A principled machine learning framework improves accuracy of stage II colorectal cancer prognosis

Few-shot Tumor Bud Segmentation Using Generative Model in Colorectal Carcinoma

Current deep learning methods in histopathology are limited by the small amount of available data and time consumption in labeling the data. Colorectal cancer (CRC) tumor budding quantification performed using H&E-stained slides is crucial for cancer staging and prognosis but is subject to labor-intensive annotation and human bias. Thus, acquiring a large-scale, fully annotated dataset for training a tumor budding (TB) segmentation/detection system is difficult. Here, we present a DatasetGAN-based approach that can generate essentially an unlimited number of images with TB masks from a moderate number of unlabeled images and a few annotated images. The images generated by our model closely resemble the real colon tissue on H&E-stained slides. We test the performance of this model by training a downstream segmentation model, UNet++, on the generated images and masks. Our results show that the trained UNet++ model can achieve reasonable TB segmentation performance, especially at the instance level. This study demonstrates the potential of developing an annotation-efficient segmentation model for automatic TB detection and quantification.

Predicting Colorectal Cancer Survival Using Time-to-Event Machine Learning: Retrospective Cohort Study

BACKGROUND

Machine learning (ML) methods have shown great potential in predicting colorectal cancer (CRC) survival. However, the ML models introduced thus far have mainly focused on binary outcomes and have not considered the time-to-event nature of this type of modeling.

OBJECTIVE

This study aims to evaluate the performance of ML approaches for modeling time-to-event survival data and develop transparent models for predicting CRC-specific survival.

METHODS

The data set used in this retrospective cohort study contains information on patients who were newly diagnosed with CRC between December 28, 2012, and December 27, 2019, at West China Hospital, Sichuan University. We assessed the performance of 6 representative ML models, including random survival forest (RSF), gradient boosting machine (GBM), DeepSurv, DeepHit, neural net-extended time-dependent Cox (or Cox-Time), and neural multitask logistic regression (N-MTLR) in predicting CRC-specific survival. Multiple imputation by chained equations method was applied to handle missing values in variables. Multivariable analysis and clinical experience were used to select significant features associated with CRC survival. Model performance was evaluated in stratified 5-fold cross-validation repeated 5 times by using the time-dependent concordance index, integrated Brier score, calibration curves, and decision curves. The SHapley Additive exPlanations method was applied to calculate feature importance.

RESULTS

A total of 2157 patients with CRC were included in this study. Among the 6 time-to-event ML models, the DeepHit model exhibited the best discriminative ability (time-dependent concordance index 0.789, 95% CI 0.779-0.799) and the RSF model produced better-calibrated survival estimates (integrated Brier score 0.096, 95% CI 0.094-0.099), but these are not statistically significant. Additionally, the RSF, GBM, DeepSurv, Cox-Time, and N-MTLR models have comparable predictive accuracy to the Cox Proportional Hazards model in terms of discrimination and calibration. The calibration curves showed that all the ML models exhibited good 5-year survival calibration. The decision curves for CRC-specific survival at 5 years showed that all the ML models, especially RSF, had higher net benefits than default strategies of treating all or no patients at a range of clinically reasonable risk thresholds. The SHapley Additive exPlanations method revealed that R0 resection, tumor-node-metastasis staging, and the number of positive lymph nodes were important factors for 5-year CRC-specific survival.

CONCLUSIONS

This study showed the potential of applying time-to-event ML predictive algorithms to help predict CRC-specific survival. The RSF, GBM, Cox-Time, and N-MTLR algorithms could provide nonparametric alternatives to the Cox Proportional Hazards model in estimating the survival probability of patients with CRC. The transparent time-to-event ML models help clinicians to more accurately predict the survival rate for these patients and improve patient outcomes by enabling personalized treatment plans that are informed by explainable ML models.

Down regulation of Cathepsin W is associated with poor prognosis in pancreatic cancer

Pancreatic ductal adenocarcinoma (PDAC) is associated with a very poor prognosis. Therefore, there has been a focus on identifying new biomarkers for its early diagnosis and the prediction of patient survival. Genome-wide RNA and microRNA sequencing, bioinformatics and Machine Learning approaches to identify differentially expressed genes (DEGs), followed by validation in an additional cohort of PDAC patients has been undertaken. To identify DEGs, genome RNA sequencing and clinical data from pancreatic cancer patients were extracted from The Cancer Genome Atlas Database (TCGA). We used Kaplan-Meier analysis of survival curves was used to assess prognostic biomarkers. Ensemble learning, Random Forest (RF), Max Voting, Adaboost, Gradient boosting machines (GBM), and Extreme Gradient Boosting (XGB) techniques were used, and Gradient boosting machines (GBM) were selected with 100% accuracy for analysis. Moreover, protein-protein interaction (PPI), molecular pathways, concomitant expression of DEGs, and correlations between DEGs and clinical data were analyzed. We have evaluated candidate genes, miRNAs, and a combination of these obtained from machine learning algorithms and survival analysis. The results of Machine learning identified 23 genes with negative regulation, five genes with positive regulation, seven microRNAs with negative regulation, and 20 microRNAs with positive regulation in PDAC. Key genes BMF, FRMD4A, ADAP2, PPP1R17, and CACNG3 had the highest coefficient in the advanced stages of the disease. In addition, the survival analysis showed decreased expression of hsa.miR.642a, hsa.mir.363, CD22, BTNL9, and CTSW and overexpression of hsa.miR.153.1, hsa.miR.539, hsa.miR.412 reduced survival rate. CTSW was identified as a novel genetic marker and this was validated using RT-PCR. Machine learning algorithms may be used to Identify key dysregulated genes/miRNAs involved in the disease pathogenesis can be used to detect patients in earlier stages. Our data also demonstrated the prognostic and diagnostic value of CTSW in PDAC.

Estimating Risk of Locoregional Failure and Overall Survival in Anal Cancer Following Chemoradiation: A Machine Learning Approach

BACKGROUND

Optimal treatment of anal squamous cell carcinoma (ASCC) is definitive chemoradiation. Patients with persistent or recurrent disease require abdominoperineal resection (APR). Current models for predicting need for APR and overall survival are limited by low accuracy or small datasets. This study sought to use machine learning (ML) to develop more accurate models for locoregional failure and overall survival for ASCC.

