Alessandro Cucchetti

Alessandro Cucchetti
  • MD
  • Professor (Assistant) at University of Bologna

About

552
Publications
76,550
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
18,421
Citations
Introduction
Alessandro Cucchetti is an assistant professor of surgery (RTD-B) at the Department of Medical and Surgical Sciences - DIMEC of the University of Bologna, Italy. He currently work at the Morgagni - Pierantoni Hospital, located in Forlì. His main fields of interest are represented by HPB surgery, transplantation, dynamics of primary and secondary liver cancers, pancreatic surgery, surveillance programs, cognitive tasks in medical decision making and statistical analysis. The h-index (November 2018) is 40 (Scopus ID: 6602432201)
Current institution
University of Bologna
Current position
  • Professor (Assistant)
Additional affiliations
July 2018 - present
Azienda Unità Sanitaria Locale Forlì
Position
  • Researcher
December 2007 - June 2018
Policlinico S.Orsola-Malpighi
Position
  • Researcher
January 2001 - present
University of Bologna
Position
  • Researcher
Education
September 1995 - March 2001
University of Bologna
Field of study

Publications

Publications (552)
Article
Introduction Nodal metastases (LNM) are one of the major determinants of prognosis following surgery for intrahepatic cholangiocarcinoma (ICC). Previous studies investigating the correlation between clinical-radiological features and the probability of LNM include patients undergoing inadequate nodal sampling. Aim of this study was to develop a mod...
Article
Full-text available
Intraperitoneal prophylactic drain (IPD) use in distal pancreatectomy (DP) is still controversial. A survey was carried out through the Italian community of pancreatic surgeons using institutional emails, Twitter, and Facebook accounts of the Italian Association for the Study of the Pancreas (AISP) and the Italian Association of Hepato-biliary-panc...
Article
Background Transarterial radioembolization (TARE) is an effective treatment to control tumor growth and improve survival in hepatocellular carcinoma (HCC). The role of TARE in downstaging patients to liver transplantation (LT) is unclear. The aim of this study was to investigate the downstaging efficacy of TARE for intermediate and advanced HCC. M...
Article
Full-text available
Purpose Transarterial radioembolization (TARE) has emerged as a promising therapeutic approach for unresectable intrahepatic cholangiocarcinoma (ICCA). We updated our previous meta-analysis with meta-regression to explore the efficacy of TARE in the context of ICCA. Methods We searched PubMed and Scopus for studies published up to September 1, 202...
Article
Importance There are currently no clinically relevant criteria to predict a futile up-front pancreatectomy in patients with anatomically resectable pancreatic ductal adenocarcinoma. Objectives To develop a futility risk model using a multi-institutional database and provide unified criteria associated with a futility likelihood below a safety thre...
Article
For many tumors, radiomics provided a relevant prognostic contribution. This study tested whether the computed tomography (CT)-based textural features of intrahepatic cholangiocarcinoma (ICC) and peritumoral tissue improve the prediction of survival after resection compared with the standard clinical indices. All consecutive patients affected by IC...
Article
Background: Endoscopic full-thickness resection (EFTR) is an effective and safe technique for non-lifting colorectal lesions. Technical issues or failures with full-thickness resection device (FTRD) system are reported but there are no data about their details. The aim of our study was to quantify and classify FTRD technical failures. Patients an...
Article
Full-text available
The use of lymphadenectomy (LND) during resection of intrahepatic cholangiocarcinoma (ICC) is still debated, leading to differing practices in different centers and countries. The aim of this study was to assess such differences. A survey on LND for ICC was distributed to the members of the International Hepato-PancreatoBiliary Association (IHPBA)...
Article
Full-text available
The REDISCOVER guidelines present 34 recommendations for the selection and perioperative care of borderline-resectable (BR-PDAC) and locally advanced ductal adenocarcinoma of the pancreas (LA-PDAC). These guidelines represent a significant shift from previous approaches, prioritizing tumor biology over anatomical features as the primary indication...
