| 1. |
- Spelt, Lidewij, et al.
(författare)
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Artificial neural networks - A method for prediction of survival following liver resection for colorectal cancer metastases.
- 2013
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Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 1532-2157 .- 0748-7983. ; 39:6, s. 648-654
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To construct an artificial neural network (ANN) model to predict survival after liver resection for colorectal cancer (CRC) metastases. BACKGROUND: CRC liver metastases are fatal if untreated and resection can possibly be curative. Predictive models stratify patients into risk categories to predict prognosis and select those who can benefit from aggressive multidisciplinary treatment and intensive follow-up. Standard linear models assume proportional hazards, whereas more flexible non-linear survival models based on ANNs may better predict individual long-term survival. METHODS: Clinicopathological and perioperative data on patients who underwent liver resection for CRC metastases between 1994 and 2009 were studied retrospectively. A five-fold cross-validated ANN model was constructed. Risk variables were ranked and minimised through calibrated ANNs. Time dependent hazard ratio (HR) was calculated using the ANN. Performance of the ANN model and Cox regression were analysed using Harrell's C-index. RESULTS: 241 patients with a median age of 66 years were included. There were no perioperative deaths and median survival was 56 months. Of 28 potential risk variables, the ANN selected six: age, preoperative chemotherapy, size of largest metastasis, haemorrhagic complications, preoperative CEA-level and number of metastases. The C-index was 0.72 for the ANN model and 0.66 for Cox regression. CONCLUSION: For the first time ANNs were used to successfully predict individual long-term survival for patients following liver resection for CRC metastases. In the future, more complex prognostic factors can be incorporated into the ANN model to increase its predictive ability.
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| 2. |
- Spelt, Lidewij, et al.
(författare)
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Combined portal vein embolization and preoperative chemotherapy prior to liver resection for colorectal cancer metastases.
- 2012
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 47:8-9, s. 975-983
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Compare perioperative course and long-term mortality after liver resection for colorectal cancer (CRC) metastases between patients who had preoperative treatment with portal vein embolization (PVE) and chemotherapy or chemotherapy alone. Methods: Among patients undergoing liver resection for CRC metastases following preoperative chemotherapy treatment, 17 patients who had received preoperative PVE (group A) were compared with 17 matched controls who had no PVE (group B). Perioperative course and long-term mortality were compared between groups A and B and between group A and the entire group of 75 cases with preoperative chemotherapy (group C). Results: Baseline characteristics for the matched groups A and B were similar. Group C included less major resections. Median intraoperative bleeding was 1600 ml in group A, 1200 ml in group B, and 1000 ml in group C (p < 0.05 vs. group A). Median postoperative stay was comparable in all groups (8-9 days). Operation time was 542 min in group A and 464 min in group B (p < 0.01). Mortality after 30 days and 1, 2, and 5 years was similar in all groups. Conclusion: Perioperative outcome and long-term survival did not differ when comparing liver resection for CRC liver metastases preceded by PVE and chemotherapy or chemotherapy alone, except for the operation time. The study supports the safety of this "aggressive" combination approach in patients in need of tumor "downstaging" by chemotherapy and PVE to increase the remnant liver volume.
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| 3. |
- Spelt, Lidewij, et al.
(författare)
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Fast-track programmes for hepatopancreatic resections: where do we stand?
- 2011
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Ingår i: HPB. - : Elsevier BV. - 1477-2574 .- 1365-182X. ; 13:12, s. 833-838
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fast-track (FT) programmes represent a series of multimodal concepts that may reduce surgical stress and speed up convalescence after surgery. The aim of this systematic review was to evaluate FT programmes for patients undergoing hepatopancreatic surgery. Methods: PubMed, Embase and the Cochrane Library databases were searched for studies of FT vs. conventional recovery strategies for liver and pancreatic resections. Results: For liver surgery, three cohort studies were included. Primary hospital stay was significantly reduced after FT care in two of the three studies. There were no significant differences in rates of readmission, morbidity and mortality. For pancreatic surgery, three cohort studies and one case-control study were included. Primary hospital stay was significantly shorter after FT care in three out of the four studies. One study reported a significantly decreased readmission rate (7% vs. 25%; P= 0.027), and another study showed lower morbidity (47.2% vs. 58.7%; P < 0.01) in favour of the FT group. There was no difference in mortality between the FT and control groups. Conclusions: FT rehabilitation for liver and pancreatic surgical patients is feasible. Future investigation should focus on optimizing individual elements of the FT programme within the context of liver and pancreatic surgery.
