ARTFICIAL INTELLIGENCE, SYSTEM ANALYSIS AND SIMULATION MODELING IN PREDICTION OF  5-YEAR SURVIVAL OF CARDIOESOPHAGEAL CANC...
Abstract <ul><li>ARTFICIAL INTELLIGENCE, SYSTEM ANALYSIS AND SIMULATION MODELING IN PREDICTION OF 5-YEAR SURVIVAL OF CARDI...
Data <ul><li>Males…………………………………………….. 116 </li></ul><ul><li>Females………..………………………………….. 34 </li></ul><ul><li>Age=54.9±0.7 ...
Radical Procedures <ul><li>Proximal Esophagogastrectomies with Single-Stage Esophagogastroplasty.…………………. 81 </li></ul><ul...
Schemas of Procedures The 60 th  Annual Meeting of Society of Surgical Oncology  March 15-18, 2007, Washington , DC, the USA
Procedures
One-Stage  Esophagogastroplasty or Esophagoenteroplasty
Schemas of Combined Procedures The 60 th  Annual Meeting of Society of Surgical Oncology  March 15-18, 2007, Washington , ...
Schemas of D3 Lymphadenectomy The 60 th  Annual Meeting of Society of Surgical Oncology  March 15-18, 2007, Washington , D...
Staging <ul><li>T1…… 16   N0..….. 59   G1………… 42 </li></ul><ul><li>T2…… 32   N1…… 18   G2………… 30 </li></ul><ul><li>T3…… 58...
Survival Rate <ul><li>5-Year Survivors…………..……. 44 (29.3%)   </li></ul><ul><li>10-Year Survivors………………. 18 (12.0%) </li></...
General Cardioesophageal Cancer Patients Survival  after Complete Left Thoracoabdominal Esophagogastrectomies (Kaplan-Meie...
Results of Univariate Analysis in Prediction of Cardioesophageal Cancer Patients Survival  ( n=150 )
Results of Univariate Analysis in Prediction of Cardioesophageal Cancer Patients Survival  ( n=150 )
Results of Univariate Analysis in Prediction of Cardioesophageal Cancer Patients Survival  ( n=150 ) The 60 th  Annual Mee...
Results of Cox Regression Modeling in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastr...
Results of Cox Regression Modeling in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastr...
Results of Discriminant Analysis   in  Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogast...
Results of Logistic Regression Analysis   in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esopha...
Results of Correspondence Analysis in Prediction of Cardioesophageal Cancer Patients Survival (n=150)   The 60 th  Annual ...
Results of Multi-Factor Clustering of Clinicopathological Data in Prediction of Cardioesophageal Cancer Patients Survival ...
Neural Networks  in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=150 ) ...
Results of  Kohonen Self-Organizing  Neural Networks Computing  in Prediction of Cardioesophageal Cancer Patients Survival...
Results of Neural Networks Computing   in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagog...
Results of Bootstrap Simulation  in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrec...
Results of Bootstrap Simulation  in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrec...
Results of Bootstrap Simulation  in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrec...
Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=150 ) <ul><li>Classificati...
Ratio of Lymphocytes to Cancer Cells & Glucose Level  in Prediction of Cardioesophageal Cancer Patients Survival after Com...
Prognostic SEPATH-Model of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies, n=150   The 60 ...
Holling-Tenner Models of Cardioesophageal  Cancer Cell Population and  Cytotoxic Cell Population Dynamics
Cardioesophageal Cancer Dynamics
Conclusions: <ul><li>5-year survival and life span  of cardioesophageal cancer patients after complete esophagogastrectomi...
Conclusions: <ul><li>Optimal treatment strategies for cardioesophageal  cancer patients are: </li></ul><ul><li>1) screenin...
Address: Oleg Kshivets  M.D., Ph.D., Consultant Thoracic, Abdominal, General Surgeon & Surgical Oncologist  <ul><li>Surger...