Article
Full-text available
Intraperitoneal prophylactic drain (IPD) use in pancreaticoduodenectomy (PD) is still controversial. A survey was designed to investigate surgeons’ use of IPD in PD patients through 23 questions and one clinical vignette. For the clinical scenario, respondents were asked to report their regret of omission and commission regarding the use of IPD eli...
Article
Background & Aims Metabolic syndrome (MS) is a growing epidemic and a risk factor for the development of hepatocellular carcinoma (HCC). This study investigated the long-term outcomes of liver resection (LR) for HCC in patients with MS. Rates, timing, patterns, and treatment of recurrences were investigated, and cancer-specific survivals were asses...
Article
Background: Pancreatic cancer (PC) has a 5-year survival of 12% despite recent therapeutic advancements. There is a desperate need to discover novel ways of treating PC since a large proportion of patients do not benefit from therapy and experience significant toxicity. A major cause of therapy failure is therapy resistance due to tumor heterogenei...
Article
Background and study aim: EUS-guided hepaticogastrostomy (EUS-HGS) is a valid option for EUS-guided biliary drainage that has been increasingly used in the last decade. The aims of the study were to provide a systematic review with meta-analysis and meta-regression of features and outcomes of this procedure. Methods: MEDLINE, Scopus, Web-of-Scie...
Article
Full-text available
Objective The REDISCOVER consensus conference aimed at developing and validate guidelines on the perioperative care of patients with borderline resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC). Summary Background Data Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic...
Article
Objective To assess the probability of being cured from pancreatic ductal adenocarcinoma (PDAC) by pancreatic surgery. Summary Background Data Statistical cure implies that a patient treated for a specific disease will have the same life expectancy as if he/she never had that disease. Methods Patients who underwent pancreatic resection for PDAC b...
Article
Full-text available
Simple Summary Intrahepatic cholangiocarcinoma is a disease with increasing incidence and poor prognosis. The clinicians have a limited capability to predict tumor behavior because the strongest predictors of survival are the pathology data that, unfortunately, can be determined only after surgery. Recently, radiomics, i.e., the mathematical analys...
Article
Full-text available
Direct endoscopic necrosectomy (DEN) is a challenging procedure for the debridement of walled-off pancreatic necrosis (WOPN), which may be complicated by several adverse events, primarily bleeding which may require radiological embolization or even surgery. The lack of dedicated devices for this purpose largely affects the possibility of safely per...
Article
Advances in the surgical and systemic therapeutic landscape of hepatocellular carcinoma have increased the complexity of patient management. A dynamic adaptation of the available staging-based algorithms is required to allow flexible therapeutic allocation. In particular, real-world hepatocellular carcinoma management increasingly relies on factors...
Article
Background: Despite second-line transplant(SLT) for recurrent hepatocellular carcinoma(rHCC) leads to the longest survival after recurrence(SAR), its real applicability has never been reported. The aim was to compare the SAR of SLT versus repeated hepatectomy and thermoablation(CUR group). Methods: Patients were enrolled from the Italian registe...
Article
Background: Pancreatic surgery is characterized by high morbidity and mortality. Biliary colonization may affect clinical outcomes in these patients. Aims: This study aimed to verify whether bacteriobilia and multidrug resistance (MDR) detected during and after pancreatic surgery may have an impact on post-operative outcomes. Methods: Data fro...
Article
Background: When treating potentially resectable pancreatic adenocarcinoma, therapeutic decisions are left to the sensibility of treating clinicians who, faced with a decision that post hoc can be proven wrong, may feel a sense of regret that they want to avoid. A regret-based decision model was applied to evaluate attitudes toward neoadjuvant the...
Article
Purpose: Textbook Outcome (TO) is inclusive of quality indicators and it not been provided for trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Materials and methods: Data on treatment-naïve HCC patients receiving TACE from 10 centers were reviewed. TO was defined as "no post-TACE grade 3-4 complications, no prolonged...
