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Fuster-Parra P, Yañez AM, López-González A, Aguiló A, Bennasar-Veny M. Identifying risk factors of developing type 2 diabetes from an adult population with initial prediabetes using a Bayesian network. Front Public Health 2023; 10:1035025. [PMID: 36711374 PMCID: PMC9878341 DOI: 10.3389/fpubh.2022.1035025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/15/2022] [Indexed: 01/14/2023] Open
Abstract
Background It is known that people with prediabetes increase their risk of developing type 2 diabetes (T2D), which constitutes a global public health concern, and it is associated with other diseases such as cardiovascular disease. Methods This study aimed to determine those factors with high influence in the development of T2D once prediabetes has been diagnosed, through a Bayesian network (BN), which can help to prevent T2D. Furthermore, the set of features with the strongest influences on T2D can be determined through the Markov blanket. A BN model for T2D was built from a dataset composed of 12 relevant features of the T2D domain, determining the dependencies and conditional independencies from empirical data in a multivariate context. The structure and parameters were learned with the bnlearn package in R language introducing prior knowledge. The Markov blanket was considered to find those features (variables) which increase the risk of T2D. Results The BN model established the different relationships among features (variables). Through inference, a high estimated probability value of T2D was obtained when the body mass index (BMI) was instantiated to obesity value, the glycosylated hemoglobin (HbA1c) to more than 6 value, the fatty liver index (FLI) to more than 60 value, physical activity (PA) to no state, and age to 48-62 state. The features increasing T2D in specific states (warning factors) were ranked. Conclusion The feasibility of BNs in epidemiological studies is shown, in particular, when data from T2D risk factors are considered. BNs allow us to order the features which influence the most the development of T2D. The proposed BN model might be used as a general tool for prevention, that is, to improve the prognosis.
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Affiliation(s)
- Pilar Fuster-Parra
- Department of Mathematics and Computer Sciences, Balearic Islands University, Palma, Spain,Institut d'Investigació Sanitària Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma, Spain
| | - Aina M. Yañez
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma, Spain,Department of Nursing and Physiotherapy, Balearic Islands University, Palma, Spain,Research Group on Global Health and Human Development, Balearic Islands University, Palma, Spain,*Correspondence: Aina M. Yañez ✉
| | - Arturo López-González
- Escuela Universitaria ADEMA, Palma, Spain,Prevention of Occupational Risk in Health Services, Balearic Islands Health Service, Palma, Spain
| | - A. Aguiló
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma, Spain,Department of Nursing and Physiotherapy, Balearic Islands University, Palma, Spain
| | - Miquel Bennasar-Veny
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma, Spain,Department of Nursing and Physiotherapy, Balearic Islands University, Palma, Spain,CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Classification of malignant and benign tissue with logistic regression. INFORMATICS IN MEDICINE UNLOCKED 2019. [DOI: 10.1016/j.imu.2019.100189] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Onisko A, Druzdzel MJ, Austin RM. Application of Bayesian network modeling to pathology informatics. Diagn Cytopathol 2018; 47:41-47. [PMID: 30451397 DOI: 10.1002/dc.23993] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/04/2018] [Accepted: 05/30/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND In the era of extensive data collection, there is a growing need for a large scale data analysis with tools that can handle many variables in one modeling framework. In this article, we present our recent applications of Bayesian network modeling to pathology informatics. METHODS Bayesian networks (BNs) are probabilistic graphical models that represent domain knowledge and allow investigators to process this knowledge following sound rules of probability theory. BNs can be built based on expert opinion as well as learned from accumulating data sets. BN modeling is now recognized as a suitable approach for knowledge representation and reasoning under uncertainty. Over the last two decades BN have been successfully applied to many studies on medical prognosis and diagnosis. RESULTS Based on data and expert knowledge, we have constructed several BN models to assess patient risk for subsequent specific histopathologic diagnoses and their related prognosis in gynecological cytopathology and breast pathology. These models include the Pittsburgh Cervical Cancer Screening Model assessing risk for histopathologic diagnoses of cervical precancer and cervical cancer, modeling of the significance of benign-appearing endometrial cells in Pap tests, diagnostic modeling to determine whether adenocarcinoma in tissue specimens is of endometrial or endocervical origin, and models to assess risk for recurrence of invasive breast carcinoma and ductal carcinoma in situ. CONCLUSIONS Bayesian network models can be used as powerful and flexible risk assessment tools on large clinical datasets and can quantitatively identify variables that are of greatest significance in predicting specific histopathologic diagnoses and their related prognosis. Resulting BN models are able to provide individualized quantitative risk assessments and prognostication for specific abnormal findings commonly reported in gynecological cytopathology and breast pathology.