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Kshivets O. Cardioesophageal Cancer Surgery

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ARTFICIAL INTELLIGENCE, SYSTEM ANALYSIS AND SIMULATION MODELING IN PREDICTION OF 5-YEAR SURVIVAL OF CARDIOESOPHAGEAL CANCER PATIENTS AFTER COMPLETE LEFT THORACOABDOMINAL ESOPHAGOGASTRECTOMIES

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Kshivets O. Cardioesophageal Cancer Surgery

  1. 1. ARTFICIAL INTELLIGENCE, SYSTEM ANALYSIS AND SIMULATION MODELING IN PREDICTION OF 5-YEAR SURVIVAL OF CARDIOESOPHAGEAL CANCER PATIENTS AFTER COMPLETE LEFT THORACOABDOMINAL ESOPHAGOGASTRECTOMIES Oleg Kshivets, MD, PhD Department of Surgery, Siauliai Public Hospital & Cancer Center, Lithuania The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  2. 2. Abstract <ul><li>ARTFICIAL INTELLIGENCE, SYSTEM ANALYSIS AND SIMULATION MODELING IN PREDICTION OF 5-YEAR SURVIVAL OF CARDIOESOPHAGEAL CANCER PATIENTS AFTER COMPLETE LEFT THORACOABDOMINAL ESOPHAGOGASTRECTOMIES </li></ul><ul><li>Oleg Kshivets Department of Surgery, Siauliai Public Hospital & Cancer Center, Siauliai, Lithuania </li></ul><ul><li>OBJECTIVE: We examined the clinicomorphologic factors associated with the low- and high-risk of generalization of cardioesophageal cancer (CEC) (T1-4N0-3M0) after complete esophagogastrectomies (EG) through left thoracoabdominal incision.     METHODS: We analyzed data of 150 consecutive CEC patients (CECP) (age=54.9±0.7 years; tumor size=6.9±0.2 cm) radically operated and monitored in 1975-2006 (males=116, females=34; combined EG with resection of pancreas, liver, diaphragm, colon transversum, splenectomies=49; lymphadenectomy D2=59, D3=91; esophagogastroanastomosis=89, esophagoenteroanastomosis=61; adenocarcinoma=125, squamos=19, mix=6; T1=16, T2=32, T3=58, T4=44; N0=59, N1=18, N2=71; N3=2; G1=42, G2=30, G3=78). Variables selected for 5-year survival (5YS) study were input levels of 45 blood parameters, sex, age, TNMPG, cell type, tumor size. Survival curves were estimated by the Kaplan-Meier method. Differences in curves between groups of CECP were evaluated using a log-rank test. Multivariate Cox modeling, multi-factor clustering, discriminant analysis, structural equation modeling, Monte Carlo, bootstrap simulation and neural networks computing were used to determine any significant dependence.     RESULTS: 44 CECP (life span: LS=3545.8±238.7 days) lived more than 5 years without any features of CEC progressing (5YS=29.3%). 106 CECP died because of generalization of CEC during the first 5 years after radical procedures (LS=593.5±32.6 days). Cox modeling displayed that 5YS of CECP (n=150) after complete EG significantly depended on: T1-4, combined procedures, histology, G1-3, blood lymphocytes, monocytes, neutrophils, lymphoid infiltration of CEC, age (P=0.000-0.038). Neural networks computing, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS of CECP and combined procedures (rank=1), N0-3 (2), histology (3), gender (4), CEC growth (5), type of operations (6), P1-4 (7), T1-4 (8), adjuvant chemoimmunotherapy (9), G1-3 (10), blood coagulation time (11), blood lymphocytes (12), thrombocytes (13), blood rest nitrogen (14), hemorrhage time (15), ESS (16), age (17), weight (18), blood chlorides (19), tumor size (20). CONCLUSIONS: Correct prediction of CECP survival after radical procedures was 90.7% by logistic regression (odds ratio=86.7), 96% by discriminant analysis and 100% by neural networks computing (area under ROC curve=1.0; error=0.0012). </li></ul>The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  3. 3. Data <ul><li>Males…………………………………………….. 