METHODS

This study used the National Cancer Database from 2004-2018, divided into training, validation, and test sets. We included patients with stage I-III ASCC who underwent chemoradiation. Our primary outcomes were need for APR and 3-year overall survival. Random forest (RF), gradient boosting (XGB), and neural network (NN) ML-based models were developed and compared with logistic regression (LR). Accuracy was assessed using area under the receiver operating characteristic curve (AUROC).

RESULTS

APR was required in 5.3% (1,015/18,978) of patients. XGB performed best with AUROC of 0.813, compared with 0.691 for LR. Tumor size, lymphovascular invasion, and tumor grade showed the strongest influence on model predictions. Mortality was 23.6% (7,988/33,834). AUROC for XGB and LR were similar at 0.766 and 0.748, respectively. For this model, age, radiation dose, sex, and insurance status were the most influential variables.

CONCLUSIONS

We developed and internally validated machine learning-based models for predicting outcomes in ASCC and showed higher accuracy versus LR for locoregional failure, but not overall survival. After external validation, these models may assist clinicians with identifying patients with ASCC at high risk of treatment failure.

Artificial intelligence in colorectal surgery: an AI-powered systematic review

Artificial intelligence (AI) has the potential to revolutionize surgery in the coming years. Still, it is essential to clarify what the meaningful current applications are and what can be reasonably expected. This AI-powered review assessed the role of AI in colorectal surgery. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic search of PubMed, Embase, Scopus, Cochrane Library databases, and gray literature was conducted on all available articles on AI in colorectal surgery (from January 1 1997 to March 1 2021), aiming to define the perioperative applications of AI. Potentially eligible studies were identified using novel software powered by natural language processing (NLP) and machine learning (ML) technologies dedicated to systematic reviews. Out of 1238 articles identified, 115 were included in the final analysis. Available articles addressed the role of AI in several areas of interest. In the preoperative phase, AI can be used to define tailored treatment algorithms, support clinical decision-making, assess the risk of complications, and predict surgical outcomes and survival. Intraoperatively, AI-enhanced surgery and integration of AI in robotic platforms have been suggested. After surgery, AI can be implemented in the Enhanced Recovery after Surgery (ERAS) pathway. Additional areas of applications included the assessment of patient-reported outcomes, automated pathology assessment, and research. Available data on these aspects are limited, and AI in colorectal surgery is still in its infancy. However, the rapid evolution of technologies makes it likely that it will increasingly be incorporated into everyday practice.

SnapEnsemFS: a snapshot ensembling-based deep feature selection model for colorectal cancer histological analysis

Colorectal cancer is the third most common type of cancer diagnosed annually, and the second leading cause of death due to cancer. Early diagnosis of this ailment is vital for preventing the tumours to spread and plan treatment to possibly eradicate the disease. However, population-wide screening is stunted by the requirement of medical professionals to analyse histological slides manually. Thus, an automated computer-aided detection (CAD) framework based on deep learning is proposed in this research that uses histological slide images for predictions. Ensemble learning is a popular strategy for fusing the salient properties of several models to make the final predictions. However, such frameworks are computationally costly since it requires the training of multiple base learners. Instead, in this study, we adopt a snapshot ensemble method, wherein, instead of the traditional method of fusing decision scores from the snapshots of a Convolutional Neural Network (CNN) model, we extract deep features from the penultimate layer of the CNN model. Since the deep features are extracted from the same CNN model but for different learning environments, there may be redundancy in the feature set. To alleviate this, the features are fed into Particle Swarm Optimization, a popular meta-heuristic, for dimensionality reduction of the feature space and better classification. Upon evaluation on a publicly available colorectal cancer histology dataset using a five-fold cross-validation scheme, the proposed method obtains a highest accuracy of 97.60% and F1-Score of 97.61%, outperforming existing state-of-the-art methods on the same dataset. Further, qualitative investigation of class activation maps provide visual explainability to medical practitioners, as well as justifies the use of the CAD framework in screening of colorectal histology. Our source codes are publicly accessible at: https://github.com/soumitri2001/SnapEnsemFS .

Data synthesis and adversarial networks: A review and meta-analysis in cancer imaging

Despite technological and medical advances, the detection, interpretation, and treatment of cancer based on imaging data continue to pose significant challenges. These include inter-observer variability, class imbalance, dataset shifts, inter- and intra-tumour heterogeneity, malignancy determination, and treatment effect uncertainty. Given the recent advancements in image synthesis, Generative Adversarial Networks (GANs), and adversarial training, we assess the potential of these technologies to address a number of key challenges of cancer imaging. We categorise these challenges into (a) data scarcity and imbalance, (b) data access and privacy, (c) data annotation and segmentation, (d) cancer detection and diagnosis, and (e) tumour profiling, treatment planning and monitoring. Based on our analysis of 164 publications that apply adversarial training techniques in the context of cancer imaging, we highlight multiple underexplored solutions with research potential. We further contribute the Synthesis Study Trustworthiness Test (SynTRUST), a meta-analysis framework for assessing the validation rigour of medical image synthesis studies. SynTRUST is based on 26 concrete measures of thoroughness, reproducibility, usefulness, scalability, and tenability. Based on SynTRUST, we analyse 16 of the most promising cancer imaging challenge solutions and observe a high validation rigour in general, but also several desirable improvements. With this work, we strive to bridge the gap between the needs of the clinical cancer imaging community and the current and prospective research on data synthesis and adversarial networks in the artificial intelligence community.

