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Klotz DM, Link T, Wimberger P, Kuhlmann JD. A predictive and prognostic model for surgical outcome and prognosis in ovarian cancer computed by clinico-pathological and serological parameters (CA125, HE4, mesothelin). Clin Chem Lab Med 2024; 62:530-539. [PMID: 37816681 DOI: 10.1515/cclm-2023-0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/18/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVES Numerous prognostic models have been proposed for ovarian cancer, extending from single serological factors to complex gene-expression signatures. Nonetheless, these models have not been routinely translated into clinical practice. We constructed a robust and readily calculable model for predicting surgical outcome and prognosis of ovarian cancer patients by exploiting commonly available clinico-pathological factors and three selected serum parameters. METHODS Serum CA125, human epididymis protein 4 (HE4) and mesothelin (MSL) were quantified by Lumipulse® G chemiluminescent enzyme immunoassay (Fujirebio) in a total of 342 serum samples from 190 ovarian cancer patients, including 152 paired pre- and post-operative samples. RESULTS Detection of pre-operative HE4 and CA125 was the optimal marker combination for blood-based prediction of surgical outcome (AUC=0.86). We constructed a prognostic model, computed by serum levels of pre-operative CA125, post-operative HE4, post-operative MSL and surgical outcome. Prognostic performance of our model was superior to any of these parameters alone and was independent from BRCA1/2 mutational status. We subsequently transformed our model into a prognostic risk index, stratifying patients as "lower risk" or "higher risk". In "higher risk" patients, relapse or death was predicted with an AUC of 0.89 and they had a significantly shorter progression free survival (HR: 9.74; 95 % CI: 5.95-15.93; p<0.0001) and overall survival (HR: 5.62; 95 % CI: 3.16-9.99; p<0.0001) compared to "lower risk" patients. CONCLUSIONS We present a robust predictive/prognostic model for ovarian cancer, which could readily be implemented into routine diagnostics in order to identify ovarian cancer patients at high risk of recurrence.
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Affiliation(s)
- Daniel Martin Klotz
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumour Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Theresa Link
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumour Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumour Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan Dominik Kuhlmann
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumour Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Wu M, Gu S, Yang J, Zhao Y, Sheng J, Cheng S, Xu S, Wu Y, Ma M, Luo X, Zhang H, Wang Y, Zhao A. Comprehensive machine learning-based preoperative blood features predict the prognosis for ovarian cancer. BMC Cancer 2024; 24:267. [PMID: 38408960 PMCID: PMC10895771 DOI: 10.1186/s12885-024-11989-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/10/2024] [Indexed: 02/28/2024] Open
Abstract
PURPOSE Significant advancements in improving ovarian cancer (OC) outcomes have been limited over the past decade. To predict prognosis and improve outcomes of OC, we plan to develop and validate a robust prognosis signature based on blood features. METHODS We screened age and 33 blood features from 331 OC patients. Using ten machine learning algorithms, 88 combinations were generated, from which one was selected to construct a blood risk score (BRS) according to the highest C-index in the test dataset. RESULTS Stepcox (both) and Enet (alpha = 0.7) performed the best in the test dataset with a C-index of 0.711. Meanwhile, the low RBS group possessed observably prolonged survival in this model. Compared to traditional prognostic-related features such as age, stage, grade, and CA125, our combined model had the highest AUC values at 3, 5, and 7 years. According to the results of the model, BRS can provide accurate predictions of OC prognosis. BRS was also capable of identifying various prognostic stratifications in different stages and grades. Importantly, developing the nomogram may improve performance by combining BRS and stage. CONCLUSION This study provides a valuable combined machine-learning model that can be used for predicting the individualized prognosis of OC patients.
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Affiliation(s)
- Meixuan Wu
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Sijia Gu
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiani Yang
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Yaqian Zhao
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Jindan Sheng
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Shanshan Cheng
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Shilin Xu
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yongsong Wu
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Mingjun Ma
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Xiaomei Luo
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Hao Zhang
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Yu Wang
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 200092, Shanghai, China.
| | - Aimin Zhao
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
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Babaei Rikan S, Sorayaie Azar A, Naemi A, Bagherzadeh Mohasefi J, Pirnejad H, Wiil UK. Survival prediction of glioblastoma patients using modern deep learning and machine learning techniques. Sci Rep 2024; 14:2371. [PMID: 38287149 PMCID: PMC10824760 DOI: 10.1038/s41598-024-53006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 01/25/2024] [Indexed: 01/31/2024] Open
Abstract
In this study, we utilized data from the Surveillance, Epidemiology, and End Results (SEER) database to predict the glioblastoma patients' survival outcomes. To assess dataset skewness and detect feature importance, we applied Pearson's second coefficient test of skewness and the Ordinary Least Squares method, respectively. Using two sampling strategies, holdout and five-fold cross-validation, we developed five machine learning (ML) models alongside a feed-forward deep neural network (DNN) for the multiclass classification and regression prediction of glioblastoma patient survival. After balancing the classification and regression datasets, we obtained 46,340 and 28,573 samples, respectively. Shapley additive explanations (SHAP) were then used to explain the decision-making process of the best model. In both classification and regression tasks, as well as across holdout and cross-validation sampling strategies, the DNN consistently outperformed the ML models. Notably, the accuracy were 90.25% and 90.22% for holdout and five-fold cross-validation, respectively, while the corresponding R2 values were 0.6565 and 0.6622. SHAP analysis revealed the importance of age at diagnosis as the most influential feature in the DNN's survival predictions. These findings suggest that the DNN holds promise as a practical auxiliary tool for clinicians, aiding them in optimal decision-making concerning the treatment and care trajectories for glioblastoma patients.