Article
Full-text available
Background Treatment of hepatocellular carcinoma (HCC) is predicated on early diagnosis such that ‘curative therapies’ can be successfully applied. The term ‘curative’ is, however, poorly quantitated. We aimed to complement our previous work by developing a statistical model to predict cure after ablation and to use this analysis to compare the tru...
Article
579 Background: Atezolizumab plus bevacizumab and lenvatinib have not been compared in a randomized controlled trial. We conducted a retrospective multi-center study to compare the clinical efficacy and safety of lenvatinib and atezolizumab with bevacizumab as a first-line treatment for patients with unresectable HCC in the real-world scenario. Met...
Article
Importance Clear indications on how to select retreatments for recurrent hepatocellular carcinoma (HCC) are still lacking. Objective To create a machine learning predictive model of survival after HCC recurrence to allocate patients to their best potential treatment. Design, Setting, and Participants Real-life data were obtained from an Italian r...
Article
Full-text available
Simple Summary Pancreatic cancer is still burdened with a severe prognosis, despite advances in the diagnosis and surgical management of this disease. The gut microbiome is gaining increasing interest in the development and management in this setting. The intent of our review is to provide a comprehensive review for researchers and clinicians in th...
Article
Full-text available
Background: Transarterial Radioembolisation (TARE) requires multidisciplinary experience and skill to be effective. The aim of this study was to identify determinants of survival in patients with hepatocellular carcinoma (HCC), focusing on learning curves, technical advancements, patient selection and subsequent therapies. Methods: From 2005 to...
Article
Background: This cross-sectional survey aimed to determine whether fluorescence cholangiography using indocyanine green (ICG-FC) can improve the detection of the cystic duct and the main bile duct during laparoscopic cholecystectomy (LC). Methods: The survey was distributed to 214 surgeons (residents/faculties) in 2021. The confidence in the ident...
Article
Full-text available
Background The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey , a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on...
Article
Background: We sought to provide a meta-analysis and credibility assessment of available randomized controlled trials and propensity score matched studies when assessing early and oncologic outcomes of laparoscopic distal pancreatectomy compared with open distal pancreatectomy. Methods: The MEDLINE, Scopus, Web of Science, and Cochrane databases...
Article
Background and aims Atezolizumab plus bevacizumab and lenvatinib have not been compared in a randomized controlled trial. We conducted a retrospective multi-center study to compare the clinical efficacy and safety of lenvatinib and atezolizumab with bevacizumab as a first-line treatment for patients with unresectable HCC in the real-world scenario....
Article
Full-text available
Surgery of the gastrointestinal tract can result in deep changes among the gut commensals in terms of abundance, function and health consequences. Elective colorectal surgery can occur for neoplastic or inflammatory bowel disease; in these settings, microbiota imbalance is described as a preoperative condition, and it is linked to post-operative co...
Article
Full-text available
To evaluate the effect of patient blood management (PBM) since its introduction, we analyzed the need for transfusion and the outcomes in patients undergoing abdominal surgery for different types of tumor pre- and post-PBM. Patients undergoing elective gastric, liver, pancreatic, and colorectal surgery between 2017 and 2020 were included. The imple...
Article
Background & aims: Lymph nodal status is an important predictor of survival in intrahepatic cholangiocarcinoma (ICC), but the need to perform lymphadenectomy in clinically node-negative (cN0) patients is still under debate. Aim of this study is to determine whether adequate lymphadenectomy improves long-term outcomes in cN0 patients undergoing liv...
Article
Background: Acute cholecystitis (AC) is largely diffused among population worldwide. Laparoscopic cholecystectomy is the treatment of choice. Current evidence suggests a clinical benefit of early cholecystectomy. The aim of the present study was to evaluate the different "timing" ("early" vs. "delayed" cholecystectomy), through the application of...
Article
Full-text available
Background Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontr...
Article
Full-text available
Following the publication of the original article [1], the author name “Dragos Serban” under The WSES COVID-19 emergency surgery survey collaboration group was incorrectly written as “Dragos Seban” instead of “Dragos Serban”. The original article has been corrected.
