RESUMEN
BACKGROUND: Neoadjuvant chemoradiotherapy (nCRT) for rectal cancer can lead to structural changes in collagen in the tumor microenvironment and increase the risk of postoperative anastomotic stenosis (AS). However, the quantitative relationship between AS and collagen has not been defined. This study is to quantitatively analyze the collagen features in rectal cancer and explore the relationship between the changes of collagen and postoperative anastomotic stenosis after nCRT. STUDY DESIGN: This is a retrospective study. A total of 371 patients with rectal cancer were included. Collagen features in the resection margin of rectal cancer anastomosis was extracted by multiphoton imaging. The least absolute shrinkage operator logistic regression was performed to select features related to AS and the collagen score (CS) was constructed. Area under the receiver operating curve (AUROC) and decision curve analysis were performed to evaluate the discrimination and clinical benefit of the nomogram. RESULTS: The probability of AS was 23% in the training cohort and 15.9% in the validation cohort. In the training cohort, the distance between tumor and resection margin, anastomotic leakage and CS were independent risk factors for postoperative AS in univariate and multivariate analyses. A nomogram was constructed based on these results. The prediction nomogram showed good discrimination (AUROC 0.864; 95% CI 0.776 to 0.952) and was validated in the validation cohort (AUROC 0.918; 95% CI 0.851 to 0.985). CONCLUSIONS: CS is an independent risk factor for AS in rectal cancer after nCRT. The predictive model based on CS can predict the occurrence of postoperative AS.
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Anastomosis Quirúrgica , Colágeno , Márgenes de Escisión , Terapia Neoadyuvante , Neoplasias del Recto , Humanos , Neoplasias del Recto/terapia , Neoplasias del Recto/patología , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Terapia Neoadyuvante/métodos , Anastomosis Quirúrgica/efectos adversos , Constricción Patológica/etiología , Colágeno/metabolismo , Anciano , Nomogramas , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Adulto , Factores de Riesgo , Quimioradioterapia Adyuvante , Recto/cirugía , Recto/patologíaRESUMEN
BACKGROUND: Despite advancements in treating right-sided colon cancer patients, the ideal scope of lymphadenectomy remains controversial. OBJECTIVE: Our objective was to investigate the likelihood of D3 lymph node metastasis in right-sided colon cancer patients and develop a clinicopathological feature-based nomogram for D3 lymphadenectomy. DESIGN: We retrospectively analyzed 286 right-sided colon cancer patients who underwent D3 lymphadenectomy. The patients were divided into 2 groups based on whether D3 lymph node metastasis was positive. Then, univariable and multivariable logistic regression analyses were performed to obtain independent risk factors for predicting D3 lymph node metastasis. Moreover, we performed receiver operating characteristic curve analyses to evaluate the predictive power of the model. SETTING: This study was conducted at Nanfang Hospital of Southern Medical University in China. PATIENTS: A total of 286 consecutive patients who underwent right hemicolectomy and D3 lymphadenectomy as a primary treatment for right-sided colon cancer between January 2016 and December 2019 were enrolled in this study. MAIN OUTCOME MEASURES: The primary measures were independent risk factors for predicting D3 lymph node metastasis in right-sided colon cancer. RESULTS: The D3 lymph node metastasis rate in right-sided colon cancer patients was 16.1% (46/286). D3 lymphadenectasis on CT, lymphatic invasion, and T4 tumors were filtered out as independent risk factors for D3 lymph node metastasis according to the multivariable logistic regression analysis. We established a nomogram that predicted D3 lymph node metastasis of right-sided colon cancer on the combination of the 3 factors with an area under the curve of 0.717 (95% CI, 0.629-0.806). LIMITATIONS: This was a retrospective study from a single center. CONCLUSIONS: We developed a valuable clinicopathological feature-based nomogram to predict the incidence of D3 lymph node metastasis in right-sided colon cancer patients. Patients with D3 lymphadenectasis on CT, preoperative T4 tumors, and lymphatic invasion should undergo D3 lymphadenectomy. See Video Abstract at http://links.lww.com/DCR/B852 . UN NOMOGRAMA BASADO EN CARACTERSTICAS CLNICOPATOLGICAS