ARTIFICIAL INTELLIGENCE, SYSTEM ANALYSIS AND SIMULATION MODELING IN PRECISE PREDICTION OF 5-YEAR SURVIVAL OF ESOPHAGEAL CANCER PATIENTS AFTER COMPLETE ESOPHAGOGASTRECTOMIES Oleg Kshivets, MD, PhD Surgery Department, Kaluga Cancer Clinical Center, Russia
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ARTIFICIAL INTELLIGENCE, SYSTEM ANALYSIS AND SIMULATION MODELING IN PRECISE PREDICTION OF 5-YEAR SURVIVAL OF ESOPHAGEAL CANCER PATIENTS AFTER COMPLETE ESOPHAGOGASTRECTOMIES
Oleg Kshivets, MD, PhD
Surgery Department, Kaluga Cancer Clinical Center, Russia
ABSTRACTArtificial Intelligence, System Analysis and Simulation Modeling in Precise Prediction of 5-Year Survival of Esophageal Cancer Patients after Complete EsophagogastrectomiesOleg Kshivets OBJECTIVE: We examined factors in terms of precise prediction of 5-year survival (5YS) of esophageal cancer (EC) patients (ECP) (T1-4N0-2M0) after complete (R0) esophagogastrectomies (EG). METHODS: We analyzed data of 491 consecutive ECP (age=56.2±8.8 years; tumor size=6.3±3.4 cm) radically operated and monitored in 1975-2015 (m=359, f=132; EG Garlock=280, EG Lewis=211, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy=147; adenocarcinoma=279, squamous=202, mix=10; T1=90, T2=112, T3=166, T4=123; N0=227, N1=69, N2=195; G1=136, G2=123, G3=232; early EC=71, invasive=420; only surgery=377, adjuvant chemoimmunoradiotherapy-AT=114: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence. RESULTS: Overall life span was 1776.1±2223.2 days and cumulative 5-year survival (5YS) reached 47.1%, 10 years – 40.3%, 20 years – 30%. 147 ECP lived more than 5 years, 79 – 10 years. 223 ECP died because of EC. Cox modeling displayed (Chi2=293.38, df=18, P=0.000) that 5YS of ECP significantly depended on: phase transition (PT) N0—N12 in terms of synergetics, cell ratio factors (CRF) (ratio between cancer cells and blood cells subpopulations), T, G, age, AT, localization, blood cells, prothrombin index, coagulation time, residual nitrogen (P=0.000-0.014). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT N0--N12 (rank=1), T, AT, G, prothrombin index, glucose, blood cells, localization, PT early-invasive EC, CRF. Correct prediction of 5YS was 100% by neural networks computing. CONCLUSIONS: 5YS of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) CRF; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) adjuvant chemotherapy; 8) tumor characteristics and localization.
Age=56.2±8.8 years Tumor Size=6.3±3.4 cm Only Surgery.…………………………………...377 Adjuvant Chemoimmunoradiotherapy (5FU+thymalin/taktivin, 5-6 cycles+ Radiotherapy 45-50Gy)………………………...........................114
RADICAL PROCEDURES: Esophagogastrectomies Lewis (R0)……………211 Esophagogastrectomies Garlock (R0)………....280 Combined Esophagogastrectomies with Resection of Pancreas, Liver, Trachea, Lung, Aorta, Vena Cava Superior, Colon Transversum, Diaphragm,
