ◽  
Predicting Performance ◽  
Significant Difference

Abstract Background: Neoadjuvant chemotherapy is a promising treatment option for potential resectable gastric cancer, but patients’ responses varied. We aimed to develop and validate a radiomics score (rad_score) to predict the treatment response of neoadjuvant chemotherapy, and to investigate its efficacy in survival stratification. Methods: A total of 106 patients with neoadjuvant chemotherapy before gastrectomy were included (training cohort: n=74; validation cohort: n=32). Radiomics features were extracted from the pre-treatment portal venous-phase CT. After feature reduction, a rad_score was established by Randomized Tree algorithm. A rad_clinical_score was constructed by integrating the rad_score with clinical variables, so was a clinical score by clinical variables only. The three scores were validated regarding their discrimination and clinical usefulness. According to the score thresholds (updated with post-operative clinical variables), patients were stratified into two groups and their survivals were compared.Results: In the validation cohort, the rad_score demonstrated a good predicting performance in treatment response of neoadjuvant chemotherapy (AUC [95% CI] =0.82 [0.67, 0.98]), which was better than the clinical score (based on pre-operative clinical variables) without significant difference (0.62 [0.42, 0.83], P=0.09). The rad_clinical_score could not further improve the performance of rad_score (0.70 [0.51, 0.88], P=0.16). Based on the thresholds of these scores, the high-score groups all achieved better survivals than the low-score groups in the whole cohort (all P<0.001). Conclusion: The rad_score was effective in predicting treatment response of neoadjuvant chemotherapy and stratifying patients’ survival for gastric cancer, which assisted in individualized treatment planning.

Sign in / Sign up

Export Citation Format

Share Document