Precancerous Lesions & Early Cancer Management Group
The PRECAM group represents a unique network in the field of clinical and translational research in Early Cancer, with a greater focus on Gastrointestinal Oncology, bringing together researchers from different leading cancer institutions, such as the IPO of Porto, IPO of Coimbra and the University Hospital Centre of Porto.
This multidisciplinary team focuses on the main mission of creating new knowledge and evaluating new and disruptive technologies in a comprehensive and integrative vision, to improve the diagnosis and follow-up of patients with precursor lesions and early cancer, through the personalization of health care.
SCIENTIFIC COORDINATOR
Mário Dinis Ribeiro, MD, PhD
ORCID ID/Ciência ID: 0000-0003-0121-6850/ 731E-7010-177F
Senior Consultant
Director of the Medicine Department IPOPorto
Sub-coordinator TL2 – Cancer/ CI-IPOP@RISE
Invited Full Professor MEDCIDS/ FMUP
Email: mario.ribeiro@ipoporto.min-saude.pt
TEAM
Senior Investigators
Ana Carina Pereira, PhD
ORCID ID/Ciência ID: 0000-0003-4302-2501 / 3515-2BE2-B60D
Assistant Researcher
Email: ana.martins.pereira@ipoporto.min-saude.pt
Filipa Fontes, PhD
ORCID ID/Ciência ID: 0000-0001-9246-589X / 5F10-FB9E-C805
Assistant Researcher
Email: filipa.fontes@ipoporto.min-saude.pt
Miguel Areia, MD, PhD
ORCID ID/Ciência ID: 0000-0001-9787-8175 / 3516-7AAD-D948
Consultant, Gastroenterology IPOC
Co-Editor GE Portuguese Journal of Gastroenterology
Editorial Team Member of Endoscopy
E-mail: miguel.areia75@gmail.com
Pedro Pimentel Nunes, MD, PhD
ORCID ID/Ciência ID: 0000-0002-7308-3295 / 0616-5C59-DC3B
Consultant, Gastroenterology Unilabs
Assistant Professor FMUP
E-mail: pedronunesml@gmail.com
Ricardo Marcos Pinto, MD, PhD
ORCID ID/Ciência ID: 0000-0001-9695-8261 / 791D-EF1B-B4C7
Consultant, Gastroenterology CHUSA
Assistant Professor ICBAS
E-mail: ricardomarcospinto@sapo.pt
Junior Researchers
Ana Paula Santos, MD, PhD
ORCID ID/Ciência ID: 0000-0002-8896-305X / BC1E-DE39-17DF
E-mail: anapaulasantos@ipoporto.min-saude.pt
Andreia Albuquerque, MD, PhD
ORCID ID/Ciência ID: 0000-0001-5258-2987 / DD1A-51B5-316E
E-mail: a.albuquerque.dias@gmail.com
Diogo Libânio, MD, PhD
ORCID ID/Ciência ID: 0000-0003-2691-7522 / 1C13-7D9E-A4B5
E-mail: diogo.monteiro@ipoporto.min-saude.pt
Ricardo Kuttner-Magalhães, MD, PhD
ORCID ID/Ciência ID: 0000-0002-8522-5756 / F31A-B091-3D92
E-mail: rkuttner@gmail.com
PhD Students
Catarina Lopes, MSc
ORCID/Ciência ID: 0000-0003-0176-286X / 6719-02C2-856E
E-mail: catarina.p.lopes@ipoporto.min-saude.pt
Research Assistant
Tatiana Cruz Almeida, MSc
ORCID / Ciência ID: 0000-0002-9444-8257 / CD18-88C4-CE90
E-mail: tatiana.almeida@ipoporto.min-saude.pt
Other collaborators:
Catarina Brandão, MD, MSc
Head of the Gastroenterology Department IPOP
ORCID ID/Ciência ID: 0009-0005-4718-9693 / 7D14-540E-A6BC
Inês Marques de Sá, MD
Attending Gastroenterologist IPOP
ORCID ID/Ciência ID: 0000-0001-8835-7183 / F113-E6A1-43FD
Jéssica Chaves, MD
Resident of Gastroenterology IPOP
ORCID ID/Ciência ID: 0009-0009-2734-4755 / 6A17-89D0-34C7
Raquel Ortigão, MD
Attending Gastroenterologist IPOP
ORCID ID/Ciência ID: / CD1F-EABB-DC3B
AIMS
The core aims of our group focus on the (1) non-invasive diagnosis of pre and early cancer (eg. liquid biopsies; big data); (2) optimization of minimal invasive diagnosis (eg, endoscopy & quality of endoscopy) of pre and early cancer (eg, AI in endoscopy); and comprehensive clinical and services management of pre and early lesions, (eg, development of clinical decision rules, development of interventions and cost-effectiveness studies). Furthermore, we also purpose to provide a common approach /platform to other researchers & cancers (inside CI-IPOP & IPOP and outside)
PROJECTS WITH EXTERNAL FUNDING
AIDA – An Artificially Intelligent Diagnostic Assistant for gastric inflammation; Horizon Europe; 101095359; 6 334 803,75€ (2023-2026); Mário Dinis-Ribeiro (PI@IPOP and WP leader)
Most cases of gastric cancer (GC) are detected at a late stage, when patients have a median life expectancy of about a year. Diagnosing people at risk of developing GC at the pre-symptomatic stage, typically chronic gastric inflammation, could significantly improve the outlook.
