Senders Joeky Tamba, Harary Maya, Stopa Brittany Morgan, Staples Patrick, Broekman Marike Lianne Daphne, Smith Timothy Richard, Gormley William Brian, Arnaout Omar
Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Neurosurgery, University Medical Center Utrecht, Utrecht, Netherlands.
Comput Math Methods Med. 2018 Jun 13;2018:8572058. doi: 10.1155/2018/8572058. eCollection 2018.
Glioma constitutes the most common type of primary brain tumor with a dismal survival, often measured in terms of months or years. The thin line between treatment effectiveness and patient harm underpins the importance of tailoring clinical management to the individual patient. Randomized trials have laid the foundation for many neuro-oncological guidelines. Despite this, their findings focus on group-level estimates. Given our current tools, we are limited in our ability to guide patients on what therapy is best for them as individuals, or even how long they should expect to survive. Machine learning, however, promises to provide the analytical support for personalizing treatment decisions, and deep learning allows clinicians to unlock insight from the vast amount of unstructured data that is collected on glioma patients. Although these novel techniques have achieved astonishing results across a variety of clinical applications, significant hurdles remain associated with the implementation of them in clinical practice. Future challenges include the assembly of well-curated cross-institutional datasets, improvement of the interpretability of machine learning models, and balancing novel evidence-based decision-making with the associated liability of automated inference. Although artificial intelligence already exceeds clinical expertise in a variety of applications, clinicians remain responsible for interpreting the implications of, and acting upon, each prediction.
胶质瘤是最常见的原发性脑肿瘤类型,患者生存率很低,通常以数月或数年计算。治疗效果与对患者造成的伤害之间界限模糊,这突出了根据个体患者情况制定临床管理方案的重要性。随机试验为许多神经肿瘤学指南奠定了基础。尽管如此,其研究结果侧重于群体层面的评估。鉴于我们现有的工具,我们在指导患者选择最适合他们个人的治疗方法,甚至是预测他们的生存时长方面能力有限。然而,机器学习有望为个性化治疗决策提供分析支持,深度学习则使临床医生能够从收集到的大量关于胶质瘤患者的非结构化数据中挖掘出有价值的信息。尽管这些新技术在各种临床应用中都取得了惊人的成果,但在临床实践中实施它们仍存在重大障碍。未来的挑战包括精心整理跨机构数据集、提高机器学习模型的可解释性,以及在基于新证据的决策与自动推理相关责任之间取得平衡。虽然人工智能在各种应用中已经超越了临床专业知识,但临床医生仍有责任解读每个预测结果的含义并据此采取行动。