Novel machine learning algorithm can identify patients at risk of poor overall survival following curative resection for colorectal liver metastases

Journal of Hepato-Biliary-Pancreatic Sciences, vol. 30, pp. 602–614

Abstract

BACKGROUND/PURPOSE: The primary cause of mortality in colorectal cancer is metastatic disease. We investigated the ability of a machine learning (ML) algorithm to stratify overall survival (OS) of patients undergoing curative resection for colorectal liver metastases (CRLM). METHODS: Patients undergoing curative liver resection for CRLM between 2010-2021 at the University Hospital RWTH Aachen were eligible for this retrospective study. Patients with recurrent metastases, incomplete resections, or early deaths, were excluded. A gradient-boosted decision tree (GBDT) model identified patients at risk of poor OS, based on clinicopathological characteristics. Differences in survival were compared with Kaplan-Meier analysis and the log-rank test. RESULTS: A total of 487 patients were split into training (n = 389, 80%) and test cohorts (n = 98, 20%). Of the latter, 20 (20%) were identified by the GBDT model as high-risk and showed significantly reduced OS (23 months vs 52 months, P = .005) and increased hazard ratio (2.434, 95%CI 1.280-4.627, P = .007). The strongest predictors were preoperative serum carcinoembryonic antigen (CEA), age, diameter of the largest metastasis, number of metastases, body mass index, and primary tumor grading. CONCLUSION: A GBDT model can identify high-risk patients regarding OS after curative resection of CRLM. Closer follow-up and aggressive systemic treatment strategies may be beneficial to these patients.

Authors 10

1. Iakovos Amygdalos corresponding Aachen Department of General, Visceral and Transplantation Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of General, Visceral and Transplantation Surgery University Hospital RWTH Aachen Aachen Germany

   Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany

2. Gustav Anton Müller‐Franzes Aachen Department of Diagnostic and Interventional Radiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology University Hospital RWTH Aachen Aachen Germany

   Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany

3. Jan Bednarsch Aachen Department of General, Visceral and Transplantation Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of General, Visceral and Transplantation Surgery University Hospital RWTH Aachen Aachen Germany

   Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany

4. Zoltán Czigány Aachen Department of General, Visceral and Transplantation Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of General, Visceral and Transplantation Surgery University Hospital RWTH Aachen Aachen Germany

   Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany

5. Tom Florian Ulmer Aachen Department of General, Visceral and Transplantation Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of General, Visceral and Transplantation Surgery University Hospital RWTH Aachen Aachen Germany

   Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany

6. Philipp Bruners Aachen Department of Diagnostic and Interventional Radiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology University Hospital RWTH Aachen Aachen Germany

   Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany

7. Christiane Katharina Kuhl Aachen Department of Diagnostic and Interventional Radiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology University Hospital RWTH Aachen Aachen Germany

   Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany

8. Ulf P. Neumann Aachen Department of General, Visceral and Transplantation Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of General, Visceral and Transplantation Surgery University Hospital RWTH Aachen Aachen Germany

   Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany

9. Daniel Truhn Aachen Department of Diagnostic and Interventional Radiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology University Hospital RWTH Aachen Aachen Germany

   Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany

10. Sven Arke Lang Aachen Department of General, Visceral and Transplantation Surgery

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of General, Visceral and Transplantation Surgery University Hospital RWTH Aachen Aachen Germany

    Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany