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      Radiomics and machine learning analysis of liver magnetic resonance imaging for prediction and early detection of tumor response in colorectal liver metastases

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          Abstract

          Purpose

          The aim of this study was to demonstrate the effectiveness of a machine learning-based radiomics model for distinguishing tumor response and overall survival in patients with unresectable colorectal liver metastases (CRLM) treated with targeted biological therapy.

          Methods

          We prospectively recruited 17 patients with unresectable liver metastases of colorectal cancer, who had been given targeted biological therapy as the first line of treatment. All patients underwent liver magnetic resonance imaging (MRI) three times up until 8 weeks after chemotherapy. We evaluated the diagnostic performance of machine learning-based radiomics model in tumor response of liver MRI compared with the guidelines for the Response Evaluation Criteria in Solid Tumors. Overall survival was evaluated using the Kaplan-Meier analysis and compared to the Cox proportional hazard ratios following univariate and multivariate analyses.

          Results

          Performance measurement of the trained model through metrics showed the accuracy of the machine learning model to be 76.5%, and the area under the receiver operating characteristic curve was 0.857 (95% confidence interval [CI], 0.605–0.976; P<0.001). For the patients classified as non-progressing or progressing by the radiomics model, the median overall survival was 17.5 months (95% CI, 12.8–22.2), and 14.8 months (95% CI, 14.2–15.4), respectively (P=0.431, log-rank test).

          Conclusion

          Machine learning-based radiomics models could have the potential to predict tumor response in patients with unresectable CRLM treated with biologic therapy.

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          Most cited references30

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          Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

          This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.
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            New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1).

            Assessment of the change in tumour burden is an important feature of the clinical evaluation of cancer therapeutics: both tumour shrinkage (objective response) and disease progression are useful endpoints in clinical trials. Since RECIST was published in 2000, many investigators, cooperative groups, industry and government authorities have adopted these criteria in the assessment of treatment outcomes. However, a number of questions and issues have arisen which have led to the development of a revised RECIST guideline (version 1.1). Evidence for changes, summarised in separate papers in this special issue, has come from assessment of a large data warehouse (>6500 patients), simulation studies and literature reviews. HIGHLIGHTS OF REVISED RECIST 1.1: Major changes include: Number of lesions to be assessed: based on evidence from numerous trial databases merged into a data warehouse for analysis purposes, the number of lesions required to assess tumour burden for response determination has been reduced from a maximum of 10 to a maximum of five total (and from five to two per organ, maximum). Assessment of pathological lymph nodes is now incorporated: nodes with a short axis of 15 mm are considered measurable and assessable as target lesions. The short axis measurement should be included in the sum of lesions in calculation of tumour response. Nodes that shrink to <10mm short axis are considered normal. Confirmation of response is required for trials with response primary endpoint but is no longer required in randomised studies since the control arm serves as appropriate means of interpretation of data. Disease progression is clarified in several aspects: in addition to the previous definition of progression in target disease of 20% increase in sum, a 5mm absolute increase is now required as well to guard against over calling PD when the total sum is very small. Furthermore, there is guidance offered on what constitutes 'unequivocal progression' of non-measurable/non-target disease, a source of confusion in the original RECIST guideline. Finally, a section on detection of new lesions, including the interpretation of FDG-PET scan assessment is included. Imaging guidance: the revised RECIST includes a new imaging appendix with updated recommendations on the optimal anatomical assessment of lesions. A key question considered by the RECIST Working Group in developing RECIST 1.1 was whether it was appropriate to move from anatomic unidimensional assessment of tumour burden to either volumetric anatomical assessment or to functional assessment with PET or MRI. It was concluded that, at present, there is not sufficient standardisation or evidence to abandon anatomical assessment of tumour burden. The only exception to this is in the use of FDG-PET imaging as an adjunct to determination of progression. As is detailed in the final paper in this special issue, the use of these promising newer approaches requires appropriate clinical validation studies.
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              Radiomics: the bridge between medical imaging and personalized medicine

              Radiomics, the high-throughput mining of quantitative image features from standard-of-care medical imaging that enables data to be extracted and applied within clinical-decision support systems to improve diagnostic, prognostic, and predictive accuracy, is gaining importance in cancer research. Radiomic analysis exploits sophisticated image analysis tools and the rapid development and validation of medical imaging data that uses image-based signatures for precision diagnosis and treatment, providing a powerful tool in modern medicine. Herein, we describe the process of radiomics, its pitfalls, challenges, opportunities, and its capacity to improve clinical decision making, emphasizing the utility for patients with cancer. Currently, the field of radiomics lacks standardized evaluation of both the scientific integrity and the clinical relevance of the numerous published radiomics investigations resulting from the rapid growth of this area. Rigorous evaluation criteria and reporting guidelines need to be established in order for radiomics to mature as a discipline. Herein, we provide guidance for investigations to meet this urgent need in the field of radiomics.
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                Author and article information

                Journal
                Korean J Clin Oncol
                Korean J Clin Oncol
                Korean Journal of Clinical Oncology
                Korean Society of Surgical Oncology
                1738-8082
                2288-4084
                June 2024
                30 June 2024
                : 20
                : 1
                : 27-35
                Affiliations
                [1 ]Department of Radiology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
                [2 ]Biomedical Engineering, Gachon University College of Medicine, Incheon, Korea
                Author notes
                Correspondence to: Seung Joon Choi, Department of Radiology, Gachon University Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea, Tel: +82-32-460-3060, Fax: +82-32-460-3045, E-mail: sjchoi1118@ 123456gmail.com
                [*]

                Sungjin Yoon and Young Jae Kim contributed equally to this work as first authors.

                Author information
                https://orcid.org/0000-0002-7030-841X
                https://orcid.org/0000-0003-0443-0051
                https://orcid.org/0000-0001-6621-283X
                https://orcid.org/0000-0001-9026-0399
                https://orcid.org/0000-0003-3861-7682
                Article
                kjco-20-1-27
                10.14216/kjco.24005
                11261177
                38988016
                8f422910-8749-4ae9-9120-9e6c095c3049
                Copyright © 2024 Korean Society of Surgical Oncology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 7 May 2024
                : 31 May 2024
                : 17 June 2024
                Categories
                Original Article

                colorectal neoplasms,neoplasm metastasis,machine learning,radiomics,chemotherapy

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