&lt;p&gt;Predictive Factors and Long-Term Outcomes of Early Gastric Carcinomas in Patients with Non-Curative Resection by Endoscopic Submucosal Dissection&lt;/p&gt;

Xu, Ping; Wang, Yun; Dang, Yini; Huang, Qin; Wang, Jianhua; Zhang, Weifeng; Zhang, Yifeng; Zhang, Guoxin

doi:10.2147/cmar.s263525

Cited by 6 publications

(3 citation statements)

References 33 publications

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“…In the context of ecological factors, age and gender have been tested with the endoscopic factors for the potential variable for the curative resection rate prediction. However, these variables were not consistently identified as important indicators for predicting curative resection [28][29][30]. Although feature importance analysis (Figure 5) or Shapley additive explanations analysis (Multimedia Appendix 6) in our study revealed that age is an important variable for the ML determination process, explainable artificial intelligence analysis is currently an experimental method to understand how ML judges.…”

Section: Discussioncontrasting

confidence: 58%

Establishing Machine Learning Models to Predict Curative Resection in Early Gastric Cancer with Undifferentiated Histology: Development and Usability Study

Bang¹,

Ahn²,

Kim³

et al. 2021

J Med Internet Res

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Background Undifferentiated type of early gastric cancer (U-EGC) is included among the expanded indications of endoscopic submucosal dissection (ESD); however, the rate of curative resection remains unsatisfactory. Endoscopists predict the probability of curative resection by considering the size and shape of the lesion and whether ulcers are present or not. The location of the lesion, indicating the likely technical difficulty, is also considered. Objective The aim of this study was to establish machine learning (ML) models to better predict the possibility of curative resection in U-EGC prior to ESD. Methods A nationwide cohort of 2703 U-EGCs treated by ESD or surgery were adopted for the training and internal validation cohorts. Separately, an independent data set of the Korean ESD registry (n=275) and an Asan medical center data set (n=127) treated by ESD were chosen for external validation. Eighteen ML classifiers were selected to establish prediction models of curative resection with the following variables: age; sex; location, size, and shape of the lesion; and whether ulcers were present or not. Results Among the 18 models, the extreme gradient boosting classifier showed the best performance (internal validation accuracy 93.4%, 95% CI 90.4%-96.4%; precision 92.6%, 95% CI 89.5%-95.7%; recall 99.0%, 95% CI 97.8%-99.9%; and F1 score 95.7%, 95% CI 93.3%-98.1%). Attempts at external validation showed substantial accuracy (first external validation 81.5%, 95% CI 76.9%-86.1% and second external validation 89.8%, 95% CI 84.5%-95.1%). Lesion size was the most important feature in each explainable artificial intelligence analysis. Conclusions We established an ML model capable of accurately predicting the curative resection of U-EGC before ESD by considering the morphological and ecological characteristics of the lesions.

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Section: Discussioncontrasting

confidence: 58%

Establishing Machine Learning Models to Predict Curative Resection in Early Gastric Cancer with Undifferentiated Histology: Development and Usability Study

Bang¹,

Ahn²,

Kim³

et al. 2021

J Med Internet Res

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“…Signi cant evidences showed that advanced age, undifferentiated type, tumor size ≥ 2 cm, and presence of ulceration were important factors in causing noncurative ER (28,29). If the elderly did not want to undergo surgery, the above individual characteristics should be evaluated in detail, fully communicated with the patients, and the bene ts and risks should be weighed before nally deciding on the treatment plan.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Additional Surgery After Noncurative Endoscopic Resection in Patients with Early Gastric Cancer: A Meta-Analysis