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Affiliation(s)
| | | | - Amin Naemi
- SDU Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | | | - Habibollah Pirnejad
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran.
| | - Uffe Kock Wiil
- SDU Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
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de Jong D, Thangavelu A, Broadhead T, Chen I, Burke D, Hutson R, Johnson R, Kaufmann A, Lodge P, Nugent D, Quyn A, Theophilou G, Laios A. Prerequisites to improve surgical cytoreduction in FIGO stage III/IV epithelial ovarian cancer and subsequent clinical ramifications. J Ovarian Res 2023; 16:214. [PMID: 37951927 PMCID: PMC10638711 DOI: 10.1186/s13048-023-01303-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND No residual disease (CC 0) following cytoreductive surgery is pivotal for the prognosis of women with advanced stage epithelial ovarian cancer (EOC). Improving CC 0 resection rates without increasing morbidity and no delay in subsequent chemotherapy favors a better outcome in these women. Prerequisites to facilitate this surgical paradigm shift and subsequent ramifications need to be addressed. This quality improvement study assessed 559 women with advanced EOC who had cytoreductive surgery between January 2014 and December 2019 in our tertiary referral centre. Following implementation of the Enhanced Recovery After Surgery (ERAS) pathway and prehabilitation protocols, the surgical management paradigm in advanced EOC patients shifted towards maximal surgical effort cytoreduction in 2016. Surgical outcome parameters before, during, and after this paradigm shift were compared. The primary outcome measure was residual disease (RD). The secondary outcome parameters were postoperative morbidity, operative time (OT), length of stay (LOS) and progression-free-survival (PFS). RESULTS R0 resection rate in patients with advanced EOC increased from 57.3% to 74.4% after the paradigm shift in surgical management whilst peri-operative morbidity and delays in adjuvant chemotherapy were unchanged. The mean OT increased from 133 + 55 min to 197 + 85 min, and postoperative high dependency/intensive care unit (HDU/ICU) admissions increased from 8.1% to 33.1%. The subsequent mean LOS increased from 7.0 + 2.6 to 8.4 + 4.9 days. The median PFS was 33 months. There was no difference for PFS in the three time frames but a trend towards improvement was observed. CONCLUSIONS Improved CC 0 surgical cytoreduction rates without compromising morbidity in advanced EOC is achievable owing to the right conditions. Maximal effort cytoreductive surgery should solely be carried out in high output tertiary referral centres due to the associated substantial prerequisites and ramifications.
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Affiliation(s)
- Diederick de Jong
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Amudha Thangavelu
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Timothy Broadhead
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Inga Chen
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Dermot Burke
- Department of Surgery, Colorectal Surgery Service, St. James's University Hospital LTHT, Leeds, UK
| | - Richard Hutson
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Racheal Johnson
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Angelika Kaufmann
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Peter Lodge
- Department of Surgery, Hepatobilliary Surgery and Liver Transplant Service, St. James's University Hospital LTHT, Leeds, UK
| | - David Nugent
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Aaron Quyn
- Department of Surgery, Hepatobilliary Surgery and Liver Transplant Service, St. James's University Hospital LTHT, Leeds, UK
| | - Georgios Theophilou
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK
| | - Alexandros Laios
- Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James's University Hospital, LTHT, Beckett Street, Leeds, LS9 7TF, UK.
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Ghavidel A, Pazos P. Machine learning (ML) techniques to predict breast cancer in imbalanced datasets: a systematic review. J Cancer Surviv 2023:10.1007/s11764-023-01465-3. [PMID: 37749361 DOI: 10.1007/s11764-023-01465-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/09/2023] [Indexed: 09/27/2023]
Abstract
Knowledge discovery in databases (KDD) is crucial in analyzing data to extract valuable insights. In medical outcome prediction, KDD is increasingly applied, particularly in diseases with high incidence, mortality, and costs, like cancer. ML techniques can develop more accurate predictive models for cancer patients' clinical outcomes, aiding informed healthcare decision-making. However, cancer prediction modeling faces challenges because of the unbalanced nature of the datasets, where there is a small minority category of patients with a cancer diagnosis compared to a majority category of cancer-free patients. Imbalanced datasets pose statistical hurdles like bias and overfitting when developing accurate prediction models. This systematic review focuses on breast cancer prediction articles published from 2008 to 2023. The objective is to examine ML methods used in three critical steps of KDD: preprocessing, data mining, and interpretation which address the imbalanced data problem in breast cancer prediction. This work synthesizes prior research in ML methods for breast cancer prediction. The findings help identify effective preprocessing strategies, including balancing and feature selection methods, robust predictive models, and evaluation metrics of those models. The study aims to inform healthcare providers and researchers about effective techniques for accurate breast cancer prediction.