Cell graph neural networks enable the precise prediction of patient survival in gastric cancer

Gastric cancer is one of the deadliest cancers worldwide. An accurate prognosis is essential for effective clinical assessment and treatment. Spatial patterns in the tumor microenvironment (TME) are conceptually indicative of the staging and progression of gastric cancer patients. Using spatial patterns of the TME by integrating and transforming the multiplexed immunohistochemistry (mIHC) images as Cell-Graphs, we propose a graph neural network-based approach, termed Cell−GraphSignatureorCG_Signature, powered by artificial intelligence, for the digital staging of TME and precise prediction of patient survival in gastric cancer. In this study, patient survival prediction is formulated as either a binary (short-term and long-term) or ternary (short-term, medium-term, and long-term) classification task. Extensive benchmarking experiments demonstrate that the CG_Signature achieves outstanding model performance, with Area Under the Receiver Operating Characteristic curve of 0.960 ± 0.01, and 0.771 ± 0.024 to 0.904 ± 0.012 for the binary- and ternary-classification, respectively. Moreover, Kaplan–Meier survival analysis indicates that the “digital grade” cancer staging produced by CG_Signature provides a remarkable capability in discriminating both binary and ternary classes with statistical significance (P value < 0.0001), significantly outperforming the AJCC 8th edition Tumor Node Metastasis staging system. Using Cell-Graphs extracted from mIHC images, CG_Signature improves the assessment of the link between the TME spatial patterns and patient prognosis. Our study suggests the feasibility and benefits of such an artificial intelligence-powered digital staging system in diagnostic pathology and precision oncology.

COVID-19 and Science Communication: The Recording and Reporting of Disease Mortality

The ongoing COVID-19 pandemic has brought science to the fore of public discourse and, considering the complexity of the issues involved, with it also the challenge of effective and informative science communication. This is a particularly contentious topic, in that it is both highly emotional in and of itself; sits at the nexus of the decision-making process regarding the handling of the pandemic, which has effected lockdowns, social behaviour measures, business closures, and others; and concerns the recording and reporting of disease mortality. To clarify a point that has caused much controversy and anger in the public debate, the first part of the present article discusses the very fundamentals underlying the issue of causative attribution with regards to mortality, lays out the foundations of the statistical means of mortality estimation, and concretizes these by analysing the recording and reporting practices adopted in England and their widespread misrepresentations. The second part of the article is empirical in nature. I present data and an analysis of how COVID-19 mortality has been reported in the mainstream media in the UK and the USA, including a comparative analysis both across the two countries as well as across different media outlets. The findings clearly demonstrate a uniform and worrying lack of understanding of the relevant technical subject matter by the media in both countries. Of particular interest is the finding that with a remarkable regularity (ρ>0.998), the greater the number of articles a media outlet has published on COVID-19 mortality, the greater the proportion of its articles misrepresented the disease mortality figures.

Relationship between miR-204 and ANGPTL2 expression and diagnosis, pathological stage, and prognosis in patients with colon cancer

Background

Angiopoietin-like protein 2 (ANGPTL2) is linked to various tumors. MicroRNA-204 (miR-204) is associated with colorectal cancer (CRC). Bioinformatic analysis has demonstrated a targeting relationship between miR-204 and ANGPTL2. The present study aimed to investigate the role of miR-204 in the proliferation and apoptosis of colorectal tumor cells.

Methods

Colorectal tumor tissues were collected. Normal colon mucosa was used as a control. The relationship between miR-204 and ANGPTL2 expression and tumor stage and prognosis was analyzed. The dual-luciferase reporter assay confirmed targeted regulation between miR-204 and ANGPTL2. SW480 cells were allocated to the miR-NC group and the miR-204 mimic group, followed by apoptotic analysis using flow cytometry and cellular proliferation analysis using EdU staining.

Results

Compared with normal colonic mucosa, miR-204 expression was decreased in colorectal tumor tissues and ANGPTL2 expression was increased, which correlated with TNM staging. The prognosis of patients with low miR-204 expression and high ANGPTL2 expression was worse than for patients with high miR-204 expression and low ANGPTL2 expression. The dual-luciferase reporter assay confirmed a targeting regulation relationship between miR-204 and ANGPTL2. Transfection of miR-204 mimic significantly inhibited the expression of ANGPTL2 and cell proliferation in SW480 cells and promoted apoptosis.

Conclusions

Downregulating miR-204 expression plays a vital role in upregulating ANGPTL2 expression and promoting the pathogenesis of CRC. MiR-204 is able to hinder the proliferation of colorectal tumor cells and encourage apoptosis by targeting the inhibition of ANGPTL2 expression.

Construction of an immune-related prognostic model by exploring the tumor microenvironment of clear cell renal cell carcinoma

OBJECTIVE

In this study, bioinformatics methods were performed to screen the candidate prognosis-related genes of clear cell renal cell carcinoma (ccRCC) by analyzing the tumor microenvironment (TME).

METHODS

Gene expression and clinical data of ccRCC patients were accessed from TCGA, and R package ESTIMATE was applied to calculate immune, stromal, and ESTIMATE scores of the patients. Survival analysis was conducted per median of these three scores. Based on the scoring results, differentially expressed genes (DEGs) were screened. Regression algorithms were utilized to screen prognostic genes and establish a risk model. Finally, pathway activity differences were analyzed through GSEA.

RESULTS

Patients with the unfavorable prognosis had high immune scores. 619 DEGs (499 up-regulated and 120 down-regulated) were screened based on the differences in gene expression of the patients with high and low immune scores. These genes mainly participated in immune-related signaling pathways. A prognostic risk model for ccRCC patients was constructed and 7 immune-related signature genes (RORB, TNFSF14, UCN2, USP2, TOX3, KLRC2, SLAMF9) were obtained through regression analysis. The constructed prognostic risk model could be used for determining prognoses of patients with ccRCC.

CONCLUSION

We unraveled the association between TME and prognosis of ccRCC patients and established a prognostic risk model based on the differentially expressed genes. These results contributed to understanding of TME that affected patients' prognosis and progression of ccRCC and conduced to finding potential biomarkers of ccRCC.

Nuances of Interpreting X-ray Analysis by Deep Learning and Lessons for Reporting Experimental Findings

With the increase in the availability of annotated X-ray image data, there has been an accompanying and consequent increase in research on machine-learning-based, and ion particular deep-learning-based, X-ray image analysis. A major problem with this body of work lies in how newly proposed algorithms are evaluated. Usually, comparative analysis is reduced to the presentation of a single metric, often the area under the receiver operating characteristic curve (AUROC), which does not provide much clinical value or insight and thus fails to communicate the applicability of proposed models. In the present paper, we address this limitation of previous work by presenting a thorough analysis of a state-of-the-art learning approach and hence illuminate various weaknesses of similar algorithms in the literature, which have not yet been fully acknowledged and appreciated. Our analysis was performed on the ChestX-ray14 dataset, which has 14 lung disease labels and metainfo such as patient age, gender, and the relative X-ray direction. We examined the diagnostic significance of different metrics used in the literature including those proposed by the International Medical Device Regulators Forum, and present the qualitative assessment of the spatial information learned by the model. We show that models that have very similar AUROCs can exhibit widely differing clinical applicability. As a result, our work demonstrates the importance of detailed reporting and analysis of the performance of machine-learning approaches in this field, which is crucial both for progress in the field and the adoption of such models in practice.