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Affiliation(s)
- Agnieszka Onisko
- Magee-Womens Hospital, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, 15213.,Faculty of Computer Science, Bialystok University of Technology, Wiejska 45A, Bialystok, 15-351, Poland
| | - Marek J Druzdzel
- Faculty of Computer Science, Bialystok University of Technology, Wiejska 45A, Bialystok, 15-351, Poland.,School of Computing and Information, University of Pittsburgh, 135 N Bellefield Ave, Pittsburgh, Pennsylvania, 15213
| | - R Marshall Austin
- Magee-Womens Hospital, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, 15213
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Luo Y, McShan D, Ray D, Matuszak M, Jolly S, Lawrence T, Ming Kong F, Ten Haken R, El Naqa I. Development of a Fully Cross-Validated Bayesian Network Approach for Local Control Prediction in Lung Cancer. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2018; 3:232-241. [PMID: 30854500 DOI: 10.1109/trpms.2018.2832609] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The purpose of this study is to demonstrate that a Bayesian network (BN) approach can explore hierarchical biophysical relationships that influence tumor response and predict tumor local control (LC) in non-small-cell lung cancer (NSCLC) patients before and during radiotherapy from a large-scale dataset. Our BN building approach has two steps. First, relevant biophysical predictors influencing LC before and during the treatment are selected through an extended Markov blanket (eMB) method. From this eMB process, the most robust BN structure for LC prediction was found via a wrapper-based approach. Sixty-eight patients with complete feature information were used to identify a full BN model for LC prediction before and during the treatment. Fifty more recent patients with some missing information were reserved for independent testing of the developed pre- and during-therapy BNs. A nested cross-validation (N-CV) was developed to evaluate the performance of the two-step BN approach. An ensemble BN model is generated from the N-CV sampling process to assess its similarity with the corresponding full BN model, and thus evaluate the sensitivity of our BN approach. Our results show that the proposed BN development approach is a stable and robust approach to identify hierarchical relationships among biophysical features for LC prediction. Furthermore, BN predictions can be improved by incorporating during treatment information.
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Affiliation(s)
- Yi Luo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA,
| | - Daniel McShan
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Dipankar Ray
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Martha Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Theodore Lawrence
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Feng Ming Kong
- Department of Radiation Oncology, Indiana University, Indianapolis, USA
| | - Randall Ten Haken
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
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Petousis P, Han SX, Aberle D, Bui AAT. Prediction of lung cancer incidence on the low-dose computed tomography arm of the National Lung Screening Trial: A dynamic Bayesian network. Artif Intell Med 2016; 72:42-55. [PMID: 27664507 PMCID: PMC5082434 DOI: 10.1016/j.artmed.2016.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 07/25/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Identifying high-risk lung cancer individuals at an early disease stage is the most effective way of improving survival. The landmark National Lung Screening Trial (NLST) demonstrated the utility of low-dose computed tomography (LDCT) imaging to reduce mortality (relative to X-ray screening). As a result of the NLST and other studies, imaging-based lung cancer screening programs are now being implemented. However, LDCT interpretation results in a high number of false positives. A set of dynamic Bayesian networks (DBN) were designed and evaluated to provide insight into how longitudinal data can be used to help inform lung cancer screening decisions. METHODS The LDCT arm of the NLST dataset was used to build and explore five DBNs for high-risk individuals. Three of these DBNs were built using a backward construction process, and two using structure learning methods. All models employ demographics, smoking status, cancer history, family lung cancer history, exposure risk factors, comorbidities related to lung cancer, and LDCT screening outcome information. Given the uncertainty arising from lung cancer screening, a cancer state-space model based on lung cancer staging was utilized to characterize the cancer status of an individual over time. The models were evaluated on balanced training and test sets of cancer and non-cancer cases to deal with data imbalance and overfitting. RESULTS Results were comparable to expert decisions. The average area under the curve (AUC) of the receiver operating characteristic (ROC) for the three intervention points of the NLST trial was higher than 0.75 for all models. Evaluation of the models on the complete LDCT arm of the NLST dataset (N=25,486) demonstrated satisfactory generalization. Consensus of predictions over similar cases is reported in concordance statistics between the models' and the physicians' predictions. The models' predictive ability with respect to missing data was also evaluated with the sample of cases that missed the second screening exam of the trial (N=417). The DBNs outperformed comparison models such as logistic regression and naïve Bayes. CONCLUSION The lung cancer screening DBNs demonstrated high discrimination and predictive power with the majority of cancer and non-cancer cases.
