Child Heath Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.
BMC Med Res Methodol. 2009 Sep 14;9:64. doi: 10.1186/1471-2288-9-64.
Multiple regression models are used in a wide range of scientific disciplines and automated model selection procedures are frequently used to identify independent predictors. However, determination of relative importance of potential predictors and validating the fitted models for their stability, predictive accuracy and generalizability are often overlooked or not done thoroughly.
Using a case study aimed at predicting children with acute lymphoblastic leukemia (ALL) who are at low risk of Tumor Lysis Syndrome (TLS), we propose and compare two strategies, bootstrapping and random split of data, for ordering potential predictors according to their relative importance with respect to model stability and generalizability. We also propose an approach based on relative increase in percentage of explained variation and area under the Receiver Operating Characteristic (ROC) curve for developing models where variables from our ordered list enter the model according to their importance. An additional data set aimed at identifying predictors of prostate cancer penetration is also used for illustrative purposes.
Age is chosen to be the most important predictor of TLS. It is selected 100% of the time using the bootstrapping approach. Using the random split method, it is selected 99% of the time in the training data and is significant (at 5% level) 98% of the time in the validation data set. This indicates that age is a stable predictor of TLS with good generalizability. The second most important variable is white blood cell count (WBC). Our methods also identified an important predictor of TLS that was otherwise omitted if relying on any of the automated model selection procedures alone. A group at low risk of TLS consists of children younger than 10 years of age, without T-cell immunophenotype, whose baseline WBC is < 20 x 10(9)/L and palpable spleen is < 2 cm. For the prostate cancer data set, the Gleason score and digital rectal exam are identified to be the most important indicators of whether tumor has penetrated the prostate capsule.
Our model selection procedures based on bootstrap re-sampling and repeated random split techniques can be used to assess the strength of evidence that a variable is truly an independent and reproducible predictor. Our methods, therefore, can be used for developing stable and reproducible models with good performances. Moreover, our methods can serve as a good tool for validating a predictive model. Previous biological and clinical studies support the findings based on our selection and validation strategies. However, extensive simulations may be required to assess the performance of our methods under different scenarios as well as check their sensitivity to a random fluctuation in the data.
多元回归模型广泛应用于各个科学领域,自动模型选择程序常用于识别独立预测因子。然而,确定潜在预测因子的相对重要性,并验证模型的稳定性、预测准确性和可推广性,往往被忽视或没有得到彻底验证。
本研究以预测急性淋巴细胞白血病(ALL)患儿发生肿瘤溶解综合征(TLS)风险为案例,我们提出并比较了两种策略,即 bootstrap 重抽样和数据随机分割,以根据模型稳定性和可推广性来评估潜在预测因子的相对重要性。我们还提出了一种方法,基于解释变异百分比和接收者操作特征(ROC)曲线下面积的相对增加,来构建模型,根据变量的重要性,按顺序将变量纳入模型。为了说明问题,我们还使用了另一个旨在识别前列腺癌穿透性预测因子的数据集。
年龄被选为 TLS 的最重要预测因子。在 bootstrap 方法中,年龄 100%被选中。使用随机分割方法,在训练数据中 99%的时间选择年龄,在验证数据集中 98%的时间是显著的(在 5%的水平)。这表明年龄是一个稳定的 TLS 预测因子,具有良好的可推广性。第二重要的变量是白细胞计数(WBC)。我们的方法还确定了一个重要的 TLS 预测因子,如果仅依赖于任何自动模型选择程序,这个预测因子可能会被忽略。TLS 低危组包括 10 岁以下、无 T 细胞免疫表型、基线白细胞计数<20×10(9)/L 和可触及脾脏<2cm 的儿童。对于前列腺癌数据集,Gleason 评分和直肠指检被确定为肿瘤是否穿透前列腺包膜的最重要指标。
我们基于 bootstrap 重抽样和重复随机分割技术的模型选择程序,可以用于评估一个变量是否真正是一个独立和可重复的预测因子的证据强度。因此,我们的方法可用于开发具有良好性能的稳定且可重复的模型。此外,我们的方法可以作为验证预测模型的有效工具。先前的生物学和临床研究支持了我们基于选择和验证策略的发现。然而,可能需要进行广泛的模拟,以评估我们的方法在不同情况下的性能,并检查其对数据随机波动的敏感性。