Article
Objective: To evaluate the effect of a liver transplantation (LT) program on the outcomes of resectable hepatocellular carcinoma (HCC). Summary background data: Surgical treatment of HCC includes both hepatic resection (HR) and LT. However, the presence of cirrhosis and the possibility of recurrence make the management of this disease complex an...
Article
Full-text available
Background and aims Transmural EUS-guided gallbladder drainage (EUS-GBD) has been increasingly used in the treatment of gallbladder diseases. Aims of the study were to provide a comprehensive meta-analysis and meta-regression of features and outcomes of this procedure. Methods MEDLINE, Scopus, Web of science, and Cochrane databases were searched f...
Article
Full-text available
Background Although gallstone disease increases with aging, elderly patients are less likely to undergo cholecystectomy. This is because age itself is a negative predictor after cholecystectomy. The ACS-NSQIP risk calculator can therefore help surgeons decide whether to operate or not. However, little is known about the accuracy of this model outsi...
Preprint
Full-text available
Purpose The effect size between total pancreatectomy (TP) over pancreatico-duodenectomy (PD) remains not well established due to the lack of high-level evidences. Aim of the study was to evaluate the average treatment effect on the patients treated (ATT) with PD in the case they received TP. Methods A reweighting scheme was applied to 202 TPs pati...
Article
Introduction Meta-analyses of randomized controlled trials (RCTs) provide the highest level of evidence but can suffer from type I (false-positive) and II (false-negative) errors, which can be estimated through trial sequential analysis (TSA) demonstrating eventual credibility of results. Aim of the study was to establish through TSA which strategy...
Article
Background Benchmark analysis for open liver surgery for cirrhotic patients with hepatocellular carcinoma (HCC) is still undefined. Methods Patients were identified from the Italian national registry HE.RC.O.LE.S. The Achievable Benchmark of Care(ABC) method was employed to identify the benchmarks. The outcomes assessed were the rate of complicati...
Article
Full-text available
Background/purpose: Quality measures in surgery are important to establish appropriate levels of care and to develop improvement strategies. Purpose of this study was to provide risk-adjusted outcome measures after laparoscopic liver resection (LLR). Methods: data from a prospective, multicenter database involving 4318 patients submitted to LLRs...
Article
Biliary tract cancer's (BTC) treatment main stone for advanced stages is constituted by chemotherapy. Surgical centralization and physicians' confidence in the use of new technologies and molecular analysis turned out to be of interest and potentially influencing survival. After applying a random-effect model, the relationship between each clinical...
Article
Full-text available
Recent evidence regarding microbiota is modifying the cornerstones on pathogenesis and the approaches to several gastrointestinal diseases, including biliary diseases. The burden of biliary diseases, indeed, is progressively increasing, considering that gallstone disease affects up to 20% of the European population. At the same time, neoplasms of t...
Article
Background We aimed to evaluate, in a large Western cohort, perioperative and long-term oncological outcomes of salvage hepatectomy (SH) for recurrent hepatocellular carcinoma (rHCC) after primary hepatectomy (PH) or locoregional treatments. Methods Data were collected from the Hepatocarcinoma Recurrence on the Liver Study Group (He.RC.O.Le.S.) It...
Article
Full-text available
Background Recently, three published phase III trials highlighted the superiority of investigational drugs compared to placebo, thus leading to their approval in the second-line setting. We report here a MAIC of second-line MKI options for patients with HCC previously treated with sorafenib using individual real-world data of regorafenib and aggreg...
Article
Full-text available
On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international an...
Article
Key messages • Liver disease is now the second leading cause of years of working life lost in Europe, after only ischaemic heart disease • The clinical focus in patients with liver disease is oriented towards cirrhosis and its complications, whereas early and reversible disease stages are frequently disregarded and overlooked • The dissociation be...
Article
Full-text available
Background Hepatocellular carcinoma (HCC) treatment remains a big challenge in the field of oncology. The liver disease (viral or not viral) underlying HCC turned out to be crucial in determining the biologic behavior of the tumor, including its response to treatment. The aim of this analysis was to investigate the role of the etiology of the under...