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Affiliation(s)
- Panayiotis Petousis
- Department of Bioengineering, University of California, Los Angeles, CA, USA; Medical Imaging Informatics (MII) Group, Department of Radiological Sciences, University of California, Los Angeles, CA, USA.
| | - Simon X Han
- Department of Bioengineering, University of California, Los Angeles, CA, USA; Medical Imaging Informatics (MII) Group, Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Denise Aberle
- Department of Bioengineering, University of California, Los Angeles, CA, USA; Medical Imaging Informatics (MII) Group, Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Alex A T Bui
- Department of Bioengineering, University of California, Los Angeles, CA, USA; Medical Imaging Informatics (MII) Group, Department of Radiological Sciences, University of California, Los Angeles, CA, USA
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Fuster-Parra P, Tauler P, Bennasar-Veny M, Ligęza A, López-González AA, Aguiló A. Bayesian network modeling: A case study of an epidemiologic system analysis of cardiovascular risk. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 126:128-142. [PMID: 26777431 DOI: 10.1016/j.cmpb.2015.12.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/28/2015] [Accepted: 12/11/2015] [Indexed: 06/05/2023]
Abstract
An extensive, in-depth study of cardiovascular risk factors (CVRF) seems to be of crucial importance in the research of cardiovascular disease (CVD) in order to prevent (or reduce) the chance of developing or dying from CVD. The main focus of data analysis is on the use of models able to discover and understand the relationships between different CVRF. In this paper a report on applying Bayesian network (BN) modeling to discover the relationships among thirteen relevant epidemiological features of heart age domain in order to analyze cardiovascular lost years (CVLY), cardiovascular risk score (CVRS), and metabolic syndrome (MetS) is presented. Furthermore, the induced BN was used to make inference taking into account three reasoning patterns: causal reasoning, evidential reasoning, and intercausal reasoning. Application of BN tools has led to discovery of several direct and indirect relationships between different CVRF. The BN analysis showed several interesting results, among them: CVLY was highly influenced by smoking being the group of men the one with highest risk in CVLY; MetS was highly influence by physical activity (PA) being again the group of men the one with highest risk in MetS, and smoking did not show any influence. BNs produce an intuitive, transparent, graphical representation of the relationships between different CVRF. The ability of BNs to predict new scenarios when hypothetical information is introduced makes BN modeling an Artificial Intelligence (AI) tool of special interest in epidemiological studies. As CVD is multifactorial the use of BNs seems to be an adequate modeling tool.
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Affiliation(s)
- P Fuster-Parra
- Department of Mathematics and Computer Science, Universitat Illes Balears, Palma de Mallorca, Baleares E-07122, Spain; Research Group on Evidence, Lifestyles & Health, Research Institute on Health Sciences (IUNICS), Universitat Illes Balears, Palma de Mallorca, Baleares E-07122, Spain.
