A119 CLINICAL MANAGEMENT OF PATIENTS WITH COLORECTAL INTRAMUCOSAL CARCINOMA COMPARED TO HIGH-GRADE DYSPLASIA AND T1 COLORECTAL CANCER
Notice bibliographique
Résumé
Abstract Background In the colorectum, intramucosal carcinoma (IMC), like high-grade dysplasia (HGD), should be resected endoscopically. Aims We were interested to understand how real-world treatment of IMC cases compares to the management of HGD and T1 colorectal cancer (CRC). Methods A multicenter retrospective cohort study was conducted. Through pathology databases, all patients diagnosed between 2010 and 2019 with HGD, IMC or T1 CRC were identified. Pathology and endoscopy reports were verified for HGD, IMC or T1 CRC polyps. The primary outcome was the proportion of surgical management of IMC compared to HGD and T1 cancer. Secondary outcomes were the adjusted odds ratios (OR) for surgical management, proportions of synchronous advanced neoplasia, and adjusted hazard ratios (HR) for metachronous advanced neoplasia. Results We identified 455 patients with follow-up endoscopy and pathology (mean age 67.1y, 42.2% female, median follow-up 3.4y): 269 with HGD, 60 with IMC, 126 with T1 CRC. Compared to patients with HGD, patients with IMC were significantly more likely to receive a CT of the abdomen despite a complete endoscopic resection (52.6% vs 13.2%, p<0.001). Surgery rates were 15.2% for HGD, 36.7% for IMC and 84.1% for T1 CRC (p<0.001). When evaluating reasons for surgery, patients with IMC were more likely to undergo unnecessary surgery after a complete endoscopic resection compared to patients with HGD (22.7% of surgical resection reasons in IMC group vs 0% in HGD group, p<0.001). After adjusting for select factors potentially affecting the decision for surgical management and that differed between groups (age, family history of CRC, lesion location, size and morphology, multiplicity of synchronous lesions, colonoscopy indication/context), the adjusted odds of surgery remained significantly higher in patients with IMC compared to HGD (OR 2.62 [1.18-5.85]). Proportions of synchronous advanced neoplasia were 24.2% for HGD, 26.7% for IMC and 25.4% for T1 CRC (p=0.908). The proportion of metachronous advanced neoplasia was 26.8% in the HGD group, 18.3% in the IMC group and 20.6% in the T1 CRC group (p=0.227). Compared to HGD, patients with IMC and T1 CRC had similar adjusted metachronous advanced neoplasia risks (respectively, HR 0.82 [0.43-1.59] and HR 1.16 [0.66-2.05]). No lymph nodes were positive (0/363) and no metastasis occurred among patients with IMC. Conclusions Patients diagnosed with colorectal IMC are more likely to receive imaging and surgery than when HGD is diagnosed, although they are not at increased risk of synchronous advanced neoplasia, metachronous advanced neoplasia, lymph node involvement or metastasis. Labeling colorectal lesions as IMC is associated with unnecessary surgical resections. Funding Agencies TRIANGLE
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».