Development of artificial intelligence technology in diagnosis, treatment, and prognosis of colorectal cancer

Artificial intelligence (AI) technology has made leaps and bounds since its invention. AI technology can be subdivided into many technologies such as machine learning and deep learning. The application scope and prospect of different technologies are also totally different. Currently, AI technologies play a pivotal role in the highly complex and wide-ranging medical field, such as medical image recognition, biotechnology, auxiliary diagnosis, drug research and development, and nutrition. Colorectal cancer (CRC) is a common gastrointestinal cancer that has a high mortality, posing a serious threat to human health. Many CRCs are caused by the malignant transformation of colorectal polyps. Therefore, early diagnosis and treatment are crucial to CRC prognosis. The methods of diagnosing CRC are divided into imaging diagnosis, endoscopy, and pathology diagnosis. Treatment methods are divided into endoscopic treatment, surgical treatment, and drug treatment. AI technology is in the weak era and does not have communication capabilities. Therefore, the current AI technology is mainly used for image recognition and auxiliary analysis without in-depth communication with patients. This article reviews the application of AI in the diagnosis, treatment, and prognosis of CRC and provides the prospects for the broader application of AI in CRC.

The role of AI technology in prediction, diagnosis and treatment of colorectal cancer

Artificial intelligence (AI) is a fascinating new technology that incorporates machine learning and neural networks to improve existing technology or create new ones. Potential applications of AI are introduced to aid in the fight against colorectal cancer (CRC). This includes how AI will affect the epidemiology of colorectal cancer and the new methods of mass information gathering like GeoAI, digital epidemiology and real-time information collection. Meanwhile, this review also examines existing tools for diagnosing disease like CT/MRI, endoscopes, genetics, and pathological assessments also benefitted greatly from implementation of deep learning. Finally, how treatment and treatment approaches to CRC can be enhanced when applying AI is under discussion. The power of AI regarding the therapeutic recommendation in colorectal cancer demonstrates much promise in clinical and translational field of oncology, which means better and personalized treatments for those in need.

Machine Learning Algorithms for Predicting Surgical Outcomes after Colorectal Surgery: A Systematic Review

BACKGROUND

Machine learning (ML) has been introduced in various fields of healthcare. In colorectal surgery, the role of ML has yet to be reported. In this systematic review, an overview of machine learning models predicting surgical outcomes after colorectal surgery is provided.

METHODS

Databases PubMed, EMBASE, Cochrane, and Web of Science were searched for studies using machine learning models for patients undergoing colorectal surgery. To be eligible for inclusion, studies needed to apply machine learning models for patients undergoing colorectal surgery. Absence of machine learning or colorectal surgery or studies reporting on reviews, children, study abstracts were excluded. The Probast risk of bias tool was used to evaluate the methodological quality of machine learning models.

RESULTS

A total of 1821 studies were analysed, resulting in the inclusion of 31 articles. A vast proportion of ML algorithms have been used to predict the course of disease and response to neoadjuvant chemoradiotherapy. Radiomics have been applied most frequently, along with predictive accuracies up to 91%. However, most studies included a retrospective study design without external validation or calibration.

CONCLUSIONS

Machine learning models have shown promising potential in predicting surgical outcomes after colorectal surgery. However, large-scale data is warranted to bridge the gap between calibration and external validation. Clinical implementation is needed to demonstrate the contribution of ML within daily practice.

Artificial intelligence in colorectal cancer management

Artificial intelligence (AI) is a new branch of computer science involving many disciplines and technologies. Since its application in the medical field, it has been constantly studied and developed. AI includes machine learning and neural networks to create new technologies or to improve existing ones. Various AI supporting systems are available for a personalized and novel strategy for the management of colorectal cancer (CRC). This mini-review aims to summarize the progress of research and possible clinical applications of AI in the investigation, early diagnosis, treatment, and management of CRC, to offer elements of knowledge as a starting point for new studies and future applications.

BH-index: A predictive system based on serum biomarkers and ensemble learning for early colorectal cancer diagnosis in mass screening

BACKGROUND AND OBJECTIVE

Colorectal cancer is one of the most common malignancies among the general population. Artificial Intelligence methodologies based on serum parameters are in continuous development to obtain less expensive tools for highly sensitive diagnoses. This study proposes a predictive system based on serum biomarkers and ensemble learning to predict colorectal cancer presence and the related TNM stage in patients.

METHODS

We have selected 17 significant plasmatic proteins, i.e., Carcinoembryonic Antigen, CA 19-9, CA 125, CA 50, CA 72-4, Tissue Polypeptide Antigen, C-Reactive Protein, Ceruloplasmin, Haptoglobin, Transferrin, Ferritin, α-1-Antitrypsin, α-2-Macroglobulin, α-1 Acid Glycoprotein, Complement C4, Complement C3, and Retinol Binding Protein, regarding 345 patients (248 affected by the neoplastic disease). The proposed system consists of two predictors, i.e., binary and staging; the former predicts the presence/absence of cancer, while the latter identifies the related TNM stage (I, II, III, or IV). The experiments were conducted by deploying and comparing Random Forest, XGBoost, Support Vector Machine, and Multilayer Perceptron with feature selection based on Gini Importance and with dimensionality reduction via PCA.

RESULTS

The results show that the system composed of XGBoost as binary and staging predictor reaches 91.30% accuracy, 90% sensitivity, and 93.33% specificity for the absence/presence outcome, while 66.66% accuracy for the staging response. With the expansion of the training set in favor of positive patients and majority voting, the system composed of the combination of Support Vector Machine, XGBoost, and Multilayer Perceptron as the binary predictor reaches 98.03% accuracy, 100% sensitivity, and 92.30% specificity, while the combination of Random Forest, XGBoost, and Multilayer Perceptron as staging predictor achieves 60% accuracy. The final system reaches, in terms of accuracy, 98.03%, and 66.66% for the binary and staging predictors, respectively. It was also found that the biomarkers which contribute most to the binary decision are Ceruloplasmin and α-2-Macroglobulin, while the least significant dimensions are CA 50 and α-1-Antitrypsin; instead, Carcinoembryonic Antigen and α-1 Acid Glycoprotein are the most significant to the staging decision.