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Affiliation(s)
- Arman Ghavidel
- Engineering Management and Systems Engineering, Old Dominion University, Norfolk, VA, USA
| | - Pilar Pazos
- Engineering Management and Systems Engineering, Old Dominion University, Norfolk, VA, USA.
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Hatamikia S, Nougaret S, Panico C, Avesani G, Nero C, Boldrini L, Sala E, Woitek R. Ovarian cancer beyond imaging: integration of AI and multiomics biomarkers. Eur Radiol Exp 2023; 7:50. [PMID: 37700218 PMCID: PMC10497482 DOI: 10.1186/s41747-023-00364-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/19/2023] [Indexed: 09/14/2023] Open
Abstract
High-grade serous ovarian cancer is the most lethal gynaecological malignancy. Detailed molecular studies have revealed marked intra-patient heterogeneity at the tumour microenvironment level, likely contributing to poor prognosis. Despite large quantities of clinical, molecular and imaging data on ovarian cancer being accumulated worldwide and the rise of high-throughput computing, data frequently remain siloed and are thus inaccessible for integrated analyses. Only a minority of studies on ovarian cancer have set out to harness artificial intelligence (AI) for the integration of multiomics data and for developing powerful algorithms that capture the characteristics of ovarian cancer at multiple scales and levels. Clinical data, serum markers, and imaging data were most frequently used, followed by genomics and transcriptomics. The current literature proves that integrative multiomics approaches outperform models based on single data types and indicates that imaging can be used for the longitudinal tracking of tumour heterogeneity in space and potentially over time. This review presents an overview of studies that integrated two or more data types to develop AI-based classifiers or prediction models.Relevance statement Integrative multiomics models for ovarian cancer outperform models using single data types for classification, prognostication, and predictive tasks.Key points• This review presents studies using multiomics and artificial intelligence in ovarian cancer.• Current literature proves that integrative multiomics outperform models using single data types.• Around 60% of studies used a combination of imaging with clinical data.• The combination of genomics and transcriptomics with imaging data was infrequently used.
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Affiliation(s)
- Sepideh Hatamikia
- Research Center for Medical Image Analysis and AI (MIAAI), Danube Private University, Krems, Austria.
- Austrian Center for Medical Innovation and Technology (ACMIT), Wiener Neustadt, Austria.
| | - Stephanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
| | - Camilla Panico
- Dipartimento di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giacomo Avesani
- Dipartimento di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Camilla Nero
- Scienze Della Salute Della Donna, del bambino e Di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Boldrini
- Dipartimento di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Evis Sala
- Dipartimento di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ramona Woitek
- Research Center for Medical Image Analysis and AI (MIAAI), Danube Private University, Krems, Austria
- Department of Radiology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
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Afrash MR, Mirbagheri E, Mashoufi M, Kazemi-Arpanahi H. Optimizing prognostic factors of five-year survival in gastric cancer patients using feature selection techniques with machine learning algorithms: a comparative study. BMC Med Inform Decis Mak 2023; 23:54. [PMID: 37024885 PMCID: PMC10080884 DOI: 10.1186/s12911-023-02154-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/15/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Gastric cancer is the most common malignant tumor worldwide and a leading cause of cancer deaths. This neoplasm has a poor prognosis and heterogeneous outcomes. Survivability prediction may help select the best treatment plan based on an individual's prognosis. Numerous clinical and pathological features are generally used in predicting gastric cancer survival, and their influence on the survival of this cancer has not been fully elucidated. Moreover, the five-year survivability prognosis performances of feature selection methods with machine learning (ML) classifiers for gastric cancer have not been fully benchmarked. Therefore, we adopted several well-known feature selection methods and ML classifiers together to determine the best-paired feature selection-classifier for this purpose. METHODS This was a retrospective study on a dataset of 974 patients diagnosed with gastric cancer in the Ayatollah Talleghani Hospital, Abadan, Iran. First, four feature selection algorithms, including Relief, Boruta, least absolute shrinkage and selection operator (LASSO), and minimum redundancy maximum relevance (mRMR) were used to select a set of relevant features that are very informative for five-year survival prediction in gastric cancer patients. Then, each feature set was fed to three classifiers: XG Boost (XGB), hist gradient boosting (HGB), and support vector machine (SVM) to develop predictive models. Finally, paired feature selection-classifier methods were evaluated to select the best-paired method using the area under the curve (AUC), accuracy, sensitivity, specificity, and f1-score metrics. RESULTS The LASSO feature selection algorithm combined with the XG Boost classifier achieved an accuracy of 89.10%, a specificity of 87.15%, a sensitivity of 89.42%, an AUC of 89.37%, and an f1-score of 90.8%. Tumor stage, history of other cancers, lymphatic invasion, tumor site, type of treatment, body weight, histological type, and addiction were identified as the most significant factors affecting gastric cancer survival. CONCLUSIONS This study proved the worth of the paired feature selection-classifier to identify the best path that could augment the five-year survival prediction in gastric cancer patients. Our results were better than those of previous studies, both in terms of the time required to form the models and the performance measurement criteria of the algorithms. These findings may be very promising and can, therefore, inform clinical decision-making and shed light on future studies.
