Kshivets O. Cardioesophageal Cancer Surgery

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ARTFICIAL INTELLIGENCE, SYSTEM ANALYSIS AND SIMULATION MODELING IN PREDICTION OF 5-YEAR SURVIVAL OF CARDIOESOPHAGEAL CANCER PATIENTS AFTER COMPLETE LEFT THORACOABDOMINAL ESOPHAGOGASTRECTOMIES

Transcript of Kshivets O. Cardioesophageal Cancer Surgery

  • ARTFICIAL INTELLIGENCE, SYSTEM ANALYSIS AND SIMULATION MODELING IN PREDICTION OF 5-YEAR SURVIVAL OF CARDIOESOPHAGEAL CANCER PATIENTS AFTER COMPLETE LEFT THORACOABDOMINAL ESOPHAGOGASTRECTOMIES Oleg Kshivets, MD, PhD Department of Surgery, Siauliai Public Hospital & Cancer Center, Lithuania The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  • Abstract
    • ARTFICIAL INTELLIGENCE, SYSTEM ANALYSIS AND SIMULATION MODELING IN PREDICTION OF 5-YEAR SURVIVAL OF CARDIOESOPHAGEAL CANCER PATIENTS AFTER COMPLETE LEFT THORACOABDOMINAL ESOPHAGOGASTRECTOMIES
    • Oleg Kshivets Department of Surgery, Siauliai Public Hospital & Cancer Center, Siauliai, Lithuania
    • OBJECTIVE: We examined the clinicomorphologic factors associated with the low- and high-risk of generalization of cardioesophageal cancer (CEC) (T1-4N0-3M0) after complete esophagogastrectomies (EG) through left thoracoabdominal incision. METHODS: We analyzed data of 150 consecutive CEC patients (CECP) (age=54.90.7 years; tumor size=6.90.2 cm) radically operated and monitored in 1975-2006 (males=116, females=34; combined EG with resection of pancreas, liver, diaphragm, colon transversum, splenectomies=49; lymphadenectomy D2=59, D3=91; esophagogastroanastomosis=89, esophagoenteroanastomosis=61; adenocarcinoma=125, squamos=19, mix=6; T1=16, T2=32, T3=58, T4=44; N0=59, N1=18, N2=71; N3=2; G1=42, G2=30, G3=78). Variables selected for 5-year survival (5YS) study were input levels of 45 blood parameters, sex, age, TNMPG, cell type, tumor size. Survival curves were estimated by the Kaplan-Meier method. Differences in curves between groups of CECP were evaluated using a log-rank test. Multivariate Cox modeling, multi-factor clustering, discriminant analysis, structural equation modeling, Monte Carlo, bootstrap simulation and neural networks computing were used to determine any significant dependence. RESULTS: 44 CECP (life span: LS=3545.8238.7 days) lived more than 5 years without any features of CEC progressing (5YS=29.3%). 106 CECPdied because of generalization of CEC during the first 5 years after radical procedures (LS=593.532.6 days). Cox modeling displayed that 5YS of CECP (n=150) after complete EG significantly depended on: T1-4, combined procedures, histology, G1-3, blood lymphocytes, monocytes, neutrophils, lymphoid infiltration of CEC, age (P=0.000-0.038). Neural networks computing, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS of CECP and combined procedures (rank=1), N0-3 (2), histology (3), gender (4), CEC growth (5), type of operations (6), P1-4 (7), T1-4 (8), adjuvant chemoimmunotherapy (9), G1-3 (10),blood coagulation time (11),blood lymphocytes (12), thrombocytes (13), blood rest nitrogen (14), hemorrhage time (15), ESS (16), age (17), weight (18), blood chlorides (19), tumor size (20). CONCLUSIONS: Correct prediction of CECP survival after radical procedures was 90.7% by logistic regression (odds ratio=86.7), 96% by discriminant analysis and 100% by neural networks computing (area under ROC curve=1.0; error=0.0012).
    The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  • Data
    • Males.. 116
    • Females.... 34
    • Age=54.90.7 years
    • Tumor Size=6.90.2 cm
    • Only Surgery.... 132
    • Adjuvant Chemoimmunotherapy (5FU+thymalin/taktivin, 5-6 cycles). 18
    The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  • Radical Procedures
    • Proximal Esophagogastrectomies with Single-Stage Esophagogastroplasty.. 81