116 </li></ul><ul><li>Females………..………………………………….. 34 </li></ul><ul><li>Age=54.9±0.7 years </li></ul><ul><li>Tumor Size=6.9±0.2 cm </li></ul><ul><li>Only Surgery.…………………………………... 132 </li></ul><ul><li>Adjuvant Chemoimmunotherapy (5FU+thymalin/taktivin, 5-6 cycles)……………. 18 </li></ul>The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  4. 4. Radical Procedures <ul><li>Proximal Esophagogastrectomies with Single-Stage Esophagogastroplasty.…………………. 81 </li></ul><ul><li>Total Esophagogastrectomies with Single-Stage Esophagoenteroplasty..………..……………… 69 </li></ul><ul><li>Combined Esophagogastrectomies with Resection of Diaphragm, Liver, Mesocolon, Colon Transversum, Splenectomy, Left Hemipancreatectomy, etc……………………. 49 </li></ul><ul><li>Lymphadenectomy D2………………………... 59 </li></ul><ul><li>Lymphadenectomy D3………………………... 91 </li></ul>The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  5. 5. Schemas of Procedures The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  6. 6. Procedures
  7. 7. One-Stage Esophagogastroplasty or Esophagoenteroplasty
  8. 8. Schemas of Combined Procedures The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  9. 9. Schemas of D3 Lymphadenectomy The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  10. 10. Staging <ul><li>T1…… 16 N0..….. 59 G1………… 42 </li></ul><ul><li>T2…… 32 N1…… 18 G2………… 30 </li></ul><ul><li>T3…… 58 N2…… 71 G3………… 78 </li></ul><ul><li>T4…… 44 N3…….. 2 </li></ul><ul><li>exophytic growth………….. 53 </li></ul><ul><li>endophytic growth……….... 85 </li></ul><ul><li>mix growth..……………….. 12 </li></ul><ul><li>adenocarcinoma…………… 93 </li></ul><ul><li>squamos cell carcinoma…… 52 </li></ul><ul><li>mix carcinoma………………. 5 </li></ul>The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  11. 11. Survival Rate <ul><li>5-Year Survivors…………..……. 44 (29.3%) </li></ul><ul><li>10-Year Survivors………………. 18 (12.0%) </li></ul><ul><li>Losses…………………………… 106 (70.7%) </li></ul><ul><li>General Life Span= 1459.5 ±132 days </li></ul><ul><li>For 5-Year Survivors= 3545.8±238.7 days </li></ul><ul><li>For Losses= 593.5±32.6 days </li></ul><ul><li>Cumulative 5-Year Survival……. 29.3% </li></ul><ul><li>Cumulative 10-Year Survival…... 22.4% </li></ul><ul><li>Cumulative 15-Year Survival…... 20.2% </li></ul>The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  12. 12. General Cardioesophageal Cancer Patients Survival after Complete Left Thoracoabdominal Esophagogastrectomies (Kaplan-Meier) ( n=150 ) The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  13. 13. Results of Univariate Analysis in Prediction of Cardioesophageal Cancer Patients Survival ( n=150 )
  14. 14. Results of Univariate Analysis in Prediction of Cardioesophageal Cancer Patients Survival ( n=150 )
  15. 15. Results of Univariate Analysis in Prediction of Cardioesophageal Cancer Patients Survival ( n=150 ) The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  16. 16. Results of Cox Regression Modeling in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=150 ) <ul><li>Factors Wald df P Exp(B) 95%CI for Exp(B) Lower Upper </li></ul><ul><li>Eosinophils% 6.539 1 0.011 1.802 1.147 2.829 </li></ul><ul><li>Stick.Neutrophils% 12.447 1 0.000 2.298 1.447 3.648 </li></ul><ul><li>Seg.Neutrophils% 14.680 1 0.000 2.379 1.527 3.706 </li></ul><ul><li>Lymphocytes% 11.949 1 0.001 2.212 1.410 3.469 </li></ul><ul><li>Monocytes% 12.832 1 0.000 2.303 1.459 3.634 </li></ul><ul><li>T1-4 12.579 3 0.006 </li></ul><ul><li>T(1) 11.124 1 0.001 0.196 0.075 0.510 </li></ul><ul><li>T(2) 6.870 1 0.009 0.349 0.159 0.767 </li></ul><ul><li>T(3) 1.409 1 0.235 0.672 0.348 1.296 </li></ul><ul><li>Ad.CHIT 0.648 1 0.421 0.744 0.362 1.529 </li></ul><ul><li>Age 10.419 1 0.001 1.042 1.016 1.068 </li></ul><ul><li>Comb.operation 15.523 6 0.017 </li></ul>The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  17. 