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Affiliation(s)
- Mohammad Reza Afrash
- Department of Artificial Intelligence, Smart University of Medical Sciences, Tehran, Iran
| | - Esmat Mirbagheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrnaz Mashoufi
- Department of Health Information Management, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hadi Kazemi-Arpanahi
- Department of Health Information Technology, Abadan University of Medical Sciences, Abadan, Iran.
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Sheehy J, Rutledge H, Acharya UR, Loh HW, Gururajan R, Tao X, Zhou X, Li Y, Gurney T, Kondalsamy-Chennakesavan S. Gynecological cancer prognosis using machine learning techniques: A systematic review of last three decades (1990–2022). Artif Intell Med 2023; 139:102536. [PMID: 37100507 DOI: 10.1016/j.artmed.2023.102536] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE Many Computer Aided Prognostic (CAP) systems based on machine learning techniques have been proposed in the field of oncology. The objective of this systematic review was to assess and critically appraise the methodologies and approaches used in predicting the prognosis of gynecological cancers using CAPs. METHODS Electronic databases were used to systematically search for studies utilizing machine learning methods in gynecological cancers. Study risk of bias (ROB) and applicability were assessed using the PROBAST tool. 139 studies met the inclusion criteria, of which 71 predicted outcomes for ovarian cancer patients, 41 predicted outcomes for cervical cancer patients, 28 predicted outcomes for uterine cancer patients, and 2 predicted outcomes for gynecological malignancies broadly. RESULTS Random forest (22.30 %) and support vector machine (21.58 %) classifiers were used most commonly. Use of clinicopathological, genomic and radiomic data as predictors was observed in 48.20 %, 51.08 % and 17.27 % of studies, respectively, with some studies using multiple modalities. 21.58 % of studies were externally validated. Twenty-three individual studies compared ML and non-ML methods. Study quality was highly variable and methodologies, statistical reporting and outcome measures were inconsistent, preventing generalized commentary or meta-analysis of performance outcomes. CONCLUSION There is significant variability in model development when prognosticating gynecological malignancies with respect to variable selection, machine learning (ML) methods and endpoint selection. This heterogeneity prevents meta-analysis and conclusions regarding the superiority of ML methods. Furthermore, PROBAST-mediated ROB and applicability analysis demonstrates concern for the translatability of existing models. This review identifies ways that this can be improved upon in future works to develop robust, clinically translatable models within this promising field.
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Laios A, De Jong D, Kalampokis E. Beauty is in the explainable artificial intelligence (XAI) of the "agnostic" beholder. Transl Cancer Res 2023; 12:226-229. [PMID: 36915578 PMCID: PMC10007889 DOI: 10.21037/tcr-22-2664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Alexandros Laios
- Department of Gynaecologic Oncology, St James's University Hospital and Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Diederick De Jong
- Department of Gynaecologic Oncology, St James's University Hospital and Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Evangelos Kalampokis
- Department of Business Administration, University of Macedonia, Thessaloniki, Greece
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Parpinel G, Laudani ME, Piovano E, Zola P, Lecuru F. The Use of Artificial Intelligence for Complete Cytoreduction Prediction in Epithelial Ovarian Cancer: A Narrative Review. Cancer Control 2023; 30:10732748231159553. [PMID: 36847148 PMCID: PMC9972055 DOI: 10.1177/10732748231159553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION In patients affected by epithelial ovarian cancer (EOC) complete cytoreduction (CC) has been associated with higher survival outcomes. Artificial intelligence (AI) systems have proved clinical benefice in different areas of healthcare. OBJECTIVE To systematically assemble and analyze the available literature on the use of AI in patients affected by EOC to evaluate its applicability to predict CC compared to traditional statistics. MATERIAL AND METHODS Data search was carried out through PubMed, Scopus, Ovid MEDLINE, Cochrane Library, EMBASE, international congresses and clinical trials. The main search terms were: Artificial Intelligence AND surgery/cytoreduction AND ovarian cancer. Two authors independently performed the search by October 2022 and evaluated the eligibility criteria. Studies were included when data about Artificial Intelligence and methodological data were detailed. RESULTS A total of 1899 cases were analyzed. Survival data were reported in 2 articles: 92% of 5-years overall survival (OS) and 73% of 2-years OS. The median area under the curve (AUC) resulted 0,62. The model accuracy for surgical resection reported in two articles reported was 77,7% and 65,8% respectively while the median AUC was 0,81. On average 8 variables were inserted in the algorithms. The most used parameters were age and Ca125. DISCUSSION AI revealed greater accuracy compared against the logistic regression models data. Survival predictive accuracy and AUC were lower for advanced ovarian cancers. One study analyzed the importance of factors predicting CC in recurrent epithelial ovarian cancer and disease free interval, retroperitoneal recurrence, residual disease at primary surgery and stage represented the main influencing factors. Surgical Complexity Scores resulted to be more useful in the algorithms than pre-operating imaging. CONCLUSION AI showed better prognostic accuracy if compared to conventional algorithms. However further studies are needed to compare the impact of different AI methods and variables and to provide survival informations.