Artificial intelligence (AI) can help clinicians make sense of their own data by automating much of the treatment and analysis, which require manual work and years of experience. But it can do more: it can bring together available data from various sources into a vast data lake and cross-correlate the data to derive a ‘risk score’ for gastric cancer and shed light on the mechanisms of its evolution.
Aida aims to do just that. It helps researchers understand the mechanisms that trigger gastric oncogenesis, helps clinicians diagnose precancerous inflammation at the earliest possible stage, suggests personalised therapeutic strategies for treatment and follow-up, and makes personalised recommendations for monitoring patient health status, thus contributing to gastric cancer prevention.
This places Aida squarely on Europe’s agenda of ‘Staying healthy in a rapidly changing society’. Aida unites some of Europe’s leading authorities in the field of gastric inflammation, gastric cancer, leading AI and machine learning experts, experts on data governance and privacy, representatives of the public administration and patient advocates. Aida also has strong ties with the industry.
After the project, the results will live on in a foundation that acts as a transnational focal point for chronic gastric inflammation — and GC in general. We hope that the solid, inclusive design principles of Aida, its societal relevance and its durability will spawn a vigorous ecosystem around chronic gastric inflammation, its understanding and its treatment. And we hope that it will inspire other data collaboratives in health — for other chronic inflammations, other forms of cancer or other ailments altogether.
TOGAS – TOwards GAstric cancer Screening implementation in the European countries; EU4H; 101101252; 11 337 063,81€ (2023-2026); Mário Dinis-Ribeiro (PI@IPOP and WP leader)
No effective screening modality to prevent gastric cancer is available in Europe. Elimination of H.pylori bacteria is expected to decrease the mortality by 40%; another approach is early is detection of precancerous lesions for surveillance.
The general objective of TOGAS is to provide the missing evidence-based knowledge to be further transferred to design plan and implement appropriate gastric cancer prevention across the EU. The results from this project will aide policy makers in incorporating gastric cancer screening into their healthcare priorities while balancing its effectiveness, feasibility and acceptability with long-term potential adverse effects.
TOGAS has 3 specific objectives: 1) Assessment of state of play as well as the needs of MSs and target populations in gastric cancer prevention, including information on ‘opportunistic’ screening initiatives organised in public and private setting. 2) Assessment of the appropriateness of various gastric cancer-screening modalities for the use in the EU. 3) Assuring the sustainability of the results by an effective dissemination strategy and coordination of the methodologywith the approaches used within the EU, including with the European Guidelines and Quality Assurance Schemes.
TOGAS will involve three pilot studies, each designed to address specific aspects of gastric cancer screening and early detection. Cost effectiveness modelling and addressing medical ethics aspects will be an important integral part of the project.
To disseminate widely project results TOGAS will organize three highly visible conferences inviting the key stakeholders and MS representatives as well as a high-level conference together with other cancer screening projects.
The TOGAS consortium unites 18 partners and 3 associated partners representing higher educational institutions, research structures, clinics and wider CSO from 14 member states.
ONCOSCREEN – A European “shield” against colorectal cancer based on novel, more precise and affordable risk-based screening methods and viable policy pathways; HORIZON; 101097036; 12 972 076,25€ (2023-2026); Mário Dinis-Ribeiro (PI@IPOP)
A multilevel campaign to boost colorectal cancer screening.
Population-based screening for colorectal cancer (CRC) is recommended in the EU. Accounting for 12.4 % of all cancer deaths, only one in seven EU citizens participate in screening programmes. The EU-funded ONCOSCREEN project aims to reverse this trend by promoting accurate, non-invasive, cost-effective screening tests based on new technologies and an increased awareness on the disease. Personalised approaches for screening are needed to consider genetic and other socioeconomic variables and environmental stressors. With this in mind, the project will develop a risk-based, population-level stratification methodology for CRC to account for genetic prevalence, socioeconomic status and other factors. Bringing together a 38-partner consortium, the project is in line with Horizon Europe’s Cancer Mission.
