BACKGROUND Hepatocellular carcinoma(HCC)in segments VII and VIII poses technical challenges for both liver resection and radiofrequency ablation(RFA).Robotic-assisted techniques may enhance safety and precision,but co...BACKGROUND Hepatocellular carcinoma(HCC)in segments VII and VIII poses technical challenges for both liver resection and radiofrequency ablation(RFA).Robotic-assisted techniques may enhance safety and precision,but comparative evidence remains limited.AIM To compare the clinical outcomes of robotic liver resection(R-LR)and robotic intraoperative RFA(RIO-RFA)for HCC located in liver segments VII and VIII.METHODS We retrospectively analyzed 93 HCC patients in segments VII/VIII with de novo(n=57)or first recurrent(n=36).HCC who underwent R-LR or RIO-RFA between 2015 and 2024.Propensity score matching was performed to reduce selection bias.Primary outcomes were overall survival(OS)and recurrence-free survival(RFS).Kaplan-Meier curves,log-rank tests,and Cox regression were used to identify prognostic factors for OS and RFS.RESULTS In the de novo group,OS and RFS did not differ significantly between R-LR and RIO-RFA before or after propensity score matching.In contrast,the recurrent group showed significantly improved OS and RFS with R-LR(P=0.005 and P=0.012,respectively).Subgroup analyses revealed that low-risk de novo patients with smaller tumors achieved superior OS after R-LR,whereas carefully selected low-risk recurrent patients undergoing RIO-RFA(smaller tumors,absence of complications)achieved outcomes comparable to R-LR.Platelet count,tumor size,and postoperative complications constituted key prognostic factors.CONCLUSION For HCC in challenging liver segments VII and VIII,R-LR and RIO-RFA achieve comparable outcomes in de novo cases,whereas R-LR confers superior survival in recurrent disease.R-LR should be prioritized for small de novo HCCs and for recurrent disease overall;RIO-RFA may serve as an effective alternative in carefully selected lowrisk recurrent patients.Tumor size,platelet count,and postoperative complications are key prognostic indicators to guide individualized treatment.展开更多
BACKGROUND Esophageal cancer carries a poor prognosis with low 5-year survival rates and limited early detection options.The skeletal muscle index at the L3 vertebral level is a well-established prognostic marker in e...BACKGROUND Esophageal cancer carries a poor prognosis with low 5-year survival rates and limited early detection options.The skeletal muscle index at the L3 vertebral level is a well-established prognostic marker in esophageal cancer,but most follow-up computed tomography(CT)scans do not extend to L3 and limiting its utility.Radiomics has emerged as a powerful tool for extracting prognostic information from medical images.AIM To evaluate the influential features for esophageal cancer prognosis by integrating radiomic and body compositionbased indices of skeletal muscle and adipose tissue at the T12 level from both pretreatment and follow-up CT images,in order to assess their value in predicting overall survival(OS).METHODS This retrospective study included 212 esophageal cancer patients who underwent concurrent chemoradiotherapy,with both pretreatment and follow-up chest CT scans available.Body organ analysis(BOA)and radiomic features were extracted from skeletal muscle and adipose tissue at the T12 level using automated tools.Four feature subsets(no-radiomics,pretreatment only,follow-up only,and combined inputs)were developed using logistic regression(LR)with least absolute shrinkage and selection operator for feature selection,followed by Cox regression.Prognostic models-including nomogram,support vector classifier,LR,and extra trees classifier-were constructed to predict 1-,2-,and 3-year OS.RESULTS The model integrating both BOA and radiomics from pretreatment and follow-up CT,combined with clinical data,achieved the best performance for 2-year OS prediction,with an area under the time-dependent receiver operating characteristic curve of 0.91,sensitivity of 0.81,and specificity of 0.88 using the LR model.The most predictive features included both clinical variables,body composition indices,and radiomic features,particularly from follow-up VAT.Follow-up imaging contributed significantly to model performance,reinforcing its value in treatment response evaluation.CONCLUSION This is the first study to demonstrate that BOA indices and their corresponding radiomics at the T12-level from both pretreatment and follow-up CT scans-combined with clinical data-can provide accurate prognostic information for esophageal cancer.This approach offers a practical alternative when L3-level imaging is unavailable and supports the clinical integration of automated T12-based imaging biomarkers.The integration of these imaging features with clinical parameters enhances the prediction of survival outcomes and contributes to non-invasive,personalized treatment planning.展开更多