Jiao

Li²,

Shang

et al. 2021

Preprint

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BackgroundThe influence of additional surgery on the prognosis of early gastric cancer who underwent noncurative endoscopic resection was controversial. Different results were observed in different studies. Therefore, this meta-analysis was conducted to evaluate whether additional surgery could produce survival benefits for these patients.MethodsA systematic search was conducted in the PubMed, Embase, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure and Wanfang databases for relevant articles published until 31 March 2021 to investigate the differences in long-term results between the additional surgery group and the observation group. ResultsSixteen studies including 3877 patients were included in this meta-analysis. The results had shown that the surgery group were younger and more male, higher undifferentiated type, higher rate of SM2, lymphatic and vascular invasion, lower recurrence and metastasis than the observation group. Good survival benefits were observed in additional surgery group with obvious significant differences in the 5-year OS, 5-year DSS and 5-year DFS. Similar results were obtained in the subgroup analysis, such as elderly patients (aged ≥70 years) in 5-year OS. ConclusionThis meta-analysis illustrated that significant survival benefits, including 5-year OS, 5-year DSS and 5-year DFS, could be obtained with additional gastrectomy in patients with EGC after noncurative ER, and patients ≥70 years could also benefit from surgery.

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“…A 2019 systematic review and meta-analysis identified location in the upper third of the stomach (odds ratio (OR) 1.49, 95%CI 1.24–1.79), depressed morphology (OR 1.49, 95%CI 1.04–2.12), and lesions whose identified characteristics lie outside standard criteria (OR 3.56, 95%CI 2.31–5.48) as predictors of this outcome [ 25 ]. Additional risk factors identified in individual studies include large tumor size (generally >20 mm), ulceration, undifferentiated tumors (including the presence of an undifferentiated component in differentiated-type-predominant mixed-type lesions), and old age [ 26 , 27 , 28 , 29 , 30 , 31 ]. Regarding lesion differentiation, a meta-analysis incorporating 5644 patients showed that undifferentiated-predominant mixed-type lesions show more aggressive biological behavior compared to pure undifferentiated-type lesions, presenting a significantly higher risk of submucosal invasion (OR 2.19, 95%CI 1.90–2.52) and LNM (OR 2.28, 95%CI 1.72–3.03) even after stratification for depth of tumor invasion [ 32 ].…”

Section: Indications For Endoscopic Resection: Pre-procedural Evaluationmentioning

confidence: 99%

Endoscopic Resection of Early Gastric Cancer and Pre-Malignant Gastric Lesions

Vasconcelos¹,

Dinis-Ribeiro

Libânio

2023

Cancers

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Early gastric cancer comprises gastric malignancies that are confined to the mucosa or submucosa, irrespective of lymph node metastasis. Endoscopic resection is currently pivotal for the management of such early lesions, and it is the recommended treatment for tumors presenting a very low risk of lymph node metastasis. In general, these lesions consist of two groups of differentiated mucosal adenocarcinomas: non-ulcerated lesions (regardless of their size) and small ulcerated lesions. Endoscopic submucosal dissection is the technique of choice in most cases. This procedure has high rates of complete histological resection while maintaining gastric anatomy and its functions, resulting in fewer adverse events than surgery and having a lesser impact on patient-reported quality of life. Nonetheless, approximately 20% of resected lesions do not fulfill curative criteria and demand further treatment, highlighting the importance of patient selection. Additionally, the preservation of the stomach results in a moderate risk of metachronous lesions, which underlines the need for surveillance. We review the current evidence regarding the endoscopic treatment of early gastric cancer, including the short-and long-term results and management after resection.

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<p>Predictive Factors and Long-Term Outcomes of Early Gastric Carcinomas in Patients with Non-Curative Resection by Endoscopic Submucosal Dissection</p>

Cited by 6 publications

References 33 publications

Establishing Machine Learning Models to Predict Curative Resection in Early Gastric Cancer with Undifferentiated Histology: Development and Usability Study

Establishing Machine Learning Models to Predict Curative Resection in Early Gastric Cancer with Undifferentiated Histology: Development and Usability Study

Long-Term Outcomes of Additional Surgery After Noncurative Endoscopic Resection in Patients with Early Gastric Cancer: A Meta-Analysis

Endoscopic Resection of Early Gastric Cancer and Pre-Malignant Gastric Lesions

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