CONCLUSIONS

The present study proves the effectiveness of deploying serum biomarkers as feature dimensions for early colorectal cancer diagnosis and of using majority voting for noise reduction in the prediction.

Progression-Free Survival Prediction in Patients with Nasopharyngeal Carcinoma after Intensity-Modulated Radiotherapy: Machine Learning vs. Traditional Statistics

Background: The Cox proportional hazards (CPH) model is the most commonly used statistical method for nasopharyngeal carcinoma (NPC) prognostication. Recently, machine learning (ML) models are increasingly adopted for this purpose. However, only a few studies have compared the performances between CPH and ML models. This study aimed at comparing CPH with two state-of-the-art ML algorithms, namely, conditional survival forest (CSF) and DeepSurv for disease progression prediction in NPC. Methods: From January 2010 to March 2013, 412 eligible NPC patients were reviewed. The entire dataset was split into training cohort and testing cohort in a ratio of 90%:10%. Ten features from patient-related, disease-related, and treatment-related data were used to train the models for progression-free survival (PFS) prediction. The model performance was compared using the concordance index (c-index), Brier score, and log-rank test based on the risk stratification results. Results: DeepSurv (c-index = 0.68, Brier score = 0.13, log-rank test p = 0.02) achieved the best performance compared to CSF (c-index = 0.63, Brier score = 0.14, log-rank test p = 0.38) and CPH (c-index = 0.57, Brier score = 0.15, log-rank test p = 0.81). Conclusions: Both CSF and DeepSurv outperformed CPH in our relatively small dataset. ML-based survival prediction may guide physicians in choosing the most suitable treatment strategy for NPC patients.

SOX9 is associated with advanced T-stages of clinical stage II colon cancer in young Mexican patients

Colorectal cancer (CRC) is one of the most common malignancies worldwide and includes colon cancer (CC) and rectal cancer (RC). Regarding CC, the development of novel molecular biomarkers for the accurate diagnosis and prognosis, as well as the identification of novel targets for therapeutic intervention, are urgently needed. SRY-related high-mobility group box 9 (SOX9), a transcription factor, is involved in development, and has been associated with the progression of human cancer. However, its underlying clinical and functional effects in CRC have not been fully understood. Therefore, the present study aimed to evaluate the clinical and functional relevance of SOX9 expression in CC. The expression of SOX9 in tumor tissues was evaluated in 97 biopsies from Mexican patients with CC with early-stage I and II disease by immunohistochemistry (IHC). In addition, SOX9 silencing in the HCT116 cell line was performed using specific small interfering RNAs, while downregulation efficiency was verified by reverse transcription-quantitative PCR and immunofluorescence. Spheroid-formation assay was carried out using ultra-low attachment plates. The IHC results showed that SOX9 was upregulated in patients with stage II (91%) and advanced T3 stage (67%) CC. Interestingly, higher SOX9 expression was associated with clinical stage, tumor size and tumor location. Furthermore, increased SOX9 expression was found in relapsed cases with local tumors; however, it was not associated with increased survival probability. Additionally, functional analysis indicated that SOX9 silencing significantly attenuated the sphere-formation capability of HCT116 cells. The present study was the first to evaluate the expression levels of SOX9 in Mexican patients diagnosed with early-stage CC. The aforementioned findings indicated that high SOX9 expression could play an important role in tumorigenesis and be associated with advanced T-stages of clinical-stage II patients, but not with relapse-free survival.

Interpretable survival prediction for colorectal cancer using deep learning

Deriving interpretable prognostic features from deep-learning-based prognostic histopathology models remains a challenge. In this study, we developed a deep learning system (DLS) for predicting disease-specific survival for stage II and III colorectal cancer using 3652 cases (27,300 slides). When evaluated on two validation datasets containing 1239 cases (9340 slides) and 738 cases (7140 slides), respectively, the DLS achieved a 5-year disease-specific survival AUC of 0.70 (95% CI: 0.66–0.73) and 0.69 (95% CI: 0.64–0.72), and added significant predictive value to a set of nine clinicopathologic features. To interpret the DLS, we explored the ability of different human-interpretable features to explain the variance in DLS scores. We observed that clinicopathologic features such as T-category, N-category, and grade explained a small fraction of the variance in DLS scores (R² = 18% in both validation sets). Next, we generated human-interpretable histologic features by clustering embeddings from a deep-learning-based image-similarity model and showed that they explained the majority of the variance (R² of 73–80%). Furthermore, the clustering-derived feature most strongly associated with high DLS scores was also highly prognostic in isolation. With a distinct visual appearance (poorly differentiated tumor cell clusters adjacent to adipose tissue), this feature was identified by annotators with 87.0–95.5% accuracy. Our approach can be used to explain predictions from a prognostic deep learning model and uncover potentially-novel prognostic features that can be reliably identified by people for future validation studies.

Assessment of Immunological Features in Muscle-Invasive Bladder Cancer Prognosis Using Ensemble Learning

The clinical staging and prognosis of muscle-invasive bladder cancer (MIBC) routinely includes the assessment of patient tissue samples by a pathologist. Recent studies corroborate the importance of image analysis in identifying and quantifying immunological markers from tissue samples that can provide further insight into patient prognosis. In this paper, we apply multiplex immunofluorescence to MIBC tissue sections to capture whole-slide images and quantify potential prognostic markers related to lymphocytes, macrophages, tumour buds, and PD-L1. We propose a machine-learning-based approach for the prediction of 5 year prognosis with different combinations of image, clinical, and spatial features. An ensemble model comprising several functionally different models successfully stratifies MIBC patients into two risk groups with high statistical significance (p value < 1×10-5). Critical to improving MIBC survival rates, our method correctly classifies 71.4% of the patients who succumb to MIBC, which is significantly more than the 28.6% of the current clinical gold standard, the TNM staging system.