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| 4. |
- Spelt, Lidewij, et al.
(författare)
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Influence of Preoperative Chemotherapy on the Intraoperative and Postoperative Course of Liver Resection for Colorectal Cancer Metastases.
- 2012
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; 36, s. 157-163
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Liver resection is a possibly curative treatment for colorectal cancer (CRC) liver metastases. Preoperative chemotherapy may make initially irresectable tumors resectable. The aim of this study was to compare perioperative course and short-term mortality after liver resection for CRC metastases between patients who were and were not treated with preoperative chemotherapy. METHODS: Patients who had undergone liver resection for CRC metastases were included. A total of 97 patients treated with preoperative chemotherapy (group A) were compared with 136 who were not (group B). Intraoperative bleeding, operating time, complications, duration of stay, and mortality were compared using Pearson's χ(2) test, Fisher's exact test, and the Mann-Whitney U-test. RESULTS: Mean intraoperative bleeding, duration of stay, and operating time were not significantly different. Complications occurred in 62.9% and 63.2% in groups A and B, respectively. The 30- and 90-day mortality rates were zero in group A, comparable to 1.5% in group B. CONCLUSIONS: There were no significant differences in the perioperative course or postoperative mortality when comparing CRC patients with or without chemotherapy prior to liver resection. Consequently, this study suggests that preoperative chemotherapy before liver resection for CRC metastases does not negatively influence perioperative outcome and can therefore be applied if "downstaging" is indicated.
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| 5. |
- SPELT, LIDEWIJ
(författare)
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Liver Resection for Colorectal Cancer Metastases. Prognostic Factors and Interventions Affecting Outcome.
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: With a yearly incidence of 56 per 100,000 inhabitants, colorectal cancer (CRC) is one of the most common malignancies in the Western world, representing the third leading cause of cancer-related mortality. Within three years after the diagnosis of CRC, 29% of patients will have developed liver metastases. Liver resection is a possibly curative treatment, and several preoperative strategies have been developed to make initially irresectable tumours resectable. Preoperative chemotherapy may decrease the tumour burden, but also damages the liver. Portal vein embolisation (PVE) is used to increase the future liver remnant prior to advanced liver resection, but has been suggested to promote tumour growth. The influence of risk factors and interventions on outcome after liver resection needs to be further investigated. This includes studying prognostic factors concerned with histopathological features of the primary, as well as the expression of tumour markers. Identifying prognostic factors may help to predict outcome and to tailor treatment to the individual patient. Aim: The aim of this thesis was to analyse prognostic factors and interventions affecting the outcome, both short-term and long-term, after resection of CRC liver metastases.Patients and methods: I: The perioperative course in 97 patients treated with preoperative chemotherapy prior to resection of CRC liver metastases was compared to that in 136 patients without preoperative chemotherapy. II: 17 patients with preoperative chemotherapy and PVE were compared with 17 matched controls, as well as with 75 unmatched controls, with preoperative chemotherapy only. III: Tumour progression after PVE was studied in 34 patients with CRC liver metastases, comparing tumours in the embolised and those in the non-embolised liver lobes. IV: An artificial neural network (ANN) model was constructed on 241 patients, to predict survival after liver resection. V: Predictive factors for overall survival (OS) and disease-free survival (DFS) after liver resection were analysed in 100 patients, with focus on histopathological features of the primary colon cancer, such as lymph node ratio (LNR). VI: Expression of cancer stem cell markers CD44, CD133 and CD24 was analysed in colonic liver metastases in 67 patients, and its predictive value for OS and DFS was determined.Results/Conclusions: I: No significant differences were found in perioperative course, when comparing patients with and without preoperative chemotherapy. II: Perioperative course was similar between patients with preoperative chemotherapy and PVE as compared to those with preoperative chemotherapy only, except for operation time. III: Tumour progression was seen in the embolised lobe in 3/34 patients and in the non-embolised lobe in 3/23 patients, with a median decrease in tumour volume of 16% and 11%, respectively. IV: The ANN model selected six risk variables and had a C-index of 0.72, showing a better performance than the Cox regression model. V: LNR and perineural invasion of the primary colon cancer can be used as predictors for DFS after liver resection, whilst vascular and perineural invasion of the primary colon cancer are predictive for OS. VI: CD133 expression in colonic liver metastases was selected as a predictor for DFS.
