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Model-guided therapy for hepatocellular carcinoma: a role for information technology in predictive, preventive and personalized medicine.

Berliner L, Lemke HU, vanSonnenberg E, Ashamalla H, Mattes MD, Dosik D, Hazin H, Shah S, Mohanty S, Verma S, Esposito G, Bargellini I, Battaglia V, Caramella D, Bartolozzi C, Morrison P - EPMA J (2014)

Bottom Line: We may, then, be able to develop a statistically valid methodology, on an individual basis, to predict certain diseases or conditions, to predict certain treatment outcomes, to prevent certain diseases or complications and to develop treatment regimens that are personalized for that particular patient.An IT system for predictive, preventive and personalized medicine (ITS-PM) for HCC is presented to provide a comprehensive system to provide unified access to general medical and patient-specific information for medical researchers and health care providers from different disciplines including hepatologists, gastroenterologists, medical and surgical oncologists, liver transplant teams, interventional radiologists and radiation oncologists.The article concludes with a review providing an outlook and recommendations for the application of MGT to enhance the medical management of HCC through PPPM.

View Article: PubMed Central - HTML - PubMed

Affiliation: New York Methodist Hospital, Brooklyn, NY 11215, USA ; Weill Medical College of Cornell University, New York, NY 10021, USA.

ABSTRACT
Predictive, preventive and personalized medicine (PPPM) may have the potential to eventually improve the nature of health care delivery. However, the tools required for a practical and comprehensive form of PPPM that is capable of handling the vast amounts of medical information that is currently available are currently lacking. This article reviews a rationale and method for combining and integrating diagnostic and therapeutic management with information technology (IT), in a manner that supports patients through their continuum of care. It is imperative that any program devised to explore and develop personalized health care delivery must be firmly rooted in clinically confirmed and accepted principles and technologies. Therefore, a use case, relating to hepatocellular carcinoma (HCC), was developed. The approach to the management of medical information we have taken is based on model theory and seeks to implement a form of model-guided therapy (MGT) that can be used as a decision support system in the treatment of patients with HCC. The IT structures to be utilized in MGT include a therapy imaging and model management system (TIMMS) and a digital patient model (DPM). The system that we propose will utilize patient modeling techniques to generate valid DPMs (which factor in age, physiologic condition, disease and co-morbidities, genetics, biomarkers and responses to previous treatments). We may, then, be able to develop a statistically valid methodology, on an individual basis, to predict certain diseases or conditions, to predict certain treatment outcomes, to prevent certain diseases or complications and to develop treatment regimens that are personalized for that particular patient. An IT system for predictive, preventive and personalized medicine (ITS-PM) for HCC is presented to provide a comprehensive system to provide unified access to general medical and patient-specific information for medical researchers and health care providers from different disciplines including hepatologists, gastroenterologists, medical and surgical oncologists, liver transplant teams, interventional radiologists and radiation oncologists. The article concludes with a review providing an outlook and recommendations for the application of MGT to enhance the medical management of HCC through PPPM.

No MeSH data available.


Related in: MedlinePlus

The Barcelona Clinic Liver Cancer (BCLC) staging system for hepatocellular carcinoma, revised 2011. PST performance status; CLT/LDLT cadaver liver transplant/living donor liver transplant; RF/PEI radiofrequency ablation/percutaneous ethanol injection; TACE transarterial chemoembolization[29].
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Figure 4: The Barcelona Clinic Liver Cancer (BCLC) staging system for hepatocellular carcinoma, revised 2011. PST performance status; CLT/LDLT cadaver liver transplant/living donor liver transplant; RF/PEI radiofrequency ablation/percutaneous ethanol injection; TACE transarterial chemoembolization[29].

Mentions: There are a number of systems available for staging and classifying HCC. We will focus on the Barcelona Clinic Liver Cancer (BCLC) staging system and its updates[28-31] (Figure 4). The BCLC staging system is based on performance status, extent of tumor including presence or absence of vascular invasion, bilirubin level, presence or absence of portal hypertension and Okuda stage. This system is advantageous in that it classifies patients as very early, early, intermediate, advanced or terminal stages thereby establishing a link between stage of disease and appropriate treatment modalities. Very early stage disease is difficult to diagnose since patients are Child-Pugh class A, have no clinical features of liver disease and have a single HCC lesion <2 cm. If diagnosis is made at this stage, the treatment of the tumor has a theoretical 5-year survival rate of 100%[28-31]. Early-stage disease includes patients with up to three nodules, each less than 3 cm, and well-preserved liver function (Child-Pugh class A and B).