Esophageal cancer is a highly aggressive malignancy often diagnosed at an advanced stage,with poor prognosis and high recurrence rates despite curative treatment.Accurate prognostic tools are urgently needed to guide ...Esophageal cancer is a highly aggressive malignancy often diagnosed at an advanced stage,with poor prognosis and high recurrence rates despite curative treatment.Accurate prognostic tools are urgently needed to guide personalized management strategies.Recent research has demonstrated significant potential of integrating quantitative imaging biomarkers,specifically radiomics and sarcopenia,with machine learning(ML)techniques to enhance outcome prediction.This review systematically summarizes six recent studies(2022-2024)exploring integrated ML models combining sarcopenia and radiomics biomarkers with clinical parameters to predict survival in patients with esophageal and gastroesophageal cancers.Sample sizes ranged from 83 to 243 patients,with studies utilizing various imaging modalities(positron emission tomography/computed tomography and computed tomography)and model analysis approaches,including Cox regression,random forest,and light gradient boosting machine.These models incorporated features such as skeletal muscle indices,tumor texture,and shape descriptors.Models that combined clinical data,radiomics,and sarcopenia outperformed those using single modalities.These findings support the utility of multimodal imaging biomarkers in developing robust,individualized prognostic models.However,the retrospective nature of most studies highlights the need for standardization and external validation.This review underscores the potential of multimodal ML-based models in enhancing personalized risk stratification and treatment planning for esophageal cancer.展开更多
BACKGROUND Minimally invasive pancreatic surgery via the multi-port approach has become a primary surgical method for distal pancreatectomy(DP)due to its advantages of lower wound pain and superior cosmetic results.So...BACKGROUND Minimally invasive pancreatic surgery via the multi-port approach has become a primary surgical method for distal pancreatectomy(DP)due to its advantages of lower wound pain and superior cosmetic results.Some studies have applied reduced-port techniques for DP in an attempt to enhance cosmetic outcomes due to the minimally invasive effects.Numerous recent review studies have compared multi-port laparoscopic DP(LDP)and multi-port robotic DP(RDP);most of these studies concluded multi-port RDP is more beneficial than multi-port LDP for spleen preservation.However,there have been no comprehensive reviews of the value of reduced-port LDP and reduced-port RDP.AIM To search for and review the studies on spleen preservation and the clinical outcomes of minimally invasive DP that compared reduced-port DP surgery with multi-port DP surgery.METHODS The PubMed medical database was searched for articles published between 2013 and 2022.The search terms were implemented using the following Boolean search algorithm:(“distal pancreatectomy”OR“left pancreatectomy”OR“peripheral pancreatic resection”)AND(“reduced-port”OR“single-site”OR“single-port”OR“dual-incision”OR“single-incision”)AND(“spleen-preserving”OR“spleen preservation”OR“splenic preservation”).A literature review was conducted to identify studies that compared the perioperative outcomes of reduced-port LDP and reduced-port RDP.RESULTS Fifteen articles published in the period from 2013 to 2022 were retrieved using three groups of search terms.Two studies were added after manually searching the related papers.Finally,10 papers were selected after removing case reports(n=3),non-English language papers(n=1),technique papers(n=1),reviews(n=1),and animal studies(n=1).The common items were defined as items reported in more than five papers,and data on these common items were extracted from all papers.The ten studies included a total of 337 patients(females/males:231/106)who underwent DP.In total,166 patients(females/males,106/60)received multi-port LDP,126(females/males,90/36)received reduced-port LDP,and 45(females/males,35/10)received reduced-port RDP.CONCLUSION Reduced-port RDP leads to a lower intraoperative blood loss,a lower postoperative pancreatic fistula rate,and shorter hospital stay and follow-up duration,but has a lower spleen preservation rate.展开更多
基金Supported by Feng Chia University/Chung Shan Medical University,No.FCU/CSMU 112-001Taiwan National Science and Technology Council,No.NSTC 114-2221-E-035-036.