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| 6. |
- Spelt, Lidewij, et al.
(författare)
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Parenchyma-sparing hepatectomy (PSH) versus non-PSH for bilobar liver metastases of colorectal cancer
- 2018
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Ingår i: Annals of Gastroenterology. - : Hellenic Society of Gastroenterology. - 1108-7471 .- 1792-7463. ; 31:1, s. 115-120
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Tidskriftsartikel (refereegranskat)abstract
- Background Preoperative interventions have increased the resectability of colorectal cancer (CRC) liver metastases. This retrospective study compares outcomes after liver resection for bilobar CRC metastases between patients who underwent parenchyma-sparing hepatectomy (PSH), i.e., segmentectomies and smaller resections on both lobes, and those treated with non-PSH, i.e., hemihepatectomy plus any resection on the other lobe. Methods A cohort of 119 patients who underwent liver resection for bilobar CRC metastases were included. Perioperative course and long-term survival were compared between 59 patients who underwent PSH and 60 patients who underwent non-PSH. Statistical analyses were done using Pearson’s chi-square test, Fisher’s exact test and the Mann-Whitney U test. Overall survival analysis was performed by the Kaplan-Meier estimator and Cox regression analysis. Results The median number of liver metastases was 2 in patients treated with PSH and 3 in those treated with non-PSH (P<0.01). Postoperative mortality, severe complications and radicality did not differ significantly between groups. Median intraoperative bleeding was 250 mL for PSH and 600 mL for non-PSH (P<0.001). Median operation time and hospital stay were significantly shorter for PSH. Overall survival was comparable between groups, also after adjustment for covariates. Conclusions There were no significant differences in outcome, except for differences in bleeding, operation time and postoperative stay, favoring PSH. Furthermore, minimizing resection did not influence radicality. Hence, this study supports the use of PSH for bilobar CRC liver metastases when possible.
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| 7. |
- Spelt, Lidewij, et al.
(författare)
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Pattern of tumour growth of the primary colon cancer predicts long-term outcome after resection of liver metastases
- 2016
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 51:10, s. 1233-1238
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To identify significant predictive factors for overall survival (OS) and disease-free survival (DFS) after liver resection for colon cancer metastases, with special focus on features of the primary colon cancer, such as lymph node ratio (LNR), vascular invasion, and perineural invasion. Methods: Patients operated for colonic cancer liver metastases between 2006 and 2014 were included. Details on patient characteristics, the primary colon cancer operation and metastatic disease were collected. Multivariate analysis was performed to select predictive variables for OS and DFS. Results: Median OS and DFS were 67 and 20 months, respectively. 1-, 3- and 5-year OS were 97, 76, and 52%. 1-, 3- and 5-year DFS were 65, 42, and 37%. Multivariate analysis showed LNR to be an independent predictive factor for DFS but not for OS. Other identified predictive factors were vascular and perineural invasion of the primary colon cancer, size of the largest metastasis and severe complications after liver surgery for OS, and perineural invasion, number of liver metastases and preoperative CEA-level for DFS. Traditional N-stage was also considered to be an independent predictive factor for DFS in a separate multivariate analysis. Conclusions: LNR and perineural invasion of the primary colon cancer can be used as a prognostic variable for DFS after a concomitant liver resection for colon cancer metastases. Vascular and perineural invasion of the primary colon cancer are predictive for OS.