BioFaeC – Novel faecal biomarkers for early detection of precancerous lesions and Cancer: Improving the current model for colorectal cancer screening; FCT; 2022.09051.PTDC; 49 909€ (2023-2024); Mário Dinis-Ribeiro (PI) and Luís Lima (Co-PI@GPTE)
One of the biggest challenges in early cancer diagnosis and prognosis is the lack of reliable biomarkers to accurately identify patients at an increased risk of malignant progression. The development of an accessible non-invasive screening method to detect a panel of biomarkers that accurately identify adenomas at risk of malignant progression will greatly advance the early detection of CRC capacity over currently approved screening approaches. Although this is a hot topic, most works often disregard the detection of advanced adenomas, only focusing on CRC, precluding the diagnosis at earlier stages of disease. Hence, BioFaeC aims to identify a reliable panel of biomarkers to improve the accuracy of CRC detection and validate their feasibility as a non-invasive screening tool.
BioFaeC is an exploratory project, granted in the 2022 FCT Call for R&D Projects in All Scientific Domains and stems from the IPOP and i3s research consortium (P.CCC Raquel Seruca). It officially started in February of 2023 and will run for 18 months. At IPOP and in a collaborative effort, this innovative project is under development at the PRECAM and Experimental Pathology and Therapeutics Groups.
CAGED – Computer Assisted Gastric Cancer Diagnosis; FCT; PTDC/EEI-EEE/5557/2020; 249.460,00€ (2021-2024); Miguel Coimbra (INESC TEC) & Mário Dinis-Ribeiro
Gastric cancer is the third deadliest worldwide and minimally invasive screening and gastrointestinal endoscopy play a primary role for early diagnosis, crucial for improving survival rates. However, due to technical and cognitive factors, the probability of a false diagnosis caused by human error is possible.
Thus, the main goal of this study is to develop computer vision-based technologies to automatically analyze videos and images obtained through non-invasive gastrointestinal endoscopies.
Artificial Intelligence, and more specifically Computer Vision, has the potential to mitigate the limitations that currently exist, by providing automated endoscopy assessment tools that can not only support physicians in the detection and characterization of gastric cancer lesions, but can also monitor the quality of the endoscopy itself.
Publications
Martins ML, Pedroso M, Libanio D, Dinis-Ribeiro M, Coimbra M, Renna F. Diagnostic Performance of Deep Learning Models for Gastric Intestinal Metaplasia Detection in Narrow-band Images. Annu Int Conf IEEE Eng Med Biol Soc. 2023 Jul;2023:1-4. doi: 10.1109/EMBC40787.2023.10340055.
Lima G, Coimbra M, Dinis-Ribeiro M, Libanio D, Renna F. Analysis of classification tradeoff in deep learning for gastric cancer detection. Annu Int Conf IEEE Eng Med Biol Soc. 2022;2022:2177-2180. doi: 10.1109/EMBC48229.2022.9871040.
Lopes I, Silva A, Coimbra M, Dinis-Ribeiro M, Libanio D, Renna F. Supervised and semi-supervised training of deep convolutional neural networks for gastric landmark detection. Annu Int Conf IEEE Eng Med Biol Soc. 2022;2022:2025-2028. doi: 10.1109/EMBC48229.2022.9870992
Renna F, Martins M, Neto A, Cunha A, Libânio D, Dinis-Ribeiro M, Coimbra M. Artificial Intelligence for Upper Gastrointestinal Endoscopy: A Roadmap from Technology Development to Clinical Practice. Diagnostics (Basel). 2022;12(5):1278. doi: 10.3390/diagnostics12051278
IMAGE – Individualized Gastric Adenocarcinoma Early Diagnosis and Improved Patients’ Survival: From Liquid Biopsies to a Comprehensive Management Approach; NORTE2020; NORTE-01-0145-FEDER-000050; 601.320,91€ (2021 – 2023); Mário Dinis-Ribeiro
The IMAGE project aims at uncovering novel cancer biomarkers that can be readily detected by non-invasive methodologies, allowing an early diagnosis of gastric cancer a significant societal problem in Portugal. Together with other patients’ information, the final diagnostic tool tackles the disease in its early development, resulting in enhancing patient’s survival and quality of life (QoL) through less aggressive and invasive therapeutic procedures (see Visual Abstract). Furthermore, it will reduce the health system’s economic burden and potentially the disparities, by empowering citizen, adding information to endoscopy and individualizing management.