SURVIVAL RATE: Alive………………………………………...238 (48.5%) 5-Year Survivors…………..……………….147 (29.9%) 10-Year Survivors…………………………...79 (16.1%) Losses……………………………………….223 (45.4%) General Life Span=1776.1±2223.2 days For 5-Year Survivors=4382.8±2559.8 days For 10-Year Survivors=6047.8±2454.2 days For Losses=630.2±320.5 days Cumulative 5-Year Survival…………………….47.1% Cumulative 10-Year Survival…………………...40.3% Cumulative 20-Year Survival…………………...30%
GENERAL ESOPHAGEAL CANCER PATIENTS SURVIVAL AFTER COMPLETE ESOPHAGOGASTRECTOMIES (KAPLAN-MEIER) (N=491):
RESULTS OF UNIVARIATE ANALYSIS OF PHASE TRANSITION EARLY—INVASIVE CANCER IN PREDICTION OF ESOPHAGEAL CANCER PATIENTS SURVIVAL (N=491):
RESULTS OF UNIVARIATE ANALYSIS OF PHASE TRANSITION N0—N1-2 IN PREDICTION OF ESOPHAGEAL CANCER PATIENTS SURVIVAL (N=491):
RESULTS OF UNIVARIATE ANALYSIS OF ADJUVANT CHEMOIMMUNORADIOTHERAPY IN PREDICTION OF ESOPHAGEAL CANCER PATIENTS SURVIVAL (N=491):
RESULTS OF UNIVARIATE ANALYSIS OF LOCALIZATION (UPPER/3 VS. MIDDLE/3 & LOWER/3) IN PREDICTION OF ESOPHAGEAL CANCER PATIENTS SURVIVAL (N=491):
RESULTS OF COX REGRESSION MODELING IN PREDICTION OF ESOPHAGEAL CANCER PATIENTS SURVIVAL AFTER COMPLETE ESOPHAGOGASTRECTOMIES (N=491):
RESULTS OF BOOTSTRAP SIMULATION IN PREDICTION OF ESOPHAGEAL CANCER PATIENTS SURVIVAL AFTER ESOPHAGOGASTRECTOMIES (N=370):
Significant Factors (Number of Samples=3333)
Rank Kendal Tau-A P
Tumor Size 1 -0.272 0.000
Healthy Cells/Cancer Cells 2 0.270 0.000
T1-4 3 -0.269 0.000
Erythrocytes/Cancer Cells 4 0.261 0.000
Leucocytes/Cancer Cells 5 0.248 0.000
Thrombocytes/Cancer Cells 6 0.247 0.000
Lymphocytes/Cancer Cells 7 0.241 0.000
Segmented Neutrophils/Cancer Cells 8 0.229 0.000
Residual Nitrogen 9 -0.222 0.000
Monocytes/Cancer Cells 10 0.207 0.000
Hemorrhage Time 11 -0.201 0.000
Phase Transition Early---Invasive Cancer 12 -0.179 0.000
Stick Neutrophils/Cancer Cells 13 0.159 0.000
Chlorides 14 0.157 0.000
Eosinophils/Cancer Cells 15 0.144 0.000
Tumor Growth 16 -0.121 0.001
G1-3 17 -0.118 0.001
Erythrocytes 18 0.086 0.05
Glucose 19 0.085 0.05
Prothrombin Index 20 -0.081 0.05
Localization 21 0.079 0.05
Weight 22 0.076 0.05
RESULTS OF KOHONEN SELF-ORGANIZING NEURAL NETWORKS COMPUTING IN PREDICTION OF ESOPHAGEAL CANCER PATIENTS SURVIVAL AFTER COMPLETE ESOPHAGOGASTRECTOMIES (N=370):
ESOPHAGEAL CANCER DYNAMICS:
PROGNOSTIC SEPATH-MODEL OF ESOPHAGEAL CANCER PATIENTS SURVIVAL AFTER COMPLETE
ESOPHAGOGASTRECTOMIES (N=370):
5-YEAR SURVIVAL OF ESOPHAGEAL CANCER PATIENTS AFTER RADICAL PROCEDURES SIGNIFICANTLY DEPENDED ON: 1) PHASE TRANSITION “EARLY-INVASIVE CANCER”; 2) PHASE TRANSITION N0--N12; 3) CELL RATIO FACTORS; 4) BLOOD CELL CIRCUIT; 5) BIOCHEMICAL FACTORS; 6) HEMOSTASIS SYSTEM; 7) ADJUVANT CHEMOTHERAPY; 8) TUMOR CHARACTERISTICS AND
LOCALIZATION.
Conclusion:
ADDRESS:
OLEG KSHIVETS, M.D.,PH.D.
CONSULTANT THORACIC, ABDOMINAL, GENERAL SURGEON & SURGICAL ONCOLOGIST