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| 8. |
- Spelt, Lidewij, et al.
(författare)
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Prognostic models for outcome following liver resection for colorectal cancer metastases: A systematic review.
- 2012
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Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 1532-2157 .- 0748-7983. ; 38:1, s. 16-24
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Liver resection provides the best chance for cure in colorectal cancer (CRC) liver metastases. A variety of factors that might influence survival and recurrence have been identified. Predictive models can help in risk stratification, to determine multidisciplinary treatment and follow-up for individual patients. AIMS: To systematically review available prognostic models described for outcome following resection of CRC liver metastases and to assess their differences and applicability. METHODS: The Pubmed, Embase and Cochrane Library databases were searched for articles proposing a prognostic model or risk stratification system for resection of CRC liver metastases. Search terms included 'colorectal', 'liver', 'metastasis', 'resection', 'prognosis' and 'prediction'. The articles were systematically reviewed. RESULTS: Fifteen prognostic systems were identified, published between 1996 and 2009. The median study population was 305 patients and the median follow-up was 32 months. All studies used Cox proportional hazards for multi-variable analysis. No prognostic factor was common in all models, though there was a tendency towards the number of metastases, CRC spread to lymph nodes, maximum size of metastases, preoperative CEA level and extrahepatic spread as representing independent risk factors. Seven models assigned more weight to selected factors considered of higher predictive value. CONCLUSION: The existing predictive models are diverse and their prognostic factors are often not weighed according to their impact. For the development of future predictive models, the complex relations within datasets and differences in relevance of individual factors should be taken into account, for example by using artificial neural networks.
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| 9. |
- Spelt, Lidewij, et al.
(författare)
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The prognostic role of cancer stem cell markers for long-term outcome after resection of colonic liver metastases
- 2018
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Ingår i: Anticancer research. - : Anticancer Research USA Inc.. - 0250-7005 .- 1791-7530. ; 38:1, s. 313-320
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aim: To assess the expression of cancer stem cell (CSC) markers CD44, CD133 and CD24 in colon cancer liver metastases and analyse their predictive value for overall survival (OS) and disease-free survival (DFS) after liver resection. Materials and Methods: Patients operated on for colon cancer liver metastases were included. CSC marker expression was determined through immunohistochemistry analysis. OS and DFS were compared between marker-positive and marker-negative patients. Multivariate analysis was performed to select predictive variables for OS and DFS. Results: CD133-positive patients had a worse DFS than CD133-negative patients, with a median DFS of 12 and 25 months (p=0.051). Multivariate analysis selected CD133 expression as a significant predictor for DFS. CD44 and CD24 were not found to predict OS or DFS. Conclusion: CD133 expression in colonic liver metastases is a negative prognostic factor for DFS after liver resection. In the future, CD133 could be used as a biomarker for risk stratification, and possibly for developing novel targeted therapy.
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| 10. |
- Spelt, Lidewij, et al.
(författare)
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Tumour growth after portal vein embolization with pre-procedural chemotherapy for colorectal liver metastases.
- 2015
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Ingår i: HPB. - : Elsevier BV. - 1477-2574 .- 1365-182X. ; 17:6, s. 529-535
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Tidskriftsartikel (refereegranskat)abstract
- For resection of colorectal cancer (CRC) liver metastases, pre-operative portal vein embolization (PVE) is used to increase the size of the future liver remnant (FLR) prior to advanced liver resection when indicated. PVE is speculated to cause tumour progression, but only a limited number of studies have analysed tumour growth after PVE in the context of pre-procedural chemotherapy, which was the aim of this retrospective study.
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