Model-guided therapy for hepatocellular carcinoma: a role for information technology in predictive, preventive and personalized medicine.

Berliner L, Lemke HU, vanSonnenberg E, Ashamalla H, Mattes MD, Dosik D, Hazin H, Shah S, Mohanty S, Verma S, Esposito G, Bargellini I, Battaglia V, Caramella D, Bartolozzi C, Morrison P - EPMA J (2014)

The Barcelona Clinic Liver Cancer (BCLC) staging system for hepatocellular carcinoma, revised 2011. PST performance status; CLT/LDLT cadaver liver transplant/living donor liver transplant; RF/PEI radiofrequency ablation/percutaneous ethanol injection; TACE transarterial chemoembolization[29].
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4274760&req=5

Figure 4: The Barcelona Clinic Liver Cancer (BCLC) staging system for hepatocellular carcinoma, revised 2011. PST performance status; CLT/LDLT cadaver liver transplant/living donor liver transplant; RF/PEI radiofrequency ablation/percutaneous ethanol injection; TACE transarterial chemoembolization[29].
Mentions: There are a number of systems available for staging and classifying HCC. We will focus on the Barcelona Clinic Liver Cancer (BCLC) staging system and its updates[28-31] (Figure 4). The BCLC staging system is based on performance status, extent of tumor including presence or absence of vascular invasion, bilirubin level, presence or absence of portal hypertension and Okuda stage. This system is advantageous in that it classifies patients as very early, early, intermediate, advanced or terminal stages thereby establishing a link between stage of disease and appropriate treatment modalities. Very early stage disease is difficult to diagnose since patients are Child-Pugh class A, have no clinical features of liver disease and have a single HCC lesion <2 cm. If diagnosis is made at this stage, the treatment of the tumor has a theoretical 5-year survival rate of 100%[28-31]. Early-stage disease includes patients with up to three nodules, each less than 3 cm, and well-preserved liver function (Child-Pugh class A and B).

Bottom Line: We may, then, be able to develop a statistically valid methodology, on an individual basis, to predict certain diseases or conditions, to predict certain treatment outcomes, to prevent certain diseases or complications and to develop treatment regimens that are personalized for that particular patient.An IT system for predictive, preventive and personalized medicine (ITS-PM) for HCC is presented to provide a comprehensive system to provide unified access to general medical and patient-specific information for medical researchers and health care providers from different disciplines including hepatologists, gastroenterologists, medical and surgical oncologists, liver transplant teams, interventional radiologists and radiation oncologists.The article concludes with a review providing an outlook and recommendations for the application of MGT to enhance the medical management of HCC through PPPM.

View Article: PubMed Central - HTML - PubMed

Affiliation: New York Methodist Hospital, Brooklyn, NY 11215, USA ; Weill Medical College of Cornell University, New York, NY 10021, USA.

ABSTRACT
Predictive, preventive and personalized medicine (PPPM) may have the potential to eventually improve the nature of health care delivery. However, the tools required for a practical and comprehensive form of PPPM that is capable of handling the vast amounts of medical information that is currently available are currently lacking. This article reviews a rationale and method for combining and integrating diagnostic and therapeutic management with information technology (IT), in a manner that supports patients through their continuum of care. It is imperative that any program devised to explore and develop personalized health care delivery must be firmly rooted in clinically confirmed and accepted principles and technologies. Therefore, a use case, relating to hepatocellular carcinoma (HCC), was developed. The approach to the management of medical information we have taken is based on model theory and seeks to implement a form of model-guided therapy (MGT) that can be used as a decision support system in the treatment of patients with HCC. The IT structures to be utilized in MGT include a therapy imaging and model management system (TIMMS) and a digital patient model (DPM). The system that we propose will utilize patient modeling techniques to generate valid DPMs (which factor in age, physiologic condition, disease and co-morbidities, genetics, biomarkers and responses to previous treatments). We may, then, be able to develop a statistically valid methodology, on an individual basis, to predict certain diseases or conditions, to predict certain treatment outcomes, to prevent certain diseases or complications and to develop treatment regimens that are personalized for that particular patient. An IT system for predictive, preventive and personalized medicine (ITS-PM) for HCC is presented to provide a comprehensive system to provide unified access to general medical and patient-specific information for medical researchers and health care providers from different disciplines including hepatologists, gastroenterologists, medical and surgical oncologists, liver transplant teams, interventional radiologists and radiation oncologists. The article concludes with a review providing an outlook and recommendations for the application of MGT to enhance the medical management of HCC through PPPM.

No MeSH data available.


Related in: MedlinePlus