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Affiliation(s)
- Giulia Parpinel
- Department of Surgical Sciences, University of Turin, Torino, Italy,Giulia Parpinel, MD, Department of Surgical
Sciences, University of Turin, Via Ventimiglia 3, Torino 10126, Italy.
| | | | - Elisa Piovano
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Paolo Zola
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Fabrice Lecuru
- Breast, Gynecology and
Reconstructive Surgery Unit, Curie Institute, Paris, France
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11
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Sarmet M, Kabani A, Coelho L, Dos Reis SS, Zeredo JL, Mehta AK. The use of natural language processing in palliative care research: A scoping review. Palliat Med 2023; 37:275-290. [PMID: 36495082 DOI: 10.1177/02692163221141969] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Natural language processing has been increasingly used in palliative care research over the last 5 years for its versatility and accuracy. AIM To evaluate and characterize natural language processing use in palliative care research, including the most commonly used natural language processing software and computational methods, data sources, trends in natural language processing use over time, and palliative care topics addressed. DESIGN A scoping review using the framework by Arksey and O'Malley and the updated recommendations proposed by Levac et al. was conducted. SOURCES PubMed, Web of Science, Embase, Scopus, and IEEE Xplore databases were searched for palliative care studies that utilized natural language processing tools. Data on study characteristics and natural language processing instruments used were collected and relevant palliative care topics were identified. RESULTS 197 relevant references were identified. Of these, 82 were included after full-text review. Studies were published in 48 different journals from 2007 to 2022. The average sample size was 21,541 (median 435). Thirty-two different natural language processing software and 33 machine-learning methods were identified. Nine main sources for data processing and 15 main palliative care topics across the included studies were identified. The most frequent topic was mortality and prognosis prediction. We also identified a trend where natural language processing was frequently used in analyzing clinical serious illness conversations extracted from audio recordings. CONCLUSIONS We found 82 papers on palliative care using natural language processing methods for a wide-range of topics and sources of data that could expand the use of this methodology. We encourage researchers to consider incorporating this cutting-edge research methodology in future studies to improve published palliative care data.
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Affiliation(s)
- Max Sarmet
- Tertiary Referral Center of Neuromuscular Diseases, Hospital de Apoio de Brasília, Brazil.,Graduate Department of Health Science and Technology, University of Brasília, Brazil
| | - Aamna Kabani
- Johns Hopkins University, School of Medicine, USA
| | - Luis Coelho
- Center of Innovation in Engineering and Industrial Technology, Polytechnic of Porto - School of Engineering (ISEP), Portugal
| | - Sara Seabra Dos Reis
- Center of Innovation in Engineering and Industrial Technology, Polytechnic of Porto - School of Engineering (ISEP), Portugal
| | - Jorge L Zeredo
- Graduate Department of Health Science and Technology, University of Brasília, Brazil
| | - Ambereen K Mehta
- Palliative Care Program, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, School of Medicine, USA
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12
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Laios A, Kalampokis E, Mamalis ME, Tarabanis C, Nugent D, Thangavelu A, Theophilou G, De Jong D. RoBERTa-Assisted Outcome Prediction in Ovarian Cancer Cytoreductive Surgery Using Operative Notes. Cancer Control 2023; 30:10732748231209892. [PMID: 37915208 PMCID: PMC10624075 DOI: 10.1177/10732748231209892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/16/2023] [Accepted: 09/29/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION Contemporary efforts to predict surgical outcomes focus on the associations between traditional discrete surgical risk factors. We aimed to determine whether natural language processing (NLP) of unstructured operative notes improves the prediction of residual disease in women with advanced epithelial ovarian cancer (EOC) following cytoreductive surgery. METHODS Electronic Health Records were queried to identify women with advanced EOC including their operative notes. The Term Frequency - Inverse Document Frequency (TF-IDF) score was used to quantify the discrimination capacity of sequences of words (n-grams) regarding the existence of residual disease. We employed the state-of-the-art RoBERTa-based classifier to process unstructured surgical notes. Discrimination was measured using standard performance metrics. An XGBoost model was then trained on the same dataset using both discrete and engineered clinical features along with the probabilities outputted by the RoBERTa classifier. RESULTS The cohort consisted of 555 cases of EOC cytoreduction performed by eight surgeons between January 2014 and December 2019. Discrete word clouds weighted by n-gram TF-IDF score difference between R0 and non-R0 resection were identified. The words 'adherent' and 'miliary disease' best discriminated between the two groups. The RoBERTa model reached high evaluation metrics (AUROC .86; AUPRC .87, precision, recall, and F1 score of .77 and accuracy of .81). Equally, it outperformed models that used discrete clinical and engineered features and outplayed the performance of other state-of-the-art NLP tools. When the probabilities from the RoBERTa classifier were combined with commonly used predictors in the XGBoost model, a marginal improvement in the overall model's performance was observed (AUROC and AUPRC of .91, with all other metrics the same). CONCLUSION/IMPLICATIONS We applied a sui generis approach to extract information from the abundant textual surgical data and demonstrated how it can be effectively used for classification prediction, outperforming models relying on conventional structured data. State-of-art NLP applications in biomedical texts can improve modern EOC care.