| | - P Tauler
- Research Group on Evidence, Lifestyles & Health, Research Institute on Health Sciences (IUNICS), Universitat Illes Balears, Palma de Mallorca, Baleares E-07122, Spain
| | - M Bennasar-Veny
- Research Group on Evidence, Lifestyles & Health, Research Institute on Health Sciences (IUNICS), Universitat Illes Balears, Palma de Mallorca, Baleares E-07122, Spain
| | - A Ligęza
- Department of Applied Computer Science, AGH University of Science and Technology, Kraków PL-30-059, Poland
| | - A A López-González
- Prevention of Occupational Risks in Health Services, GESMA, Balearic Islands Health Service, Hospital de Manacor, Manacor, Baleares E-07500, Spain
| | - A Aguiló
- Research Group on Evidence, Lifestyles & Health, Research Institute on Health Sciences (IUNICS), Universitat Illes Balears, Palma de Mallorca, Baleares E-07122, Spain
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Positive Association of Fibroadenomatoid Change with HER2-Negative Invasive Breast Cancer: A Co-Occurrence Study. PLoS One 2015; 10:e0129500. [PMID: 26098961 PMCID: PMC4476726 DOI: 10.1371/journal.pone.0129500] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 05/09/2015] [Indexed: 12/05/2022] Open
Abstract
Background Risk assessment of a benign breast disease/lesion (BBD) for invasive breast cancer (IBC) is typically done through a longitudinal study. For an infrequently-reported BBD, the shortage of occurrence data alone is a limiting factor to conducting such a study. Here we present an approach based on co-occurrence analysis, to help address this issue. We focus on fibroadenomatoid change (FAC), an under-studied BBD, as our preliminary analysis has suggested its previously unknown significant co-occurrence with IBC. Methods A cohort of 1667 female patients enrolled in the Clinical Breast Care Project was identified. A single experienced breast pathologist reviewed all pathology slides for each case and recorded all observed lesions, including FAC. Fibroadenoma (FA) was studied for comparison since FAC had been speculated to be an immature FA. FA and Fibrocystic Changes (FCC) were used for method validation since they have been comprehensively studied. Six common IBC and BBD risk/protective factors were also studied. Co-occurrence analyses were performed using logistic regression models. Results Common risk/protective factors were associated with FA, FCC, and IBC in ways consistent with the literature in general, and they were associated with FAC, FA, and FCC in distinct patterns. Age was associated with FAC in a bell-shape curve so that middle-aged women were more likely to have FAC. We report for the first time that FAC is positively associated with IBC with odds ratio (OR) depending on BMI (OR = 6.78, 95%CI = 3.43-13.42 at BMI<25 kg/m2; OR = 2.13, 95%CI = 1.20-3.80 at BMI>25 kg/m2). This association is only significant with HER2-negative IBC subtypes. Conclusions We conclude that FAC is a candidate risk factor for HER2-negative IBCs, and it is a distinct disease from FA. Co-occurrence analysis can be used for initial assessment of the risk for IBC from a BBD, which is vital to the study of infrequently-reported BBDs.
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Sesen MB, Nicholson AE, Banares-Alcantara R, Kadir T, Brady M. Bayesian networks for clinical decision support in lung cancer care. PLoS One 2013; 8:e82349. [PMID: 24324773 PMCID: PMC3855802 DOI: 10.1371/journal.pone.0082349] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 10/30/2013] [Indexed: 01/22/2023] Open
Abstract
Survival prediction and treatment selection in lung cancer care are characterised by high levels of uncertainty. Bayesian Networks (BNs), which naturally reason with uncertain domain knowledge, can be applied to aid lung cancer experts by providing personalised survival estimates and treatment selection recommendations. Based on the English Lung Cancer Database (LUCADA), we evaluate the feasibility of BNs for these two tasks, while comparing the performances of various causal discovery approaches to uncover the most feasible network structure from expert knowledge and data. We show first that the BN structure elicited from clinicians achieves a disappointing area under the ROC curve of 0.75 (± 0.03), whereas a structure learned by the CAMML hybrid causal discovery algorithm, which adheres with the temporal restrictions, achieves 0.81 (± 0.03). Second, our causal intervention results reveal that BN treatment recommendations, based on prescribing the treatment plan that maximises survival, can only predict the recorded treatment plan 29% of the time. However, this percentage rises to 76% when partial matches are included.