Images of Roman Imperial Denarii: A Curated Data Set for the Evaluation of Computer Vision Algorithms Applied to Ancient Numismatics, and an Overview of Challenges in the Field

Automatic ancient Roman coin analysis only recently emerged as a topic of computer science research. Nevertheless, owing to its ever-increasing popularity, the field is already reaching a certain degree of maturity, as witnessed by a substantial publication output in the last decade. At the same time, it is becoming evident that research progress is being limited by a somewhat veering direction of effort and the lack of a coherent framework which facilitates the acquisition and dissemination of robust, repeatable, and rigorous evidence. Thus, in the present article, we seek to address several associated challenges. To start with, (i) we provide a first overview and discussion of different challenges in the field, some of which have been scarcely investigated to date, and others which have hitherto been unrecognized and unaddressed. Secondly, (ii) we introduce the first data set, carefully curated and collected for the purpose of facilitating methodological evaluation of algorithms and, specifically, the effects of coin preservation grades on the performance of automatic methods. Indeed, until now, only one published work at all recognized the need for this kind of analysis, which, to any numismatist, would be a trivially obvious fact. We also discuss a wide range of considerations which had to be taken into account in collecting this corpus, explain our decisions, and describe its content in detail. Briefly, the data set comprises 100 different coin issues, all with multiple examples in Fine, Very Fine, and Extremely Fine conditions, giving a total of over 650 different specimens. These correspond to 44 issuing authorities and span the time period of approximately 300 years (from 27 BC until 244 AD). In summary, the present article should be an invaluable resource to researchers in the field, and we encourage the community to adopt the collected corpus, freely available for research purposes, as a standard evaluation benchmark.

Images of Roman Imperial Denarii: A Curated Data Set for the Evaluation of Computer Vision Algorithms Applied to Ancient Numismatics, and an Overview of Challenges in the Field

Automatic ancient Roman coin analysis only recently emerged as a topic of computer science research. Nevertheless, owing to its ever-increasing popularity, the field is already reaching a certain degree of maturity, as witnessed by a substantial publication output in the last decade. At the same time, it is becoming evident that research progress is being limited by a somewhat veering direction of effort and the lack of a coherent framework which facilitates the acquisition and dissemination of robust, repeatable, and rigorous evidence. Thus, in the present article, we seek to address several associated challenges. To start with, (i) we provide a first overview and discussion of different challenges in the field, some of which have been scarcely investigated to date, and others which have hitherto been unrecognized and unaddressed. Secondly, (ii) we introduce the first data set, carefully curated and collected for the purpose of facilitating methodological evaluation of algorithms and, specifically, the effects of coin preservation grades on the performance of automatic methods. Indeed, until now, only one published work at all recognized the need for this kind of analysis, which, to any numismatist, would be a trivially obvious fact. We also discuss a wide range of considerations which had to be taken into account in collecting this corpus, explain our decisions, and describe its content in detail. Briefly, the data set comprises 100 different coin issues, all with multiple examples in Fine, Very Fine, and Extremely Fine conditions, giving a total of over 650 different specimens. These correspond to 44 issuing authorities and span the time period of approximately 300 years (from 27 BC until 244 AD). In summary, the present article should be an invaluable resource to researchers in the field, and we encourage the community to adopt the collected corpus, freely available for research purposes, as a standard evaluation benchmark.

Images of Roman Imperial Denarii: A Curated Data Set for the Evaluation of Computer Vision Algorithms Applied to Ancient Numismatics, and an Overview of Challenges in the Field

Automatic ancient Roman coin analysis only recently emerged as a topic of computer science research. Nevertheless, owing to its ever-increasing popularity, the field is already reaching a certain degree of maturity, as witnessed by a substantial publication output in the last decade. At the same time, it is becoming evident that research progress is being limited by a somewhat veering direction of effort and the lack of a coherent framework which facilitates the acquisition and dissemination of robust, repeatable, and rigorous evidence. Thus, in the present article, we seek to address several associated challenges. To start with, (i) we provide a first overview and discussion of different challenges in the field, some of which have been scarcely investigated to date, and others which have hitherto been unrecognized and unaddressed. Secondly, (ii) we introduce the first data set, carefully curated and collected for the purpose of facilitating methodological evaluation of algorithms and, specifically, the effects of coin preservation grades on the performance of automatic methods. Indeed, until now, only one published work at all recognized the need for this kind of analysis, which, to any numismatist, would be a trivially obvious fact. We also discuss a wide range of considerations which had to be taken into account in collecting this corpus, explain our decisions, and describe its content in detail. Briefly, the data set comprises 100 different coin issues, all with multiple examples in Fine, Very Fine, and Extremely Fine conditions, giving a total of over 650 different specimens. These correspond to 44 issuing authorities and span the time period of approximately 300 years (from 27 BC until 244 AD). In summary, the present article should be an invaluable resource to researchers in the field, and we encourage the community to adopt the collected corpus, freely available for research purposes, as a standard evaluation benchmark.

Comprehensive insights on pivotal prognostic signature involved in clear cell renal cell carcinoma microenvironment using the ESTIMATE algorithm

Emerging evidence has highlighted that the immune and stromal cells formed the majority of tumor microenvironment (TME) which are served as important roles in tumor progression. In our study, we aimed to screen vital prognostic signature associated with TME in clear cell renal cell carcinoma (ccRCC). We obtained total 611 samples from TCGA database consisting of transcriptome profiles and clinical data. ESTIMATE algorithm was applied to estimate the infiltrating fractions of immune/stromal cells. We found that the immune scores revealed more prognostic significance in overall survival and positive associations with risk clinical factors than stromal scores. We carried out differential expression analysis between Immunescore and stromalscore groups to obtain the 72 intersect genes. Protein to protein interaction (PPI) network and functional analysis was performed to indicate potential altered pathways. Additionally, we further conducted multivariate Cox analysis to identify 12 hub genes associated highly with TME of ccRCC using a stepwise regression procedure. Accordingly, risk score was constructed from the multivariate Cox results and Receiver Operating Characteristic (ROC) curve was used to assess the predictive value (AUC = 0.781). The ccRCC patients with high risk scores suffered poor survival outcomes than that with low risk scores. In the validation cohort from GSE53757, TNFSF13B, CASP5, and GJB6 correlated positively with tumor stages, while FREM1 negatively correlated with tumor stages. Importantly, we further observed that TNFSF13B, CASP5 and XCR1 showed the remarkable correlations with tumor‐infiltrating immune cells. Taken together, our research identified specific signatures that related to the infiltration of stromal and immune cells in TME of ccRCC using the transciptome profiles, which reached a comprehensive understanding of tumor microenvironment in ccRCC.

