Development of a tongue image-based machine learning tool for the diagnosis of gastric cancer: a prospective multicentre clinical cohort study.

Autor:	Yuan L; Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China.; Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou, 310022, China.; Zhejiang Key Lab of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer, Zhejiang Cancer Hospital, Hangzhou, 310022, China., Yang L; Artificial Intelligence and Biomedical Images Analysis Lab, School of Engineering, Westlake University, China., Zhang S; Artificial Intelligence and Biomedical Images Analysis Lab, School of Engineering, Westlake University, China., Xu Z; Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China.; Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou, 310022, China.; Zhejiang Key Lab of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer, Zhejiang Cancer Hospital, Hangzhou, 310022, China., Qin J; Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China.; Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou, 310022, China.; Zhejiang Key Lab of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer, Zhejiang Cancer Hospital, Hangzhou, 310022, China., Shi Y; First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China.; Oncology Department, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, China., Yu P; First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China., Wang Y; First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China., Bao Z; First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China., Xia Y; First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China., Sun J; Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325099, China., He W; Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, 610042, China., Chen T; Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China., Chen X; Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325099, China., Hu C; First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China., Zhang Y; Artificial Intelligence and Biomedical Images Analysis Lab, School of Engineering, Westlake University, China., Dong C; College of Traditional Chinese Medicine, Anhui University of Traditional Chinese Medicine, HeFei, 230038, China., Zhao P; Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, 610042, China., Wang Y; College of Traditional Chinese Medicine, Anhui University of Traditional Chinese Medicine, HeFei, 230038, China., Jiang N; College of Traditional Chinese Medicine, Anhui University of Traditional Chinese Medicine, HeFei, 230038, China., Lv B; Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053, China., Xue Y; Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, China., Jiao B; Department of General Surgery, Shanxi Cancer Hospital, Taiyuan, 030013, China., Gao H; Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, China., Chai K; Oncology Department, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, China., Li J; Department of General Surgery, Shanxi Cancer Hospital, Taiyuan, 030013, China., Wang H; Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, China., Wang X; Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, China., Guan X; Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China., Liu X; Department of Gastrointestinal Surgery, RenJi Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China., Zhao G; Department of Gastrointestinal Surgery, RenJi Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China., Zheng Z; Department of Gastric Surgery, Cancer Hospital of China Medical University (Liaoning Cancer Hospital and Institute), Shenyang, 110042, China., Yan J; Department of Gastric Surgery, Cancer Hospital of China Medical University (Liaoning Cancer Hospital and Institute), Shenyang, 110042, China., Yu H; Department of Gastric Surgery, Cancer Hospital of China Medical University (Liaoning Cancer Hospital and Institute), Shenyang, 110042, China., Chen L; Department of Gastrointestinal Surgery, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China., Ye Z; Department of Gastrointestinal Surgery, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China., You H; Department of Gastroenterology, Yuhang District People's Hospital, Hangzhou, 311199, China., Bao Y; Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, 610042, China., Cheng X; Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, 610042, China., Zhao P; Department of Health Management Center, Yueyang Central Hospital, Yueyang, 414000, China., Wang L; Department of Endoscopy Center, Kecheng District People's Hospital, Quzhou, 324000, China., Zeng W; Department of General Surgery, Shanxi Cancer Hospital, Taiyuan, 030013, China., Tian Y; Department of Gastric Surgery, Cancer Hospital of China Medical University (Liaoning Cancer Hospital and Institute), Shenyang, 110042, China., Chen M; Department of Endoscopy Center, Shandong Cancer Hospital, Shandong, 250117, China., You Y; Department of Health Management Center, Zigong Fourth People's Hospital, Zigong, 643099, China., Yuan G; Department of Gastroenterology, Hainan Cancer Hospital, Hainan, 570312, China., Ruan H; Department of Chinese Surgery, Linping District Hospital of Traditional Chinese Medicine, Hangzhou, 311100, China., Gao X; The First Affiliated Hospital of Henan University of Science and Technology, Zhengzhou, 450062, China., Xu J; First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China., Xu H; First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China., Du L; Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China., Zhang S; Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China., Fu H; Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China., Cheng X; Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China.; Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou, 310022, China.; Zhejiang Key Lab of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer, Zhejiang Cancer Hospital, Hangzhou, 310022, China.
Jazyk:	angličtina
Zdroj:	EClinicalMedicine [EClinicalMedicine] 2023 Feb 06; Vol. 57, pp. 101834. Date of Electronic Publication: 2023 Feb 06 (Print Publication: 2023).
DOI:	10.1016/j.eclinm.2023.101834
Abstrakt:	Background: Tongue images (the colour, size and shape of the tongue and the colour, thickness and moisture content of the tongue coating), reflecting the health state of the whole body according to the theory of traditional Chinese medicine (TCM), have been widely used in China for thousands of years. Herein, we investigated the value of tongue images and the tongue coating microbiome in the diagnosis of gastric cancer (GC). Methods: From May 2020 to January 2021, we simultaneously collected tongue images and tongue coating samples from 328 patients with GC (all newly diagnosed with GC) and 304 non-gastric cancer (NGC) participants in China, and 16 S rDNA was used to characterize the microbiome of the tongue coating samples. Then, artificial intelligence (AI) deep learning models were established to evaluate the value of tongue images and the tongue coating microbiome in the diagnosis of GC. Considering that tongue imaging is more convenient and economical as a diagnostic tool, we further conducted a prospective multicentre clinical study from May 2020 to March 2022 in China and recruited 937 patients with GC and 1911 participants with NGC from 10 centres across China to further evaluate the role of tongue images in the diagnosis of GC. Moreover, we verified this approach in another independent external validation cohort that included 294 patients with GC and 521 participants with NGC from 7 centres. This study is registered at ClinicalTrials.gov, NCT01090362. Findings: For the first time, we found that both tongue images and the tongue coating microbiome can be used as tools for the diagnosis of GC, and the area under the curve (AUC) value of the tongue image-based diagnostic model was 0.89. The AUC values of the tongue coating microbiome-based model reached 0.94 using genus data and 0.95 using species data. The results of the prospective multicentre clinical study showed that the AUC values of the three tongue image-based models for GCs reached 0.88-0.92 in the internal verification and 0.83-0.88 in the independent external verification, which were significantly superior to the combination of eight blood biomarkers. Interpretation: Our results suggest that tongue images can be used as a stable method for GC diagnosis and are significantly superior to conventional blood biomarkers. The three kinds of tongue image-based AI deep learning diagnostic models that we developed can be used to adequately distinguish patients with GC from participants with NGC, even early GC and precancerous lesions, such as atrophic gastritis (AG). Funding: The National Key R&D Program of China (2021YFA0910100), Program of Zhejiang Provincial TCM Sci-tech Plan (2018ZY006), Medical Science and Technology Project of Zhejiang Province (2022KY114, WKJ-ZJ-2104), Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer (JBZX-202006), Natural Science Foundation of Zhejiang Province (HDMY22H160008), Science and Technology Projects of Zhejiang Province (2019C03049), National Natural Science Foundation of China (82074245, 81973634, 82204828), and Chinese Postdoctoral Science Foundation (2022M713203). Competing Interests: All authors declare no competing interests. (© 2023 The Author(s).)
Databáze:	MEDLINE
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