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Affiliation(s)
- Alexandros Laios
- Department of Gynaecologic Oncology, ESGO Center of Excellence for Ovarian Cancer Surgery, St James’s University Hospital, Leeds, UK
| | - Evangelos Kalampokis
- Information Systems Lab, Department of Business Administration, University of Macedonia, Thessaloniki, Greece
| | - Marios Evangelos Mamalis
- Information Systems Lab, Department of Business Administration, University of Macedonia, Thessaloniki, Greece
| | - Constantine Tarabanis
- Department of Internal Medicine, School of Medicine, New York University, New York, NY, USA
| | - David Nugent
- Department of Gynaecologic Oncology, ESGO Center of Excellence for Ovarian Cancer Surgery, St James’s University Hospital, Leeds, UK
| | - Amudha Thangavelu
- Department of Gynaecologic Oncology, ESGO Center of Excellence for Ovarian Cancer Surgery, St James’s University Hospital, Leeds, UK
| | - Georgios Theophilou
- Department of Gynaecologic Oncology, ESGO Center of Excellence for Ovarian Cancer Surgery, St James’s University Hospital, Leeds, UK
| | - Diederick De Jong
- Department of Gynaecologic Oncology, ESGO Center of Excellence for Ovarian Cancer Surgery, St James’s University Hospital, Leeds, UK
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Sorayaie Azar A, Babaei Rikan S, Naemi A, Bagherzadeh Mohasefi J, Pirnejad H, Bagherzadeh Mohasefi M, Wiil UK. Application of machine learning techniques for predicting survival in ovarian cancer. BMC Med Inform Decis Mak 2022; 22:345. [PMID: 36585641 PMCID: PMC9801354 DOI: 10.1186/s12911-022-02087-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Ovarian cancer is the fifth leading cause of mortality among women in the United States. Ovarian cancer is also known as forgotten cancer or silent disease. The survival of ovarian cancer patients depends on several factors, including the treatment process and the prognosis. METHODS The ovarian cancer patients' dataset is compiled from the Surveillance, Epidemiology, and End Results (SEER) database. With the help of a clinician, the dataset is curated, and the most relevant features are selected. Pearson's second coefficient of skewness test is used to evaluate the skewness of the dataset. Pearson correlation coefficient is also used to investigate the associations between features. Statistical test is utilized to evaluate the significance of the features. Six Machine Learning (ML) models, including K-Nearest Neighbors , Support Vector Machine (SVM), Decision Tree (DT), Random Forest (RF), Adaptive Boosting (AdaBoost), and Extreme Gradient Boosting (XGBoost), are implemented for survival prediction in both classification and regression approaches. An interpretable method, Shapley Additive Explanations (SHAP), is applied to clarify the decision-making process and determine the importance of each feature in prediction. Additionally, DTs of the RF model are displayed to show how the model predicts the survival intervals. RESULTS Our results show that RF (Accuracy = 88.72%, AUC = 82.38%) and XGBoost (Root Mean Squad Error (RMSE)) = 20.61%, R2 = 0.4667) have the best performance for classification and regression approaches, respectively. Furthermore, using the SHAP method along with extracted DTs of the RF model, the most important features in the dataset are identified. Histologic type ICD-O-3, chemotherapy recode, year of diagnosis, age at diagnosis, tumor stage, and grade are the most important determinant factors in survival prediction. CONCLUSION To the best of our knowledge, our study is the first study that develops various ML models to predict ovarian cancer patients' survival on the SEER database in both classification and regression approaches. These ML algorithms also achieve more accurate results and outperform statistical methods. Furthermore, our study is the first study to use the SHAP method to increase confidence and transparency of the proposed models' prediction for clinicians. Moreover, our developed models, as an automated auxiliary tool, can help clinicians to have a better understanding of the estimated survival as well as important features that affect survival.