Learning to Describe: A New Approach to Computer Vision Based Ancient Coin Analysis

In recent years, a range of problems under the broad umbrella of computer vision based analysis of ancient coins have been attracting an increasing amount of attention. Notwithstanding this research effort, the results achieved by the state of the art in published literature remain poor and far from sufficiently well performing for any practical purpose. In the present paper we present a series of contributions which we believe will benefit the interested community. We explain that the approach of visual matching of coins, universally adopted in existing published papers on the topic, is not of practical interest because the number of ancient coin types exceeds by far the number of those types which have been imaged, be it in digital form (e.g., online) or otherwise (traditional film, in print, etc.). Rather, we argue that the focus should be on understanding the semantic content of coins. Hence, we describe a novel approach—to first extract semantic concepts from real-world multimodal input and associate them with their corresponding coin images, and then to train a convolutional neural network to learn the appearance of these concepts. On a real-world data set, we demonstrate highly promising results, correctly identifying a range of visual elements on unseen coins with up to 84% accuracy.

Images of Roman Imperial Denarii: A Curated Data Set for the Evaluation of Computer Vision Algorithms Applied to Ancient Numismatics, and an Overview of Challenges in the Field

Automatic ancient Roman coin analysis only recently emerged as a topic of computer science research. Nevertheless, owing to its ever-increasing popularity, the field is already reaching a certain degree of maturity, as witnessed by a substantial publication output in the last decade. At the same time, it is becoming evident that research progress is being limited by a somewhat veering direction of effort and the lack of a coherent framework which facilitates the acquisition and dissemination of robust, repeatable, and rigorous evidence. Thus, in the present article, we seek to address several associated challenges. To start with, (i) we provide a first overview and discussion of different challenges in the field, some of which have been scarcely investigated to date, and others which have hitherto been unrecognized and unaddressed. Secondly, (ii) we introduce the first data set, carefully curated and collected for the purpose of facilitating methodological evaluation of algorithms and, specifically, the effects of coin preservation grades on the performance of automatic methods. Indeed, until now, only one published work at all recognized the need for this kind of analysis, which, to any numismatist, would be a trivially obvious fact. We also discuss a wide range of considerations which had to be taken into account in collecting this corpus, explain our decisions, and describe its content in detail. Briefly, the data set comprises 100 different coin types, all with multiple examples in Fine, Very Fine, and Extremely Fine conditions, giving a total of over 650 different specimens. These correspond to 44 issuing authorities and span the time period of approximately 300 years (from 27 BC until 244 AD). In summary, the present article should be an invaluable resource to researchers in the field, and we encourage the community to adopt the collected corpus, freely available for research purposes, as a standard evaluation benchmark.

Data-Driven Audiogram Classification for Mobile Audiometry

Recent mobile and automated audiometry technologies have allowed for the democratization of hearing healthcare and enables non-experts to deliver hearing tests. The problem remains that a large number of such users are not trained to interpret audiograms. In this work, we outline the development of a data-driven audiogram classification system designed specifically for the purpose of concisely describing audiograms. More specifically, we present how a training dataset was assembled and the development of the classification system leveraging supervised learning techniques. We show that three practicing audiologists had high intra- and inter-rater agreement over audiogram classification tasks pertaining to audiogram configuration, symmetry and severity. The system proposed here achieves a performance comparable to the state of the art, but is significantly more flexible. Altogether, this work lays a solid foundation for future work aiming to apply machine learning techniques to audiology for audiogram interpretation.

Learning to Describe: A New Approach to Computer Vision Based Ancient Coin Analysis

In recent years, a range of problems under the broad umbrella of computer vision based analysis of ancient coins have been attracting an increasing amount of attention. Notwithstanding this research effort, the results achieved by the state of the art in published literature remain poor and far from sufficiently well performing for any practical purpose. In the present paper we present a series of contributions which we believe will benefit the interested community. We explain that the approach of visual matching of coins, universally adopted in existing published papers on the topic, is not of practical interest because the number of ancient coin types exceeds by far the number of those types which have been imaged, be it in digital form (e.g., online) or otherwise (traditional film, in print, etc.). Rather, we argue that the focus should be on understanding the semantic content of coins. Hence, we describe a novel approach—to first extract semantic concepts from real-world multimodal input and associate them with their corresponding coin images, and then to train a convolutional neural network to learn the appearance of these concepts. On a real-world data set, we demonstrate highly promising results, correctly identifying a range of visual elements on unseen coins with up to 84% accuracy.

Deep Learning for Whole Slide Image Analysis: An Overview

The widespread adoption of whole slide imaging has increased the demand for effective and efficient gigapixel image analysis. Deep learning is at the forefront of computer vision, showcasing significant improvements over previous methodologies on visual understanding. However, whole slide images have billions of pixels and suffer from high morphological heterogeneity as well as from different types of artifacts. Collectively, these impede the conventional use of deep learning. For the clinical translation of deep learning solutions to become a reality, these challenges need to be addressed. In this paper, we review work on the interdisciplinary attempt of training deep neural networks using whole slide images, and highlight the different ideas underlying these methodologies.