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Affiliation(s)
- M. Berkan Sesen
- Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Ann E. Nicholson
- Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| | | | | | - Michael Brady
- Department of Oncology, University of Oxford, Oxford, United Kingdom
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Liebman MN. Company Profile: Strategic Medicine, Inc. and Strategic Medicine, BV. Per Med 2013; 10:633-637. [PMID: 29768758 DOI: 10.2217/pme.13.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Strategic Medicine, BV (The Hague, The Netherlands) and Strategic Medicine, Inc. (PA, USA) deliver products and services to therapeutic and diagnostic companies, healthcare providers and payers and the investment community based on unique methodologies for modeling disease processes, from predisease through diagnosis, disease and patient stratification and outcome. Strategic Medicine, Inc. focuses on the development of disease models that design and incorporate a personalized health record to model the progression of a patient from genetic risk, through interaction with lifestyle and environment, to early disease detection, disease and patient stratification and treatment decision support for enhanced outcomes. This model involves the integration of disparate data and databases, evaluation of data quality and completeness, data simulation (when necessary), systems modeling and quantitative risk/opportunity evaluation. Strategic Medicine, Inc. has been involved in applying these approaches in oncology, cardiology, women's health and pediatric conditions and rare diseases, and has focused on the development of both disease- and data-agnostic infrastructures and analytics.
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Affiliation(s)
- Michael N Liebman
- Strategic Medicine, Inc., 231 Deepdale Drive, Kennett Square, PA 19348, USA.
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Stojadinovic A, Bilchik A, Smith D, Eberhardt JS, Ward EB, Nissan A, Johnson EK, Protic M, Peoples GE, Avital I, Steele SR. Clinical decision support and individualized prediction of survival in colon cancer: bayesian belief network model. Ann Surg Oncol 2012; 20:161-74. [PMID: 22899001 DOI: 10.1245/s10434-012-2555-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND We used a large population-based data set to create a clinical decision support system (CDSS) for real-time estimation of overall survival (OS) among colon cancer (CC) patients. Patients with CC diagnosed between 1969 and 2006 were identified from the Surveillance Epidemiology and End Results (SEER) registry. Low- and high-risk cohorts were defined. The tenfold cross-validation assessed predictive utility of the machine-learned Bayesian belief network (ml-BBN) model for clinical decision support (CDS). METHODS A data set consisting of 146,248 records was analyzed using ml-BBN models to provide CDS in estimating OS based on prognostic factors at 12-, 24-, 36-, and 60-month post-treatment follow-up. RESULTS Independent prognostic factors in the ml-BBN model included age, race; primary tumor histology, grade and location; Number of primaries, AJCC T stage, N stage, and M stage. The ml-BBN model accurately estimated OS with area under the receiver-operating-characteristic curve of 0.85, thereby improving significantly upon existing AJCC stage-specific OS estimates. Significant differences in OS were found between low- and high-risk cohorts (odds ratios for mortality: 17.1, 16.3, 13.9, and 8.8 for 12-, 24-, 36-, and 60-month cohorts, respectively). CONCLUSIONS A CDSS was developed to provide individualized estimates of survival in CC. This ml-BBN model provides insights as to how disease-specific factors influence outcome. Time-dependent, individualized mortality risk assessments may inform treatment decisions and facilitate clinical trial design.
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Affiliation(s)
- Alexander Stojadinovic
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Forsberg JA, Healey JH, Brennan MF. A probabilistic analysis of completely excised high-grade soft tissue sarcomas of the extremity: an application of a Bayesian belief network. Ann Surg Oncol 2012; 19:2992-3001. [PMID: 22526900 DOI: 10.1245/s10434-012-2345-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Indexed: 12/28/2022]
Abstract
BACKGROUND It is important to understand the relative importance of prognostic variables in patients with soft tissue sarcomas. The purpose of this study was to describe the hierarchical relationships between features inherent to completely excised, localized high-grade soft tissue sarcomas of the extremity and compare the associations to those previously reported. METHODS Data were collected from the Memorial Sloan-Kettering Cancer Center Sarcoma Database. All adult patients with high-grade extremity soft tissue sarcomas who underwent complete excision (R0 margins) at our institution between 1982 and 2010 were included in the analysis. Bayesian belief network (BBN) modeling software was used to develop a hierarchical network of features trained to estimate the likelihood of disease-specific survival. Important relationships depicted by the BBN model were compared to those previously reported. RESULTS The records of 1318 consecutive patients met the inclusion criteria, and all were included in the analysis. First-degree associates of disease-specific survival were the primary tumor size; presence of and time to distant recurrence; and presence of and time to local recurrence. On cross-validation, the BBN model was sufficiently robust, with an area under the curve of 0.94 (95 % confidence interval 0.93-0.96). CONCLUSIONS We successfully described the hierarchical relationships between features inherent to patients with completely excised high-grade soft tissue sarcomas of the extremity. The relationships defined by the BBN model were similar to those previously reported. Cross-validation results were encouraging, demonstrating that BBN modeling can be used to graphically illustrate the complex hierarchical relationships between prognostic features in this setting.