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Affiliation(s)
- Amir Sorayaie Azar
- grid.412763.50000 0004 0442 8645Department of Computer Engineering, Urmia University, Urmia, Iran
| | - Samin Babaei Rikan
- grid.412763.50000 0004 0442 8645Department of Computer Engineering, Urmia University, Urmia, Iran
| | - Amin Naemi
- grid.10825.3e0000 0001 0728 0170Center for Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | | | - Habibollah Pirnejad
- grid.412763.50000 0004 0442 8645Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran ,grid.6906.90000000092621349Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Uffe Kock Wiil
- grid.10825.3e0000 0001 0728 0170Center for Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
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14
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Laios A, Kalampokis E, Johnson R, Munot S, Thangavelu A, Hutson R, Broadhead T, Theophilou G, Leach C, Nugent D, De Jong D. Factors Predicting Surgical Effort Using Explainable Artificial Intelligence in Advanced Stage Epithelial Ovarian Cancer. Cancers (Basel) 2022; 14:cancers14143447. [PMID: 35884506 PMCID: PMC9316555 DOI: 10.3390/cancers14143447] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 12/24/2022] Open
Abstract
(1) Background: Surgical cytoreduction for epithelial ovarian cancer (EOC) is a complex procedure. Encompassed within the performance skills to achieve surgical precision, intra-operative surgical decision-making remains a core feature. The use of eXplainable Artificial Intelligence (XAI) could potentially interpret the influence of human factors on the surgical effort for the cytoreductive outcome in question; (2) Methods: The retrospective cohort study evaluated 560 consecutive EOC patients who underwent cytoreductive surgery between January 2014 and December 2019 in a single public institution. The eXtreme Gradient Boosting (XGBoost) and Deep Neural Network (DNN) algorithms were employed to develop the predictive model, including patient- and operation-specific features, and novel features reflecting human factors in surgical heuristics. The precision, recall, F1 score, and area under curve (AUC) were compared between both training algorithms. The SHapley Additive exPlanations (SHAP) framework was used to provide global and local explainability for the predictive model; (3) Results: A surgical complexity score (SCS) cut-off value of five was calculated using a Receiver Operator Characteristic (ROC) curve, above which the probability of incomplete cytoreduction was more likely (area under the curve [AUC] = 0.644; 95% confidence interval [CI] = 0.598−0.69; sensitivity and specificity 34.1%, 86.5%, respectively; p = 0.000). The XGBoost outperformed the DNN assessment for the prediction of the above threshold surgical effort outcome (AUC = 0.77; 95% [CI] 0.69−0.85; p < 0.05 vs. AUC 0.739; 95% [CI] 0.655−0.823; p < 0.95). We identified “turning points” that demonstrated a clear preference towards above the given cut-off level of surgical effort; in consultant surgeons with <12 years of experience, age <53 years old, who, when attempting primary cytoreductive surgery, recorded the presence of ascites, an Intraoperative Mapping of Ovarian Cancer score >4, and a Peritoneal Carcinomatosis Index >7, in a surgical environment with the optimization of infrastructural support. (4) Conclusions: Using XAI, we explain how intra-operative decisions may consider human factors during EOC cytoreduction alongside factual knowledge, to maximize the magnitude of the selected trade-off in effort. XAI techniques are critical for a better understanding of Artificial Intelligence frameworks, and to enhance their incorporation in medical applications.
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Affiliation(s)
- Alexandros Laios
- Department of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UK; (R.J.); (S.M.); (A.T.); (R.H.); (T.B.); (G.T.); (D.N.); (D.D.J.)
- Correspondence:
| | | | - Racheal Johnson
- Department of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UK; (R.J.); (S.M.); (A.T.); (R.H.); (T.B.); (G.T.); (D.N.); (D.D.J.)
| | - Sarika Munot
- Department of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UK; (R.J.); (S.M.); (A.T.); (R.H.); (T.B.); (G.T.); (D.N.); (D.D.J.)
| | - Amudha Thangavelu
- Department of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UK; (R.J.); (S.M.); (A.T.); (R.H.); (T.B.); (G.T.); (D.N.); (D.D.J.)
| | - Richard Hutson
- Department of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UK; (R.J.); (S.M.); (A.T.); (R.H.); (T.B.); (G.T.); (D.N.); (D.D.J.)
| | - Tim Broadhead
- Department of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UK; (R.J.); (S.M.); (A.T.); (R.H.); (T.B.); (G.T.); (D.N.); (D.D.J.)
| | - Georgios Theophilou
- Department of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UK; (R.J.); (S.M.); (A.T.); (R.H.); (T.B.); (G.T.); (D.N.); (D.D.J.)
| | - Chris Leach
- School of Human & Health Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK;
- Department of Psychology Services, South West Yorkshire Mental Health NHS Foundation Trust, The Laura Mitchell Health & Wellbeing Centre, Halifax HX1 1YR, UK
| | - David Nugent
- Department of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UK; (R.J.); (S.M.); (A.T.); (R.H.); (T.B.); (G.T.); (D.N.); (D.D.J.)
| | - Diederick De Jong
- Department of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UK; (R.J.); (S.M.); (A.T.); (R.H.); (T.B.); (G.T.); (D.N.); (D.D.J.)
