Language：Japanese   Publisher：(公社)神奈川県医師会  

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

Abstract

Aim

Lymph node metastasis is an adverse prognostic factor in pancreatic ductal adenocarcinoma. However, it remains a challenge to predict lymph node metastasis using preoperative imaging alone. We used machine learning (combining preoperative imaging findings, tumor markers, and clinical information) to create a novel prediction model for lymph node metastasis in resectable pancreatic ductal adenocarcinoma.

Methods

The data of patients with resectable pancreatic ductal adenocarcinoma who underwent surgery between September 1991 and October 2022 were retrospectively examined. Machine‐learning software (Statistical Package for the Social Sciences Modeler) was used to create a prediction model, and parameter tuning was performed to improve the model's accuracy. We also analyzed the contribution of each feature to prediction using individual conditional expectation and partial dependence plots.

Results

Of the 331 cases included in the study, 241 comprised the training cohort and 90 comprised the test cohort. After parameter tuning, the areas under the receiver operating characteristic curves for the training and test cohorts were 0.780 and 0.795, respectively. Individual conditional expectation and partial dependence plots showed that larger tumor size and carbohydrate antigen 19–9 and Duke pancreatic monoclonal antigen type 2 levels were associated with positive lymph node metastasis prediction in this model; neoadjuvant treatment was associated with negative lymph node metastasis prediction.

Conclusion

Machine learning may contribute to the creation of an effective predictive model of lymph node metastasis in pancreatic ductal adenocarcinoma. Prediction models using machine learning may contribute to the development of new treatment strategies in resectable pancreatic ductal adenocarcinoma.

DOI： 10.1002/ags3.12836

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：Japanese   Publisher：日本臨床外科学会  

症例は36歳,男性.海外出張中に,左側腹部痛を主訴に前医へ搬送された.上腸間膜動脈血栓症と診断され,精査されたが原因不明であった.腹痛は軽快傾向であったため,高血圧に対して降圧治療をされ帰国した.しかし,疼痛が持続していたため当院を受診した.腹部造影CTでは上腸間膜動脈解離,左結腸動脈瘤と周囲の血腫を認めた.下腸間膜動脈の血管造影では脾彎曲の辺縁動脈の動脈瘤と,口側に連続する不整な血管拡張を認めた.腸管虚血の可能性が高いことから動脈塞栓(transcatheter arterial embolization;以下,TAE)は施行せず,準緊急手術を行う方針とした.術中所見では腹腔内出血を認め,脾彎曲近傍では腸間膜,後腹膜に広範に血腫を認めた.腹腔鏡下に脾彎曲の授動を行い,腸間膜内血腫のため小開腹創から切除範囲を決定し結腸左半切除術とした.病理診断は分節性動脈中膜融解症(segmental arterial mediolysis;以下,SAM)であった.上腸間膜動脈解離は保存的加療を行い,1ヵ月後には偽腔の血栓化を認めた.SAMによる左結腸動脈瘤破裂に対して腹腔鏡補助下手術を施行した1例を経験したので報告する.(著者抄録)

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：神奈川県医師会  

J-GLOBAL

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Language：Japanese   Publisher：The Japan Society of Coloproctology  

DOI： 10.3862/jcoloproctology.65.294

CiNii Books

J-GLOBAL

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Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Books

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Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Books

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