    • Total Esophagogastrectomies with Single-Stage Esophagoenteroplasty.... 69
    • Combined Esophagogastrectomies with Resection of Diaphragm, Liver, Mesocolon, Colon Transversum, Splenectomy, Left Hemipancreatectomy, etc. 49
    • Lymphadenectomy D2... 59
    • Lymphadenectomy D3... 91
    The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  • Schemas of Procedures The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  • Procedures
  • One-Stage Esophagogastroplasty or Esophagoenteroplasty
  • Schemas of Combined Procedures The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  • Schemas of D3 Lymphadenectomy The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  • Staging
    • T1 16 N0.... 59 G1 42
    • T2 32 N1 18 G2 30
    • T3 58 N2 71 G3 78
    • T4 44 N3.. 2
    • exophytic growth.. 53
    • endophytic growth.... 85
    • mix growth.... 12
    • adenocarcinoma 93
    • squamos cell carcinoma 52
    • mix carcinoma. 5
    The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  • Survival Rate
    • 5-Year Survivors... 44 (29.3%)
    • 10-Year Survivors. 18 (12.0%)
    • Losses 106 (70.7%)
    • General Life Span= 1459.5 132 days
    • For 5-Year Survivors= 3545.8238.7 days
    • For Losses= 593.532.6 days
    • Cumulative 5-Year Survival. 29.3%
    • Cumulative 10-Year Survival... 22.4%
    • Cumulative 15-Year Survival... 20.2%
    The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  • General Cardioesophageal Cancer Patients Survival after Complete Left Thoracoabdominal Esophagogastrectomies (Kaplan-Meier) ( n=150 ) The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  • Results of Univariate Analysis in Prediction of Cardioesophageal Cancer Patients Survival ( n=150 )
  • Results of Univariate Analysis in Prediction of Cardioesophageal Cancer Patients Survival ( n=150 )
  • Results of Univariate Analysis in Prediction of Cardioesophageal Cancer Patients Survival ( n=150 ) The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  • Results of Cox Regression Modeling in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=150 )
    • Factors Wald df P Exp(B) 95%CI for Exp(B) Lower Upper
    • Eosinophils% 6.539 1 0.011 1.802 1.147 2.829
    • Stick.Neutrophils% 12.447 1 0.000 2.298 1.447 3.648
    • Seg.Neutrophils% 14.680 1 0.000 2.379 1.527 3.706
    • Lymphocytes% 11.949 1 0.001 2.212 1.410 3.469
    • Monocytes% 12.832 1 0.000 2.303 1.459 3.634
    • T1-4 12.579 3 0.006
    • T(1) 11.124 1 0.001 0.196 0.075 0.510
    • T(2) 6.870 1 0.009 0.349 0.159 0.767
    • T(3) 1.409 1 0.235 0.672 0.348 1.296
    • Ad.CHIT 0.648 1 0.421 0.744 0.362 1.529
    • Age 10.419 1 0.001 1.042 1.016 1.068
    • Comb.operation 15.523 6 0.017
    The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  • Results of Cox Regression Modeling in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=150 )
    • Factors Wald df P Exp(B) 95%CI for Exp(B) Lower Upper
    • Histology 15.864 2 0.000
    • Histology(1) 13.556 1 0.000 8.361 2.700 25.894
    • Histology(2) 15.753 1 0.000 9.631 3.147 29.473
    • Lymphocytes abs 5.423 1 0.020 6.126 1.332 28.166
    • Seg.Neutrophils abs 4.899 1 0.027 0.495 0.265 0.923
    • G1-3 6.539 2 0.038
    • G(1) 5.907 1 0.015 0.519 0.305 0.881
    • G(2) 3.578 1 0.059 0.565 0.313 1.021
    • LIT 32.081 3 0.000
    • LIT(1) 25.546 1 0.000 6.648 3.189 13.858
    • LIT(2) 23.429 1 0.000 5.804 2.848 11.829
    • LIT(3) 1.084 1 0.298 1.424 0.732 2.768
    The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  • Results of Discriminant Analysis in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=150 )
    • Discriminant Function Analysis Summary
    • Wilks' Lambda: 0.305 approx. F (61,88)=3.281 p< 0.0000
    • Wilks' Partial F-remove P-level
    • Lambda Lambda (1,88)
    • LIT 0 .403 0.757 28.238 0.000