The project is structured in three specific lines:
- in RL1, transcriptomic studies will be performed to determine a panel of biomarkers in saliva to non-invasively allow gastric cancer screening and monitoring;
- in RL2, the focus is the concept of functional endoscopy, i.e., the purely morphological/imagiological concept of endoscopy will be challenged by adding the information from biomarkers in the gastric mucus (microbiota);
- and in RL3, a comprehensive clinical decision rule will be developed by integrating a priori data (clinical, endoscopic and molecular) and with this tailored screening to gastric cancer.
This consortium and unique project will promote further gains in this area of research, contributing to answer to a societal responsibility towards a relevant health problem, especially in the North of Portugal. We hypothesize that, all together, our findings will clearly improve the knowledge and technologies available for the early diagnosis of gastric cancer and patients’ surveillance and, due to a clear impact in health-care resources and patients’ burden, will potentially decrease disparities in the access to care by providing the best care to those in need – the final aim for clinical and translational research.
Publications
Lopes C, Almeida TC, Pimentel-Nunes P, Dinis-Ribeiro M, Pereira C. Linking dysbiosis to precancerous stomach through inflammation: Deeper than and beyond imaging. Front Immunol. 2023;14:1134785. doi: 10.3389/fimmu.2023.1134785
Lopes C, Chaves J, Ortigão R, Dinis-Ribeiro M, Pereira C. Gastric cancer detection by non-blood-based liquid biopsies: A systematic review looking into the last decade of research. United European Gastroenterol J. 2023;11(1):114-130. doi: 10.1002/ueg2.12328
Selected Publications
- Rei A, et al. Metachronous lesions after gastric endoscopic submucosal dissection: First assessment of the FAMISH predicting score. Endoscopy. 2023 May 9. doi: 10.1055/a-2089-6849
- Arribas J, et al. Standalone performance of artificial intelligence for upper GI neoplasia: a meta-analysis. Gut 2020. doi.org/10.1136/gutjnl-2020-321922
- Libânio D, et al. Prospective comparative study of endoscopic submucosal dissection and gastrectomy for early neoplastic lesions including patients’ perspectives. Endoscopy 2019;51(1):30-39. doi.org/10.1055/a-0628-6601
- Areia M, et al. Endoscopic screening for gastric cancer: A cost-utility analysis for countries with an intermediate gastric cancer risk. United European Gastroenterol J 2018;6(2):192-202. doi.org/10.1177/2050640617722902
- Hess T, et al. Dissecting the genetic heterogeneity of gastric cancer. EBioMedicine. 2023;18(92):104616. doi: 10.1016/j.ebiom.2023.104616
NATIONAL COLLABORATIONS
Miguel Coimbra | INESC TEC
Adelino Leite-Moreira | UnIC
Conceição Calhau | CINTESIS / UNL
Salomé Pinho | i3s
Diogo Caetano & Elisabete Fernandes | INESC MN & INL
INTERNATIONAL COLLABORATIONS:
Johannes Schumacher
Centre for Human Genetics, University of Marburg | Germany
Marino Venerito / Peter Malfertheiner
Consortium: staR – European Network on the Germline Genetics of Gastric Cancer | Germany
Javier P. Gisbert / Francis Megraud / Colm O’Morain / Adrian G. McNicholl
Consortium: Hp-EuReg – European Registry on the Management of Helicobacter Pylori Infection | Spain
Rodrigo Jover
Consortium: European Polyp Surveillance (EPoS) Trials | Europe
Talía Malagón / Kimon Chatzistamatiou / Elisabeth McClymont / Staci Sudenga / Anna R Giuliano
Consortium: IPVS Early Career Working Group | Switzerland
Tania Fleitas / Marcis Leja / Fátima Carneiro / Javier P. Gisbert / Leticia Moreira / Tamara Matysiak-Budnik / Laimas Jonaitis / Mário Dinis-Ribeiro / Manon Spaander
Consortium: AIDA Consortium | Spain
Marcis Leja / Tamara-Matysiak-Budnik / Iris Vogelaar-Lansdorp / Zorana Maravic / Javier P. Gisbert / Juozas Kupcinskas / Dan Lucian Dumitrascu / Annemieke Smet / Mike Morrissey / Katarzyna Neubauer / Nadan Rustemovic / Sandra Milic / Wessel vaonn de Veerdonk / Victoria McEneaney / Jochen Weigt
Consortium: TOGAS Consortium | Latvia
Anax Fotopoulos / Markus Mohler
Consortium: ONCOSCREEN Consortium | Greece