Identification of a 6-lncRNA prognostic signature based on microarray re-annotation in gastric cancer

Gastric cancer (GC) remains an important malignancy worldwide with poor prognosis. Long noncoding RNAs (lncRNAs) can markedly affect cancer progression. Moreover, lncRNAs have been proposed as diagnostic or prognostic biomarkers of GC. Therefore, the current study aimed to explore lncRNA‐based prognostic biomarkers for GC. LncRNA expression profiles from the Gene Expression Omnibus (GEO) database were first downloaded. After re‐annotation of lncRNAs, a univariate Cox analysis identified 177 prognostic lncRNA probes in the training set http://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSE62254 (n = 225). Multivariate Cox analysis of each lncRNA with clinical characteristics as covariates identified a total of 46 prognostic lncRNA probes. Robust likelihood‐based survival and least absolute shrinkage and selection operator (LASSO) models were used to establish a 6‐lncRNA signature with prognostic value. Receiver operating characteristic (ROC) curve analyses were employed to compare survival prediction in terms of specificity and sensitivity. Patients with high‐risk scores exhibited a significantly worse overall survival (OS) than patients with low‐risk scores (log‐rank test P‐value <.0001), and the area under the ROC curve (AUC) for 5‐year survival was 0.77. A nomogram and forest plot were constructed to compare the clinical characteristics and risk scores by a multivariable Cox regression analysis, which suggested that the 6‐lncRNA signature can independently make the prognosis evaluation of patients. Single‐sample GSEA (ssGSEA) was used to determine the relationships between the 6‐lncRNA signature and biological functions. The internal validation set http://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSE62254 (n = 75) and the external validation set http://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSE57303 (n = 70) were successfully used to validate the robustness of our 6‐lncRNA signature. In conclusion, based on the above results, the 6‐lncRNA signature can effectively make the prognosis evaluation of GC patients.

The Performance of Different Artificial Intelligence Models in Predicting Breast Cancer among Individuals Having Type 2 Diabetes Mellitus

Objective: Early reports indicate that individuals with type 2 diabetes mellitus (T2DM) may have a greater incidence of breast malignancy than patients without T2DM. The aim of this study was to investigate the effectiveness of three different models for predicting risk of breast cancer in patients with T2DM of different characteristics. Study design and methodology: From 2000 to 2012, data on 636,111 newly diagnosed female T2DM patients were available in the Taiwan’s National Health Insurance Research Database. By applying their data, a risk prediction model of breast cancer in patients with T2DM was created. We also collected data on potential predictors of breast cancer so that adjustments for their effect could be made in the analysis. Synthetic Minority Oversampling Technology (SMOTE) was utilized to increase data for small population samples. Each datum was randomly assigned based on a ratio of about 39:1 into the training and test sets. Logistic Regression (LR), Artificial Neural Network (ANN) and Random Forest (RF) models were determined using recall, accuracy, F₁ score and area under the receiver operating characteristic curve (AUC). Results: The AUC of the LR (0.834), ANN (0.865), and RF (0.959) models were found. The largest AUC among the three models was seen in the RF model. Conclusions: Although the LR, ANN, and RF models all showed high accuracy predicting the risk of breast cancer in Taiwanese with T2DM, the RF model performed best.

An animal health example of managing and analyzing a large volume of data on a PC: Modeling body weight and age of over 13 million cats for explanatory and predictive purposes

Large amounts of animal health data are available to researchers, but are often stored in different formats and information silos. Analysis of this existing information can provide new insights into the health and welfare of animals and possibly reduce the need to collect additional data. The objective of this study was to develop a method of managing and analyzing large amounts of data on a personal computer that can be run within 24 h to limit the time and resources spent deploying models on larger servers. This paper describes an overall approach that makes use of existing methods for data acquisition and modeling, but adapts and combines them in a way that allows manipulation and analysis of large volumes of data on a PC. This included a total of five steps: removing errors; removing data points outside the scope of a specific hypothesis; creating descriptive statistics; developing explanatory and/or predictive models; and assessing the fit or accuracy of the models created. The approach was developed using electronic medical records for 19,416,753 feline patients from 3972 anonymized veterinary clinics in the United States and Canada, recorded between January 1981 and June 2016. Data regarding patient signalment (age, sex, breed, reproductive status) and body weight were extracted from the records and used to create linear regression models to describe body weight in cats of different ages, breeds, genders and reproductive status. Ordinary least squares linear regression and stochastic gradient descent linear regression were compared to determine their effectiveness and suitability for creating predictive models with large datasets, using 10 fold cross validation. This approach could be used to build workflows to create models to determine exploratory and predictive properties of health parameters for animals and people. The ability to work with large datasets on a PC or equivalent technology was demonstrated. Significant interactions were present among sex, reproductive status and age. A peak in weight occurred between 6 and 9 years depending on the sex, reproductive status and breed. The predictive ability of the two models was similar, with both producing a root mean square error of 1.45 and a mean absolute error of 1.09, and mean error that was approximately zero on the validation dataset.

The landscape of genomic copy number alterations in colorectal cancer and their consequences on gene expression levels and disease outcome

Aneuploidy, the unbalanced state of the chromosome content, represents a hallmark of most solid tumors, including colorectal cancer. Such aneuploidies result in tumor specific genomic imbalances, which emerge in premalignant precursor lesions. Moreover, increasing levels of chromosomal instability have been observed in adenocarcinomas and are maintained in distant metastases. A number of studies have systematically integrated copy number alterations with gene expression changes in primary carcinomas, cell lines, and experimental models of aneuploidy. In fact, chromosomal aneuploidies target a number of genes conferring a selective advantage for the metabolism of the cancer cell. Copy number alterations not only have a positive correlation with expression changes of the majority of genes on the altered genomic segment, but also have effects on the transcriptional levels of genes genome-wide. Finally, copy number alterations have been associated with disease outcome; nevertheless, the translational applicability in clinical practice requires further studies. Here, we (i) review the spectrum of genetic alterations that lead to colorectal cancer, (ii) describe the most frequent copy number alterations at different stages of colorectal carcinogenesis, (iii) exemplify their positive correlation with gene expression levels, and (iv) discuss copy number alterations that are potentially involved in disease outcome of individual patients.

Health intelligence: how artificial intelligence transforms population and personalized health

Advances in computational and data sciences for data management, integration, mining, classification, filtering, visualization along with engineering innovations in medical devices have prompted demands for more comprehensive and coherent strategies to address the most fundamental questions in health care and medicine. Theory, methods, and models from artificial intelligence (AI) are changing the health care landscape in clinical and community settings and have already shown promising results in multiple applications in healthcare including, integrated health information systems, patient education, geocoding health data, social media analytics, epidemic and syndromic surveillance, predictive modeling and decision support, mobile health, and medical imaging (e.g. radiology and retinal image analyses). Health intelligence uses tools and methods from artificial intelligence and data science to provide better insights, reduce waste and wait time, and increase speed, service efficiencies, level of accuracy, and productivity in health care and medicine.