17. Results of Cox Regression Modeling in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=150 ) <ul><li>Factors Wald df P Exp(B) 95%CI for Exp(B) Lower Upper </li></ul><ul><li>Histology 15.864 2 0.000 </li></ul><ul><li>Histology(1) 13.556 1 0.000 8.361 2.700 25.894 </li></ul><ul><li>Histology(2) 15.753 1 0.000 9.631 3.147 29.473 </li></ul><ul><li>Lymphocytes abs 5.423 1 0.020 6.126 1.332 28.166 </li></ul><ul><li>Seg.Neutrophils abs 4.899 1 0.027 0.495 0.265 0.923 </li></ul><ul><li>G1-3 6.539 2 0.038 </li></ul><ul><li>G(1) 5.907 1 0.015 0.519 0.305 0.881 </li></ul><ul><li>G(2) 3.578 1 0.059 0.565 0.313 1.021 </li></ul><ul><li>LIT 32.081 3 0.000 </li></ul><ul><li>LIT(1) 25.546 1 0.000 6.648 3.189 13.858 </li></ul><ul><li>LIT(2) 23.429 1 0.000 5.804 2.848 11.829 </li></ul><ul><li>LIT(3) 1.084 1 0.298 1.424 0.732 2.768 </li></ul>The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  18. 18. Results of Discriminant Analysis in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=150 ) <ul><li>Discriminant Function Analysis Summary </li></ul><ul><li>Wilks' Lambda: 0.305 approx. F (61,88)=3.281 p< 0.0000 </li></ul><ul><li> Wilks' Partial F-remove P-level </li></ul><ul><li> Lambda Lambda (1,88) </li></ul><ul><li>LIT 0 .403 0.757 28.238 0.000 </li></ul><ul><li>Comb.Operation 0.319 0.956 4.032 0.048 </li></ul><ul><li>Erythrocytes 0 .319 0.956 4.012 0.048 </li></ul><ul><li>Weight 0 .319 0.958 3.893 0.052 </li></ul><ul><li>Glucose 0.318 0.962 3.503 0.065 </li></ul><ul><li>Growth 0.312 0.979 1.904 0.171 </li></ul><ul><li>G1-3 0.308 0.990 0.854 0.358 </li></ul><ul><li>Ad.CHIT 0.307 0.995 0.402 0.528 </li></ul><ul><li>T1-4 0.306 0.999 0.128 0.722 </li></ul><ul><li>N0-3 0.306 0.999 0.064 0.801 </li></ul>The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  19. 19. Results of Logistic Regression Analysis in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=150 ) <ul><li> Est. S.E. Wald P Odds 95.0% C.I.for Odds Ratio Ratio Lower Upper </li></ul><ul><li>Const.B 18.24 9.25 3.89 0.049 8.3e+7 0.95 5.8e+12 </li></ul><ul><li>Seg.Neut.% -0.21 0.10 4.44 0035 0.81 0.67 0.99 </li></ul><ul><li>Monocytes abs-5.46 2.51 4.74 0.030 0.00 0.00 0.608 </li></ul><ul><li>LIT 1.99 0.42 22.38 0.000 7.28 3.18 16.70 </li></ul><ul><li>G1-3 -0.59 0.42 2.02 0.155 0.55 0.24 1.26 </li></ul><ul><li>Growth 1.54 0.71 4.75 0.029 4.69 1.15 19.04 </li></ul><ul><li>Comb.Oper. -0.47 0.16 8.75 0.003 0.63 0.46 0.86 </li></ul><ul><li>T1-4 -0.26 0.48 0.29 0.589 0.77 0.30 1.99 </li></ul><ul><li>N0-3 -0.20 0.40 0.26 0.613 0.817 0.370 1.80 </li></ul>Chi2=105.11; df=15; P=0.0000 ; Odds ratio=86.70 The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  20. 20. Results of Correspondence Analysis in Prediction of Cardioesophageal Cancer Patients Survival (n=150) The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  21. 21. Results of Multi-Factor Clustering of Clinicopathological Data in Prediction of Cardioesophageal Cancer Patients Survival (n=150) The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  22. 22. Neural Networks in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=150 ) <ul><li> Baseline Errors=0.0012 </li></ul><ul><li>Area under ROC curve=1 .00 </li></ul><ul><li>Correct Classification Rate= 100% </li></ul><ul><li> Losses 5-year survivors </li></ul><ul><li>Total 106 44 Correct 106 44 Wrong 0 0 </li></ul><ul><li>Genetic Algorithm Selection </li></ul><ul><li>Useful for L ESS Haemor.Time Protein PI D Histology G1-3 Growth Sabs </li></ul><ul><li>Survival Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes </li></ul><ul><li>Useful for Lymabs Comb.Oper. P1-4 L/CC S/CC T1-4 N0-3 Chlorides Stot </li></ul><ul><li>Survival Yes Yes Yes Yes Yes Yes Yes Yes Yes </li></ul>The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  23. 