PARA PREDECIR LA PROBABILIDAD DE METSTASIS EN GANGLIOS LINFTICOS D EN PACIENTES CON CNCER DE COLON DERECHO: ANTECEDENTES:A pesar de los avances en el tratamiento de pacientes con cáncer de colon derecho, el ámbito ideal de la linfadenectomía sigue siendo controvertido.OBJETIVO:Investigar la probabilidad de metástasis en los ganglios linfáticos D3 en pacientes con cáncer de colon derecho y desarrollar un nomograma basado en características clínico-patológicas basado para la linfadenectomía D3.DISEÑO:Analizamos retrospectivamente a 286 pacientes con cáncer de colon derecho que se sometieron a linfadenectomía D3. Los pacientes se dividieron en dos grupos en función de si eran positivos para metástasis en los ganglios linfáticos D3. Luego, se realizaron análisis de regresión logística univariable y multivariable para obtener factores de riesgo independientes para predecir metástasis en los ganglios linfáticos D3. Además, realizamos análisis de las curvas de características operatorias del receptor para evaluar el poder predictivo del modelo.SEDE:Este estudio se realizó en el Hospital Nanfang de la Universidad Médica del Sur en China.PACIENTES:Un total de 286 pacientes consecutivos que se sometieron a hemicolectomía derecha y linfadenectomía D3 como tratamiento primario para el cáncer de colon derecho entre enero de 2016 y diciembre de 2019 se inscribieron en este estudio.PRINCIPALES MEDIDAS DE RESULTADO:Las medidas primarias fueron factores de riesgo independientes para predecir las metástasis en ganglios linfáticos D3 en el cáncer de colon derecho.RESULTADOS:La tasa de metástasis en los ganglios linfáticos D3 en pacientes con cáncer de colon del lado derecho fue del 16,1% (46/286). El aumento de tamaño de ganglios D3 en la TC, la invasión linfática y los tumores T4 se filtraron como factores de riesgo independientes de metástasis en los ganglios linfáticos D3 de acuerdo con el análisis de regresión logística multivariable. Establecimos un nomograma que predijo metástasis en los ganglios linfáticos D3 del cáncer de colon derecho en la combinación de los tres factores con un área bajo la curva de 0,717 (IC del 95%, 0,629-0,806).LIMITACIONES:Este fue un estudio retrospectivo de un solo centro.CONCLUSIONES:Desarrollamos un valioso nomograma basado en características clínico-patológicas para predecir la incidencia de metástasis en los ganglios linfáticos D3 en pacientes con cáncer de colon derecho. Los pacientes con crecimiento de ganglios D3 en TC, tumores con clasificación preoperatoria T4 e invasión linfática, deben ser sometidos a linfadenectomía D3. Consulte Video Resumen en http://links.lww.com/DCR/B852 . (Traducción-Dr. Juan Carlos Reyes ).
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Neoplasias del Colon , Nomogramas , Humanos , Metástasis Linfática , Estudios Retrospectivos , Neoplasias del Colon/patología , Estadificación de NeoplasiasRESUMEN
BACKGROUND AND STUDY AIMS: Anastomotic ischemia can affect healing and eventually lead to anastomotic leakage, and confocal laser endomicroscopy (CLE) can offer detailed observations at the subcellular level. We aimed to evaluate the anastomotic microcirculation in different anastomotic perfusion models using CLE. METHODS: Anastomotic perfusion models were established using twelve rabbits distributed into two groups: group A (good perfusion, n = 6) and group B (poor perfusion, n = 6). Afterward, intraoperative detection of anastomotic perfusion was carried out using CLE, and quantitative analysis of blood cells was performed. Rabbits that satisfied the criteria underwent a second exploratory operation and specimens were stained by hematoxylin and eosin. RESULTS: Enhanced with fluorescein sodium, capillaries were obviously highlighted in group A, while few capillaries were viewed in group B. Delayed development of fluorescence occurred in group B. The average flow of blood cells was 37.0 ± 5.93 per minute in group A and 6.33 ± 2.16 per minute in group B (p < 0.001). In addition, during the second exploratory surgery, rabbits with inadequate anastomotic perfusion exhibited more serious intestinal adhesion and ischemia. Anastomotic leakage and abdominal infection occurred in all rabbits in group B. CONCLUSION: CLE can realize real-time imaging of the anastomotic microcirculation and is a feasible technique for performing intraoperative evaluation in different anastomotic perfusion situations. This animal experiment provides the groundwork for future in vivo research in humans.