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Modeling Paradigms for Medical Diagnostic Decision Support: A Survey and Future Directions. J Med Syst 2011; 36:3029-49. [PMID: 21964969 DOI: 10.1007/s10916-011-9780-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 09/12/2011] [Indexed: 10/17/2022]
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Hu H, Correll M, Kvecher L, Osmond M, Clark J, Bekhash A, Schwab G, Gao D, Gao J, Kubatin V, Shriver CD, Hooke JA, Maxwell LG, Kovatich AJ, Sheldon JG, Liebman MN, Mural RJ. DW4TR: A Data Warehouse for Translational Research. J Biomed Inform 2011; 44:1004-19. [PMID: 21872681 DOI: 10.1016/j.jbi.2011.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 07/05/2011] [Accepted: 08/04/2011] [Indexed: 10/17/2022]
Abstract
The linkage between the clinical and laboratory research domains is a key issue in translational research. Integration of clinicopathologic data alone is a major task given the number of data elements involved. For a translational research environment, it is critical to make these data usable at the point-of-need. Individual systems have been developed to meet the needs of particular projects though the need for a generalizable system has been recognized. Increased use of Electronic Medical Record data in translational research will demand generalizing the system for integrating clinical data to support the study of a broad range of human diseases. To ultimately satisfy these needs, we have developed a system to support multiple translational research projects. This system, the Data Warehouse for Translational Research (DW4TR), is based on a light-weight, patient-centric modularly-structured clinical data model and a specimen-centric molecular data model. The temporal relationships of the data are also part of the model. The data are accessed through an interface composed of an Aggregated Biomedical-Information Browser (ABB) and an Individual Subject Information Viewer (ISIV) which target general users. The system was developed to support a breast cancer translational research program and has been extended to support a gynecological disease program. Further extensions of the DW4TR are underway. We believe that the DW4TR will play an important role in translational research across multiple disease types.
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Affiliation(s)
- Hai Hu
- Windber Research Institute, Windber, PA 15963, USA.
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Elster EA, Hawksworth JS, Cheng O, Leeser DB, Ring M, Tadaki DK, Kleiner DE, Eberhardt JS, Brown TS, Mannon RB. Probabilistic (Bayesian) modeling of gene expression in transplant glomerulopathy. J Mol Diagn 2010; 12:653-63. [PMID: 20688906 DOI: 10.2353/jmoldx.2010.090101] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Transplant glomerulopathy (TG) is associated with rapid decline in glomerular filtration rate and poor outcome. We used low-density arrays with a novel probabilistic analysis to characterize relationships between gene transcripts and the development of TG in allograft recipients. Retrospective review identified TG in 10.8% of 963 core biopsies from 166 patients; patients with stable function were studied for comparison. The biopsies were analyzed for expression of 87 genes related to immune function and fibrosis by using real-time PCR, and a Bayesian model was generated and validated to predict histopathology based on gene expression. A total of 57 individual genes were increased in TG compared with stable function biopsies (P < 0.05). The Bayesian analysis identified critical relationships between ICAM-1, IL-10, CCL3, CD86, VCAM-1, MMP-9, MMP-7, and LAMC2 and allograft pathology. Moreover, Bayesian models predicted TG when derived from either immune function (area under the curve [95% confidence interval] of 0.875 [0.675 to 0.999], P = 0.004) or fibrosis (area under the curve [95% confidence interval] of 0.859 [0.754 to 0.963], P < 0.001) gene networks. Critical pathways in the Bayesian models were also analyzed by using the Fisher exact test and had P values <0.005. This study demonstrates that evaluating quantitative gene expression profiles with Bayesian modeling can identify significant transcriptional associations that have the potential to support the diagnostic capability of allograft histology. This integrated approach has broad implications in the field of transplant diagnostics.
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Affiliation(s)
- Eric A Elster
- Regenerative Medicine Department, Combat Casualty Care, Naval Medical Research Center, Silver Spring, Maryland 20910, USA.
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