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