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Cirugía Colorrectal , Procedimientos Quirúrgicos del Sistema Digestivo , Anastomosis Quirúrgica , Fuga Anastomótica , Animales , Humanos , Rayos Láser , Microscopía Confocal , ConejosRESUMEN
BACKGROUND: Collagen changes in the extracellular matrix caused by neoadjuvant chemoradiotherapy are a potential mechanism of anastomotic leakage. We aimed to construct a fully quantitative collagen score to describe collagen structure changes in the extracellular matrix and then develop and validate a prediction model to identify patients who are at a high risk of postoperative anastomotic leakage. METHODS: This is a retrospective study in which 372 patients were enrolled, and their baseline clinicopathological characteristics were collected. Anastomotic distal and proximal "doughnut" specimens underwent second harmonic generation imaging, and collagen features were extracted. A LASSO regression was used to select significant predictors, and the collagen score was constructed. A prediction model based on collagen score was developed and internally and externally validated. RESULTS: The primary cohort included 214 consecutive patients, and the anastomotic leakage rate was 8.9%. The validation cohort comprised 158 consecutive patients, and the anastomotic leakage rate was 10.1%. The collagen score was significantly related to anastomotic leakage in both cohorts (P < .001). Multivariate analysis revealed that tumor location, preoperative albumin, and collagen score were independent predictors of anastomotic leakage. These 3 predictors were incorporated into the prediction model, and a nomogram was established. The model showed good discrimination in the primary (area under the curve: 0.954) and validation (area under the curve: 0.928) cohorts. Decision curve analysis demonstrated that the nomogram was clinically useful. CONCLUSION: The collagen score is associated with anastomotic leakage, and the collagen nomogram based on the collagen score is useful for individualized prediction of anastomotic leakage in rectal cancer patients with neoadjuvant chemoradiotherapy after surgery.
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Fuga Anastomótica/epidemiología , Colágeno/metabolismo , Nomogramas , Neoplasias del Recto/terapia , Fuga Anastomótica/etiología , Fuga Anastomótica/metabolismo , Biomarcadores de Tumor/metabolismo , Quimioradioterapia/métodos , China/epidemiología , Matriz Extracelular/metabolismo , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: The relationship between collagen features (CFs) in the tumor microenvironment and the treatment response to neoadjuvant chemoradiotherapy (nCRT) is still unknown. This study aimed to develop and validate a perdition model based on the CFs and clinicopathological characteristics to predict the treatment response to nCRT among locally advanced rectal cancer (LARC) patients. METHODS: In this multicenter, retrospective analysis, 428 patients were included and randomly divided into a training cohort (299 patients) and validation cohort (129 patients) [7:3 ratio]. A total of 11 CFs were extracted from a multiphoton image of pretreatment biopsy, and a support vector machine (SVM) was then used to construct a CFs-SVM classifier. A prediction model was developed and presented with a nomogram using multivariable analysis. Further validation of the nomogram was performed in the validation cohort. RESULTS: The CFs-SVM classifier, which integrated collagen area, straightness, and crosslink density, was significantly associated with treatment response. Predictors contained in the nomogram included the CFs-SVM classifier and clinicopathological characteristics by multivariable analysis. The CFs nomogram demonstrated good discrimination, with area under the receiver operating characteristic curves (AUROCs) of 0.834 in the training cohort and 0.854 in the validation cohort. Decision curve analysis indicated that the CFs nomogram was clinically useful. Moreover, compared with the traditional clinicopathological model, the CFs nomogram showed more powerful discrimination in determining the response to nCRT. CONCLUSIONS: The CFs-SVM classifier based on CFs in the tumor microenvironment is associated with treatment response, and the CFs nomogram integrating the CFs-SVM classifier and clinicopathological characteristics is useful for individualized prediction of the treatment response to nCRT among LARC patients.
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Neoplasias del Recto , Máquina de Vectores de Soporte , Quimioradioterapia , Colágeno , Humanos , Terapia Neoadyuvante , Nomogramas , Neoplasias del Recto/terapia , Estudios Retrospectivos , Microambiente TumoralRESUMEN
BACKGROUND: The feasibility of endoscopic dissection for gastric gastrointestinal stromal tumor (gGIST) between 2 and 5 cm in size has been demonstrated. However, its impact on short-term and long-term outcomes, compared with laparoscopic resection, is unknown. The purpose of this study was to compare short-term and long-term outcomes between laparoscopic resection and endoscopic dissection for 2-5-cm gGIST. METHODS: A case-matched study was performed using the propensity score. To overcome selection bias, we performed a 1:1 match using six covariates, including age, sex, BMI, ASA score, tumor size, and tumor location. Short-term and long-term outcomes between laparoscopic resection and endoscopic dissection were compared. RESULTS: A total of 210 patients with 2-5-cm gGIST were enrolled between 2006 and 2017 in our gastrointestinal center. According to the intention-to-treat approach, 165 patients underwent laparoscopic resection, and 45 patients underwent endoscopic dissection. After the propensity score, 45 pairs were balanced and analyzed. There was no significant difference in the baseline characteristics between the laparoscopic and endoscopic groups after matching. The rate of complications was significantly higher in the endoscopic group compared with the laparoscopic group (P < 0.001). Perforations occurred in 16 patients in the endoscopic group (16/45, 35.6%). The postoperative hospital stay was significantly longer in the endoscopic group compared with the laparoscopic group (P < 0.001). There was no significant difference between the two groups in disease-free survival or overall survival. CONCLUSION: Laparoscopic resection is better than endoscopic dissection for 2-5-cm gGIST because of the lower complication rate and shorter hospital stay.