文摘BACKGROUND Hepatocellular carcinoma(HCC)in segments VII and VIII poses technical challenges for both liver resection and radiofrequency ablation(RFA).Robotic-assisted techniques may enhance safety and precision,but comparative evidence remains limited.AIM To compare the clinical outcomes of robotic liver resection(R-LR)and robotic intraoperative RFA(RIO-RFA)for HCC located in liver segments VII and VIII.METHODS We retrospectively analyzed 93 HCC patients in segments VII/VIII with de novo(n=57)or first recurrent(n=36).HCC who underwent R-LR or RIO-RFA between 2015 and 2024.Propensity score matching was performed to reduce selection bias.Primary outcomes were overall survival(OS)and recurrence-free survival(RFS).Kaplan-Meier curves,log-rank tests,and Cox regression were used to identify prognostic factors for OS and RFS.RESULTS In the de novo group,OS and RFS did not differ significantly between R-LR and RIO-RFA before or after propensity score matching.In contrast,the recurrent group showed significantly improved OS and RFS with R-LR(P=0.005 and P=0.012,respectively).Subgroup analyses revealed that low-risk de novo patients with smaller tumors achieved superior OS after R-LR,whereas carefully selected low-risk recurrent patients undergoing RIO-RFA(smaller tumors,absence of complications)achieved outcomes comparable to R-LR.Platelet count,tumor size,and postoperative complications constituted key prognostic factors.CONCLUSION For HCC in challenging liver segments VII and VIII,R-LR and RIO-RFA achieve comparable outcomes in de novo cases,whereas R-LR confers superior survival in recurrent disease.R-LR should be prioritized for small de novo HCCs and for recurrent disease overall;RIO-RFA may serve as an effective alternative in carefully selected lowrisk recurrent patients.Tumor size,platelet count,and postoperative complications are key prognostic indicators to guide individualized treatment.
基金Supported by Taiwan National Science and Technology Council,No.NSTC114-2221-E-035-036Taichung Veterans General Hospital/Feng Chia University Joint Research Program,No.TCVGH-FCU1148207.
文摘BACKGROUND Esophageal cancer carries a poor prognosis with low 5-year survival rates and limited early detection options.The skeletal muscle index at the L3 vertebral level is a well-established prognostic marker in esophageal cancer,but most follow-up computed tomography(CT)scans do not extend to L3 and limiting its utility.Radiomics has emerged as a powerful tool for extracting prognostic information from medical images.AIM To evaluate the influential features for esophageal cancer prognosis by integrating radiomic and body compositionbased indices of skeletal muscle and adipose tissue at the T12 level from both pretreatment and follow-up CT images,in order to assess their value in predicting overall survival(OS).METHODS This retrospective study included 212 esophageal cancer patients who underwent concurrent chemoradiotherapy,with both pretreatment and follow-up chest CT scans available.Body organ analysis(BOA)and radiomic features were extracted from skeletal muscle and adipose tissue at the T12 level using automated tools.Four feature subsets(no-radiomics,pretreatment only,follow-up only,and combined inputs)were developed using logistic regression(LR)with least absolute shrinkage and selection operator for feature selection,followed by Cox regression.Prognostic models-including nomogram,support vector classifier,LR,and extra trees classifier-were constructed to predict 1-,2-,and 3-year OS.RESULTS The model integrating both BOA and radiomics from pretreatment and follow-up CT,combined with clinical data,achieved the best performance for 2-year OS prediction,with an area under the time-dependent receiver operating characteristic curve of 0.91,sensitivity of 0.81,and specificity of 0.88 using the LR model.The most predictive features included both clinical variables,body composition indices,and radiomic features,particularly from follow-up VAT.Follow-up imaging contributed significantly to model performance,reinforcing its value in treatment response evaluation.CONCLUSION This is the first study to demonstrate that BOA indices and their corresponding radiomics at the T12-level from both pretreatment and follow-up CT scans-combined with clinical data-can provide accurate prognostic information for esophageal cancer.This approach offers a practical alternative when L3-level imaging is unavailable and supports the clinical integration of automated T12-based imaging biomarkers.The integration of these imaging features with clinical parameters enhances the prediction of survival outcomes and contributes to non-invasive,personalized treatment planning.