Article
Aim This study investigated how material deprivation in Italy influences the stage of hepatocellular carcinoma (HCC) at diagnosis and the chance of cure. Methods 4114 patients from the Italian Liver Cancer database consecutively diagnosed with HCC between January 2008 and December 2018 were analysed about severe material deprivation (SMD) rate ter...
Article
Full-text available
Background: In the last decades, there has been an exponential diffusion of minimally invasive liver surgery (MILS) worldwide. The aim of this study was to evaluate our initial experience of 100 patients undergoing MILS resection comparing their outcomes with the standard open procedures. Materials and methods: One hundred consecutive MILS from...
Article
Background: The therapeutic value of repeat hepatic resection (rHR) or radiofrequency ablation (RFA) for recurrent hepatocellular carcinoma (HCC) is unknown. This study aimed to investigate the safety and efficacy of rHR or RFA. Methods: This was a retrospective multicentre study of patients with recurrent HCC within the Milan criteria who under...
Article
Background and Aims Meta-analytic comparison of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) versus percutaneous gallbladder drainage (PT-GBD) for acute cholecystitis (AC) brings the risk of spurious results if too few studies are included. Trial sequential analysis (TSA) can overcome this, providing information about its credibility...
Article
Background The Textbook Outcome (TO) is a quality indicator accounting for both efficacy and safety. Herein, we aimed to assess TO in patients with hepatocellular carcinoma (HCC) undergoing percutaneous radiofrequency ablation (RFA). Methods All consecutive patients undergoing RFA for HCC between 2014 and 2020, were included. TO was defined as 1)...
Article
Full-text available
Hepatocellular carcinoma (HCC) with portal vein tumoral thrombosis (PVTT) represents a major concern especially in the field of deceased donor liver transplantation (DDLT). However, when receiving trans‐arterial radioembolization (TARE), a considerable percentage of such patients are able to obtain complete radiological response with adequate survi...
Article
Full-text available
Background & Aims The Pre-TACE-Predict model was devised to assess prognosis of patients treated with trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). However, before entering clinical practice, a model should demonstrate that it performs a useful role. Methods We performed an independent external validation of the Pre-T...
Article
Objectives: To evaluate the inter-observer reliability of modified Response Evaluation Criteria In Solid Tumours (mRECIST) of patients with hepatocellular carcinoma (HCC) undergoing neo-adjuvant treatments before liver transplant (LT). The agreement of tumor number, size, transplant criteria, and the radiological-pathological concordance were also...
Article
Full-text available
Background: Sarcopenia, defined as low muscle mass with reduced function, is frequently encountered in cirrhotic patients and is a major predictor of adverse events, including post-liver transplant (LT) outcome. Objectives: This study assessed the impact of sarcopenia using computed tomography (CT)-based measurements on post-LT mortality and compli...
Article
Full-text available
FOLFIRINOX (FFX) and gemcitabine + nab-paclitaxel (GN) are the most common chemotherapy regimens in first-line treatment of metastatic pancreatic cancer (PC). They have not been compared each other in a prospective trial, but only in retrospective studies, which can thus be affected by several biases. In order to overcome these biases, we took adva...
Article
BACKGROUND It has been demonstrated the link between malnutrition, immunological status and Hepatocarcinoma (HCC). The Prognostic Nutritional Index (PNI) has been recognized as prognostic indicator in early‐stage HCC and in patients treated with first line therapy. Nowadays, no data report the role of the PNI in HCC patients treated with regorafeni...
Article
Full-text available
Background and aims In patients with hepatocellular carcinoma (HCC), macrovascular invasion (MaVI) limits treatment options and decreases survival. Detailed data on the relationship between MaVI extension and patients' characteristics, and its impact on patients' outcome are limited. We evaluated the prevalence and extension of MaVI in a large coho...
Article
PurposeIntrahepatic cholangiocarcinoma (ICC) has a poor prognosis, when unresectable; therefore, intra-arterial therapies (IAT) such as trans-arterial chemoembolization (TACE) and trans-arterial radioembolization (TARE) have been employed. With the present systematic review and meta-analysis, we aimed to analyse published studies to understand if o...
