Automatic segmentation of head and neck primary tumors on MRI using a multi-view CNN

Background Accurate segmentation of head and neck squamous cell cancer (HNSCC) is important for radiotherapy treatment planning. Manual segmentation of these tumors is time-consuming and vulnerable to inconsistencies between experts, especially in the complex head and neck region. The aim of this study is to introduce and evaluate an automatic segmentation pipeline for HNSCC using a multi-view CNN (MV-CNN). Methods The dataset included 220 patients with primary HNSCC and availability of T1-weighted, STIR and optionally contrast-enhanced T1-weighted MR images together with a manual reference segmentation of the primary tumor by an expert. A T1-weighted standard space of the head and neck region was created to register all MRI sequences to. An MV-CNN was trained with these three MRI sequences and evaluated in terms of volumetric and spatial performance in a cross-validation by measuring intra-class correlation (ICC) and dice similarity score (DSC), respectively. Results The average manual segmented primary tumor volume was 11.8±6.70 cm3 with a median [IQR] of 13.9 [3.22-15.9] cm3. The tumor volume measured by MV-CNN was 22.8±21.1 cm3 with a median [IQR] of 16.0 [8.24-31.1] cm3. Compared to the manual segmentations, the MV-CNN scored an average ICC of 0.64±0.06 and a DSC of 0.49±0.19. Improved segmentation performance was observed with increasing primary tumor volume: the smallest tumor volume group (<3 cm3) scored a DSC of 0.26±0.16 and the largest group (>15 cm3) a DSC of 0.63±0.11 (p<0.001). The automated segmentation tended to overestimate compared to the manual reference, both around the actual primary tumor and in false positively classified healthy structures and pathologically enlarged lymph nodes. Conclusion An automatic segmentation pipeline was evaluated for primary HNSCC on MRI. The MV-CNN produced reasonable segmentation results, especially on large tumors, but overestimation decreased overall performance. In further research, the focus should be on decreasing false positives and make it valuable in treatment planning.

An evaluation of the role of tumor load in cytoreductive nephrectomy

Introduction: New radiological tools can accurately provide preoperative three-dimensional spatial assessment of metastatic renal cell carcinoma (RCC) We aimed to determine whether the distribution, volume, shape, and fraction of RCC resected in a cytoreductive nephrectomy associates with survival. Methods: We retrospectively reviewed 560 patients undergoing cytoreductive nephrectomy performing a comprehensive volumetric analysis in eligible patients of all detectable primary and metastatic RCC prior to surgery. We used Cox regression analysis to determine the association between the volume, shape, fraction resected, and distribution of RCC and overall survival (OS). Results: There were 62 patients eligible for volumetric analysis, with similar baseline characteristics to the entire cohort, and median survivor followup was 34 months. Larger primary tumors were less spherical, but not associated with different metastatic patterns. Increased primary tumor volume and tumor size, but not the fraction of tumor resected, were associated with inferior survival. The rank of tumors based on unidimensional size did not completely correspond to the rank by primary tumor volume, however, both measurements yielded similar concordance for predicted OS. Larger tumor volume was not associated with a longer postoperative time off treatment. Conclusions: Primary tumor volume was significant for predicting OS, while the fraction of disease resected did not appear to impact upon patient outcomes. Although rich in detail, our study is potentially limited by selection bias. Future temporal studies may help elucidate whether the primary tumor shape is associated with tumor growth kinetics.

THE ASSOCIATION BETWEEN EXPRESSION OF EPIDERMAL GROWTH FACTOR RECEPTOR WITH PRIMARY TUMOR VOLUME OF NASOPHARYNGEAL CARCINOMA

Objective: Tumor development was triggered by the excess population of the Epidermal Growth Factor Receptor (EGFR). Expression of EGFR with primary tumor volume of in patients with NPC. Expression of EGFR has a role in the increasing of metastasis, self-renewal, drug resistance and anti-apoptosis. EGFR expression associated with tumors size, positively nodules and advanced tumor stage in NPC patients. High level of EGFR expression by immunohistochemical examination associated with the development, progression and differentiation cell of tumors. Methods: Using Cross-sectional as study design. Formalin-fixed paraffin-embedded biopsy specimens were obtained. The expression of EGFR was studied with immunohistochemistry using EGFR polyclonal antibody (Bioss, USA). Assessment of the staining was performed by pathologist consultant used histoscore. The Pearson’s correlation test was used to determine the correlation between expression of EGFR and primary tumor volume of nasopharyngeal carcinoma. Statistical significance was defined as p <0.05. Result: Total samples are 19 patients. The result of EGFR expression in NPC patients with a primary tumor volume of 1-50 ml is 5 samples with a weak positive expression and 4 samples with moderate positive expression. NPC with a primary tumor volume of 51-100 ml is 2 samples of negative expression, 1 sample of weak positive expression, 3 samples with moderate positive expression and 2 samples with strong positive expression. NPC with primary tumor volume >100 ml is 1 sample weak positive expression and 1 sample strong positive expression. Statistical analysis using Pearson’s exact test was obtained p=0.047 with a correlation coefficient 0.461. EGFR expression from all of the patients there was 2 samples (10.53%) negatives, 7 samples (36.84%) weak positive, moderate positive was 7 samples (36.84%), and strong positive 3 samples (15.79%). Conclusion: There was an association between the expression of EGFR with the primary tumor volume of nasopharyngeal carcinoma.

Neutrophil-to-Lymphocyte Ratio in Rectal Cancer—Novel Biomarker of Tumor Immunogenicity During Radiotherapy or Confounding Variable?

The aim of this study was to investigate the predictive value of blood-derived makers of local and systemic inflammatory responses on early and long-term oncological outcomes. A retrospective analysis of patients with locally advanced rectal cancer treated with preoperative long-course 5-fluorouracil-based radiochemotherapy was performed. Differential blood counts before neoadjuvant treatment were extracted from the patients’ electronic charts. Optimal cut-off values for neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were determined. Potential clinical and hematological prognostic factors for disease-free survival (DFS) were studied using uni- and multivariate analysis. A total of 220 patients were included in the analysis. Median follow-up was 67 months. Five-year DFS and overall survival (OS) were 70% and 85%, respectively. NLR with a cut-off value of 4.06 was identified as optimal to predict DFS events. In multivariate analysis, only tumor volume (HR 0.33, 95% CI (0.14–0.83), p = 0.017) and NLR (HR 0.3, 95% CI (0.11–0.81), p = 0.017) remained significant predictors of DFS. Patients with a good histological response (Dworak 3 and 4) to radiotherapy also had a lower NLR than patients with less pronounced tumor regression (3.0 vs. 4.2, p = 0.015). A strong correlation between primary tumor volume and NLR was seen (Pearson’s r = 0.64, p < 0.001). Moreover, patients with T4 tumors had a significantly higher NLR than patients with T1–T3 tumors (6.6 vs. 3.3, p < 0.001). An elevated pretherapeutic NLR was associated with higher T stage, inferior DFS, and poor pathological response to neoadjuvant radiochemotherapy. A strong correlation between NLR and primary tumor volume was seen. This association is important for the interpretation of study results and for the design of translational studies which are warranted.