1. Predicting Prostate Cancer-Specific Mortality with A.I.-based Gleason Grading
- Author
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Wulczyn, Ellery, Nagpal, Kunal, Symonds, Matthew, Moran, Melissa, Plass, Markus, Reihs, Robert, Nader, Farah, Tan, Fraser, Cai, Yuannan, Brown, Trissia, Flament-Auvigne, Isabelle, Amin, Mahul B., Stumpe, Martin C., Muller, Heimo, Regitnig, Peter, Holzinger, Andreas, Corrado, Greg S., Peng, Lily H., Chen, Po-Hsuan Cameron, Steiner, David F., Zatloukal, Kurt, Liu, Yun, and Mermel, Craig H.
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Computer Science - Computer Vision and Pattern Recognition ,Computer Science - Machine Learning - Abstract
Gleason grading of prostate cancer is an important prognostic factor but suffers from poor reproducibility, particularly among non-subspecialist pathologists. Although artificial intelligence (A.I.) tools have demonstrated Gleason grading on-par with expert pathologists, it remains an open question whether A.I. grading translates to better prognostication. In this study, we developed a system to predict prostate-cancer specific mortality via A.I.-based Gleason grading and subsequently evaluated its ability to risk-stratify patients on an independent retrospective cohort of 2,807 prostatectomy cases from a single European center with 5-25 years of follow-up (median: 13, interquartile range 9-17). The A.I.'s risk scores produced a C-index of 0.84 (95%CI 0.80-0.87) for prostate cancer-specific mortality. Upon discretizing these risk scores into risk groups analogous to pathologist Grade Groups (GG), the A.I. had a C-index of 0.82 (95%CI 0.78-0.85). On the subset of cases with a GG in the original pathology report (n=1,517), the A.I.'s C-indices were 0.87 and 0.85 for continuous and discrete grading, respectively, compared to 0.79 (95%CI 0.71-0.86) for GG obtained from the reports. These represent improvements of 0.08 (95%CI 0.01-0.15) and 0.07 (95%CI 0.00-0.14) respectively. Our results suggest that A.I.-based Gleason grading can lead to effective risk-stratification and warrants further evaluation for improving disease management.
- Published
- 2020
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