23. Results of Kohonen Self-Organizing Neural Networks Computing in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=150) The 60th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  24. 24. Results of Neural Networks Computing in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=150 ) Error=0.0011; Area under ROC Curve=1.00; Correct Classification Rate=100% <ul><ul><li>Factor Rank Error Ratio </li></ul></ul><ul><li>Comb.Operat. 1 0.199 159.5 </li></ul><ul><li>N0-3 2 0.185 148.0 </li></ul><ul><li>Histology 3 0.172 138.0 </li></ul><ul><li>Sex 4 0.166 133.1 </li></ul><ul><li>Growth 5 0.164 130.9 </li></ul><ul><li>Oper. Type 6 0.153 122.6 </li></ul><ul><li>P1-4 7 0.117 94.0 </li></ul><ul><li>T1-4 8 0.109 87.2 </li></ul><ul><li>Ad.CHIT 9 0.106 84.7 </li></ul><ul><li>G1-3 10 0.071 57.1 </li></ul><ul><li>Coag.Time 11 0.029 23.5 </li></ul><ul><li>Lymph.% 12 0.029 23.2 </li></ul><ul><ul><li>Factor Rank Error Ratio </li></ul></ul><ul><li>Thr.tot 13 0.023 18.2 </li></ul><ul><li>Rest Nitrogens 14 0.019 15.2 </li></ul><ul><li>Haem.Time 15 0.007 5.6 </li></ul><ul><li>ESS 16 0.005 3.8 </li></ul><ul><li>Age 17 0.003 2.6 </li></ul><ul><li>Weight 18 0.003 2.5 </li></ul><ul><li>Chlorides 19 0.002 1.9 </li></ul><ul><li>D 20 0.002 1.8 </li></ul><ul><li>St.Neutr.tot 21 0.002 1.6 </li></ul><ul><li>Protein 22 0.002 1.5 </li></ul><ul><li>L/CC 23 0.002 1.4 </li></ul><ul><li>Erythrocytes 24 0.002 1.4 </li></ul>The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  25. 25. Results of Bootstrap Simulation in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=150 ) <ul><li>Number of Samples=3333 </li></ul><ul><li>Significant Factors Rank Kendall’s Tau-A P< </li></ul><ul><li>LIT 1 0.316 0.000 </li></ul><ul><li>D 2 -0.196 0.000 </li></ul><ul><li>P1-4 3 -0.189 0.000 </li></ul><ul><li>Leucocytes/CC 4 0.188 0.000 </li></ul><ul><li>HC/CC 5 0.187 0.000 </li></ul><ul><li>Erythrocytes/CC 6 0.186 0.000 </li></ul><ul><li>Lymphocytes/CC 7 0.185 0.000 </li></ul><ul><li>T1-4 8 -0.184 0.000 </li></ul><ul><li>N0-3 9 -0.176 0.000 </li></ul><ul><li>Seg.Neutrophils/CC 10 0.167 0.000 </li></ul><ul><li>Thrombocytes/CC 11 0.160 0.000 </li></ul><ul><li>Monocytes/CC 12 0.146 0.000 </li></ul>The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  26. 26. Results of Bootstrap Simulation in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=150 ) <ul><li>Number of Samples=3333 </li></ul><ul><li>Significant Factors Rank Kendall’s Tau-A P< </li></ul><ul><li>Eosinophils/CC 13 0.124 0.000 </li></ul><ul><li>Operation Type 14 -0.119 0.000 </li></ul><ul><li>G1-3 15 -0.119 0.000 </li></ul><ul><li>Histology 16 -0.118 0.000 </li></ul><ul><li>Chlorides 17 0.106 0.000 </li></ul><ul><li>Coagulation Time 18 -0.096 0.000 </li></ul><ul><li>Growth 19 -0.092 0.000 </li></ul><ul><li>Stick Neutrophils/CC 20 0.068 0.000 </li></ul><ul><li>Protein 21 0.063 0.000 </li></ul><ul><li>Combined Operation 22 0.048 0.000 </li></ul><ul><li>Rest Nitrogens 23 0.042 0.001 </li></ul><ul><li>Colour Index 24 0.041 0.000 </li></ul>The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  27. 27. Results of Bootstrap Simulation in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=150 ) <ul><li>Number of Samples=3333 </li></ul><ul><li>Significant Factors Rank Kendall’s Tau-A P< </li></ul><ul><li>ESS 25 0.038 0.002 </li></ul><ul><li>Erythrocytes tot 26 0.038 0.002 </li></ul><ul><li>Thrombocytes 27 -0.033 0.005 </li></ul><ul><li>Adjuvant CHIT 28 0.031 0.005 </li></ul><ul><li>Eosinophils tot 29 0.028 0.018 </li></ul><ul><li>Leucocytes tot 30 0.027 0.023 </li></ul><ul><li>Sex 31 0.027 0.023 </li></ul><ul><li>Weight 32 0.026 0.024 </li></ul><ul><li>Haemorrhage Time 33 0.026 0.024 </li></ul><ul><li>Monocytes tot 34 0.024 0.05 </li></ul>The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  28. 28. Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=150 ) <ul><li>Classification of Cases by Logistic Regression, n=150, Odds Ratio=86.7 </li></ul><ul><li>Observed Pred.Losses Pred.Survivors Correct </li></ul><ul><li>Losses 102 4 96.2% </li></ul><ul><li>5-Year Survivors 10 34 77.3% </li></ul><ul><li>Total 112 38 90.7% </li></ul><ul><li>Classification of Cases by Discriminant Analysis, n=150 </li></ul><ul><li>Observed Pred.Losses Pred.Survivors Correct </li></ul><ul><li>Losses 105 1 99.1% </li></ul><ul><li>5-Year Survivors 5 39 88.6% </li></ul><ul><li>Total 110 44 96 .0% </li></ul><ul><li>Classification of Cases by Neural Networks, n=150, Errors=0.0012 </li></ul><ul><li>Observed Pred.Losses Pred.Survivors Correct </li></ul><ul><li>Losses 106 0 100% </li></ul><ul><li>5-Year Survivors 0 44 100% </li></ul><ul><li>Total 106 44 100 % </li></ul>The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  29. 29. Ratio of Lymphocytes to Cancer Cells & Glucose Level in Prediction of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=150 ) The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  30. 30. Prognostic SEPATH-Model of Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies, n=150 The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  31. 31. Holling-Tenner Models of Cardioesophageal Cancer Cell Population and Cytotoxic Cell Population Dynamics
  32. 32. Cardioesophageal Cancer Dynamics
  33. 33. Conclusions: <ul><li>5-year survival and life span of cardioesophageal cancer patients after complete esophagogastrectomies significantly depended on: </li></ul><ul><li>1) cell ratio factors: ratio of cancer cell population to blood cell subpopulations in integral patient organism; </li></ul><ul><li>2) cancer characteristics (cancer cell population number, TNMG-system); </li></ul><ul><li>3) the data of blood cell circuit, biochemical homeostasis and hemostasis system; </li></ul><ul><li>4) character of surgical procedure; </li></ul><ul><li>5) anthropometric data. </li></ul>The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  34. 34. Conclusions: <ul><li>Optimal treatment strategies for cardioesophageal cancer patients are: </li></ul><ul><li>1) screening and early detection of cardioesophageal cancer; </li></ul><ul><li>2) availability of very experienced surgeons because of complexity of radical procedures; </li></ul><ul><li>3) aggressive en block surgery for completeness; </li></ul><ul><li>4) precise prediction; </li></ul><ul><li>5) adjuvant chemioimmunotherapy for patients with </li></ul><ul><li>unfavorable prognosis. </li></ul>The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA
  35. 35. Address: Oleg Kshivets M.D., Ph.D., Consultant Thoracic, Abdominal, General Surgeon & Surgical Oncologist <ul><li>Surgery Department, Siauliai Public Hospital & Cancer Center </li></ul><ul><li>Tilzes:42-16, LT78206 Siauliai, Lithuania </li></ul><ul><li>Tel. 37041-416614 </li></ul><ul><li>e-mail: kshivets@yahoo.com </li></ul><ul><li>http//:myprofile.cos.com/Kshivets </li></ul>The 60 th Annual Meeting of Society of Surgical Oncology March 15-18, 2007, Washington , DC, the USA

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