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15
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Laios A, Kalampokis E, Johnson R, Thangavelu A, Tarabanis C, Nugent D, De Jong D. Explainable Artificial Intelligence for Prediction of Complete Surgical Cytoreduction in Advanced-Stage Epithelial Ovarian Cancer. J Pers Med 2022; 12:607. [PMID: 35455723 PMCID: PMC9030484 DOI: 10.3390/jpm12040607] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Complete surgical cytoreduction (R0 resection) is the single most important prognosticator in epithelial ovarian cancer (EOC). Explainable Artificial Intelligence (XAI) could clarify the influence of static and real-time features in the R0 resection prediction. We aimed to develop an AI-based predictive model for the R0 resection outcome, apply a methodology to explain the prediction, and evaluate the interpretability by analysing feature interactions. The retrospective cohort finally assessed 571 consecutive advanced-stage EOC patients who underwent cytoreductive surgery. An eXtreme Gradient Boosting (XGBoost) algorithm was employed to develop the predictive model including mostly patient- and surgery-specific variables. The Shapley Additive explanations (SHAP) framework was used to provide global and local explainability for the predictive model. The XGBoost accurately predicted R0 resection (area under curve [AUC] = 0.866; 95% confidence interval [CI] = 0.8−0.93). We identified “turning points” that increased the probability of complete cytoreduction including Intraoperative Mapping of Ovarian Cancer Score and Peritoneal Carcinomatosis Index < 4 and <5, respectively, followed by Surgical Complexity Score > 4, patient’s age < 60 years, and largest tumour bulk < 5 cm in a surgical environment of optimized infrastructural support. We demonstrated high model accuracy for the R0 resection prediction in EOC patients and provided novel global and local feature explainability that can be used for quality control and internal audit.
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Affiliation(s)
- Alexandros Laios
- Department of Gynaecologic Oncology, St James's University Hospital, Leeds LS9 7TF, UK
| | - Evangelos Kalampokis
- Department of Business Administration, University of Macedonia, 54636 Thessaloniki, Greece
- Center for Research & Technology HELLAS (CERTH), 6th km Charilaou-Thermi Rd., 57001 Thessaloniki, Greece
| | - Racheal Johnson
- Department of Gynaecologic Oncology, St James's University Hospital, Leeds LS9 7TF, UK
| | - Amudha Thangavelu
- Department of Gynaecologic Oncology, St James's University Hospital, Leeds LS9 7TF, UK
| | - Constantine Tarabanis
- Department of Internal Medicine, School of Medicine, New York University, NYU, Langone Health, New York, NY 10016, USA
| | - David Nugent
- Department of Gynaecologic Oncology, St James's University Hospital, Leeds LS9 7TF, UK
| | - Diederick De Jong
- Department of Gynaecologic Oncology, St James's University Hospital, Leeds LS9 7TF, UK
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Machine Learning-Based Risk Prediction of Critical Care Unit Admission for Advanced Stage High Grade Serous Ovarian Cancer Patients Undergoing Cytoreductive Surgery: The Leeds-Natal Score. J Clin Med 2021; 11:jcm11010087. [PMID: 35011828 PMCID: PMC8745521 DOI: 10.3390/jcm11010087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/12/2022] Open
Abstract
Achieving complete surgical cytoreduction in advanced stage high grade serous ovarian cancer (HGSOC) patients warrants an availability of Critical Care Unit (CCU) beds. Machine Learning (ML) could be helpful in monitoring CCU admissions to improve standards of care. We aimed to improve the accuracy of predicting CCU admission in HGSOC patients by ML algorithms and developed an ML-based predictive score. A cohort of 291 advanced stage HGSOC patients with fully curated data was selected. Several linear and non-linear distances, and quadratic discriminant ML methods, were employed to derive prediction information for CCU admission. When all the variables were included in the model, the prediction accuracies were higher for linear discriminant (0.90) and quadratic discriminant (0.93) methods compared with conventional logistic regression (0.84). Feature selection identified pre-treatment albumin, surgical complexity score, estimated blood loss, operative time, and bowel resection with stoma as the most significant prediction features. The real-time prediction accuracy of the Graphical User Interface CCU calculator reached 95%. Limited, potentially modifiable, mostly intra-operative factors contributing to CCU admission were identified and suggest areas for targeted interventions. The accurate quantification of CCU admission patterns is critical information when counseling patients about peri-operative risks related to their cytoreductive surgery.
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