基金Supported by Feng Chia University/Chung Shan Medical University,No.FCU/CSMU 112-001Taiwan National Science and Technology Council,No.111-2314-B-035-001-MY3.
文摘Esophageal cancer is a highly aggressive malignancy often diagnosed at an advanced stage,with poor prognosis and high recurrence rates despite curative treatment.Accurate prognostic tools are urgently needed to guide personalized management strategies.Recent research has demonstrated significant potential of integrating quantitative imaging biomarkers,specifically radiomics and sarcopenia,with machine learning(ML)techniques to enhance outcome prediction.This review systematically summarizes six recent studies(2022-2024)exploring integrated ML models combining sarcopenia and radiomics biomarkers with clinical parameters to predict survival in patients with esophageal and gastroesophageal cancers.Sample sizes ranged from 83 to 243 patients,with studies utilizing various imaging modalities(positron emission tomography/computed tomography and computed tomography)and model analysis approaches,including Cox regression,random forest,and light gradient boosting machine.These models incorporated features such as skeletal muscle indices,tumor texture,and shape descriptors.Models that combined clinical data,radiomics,and sarcopenia outperformed those using single modalities.These findings support the utility of multimodal imaging biomarkers in developing robust,individualized prognostic models.However,the retrospective nature of most studies highlights the need for standardization and external validation.This review underscores the potential of multimodal ML-based models in enhancing personalized risk stratification and treatment planning for esophageal cancer.
基金Chung Shan Medical University,No.15I42440Feng Chia University/Chung Shan Medical University,No.FCU/CSMU104-001and Taiwan National Science and Technology Council,No.111-2314-B-035-001-MY3 and No.110-2221-E-035-016.
文摘BACKGROUND Minimally invasive pancreatic surgery via the multi-port approach has become a primary surgical method for distal pancreatectomy(DP)due to its advantages of lower wound pain and superior cosmetic results.Some studies have applied reduced-port techniques for DP in an attempt to enhance cosmetic outcomes due to the minimally invasive effects.Numerous recent review studies have compared multi-port laparoscopic DP(LDP)and multi-port robotic DP(RDP);most of these studies concluded multi-port RDP is more beneficial than multi-port LDP for spleen preservation.However,there have been no comprehensive reviews of the value of reduced-port LDP and reduced-port RDP.AIM To search for and review the studies on spleen preservation and the clinical outcomes of minimally invasive DP that compared reduced-port DP surgery with multi-port DP surgery.METHODS The PubMed medical database was searched for articles published between 2013 and 2022.The search terms were implemented using the following Boolean search algorithm:(“distal pancreatectomy”OR“left pancreatectomy”OR“peripheral pancreatic resection”)AND(“reduced-port”OR“single-site”OR“single-port”OR“dual-incision”OR“single-incision”)AND(“spleen-preserving”OR“spleen preservation”OR“splenic preservation”).A literature review was conducted to identify studies that compared the perioperative outcomes of reduced-port LDP and reduced-port RDP.RESULTS Fifteen articles published in the period from 2013 to 2022 were retrieved using three groups of search terms.Two studies were added after manually searching the related papers.Finally,10 papers were selected after removing case reports(n=3),non-English language papers(n=1),technique papers(n=1),reviews(n=1),and animal studies(n=1).The common items were defined as items reported in more than five papers,and data on these common items were extracted from all papers.The ten studies included a total of 337 patients(females/males:231/106)who underwent DP.In total,166 patients(females/males,106/60)received multi-port LDP,126(females/males,90/36)received reduced-port LDP,and 45(females/males,35/10)received reduced-port RDP.CONCLUSION Reduced-port RDP leads to a lower intraoperative blood loss,a lower postoperative pancreatic fistula rate,and shorter hospital stay and follow-up duration,but has a lower spleen preservation rate.
