可切除结直肠癌肝转移的 upfront 手术与新辅助围手术期化疗:一种基于实质保留策略识别最佳潜在候选者的机器学习决策树

Upfront Surgery versus Neoadjuvant Perioperative Chemotherapy for Resectable Colorectal Liver Metastases: A Machine-Learning Decision Tree to Identify the Best Potential Candidates under a Parenchyma-Sparing Policy.

作者信息

Famularo Simone, Milana Flavio, Cimino Matteo, Franchi Eloisa, Giuffrida Mario, Costa Guido, Procopio Fabio, Donadon Matteo, Torzilli Guido

机构信息

Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy.

Division of Hepatobiliary Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy.

出版信息

Cancers (Basel). 2023 Jan 18;15(3):613. doi: 10.3390/cancers15030613.

Abstract

Addressing patients to neoadjuvant systemic chemotherapy followed by surgery rather than surgical resection upfront is controversial in the case of resectable colorectal -liver metastases (CLM). The aim of this study was to develop a machine-learning model to identify the best potential candidates for upfront surgery (UPS) versus neoadjuvant perioperative chemotherapy followed by surgery (NEOS). Patients at first liver resection for CLM were consecutively enrolled and collected into two groups, regardless of whether they had UPS or NEOS. An inverse -probability weighting (IPW) was performed to weight baseline differences; survival analyses; and risk predictions were estimated. A mortality risk model was built by Random-Forest (RF) to assess the best -potential treatment (BPT) for each patient. The characteristics of BPT-upfront and BPT-neoadjuvant candidates were automatically identified after developing a classification -and -regression tree (CART). A total of 448 patients were enrolled between 2008 and 2020: 95 UPS and 353 NEOS. After IPW, two balanced pseudo-populations were obtained: UPS = 432 and NEOS = 440. Neoadjuvant therapy did not significantly affect the risk of mortality (HR 1.44, 95% CI: 0.95-2.17, = 0.07). A mortality prediction model was fitted by RF. The BPT was NEOS for 364 patients and UPS for 84. At CART, planning R1vasc surgery was the main factor determining the best candidates for NEOS and UPS, followed by primitive tumor localization, number of metastases, sex, and pre-operative CEA. Based on these results, a decision three was developed. The proposed treatment algorithm allows for better allocation according to the patient's tailored risk of mortality.

摘要

对于可切除的结直肠癌肝转移(CLM)患者,先进行新辅助全身化疗再手术,而非直接进行手术切除,这一做法存在争议。本研究的目的是开发一种机器学习模型,以识别最适合直接手术(UPS)与新辅助围手术期化疗后手术(NEOS)的潜在最佳候选人。因CLM首次进行肝切除的患者被连续纳入并分为两组,无论他们接受的是UPS还是NEOS。进行逆概率加权(IPW)以权衡基线差异;进行生存分析;并估计风险预测。通过随机森林(RF)建立死亡率风险模型,以评估每位患者的最佳潜在治疗方案(BPT)。在开发分类回归树(CART)后,自动识别出BPT-直接手术和BPT-新辅助治疗候选人的特征。2008年至2020年间共纳入448例患者:95例接受UPS,353例接受NEOS。经过IPW后,获得了两个平衡的伪总体:UPS = 432例,NEOS = 440例。新辅助治疗对死亡风险没有显著影响(HR 1.44,95% CI:0.95 - 2.17,P = 0.07)。通过RF拟合了死亡率预测模型。364例患者的BPT为NEOS,84例患者的BPT为UPS。在CART分析中,计划进行R1vasc手术是决定NEOS和UPS最佳候选人的主要因素,其次是原发肿瘤位置、转移灶数量、性别和术前癌胚抗原(CEA)。基于这些结果,制定了一个决策树。所提出的治疗算法能够根据患者个体化的死亡风险进行更好的分配。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2563/9913658/8c143bfef70c/cancers-15-00613-g001.jpg

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