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Post-operative anastomotic leakage and collagen changes in patients with rectal cancer undergoing neoadjuvant chemotherapy vs chemoradiotherapy

BACKGROUND: A significant difference in the anastomotic leakage (AL) rate has been observed between patients with locally advanced rectal cancer who have undergone preoperative chemotherapy and those undergoing preoperative chemoradiotherapy. This study aimed to quantitatively analyse collagen struc...

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Autores principales: Jiang, Wei, Wang, Huaiming, Zheng, Jixiang, Zhao, Yandong, Xu, Shuoyu, Zhuo, Shuangmu, Wang, Hui, Yan, Jun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9619829/
https://www.ncbi.nlm.nih.gov/pubmed/36324613
http://dx.doi.org/10.1093/gastro/goac058
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author Jiang, Wei
Wang, Huaiming
Zheng, Jixiang
Zhao, Yandong
Xu, Shuoyu
Zhuo, Shuangmu
Wang, Hui
Yan, Jun
author_facet Jiang, Wei
Wang, Huaiming
Zheng, Jixiang
Zhao, Yandong
Xu, Shuoyu
Zhuo, Shuangmu
Wang, Hui
Yan, Jun
author_sort Jiang, Wei
collection PubMed
description BACKGROUND: A significant difference in the anastomotic leakage (AL) rate has been observed between patients with locally advanced rectal cancer who have undergone preoperative chemotherapy and those undergoing preoperative chemoradiotherapy. This study aimed to quantitatively analyse collagen structural changes caused by preoperative chemoradiotherapy and illuminate the relationship between collagen changes and AL. METHODS: Anastomotic distal and proximal “doughnut” specimens from the Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) were quantitatively assessed for collagen structural changes between patients with and without preoperative radiotherapy using multiphoton imaging. Then, patients treated with preoperative chemoradiotherapy were used as a training cohort to construct an AL–SVM classifier by the Mann–Whitney U test and support vector machine (SVM). An independent test cohort from the Fujian Province Cancer Hospital (Fuzhou, China) was used to validate the AL–SVM classifier. RESULTS: A total of 207 patients were included from the Sixth Affiliated Hospital of Sun Yat-sen University. The AL rate in the preoperative chemoradiotherapy group (n = 107) was significantly higher than that in the preoperative chemotherapy group (n = 100) (21.5% vs 7.0%, P = 0.003). A fully quantitative analysis showed notable morphological and spatial distribution feature changes in collagen in the preoperative chemoradiotherapy group. Then, the patients who received preoperative chemoradiotherapy were used as a training cohort to construct the AL–SVM classifier based on five collagen features and the tumor distance from the anus. The AL–SVM classifier showed satisfactory discrimination and calibration with areas under the curve of 0.907 and 0.856 in the training and test cohorts, respectively. CONCLUSIONS: The collagen structure may be notably altered by preoperative radiotherapy. The AL–SVM classifier was useful for the individualized prediction of AL in rectal cancer patients undergoing preoperative chemoradiotherapy.
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spelling pubmed-96198292022-11-01 Post-operative anastomotic leakage and collagen changes in patients with rectal cancer undergoing neoadjuvant chemotherapy vs chemoradiotherapy Jiang, Wei Wang, Huaiming Zheng, Jixiang Zhao, Yandong Xu, Shuoyu Zhuo, Shuangmu Wang, Hui Yan, Jun Gastroenterol Rep (Oxf) Original Article BACKGROUND: A significant difference in the anastomotic leakage (AL) rate has been observed between patients with locally advanced rectal cancer who have undergone preoperative chemotherapy and those undergoing preoperative chemoradiotherapy. This study aimed to quantitatively analyse collagen structural changes caused by preoperative chemoradiotherapy and illuminate the relationship between collagen changes and AL. METHODS: Anastomotic distal and proximal “doughnut” specimens from the Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) were quantitatively assessed for collagen structural changes between patients with and without preoperative radiotherapy using multiphoton imaging. Then, patients treated with preoperative chemoradiotherapy were used as a training cohort to construct an AL–SVM classifier by the Mann–Whitney U test and support vector machine (SVM). An independent test cohort from the Fujian Province Cancer Hospital (Fuzhou, China) was used to validate the AL–SVM classifier. RESULTS: A total of 207 patients were included from the Sixth Affiliated Hospital of Sun Yat-sen University. The AL rate in the preoperative chemoradiotherapy group (n = 107) was significantly higher than that in the preoperative chemotherapy group (n = 100) (21.5% vs 7.0%, P = 0.003). A fully quantitative analysis showed notable morphological and spatial distribution feature changes in collagen in the preoperative chemoradiotherapy group. Then, the patients who received preoperative chemoradiotherapy were used as a training cohort to construct the AL–SVM classifier based on five collagen features and the tumor distance from the anus. The AL–SVM classifier showed satisfactory discrimination and calibration with areas under the curve of 0.907 and 0.856 in the training and test cohorts, respectively. CONCLUSIONS: The collagen structure may be notably altered by preoperative radiotherapy. The AL–SVM classifier was useful for the individualized prediction of AL in rectal cancer patients undergoing preoperative chemoradiotherapy. Oxford University Press 2022-10-31 /pmc/articles/PMC9619829/ /pubmed/36324613 http://dx.doi.org/10.1093/gastro/goac058 Text en © The Author(s) 2022. Published by Oxford University Press and Sixth Affiliated Hospital of Sun Yat-sen University https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Article
Jiang, Wei
Wang, Huaiming
Zheng, Jixiang
Zhao, Yandong
Xu, Shuoyu
Zhuo, Shuangmu
Wang, Hui
Yan, Jun
Post-operative anastomotic leakage and collagen changes in patients with rectal cancer undergoing neoadjuvant chemotherapy vs chemoradiotherapy
title Post-operative anastomotic leakage and collagen changes in patients with rectal cancer undergoing neoadjuvant chemotherapy vs chemoradiotherapy
title_full Post-operative anastomotic leakage and collagen changes in patients with rectal cancer undergoing neoadjuvant chemotherapy vs chemoradiotherapy
title_fullStr Post-operative anastomotic leakage and collagen changes in patients with rectal cancer undergoing neoadjuvant chemotherapy vs chemoradiotherapy
title_full_unstemmed Post-operative anastomotic leakage and collagen changes in patients with rectal cancer undergoing neoadjuvant chemotherapy vs chemoradiotherapy
title_short Post-operative anastomotic leakage and collagen changes in patients with rectal cancer undergoing neoadjuvant chemotherapy vs chemoradiotherapy
title_sort post-operative anastomotic leakage and collagen changes in patients with rectal cancer undergoing neoadjuvant chemotherapy vs chemoradiotherapy
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9619829/
https://www.ncbi.nlm.nih.gov/pubmed/36324613
http://dx.doi.org/10.1093/gastro/goac058
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