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Using Machine Learning Models to Predict Pathologic Complete Response to Neoadjuvant Chemotherapy in Breast Cancer.

Authors :
Rahadian RE
Tan HQ
Ho BS
Kumaran A
Villanueva A
Sng J
Tan RSYC
Tan TJY
Tan VKM
Tan BKT
Lim GH
Cai Y
Nei WL
Wong FY
Source :
JCO clinical cancer informatics [JCO Clin Cancer Inform] 2024 Nov; Vol. 8, pp. e2400071. Date of Electronic Publication: 2024 Nov 22.
Publication Year :
2024

Abstract

Purpose: Neoadjuvant chemotherapy (NAC) is increasingly used in breast cancer. Predictive modeling is useful in predicting pathologic complete response (pCR) to NAC. We test machine learning (ML) models to predict pCR in breast cancer and explore methods of handling missing data.<br />Methods: Four hundred and ninety-nine patients with breast cancer treated with NAC in two centers in Singapore (National Cancer Centre Singapore [NCCS] and KK Hospital) between January 2014 and December 2017 were included. Eleven clinical features were used to train five different ML models. Listwise deletion and imputation were evaluated on handling missing data. Model performance was evaluated by AUC and calibration (Brier score). Feature importance from the best performing model in the external testing data set was calculated using Shapley additive explanations.<br />Results: Seventy-two (24.6%), 18 (24.7%), and 31 (24.8%) patients attained pCR in NCCS training, NCCS testing, and KK Women's and Children's Hospital (KKH) testing data sets, respectively. The random forest (RF) base and imputed models have the highest AUCs in the KKH cohort of 0.794 (95% CI, 0.709 to 0.873) and 0.795 (95% CI, 0.706 to 0.871), respectively, and were the best calibrated with the lowest Brier score. No statistically significant difference was noted between AUCs of the base and imputed models in all data sets. The imputed model had a larger positive predictive value (PPV; 98.2% v 95.1%) and negative predictive value (NPV; 96.7% v 90.0%) than the base model in the KKH data set. Estrogen receptor intensity, human epidermal growth factor 2 intensity, and age at diagnosis were the three most important predictors.<br />Conclusion: ML, particularly RF, demonstrates reasonable accuracy in pCR prediction after NAC. Imputing missing fields in the data can improve the PPV and NPV of the pCR prediction model.

Details

Language :
English
ISSN :
2473-4276
Volume :
8
Database :
MEDLINE
Journal :
JCO clinical cancer informatics
Publication Type :
Academic Journal
Accession number :
39576956
Full Text :
https://doi.org/10.1200/CCI.24.00071