Article
Introduction Bile leak (BL) after hepato-pancreato-biliary (HPB) surgery is associated with significant morbidity and mortality. Aim of this study was to evaluate effectiveness and safety of percutaneous transhepatic approach (PTA) to drainage BL after HPB surgery. Methods Between 2006-2018, consecutive patients who were referred to interventional...
Article
Background: Atezolizumab plus bevacizumab showed superior progression-free and overall survival compared to sorafenib in the IMbrave150 trial. It would therefore be useful to compare the efficacy of lenvatinib and that of atezolizumab plus bevacizumab to determine if a benefit of one therapy against the other exists. Objective: The aim of the pr...
Article
Purpose: Data from common clinical practice were used to generate balanced cohorts of patients receiving either sorafenib or lenvatinib, for unresectable hepatocellular carcinoma, with the final aim to investigate their declared equivalence. Methods: Clinical features of lenvatinib and sorafenib patients were balanced through inverse probability...
Article
Full-text available
We externally validated the fatty liver index (FLI), the lipid accumulation product (LAP), the hepatic steatosis index (HSI), and the Zhejiang University index (ZJU) for the diagnosis of fatty liver (FL) and non-alcoholic fatty liver disease (NAFLD) in the general population. The validation was performed on 2159 citizens of the town of Bagnacavallo...

Questions

Questions (13)
Question
Dear reader.
We would like to try to translate a method commonly used in ecology in a specific field of medicine. We believe that MARK software can be sutiable and we would like to use it for repeated observations during a screening program for cancer detection.
Is there anyone out there who has a good experience with this model and has the mind open enough to be able to perceive its applicability outside of ecology?
Best wishes
Question
Complications related to viral hepatitis, alcohol-related and non-alcoholic liver disease, are the main reason for seeking gastroenterologists and hepatologists advice. In addition, hepatocellular carcinoma often arise on the ground of hepatitis, representing the fifth most common cancer in men and the ninth in women. In 2015, the World Health Organization estimated that 325 million people were living with chronic hepatitis infections (hepatitis B or C) worldwide and that globally, 1.34 million people died of viral in 2015.
In front of this global health problem, gastroenterologists, hepatologists and hepato-biliary-pancreatic (HBP) surgeons, are daily involved in the clinical routine in taking difficult clinical decisions. As Sir William Osler quoted: “medicine is a science of uncertainty and an art of probability” and no doctor returns home from a busy day at the hospital without the nagging feeling that some of his/her diagnoses may turn out to be wrong, or some treatments may not lead to the expected cure. Probability is a recurring theme in medical practice and the ability of dealing with risk and uncertainty can be elicited through a special kind of intelligence. In 2012, The UK psychologist Dylan Evans defined it as “risk-intelligence” that is "a special kind of intelligence for thinking about risk and uncertainty", at the core of which is the ability to estimate probabilities accurately.  
Consequently, doctors are routinely asked to make predictions, and their predictions would lead to a consistent payoff when regarding a patient’s life. At the basis of “wise” medical decisions, physician’s experience surely plays a vital role. However, doctors can assume that their competency in a given area can be significantly higher than it really is. Such illusory superiority, is described as the Dunning – Kruger effect, a meta-cognitive bias leading to a discrepancy between the way people actually perform and the way they perceive their own performance level. The concept of “risk-intelligence” relies on the confidence that each subject has with their own knowledge, thus returning accurate probability estimates, and a “wise” doctor should be aware that he/she do not known, thus, returning high risk-intelligence.
To date, little is known about risk-intelligence and the Dunning – Kruger effect between doctors, and, especially, among hepatologists, a specialty strongly involved in important clinical decisions. With this aim we conducted a survey to test how risk-intelligence affects medical decision making in this particular clinical setting and whether the Dunning – Kruger bias can effectively affect these physicians.
If you are a gastroenterologist, hepatologist or HBP surgeon please help us in investigate this issue by completing the following survey:
Question
I have r-project with meta and metafor packages.
I know how to perform meta-analysis of mean differences but I need to report also the meta-analyzed means (and sd) of the two comparison groups.
Doeas anyone know how to do this?
Question
Regret theory postulates that the optimal (therapeutic) strategy is the action that results in the least amount of regret in case it is proven wrong. Faced with a cirrhotic patient with intermediate HCC the clinician must choose between the treatment suggested by the guidelines (trans-catheter arterial chemo-embolization - TACE) and surgery. The therapeutic strategy to adopt will depend on expectations from surgery (as well as from TACE). If expectations from surgery are too high, an eventual failure (patient death) will result in a great sense of regret. Regret can be used as a measure of expectations from surgery and present study showed how it can be applied in the decision-making of intermediate HCC.
The regret model assumes that a patient should be submitted to surgery if the probability of survival is equal or greater than a specific value (threshold probability - Pt) that can be derived by weighting the two components of regret: the result of a wrong action (regret of commission) and the failure to act (regret of omission). Assume that for a specific HCC patient the physician elicits a regret of omission of 70 and a regret of commission of 60; the threshold value can be calculated as 46.2% (Pt=1/(1+regret of omission/regret of commission)). If the patient survival, at a specific temporal end-point, is superior to 46.2% the physician should opt for surgery. Otherwise, TACE will be the least regretful strategy to adopt.
When three hypothetical clinical cases were send to 20 hepatologists and 20 surgeons asking for regret of omission and commission elicitation, results showed a significant separation among physicians' threshold values. However, the application of the regret-model has put in accordance more than 90% of clinicians on the optimal therapeutic strategy to adopt for each of the three clinical cases.
Question
I am working on an accelerated failure time model in the setting of liver transplantation using survreg package for R. I have no problem in fitting the model but I can not obtain median survivals on the basis of covariates.
If I use only one variable (example recipient age: young=0, old=1) I have no problem using the formula: median <-predict(weibull.aft, newdata=list(recipient_age=c(0,1)), type=’quantile’,p=0.5), but how can I obtain the same results when fitting a model with more than one variable?
Question
I would like to perform a trial where a reduction of 33% of the event (from 30% to 20%) is expected with the new treatment. I will perform 3 interim analyses (at 25%, 50% and 75% of enrollment) and I need to calculate futility boundary for stopping trial.
There are many functions in R-project but I am unsure of what to search for.
Can anyone help me?
Question
I am trying to apply cure models in the setting of hepatocellular carcinoma. Reading pertinent literature, non-mixture models fit my needs well, because this model has a background in modelling of tumor recurrence.
Now the question is: what survival should be considered? Patient survival (event=death) or disease-free survival (event= death or tumor recurrence)?
From my point of view, cure should be defined for patients who are alive and without tumor, so disease-free survival has to be used. Is that right?
Question
In the case of cancer, some patients will have fast-growing, aggressive tumors with short asymptomatic periods and rapid progression from symptoms to death. Other patients will have slower-growing, less aggressive tumors that are less likely to metastasize and, therefore, have a better prognosis. These less aggressive tumors have a longer asymptomatic period and are therefore more likely to be identified in a screening program.
When a cohort identified by screening (e.g., mammography) is compared with a cohort identified by clinical presentation (e.g., palpable mass), less aggressive tumors will be overrepresented in the screening cohort, and more aggressive tumors will be overrepresented in the clinical presentation cohort. Even in the absence of therapy, the cohort identified by screening will have a better prognosis. A screening program may appear to improve survival when in fact it has only preferentially selected out the subgroup with the best prognosis.
Is there anyone who knows that some work has addressed this problem with a mathematical approach easy to understand?
Question
I found in statistical books that to verify the linear assumption of a Cox model I need to plot Martingale residuals.
However, I cannot find any explanation about interpretation of the plot!
So, if I plot predicted values versus Martingale residuals what have I to expect if linearity is satisfied?
Thank you in advance... please help me!

Network

Cited By