Maruyama computer program

To evaluate the accuracy of the computer program, the differences between the individual reports generated by the computer and the stored data were investigated in Italian patients submitted to curative gastrectomy and D2 or more extended LN dissections for gastric cancer.

Receiver operating characteristic ROC analysis was used to assess the sensitivity and specificity of the program for predicting LN metastases in each of the 16 regional LN stations. The computer program showed good predictive ability for LN metastases in most of the 16 LN stations, as the areas under the curve ranged from 0. Based on these data, the program predicts with good accuracy the extent of LN metastases from gastric cancer, but it is not recommended for directing the surgeon to perform more extensive lymphadenectomy.

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Bookmark this article. You can see your Bookmarks on your DeepDyve Library. Sign Up Log In. Global cancer statistics. CA Cancer J Clin. Comparative epidemiology of gastric cancer between Japan and China. World J Gastroenterol. Cancer Control. Cancer statistics, Cancer of the Stomach. The Japanese guidelines for gastric cancer screening. Jpn J Clin Oncol. Gastric cancer screening in Korea: Report on the national cancer screening program in Cancer Res Treat.

Detection of early gastric cancer: Misunderstanding the role of mass screening. Gastric Cancer. Changes in clinicopathological features and survival after gastrectomy for gastric cancer over a year period. Br J Surg. J Natl Cancer Inst. Prevention of gastric cancer by Helicobacter pylori eradication. Intern Med. Kajitani T. The general rules for the gastric cancer study in surgery.

Jpn J Surg. Japanese classification of gastric carcinoma. Japanese Gastric Cancer Association. Sano T, Aiko T. New Japanese classifications and treatment guidelines for gastric cancer: Revision concepts and major revised points. Japanese gastric cancer treatment guidelines ver. Progress in gastric cancer surgery in Japan and its limits of radicality.

World J Surg. Computer analysis in making preoperative decisions: A rational approach to lymph node dissection in gastric cancer patients. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Gastric cancer diagnosis and treatment - an interactive training program.

Berlin: Springer Electronic Media; Evaluation of the Maruyama computer program accuracy for preoperative estimation of lymph node metastases from gastric cancer. Hospital volume and surgical mortality in the United States.

N Engl J Med. Factors influencing the volume-outcome relationship in gastrectomies: A population-based study. Ann Surg Oncol. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. Predictors of operative morbidity and mortality in gastric cancer surgery.

Gastric cancer surgery: Morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy—Japan Clinical Oncology Group study J Clin Oncol. Complications of gastrectomy following CPTbased neoadjuvant chemotherapy for gastric cancer. J Gastrointest Surg. American Joint Committee on Cancer. New York, NY: Springer; Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: Data from a large US-population database.

How many nodes must be examined to accurately stage gastric carcinomas? Results from a population based study. Inadequate documentation and resection for gastric cancer in the United States: A preliminary report.

Am Surg. Treatment of gastric adenocarcinoma may differ among hospital types in the United States, a report from theNational Cancer Data Base. Ann Surg. Gunderson LL, Sosin H. Adenocarcinoma of the stomach: Areas of failure in a re-operation series second or symptomatic look clinicopathologic correlation and implications for adjuvant therapy.

Patterns of initial recurrence in completely resected gastric adenocarcinoma. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. Patient survival after D1 and D2 resections for gastric cancer: Long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Methods: A total of 23 patients were enrolled in the study. The Maruyama computer program was used to determine the most likely first metastatic site.

These results were compared with the actual staining patterns to evaluate whether the first draining LN was extracted. The NPV was The accuracy was We evaluated the accuracy of MCP for the first tier lymph nodes, owing to the low value of the area under the ROC curve in stations 9, 10, and However, the accuracy and the statistical features sensitivity, specificity, PPV, NPV did not change, because patients with false-negative second-tier lymph nodes had false-negative lymph nodes in the first tier also.

In these patients the specificity and NPV could not be defined, owing to the lack of sentinel node-negative patients. There were no side-effects of the blue dye mapping. The postoperative period was uneventful in all the 40 patients, without any surgical or nonsurgical complications.

Dutch and British prospective randomized trials found higher morbidity and mortality rates in patients with gastric cancer following extended lymph node dissection when compared with findings for those who underwent D1 dissection only [ 4 , 5 ].

Forty percent of Western European patients with R0 resection have an unnecessary extended lymph node dissection [ 3 ].

Preoperative diagnostic tools have low sensitivity and specificity for defining the patient subpopulations which would and which would not benefit from an extended lymph node dissection. The sensitivity, specificity, and accuracy of spiral computed tomography for the detection of pathological lymph node involvement are The real problem of these imaging procedures is that they look only at the size of lymph nodes; however, metastases can be found in small nodes as well, and conversely, large nodes may be metastasis-free.

To overcome this problem, the Maruyama computer model was developed, and it was first described in the English-language literature in [ 7 ]. In Italian patients the accuracy was The false-positive rate was close to that in the German patients, but the false-negative rate was higher [ 22 ]. Better prediction of lymph node metastases may be feasible with an artificial neural network ANN using the following parameters: Bormann classification, depth of tumor infiltration, size, location of tumor, and lymph node metastases in station 3.

These studies demonstrate that, even if the sensitivity and the NPV are high, the specificity and the PPV of the Maruyama model may be low. Still, the results of the computerized prediction of LN metastases are superior to those of radiological estimation techniques.

A meta-analysis of SLN mapping has shown a high detection rate A single comparative study SNB vs. MCP from Germany has proven SNB to be of higher clinical relevance than the Maruyama computer model for predicting nodal status and compartimental involvement [ 25 ].

Although it is difficult to draw definitive conclusions in our prospective comparative study, owing to the small size of the series, we demonstrated a degree of reliability of MCP similar to that in the cited studies, with We detected SLNs in The false-negative rate was 4. We are planning to carry out reduced lymphadenectomy in SLN-negative patients in the near future, according to the internationally accepted guidelines.

As to the clinical meaning of the equivalence range 0. However, the point estimate is at a relative sensitivity of 0. The analysis of other indicators produced no conclusive results, as the confidence intervals for the indicator ratios included values both inside and outside the equivalence range.

It is generally accepted that metastases in SLNs indicate the need for a D2 lymphadenectomy. We analyzed the relevance of MCP in sentinel node-positive patients. Unfortunately, in this cohort of patients, the accuracy of MCP was low in the prediction of lymph node involvement in stations 7— So, it would be interesting in the future to find an appropriate technique that combines the sentinel node status and the results of MCP for determining the adequate extension of lymphadenectomy.

In summary, our comparative study showed a lower clinical impact of the MCP compared with that of SNB; however, using these two methods in a parallel fashion could be useful in preoperative decision-making for determining the appropriate extent of lymphadenectomy and individualized stage-adapted surgery in gastric cancer.

The efficiency of MCP in the cohort of sentinel node-positive patients requires further evaluation. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg. Significant prognostic factors by multivariate analysis of gastric cancer patients. World J Surg. PubMed Article Google Scholar. Biologic predictors of survival in node-negative gastric cancer.

PubMed Google Scholar. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in Dutch patients. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer. Randomized comparison of R1 and R2 gastrectomy for gastric carcinoma.