School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia.
Department of Neurosurgery, Monash Health, Melbourne, VIC, Australia.
PLoS One. 2022 Jul 27;17(7):e0272147. doi: 10.1371/journal.pone.0272147. eCollection 2022.
Patients with pituitary lesions experience decrements in quality of life (QoL) and treatment aims to arrest or improve QoL decline.
To detect associations with QoL in trans-nasal endoscopic skull base surgery patients and train supervised learning classifiers to predict QoL improvement at 12 months.
A supervised learning analysis of a prospective multi-institutional dataset (451 patients) was conducted. QoL was measured using the anterior skull base surgery questionnaire (ASBS). Factors associated with QoL at baseline and at 12-month follow-up were identified using multivariate logistic regression. Multiple supervised learning models were trained to predict postoperative QoL improvement with five-fold cross-validation.
ASBS at 12-month follow-up was significantly higher (132.19,SD = 24.87) than preoperative ASBS (121.87,SD = 25.72,p<0.05). High preoperative scores were significantly associated with institution, diabetes and lesions at the planum sphenoidale / tuberculum sella site. Patients with diabetes were five times less likely to report high preoperative QoL. Low preoperative QoL was significantly associated with female gender, a vision-related presentation, diabetes, secreting adenoma and the cavernous sinus site. Top quartile change in postoperative QoL at 12-month follow-up was negatively associated with baseline hypercholesterolemia, acromegaly and intraoperative CSF leak. Positive associations were detected for lesions at the sphenoid sinus site and deficient preoperative endocrine function. AdaBoost, logistic regression and neural network classifiers yielded the strongest predictive performance.
It was possible to predict postoperative positive change in QoL at 12-month follow-up using perioperative data. Further development and implementation of these models may facilitate improvements in informed consent, treatment decision-making and patient QoL.
患有垂体病变的患者生活质量（QoL）下降，治疗旨在阻止或改善 QoL 下降。
检测经鼻内镜颅底手术患者与 QoL 的相关性，并训练监督学习分类器预测 12 个月时的 QoL 改善。
对前瞻性多机构数据集（451 例患者）进行了监督学习分析。使用前颅底手术问卷（ASBS）测量 QoL。使用多变量逻辑回归确定基线和 12 个月随访时与 QoL 相关的因素。使用五折交叉验证训练了多个监督学习模型，以预测术后 QoL 的改善。
12 个月随访时的 ASBS 明显高于术前 ASBS（121.87，SD=25.72，p<0.05）。高术前评分与机构、糖尿病和蝶鞍/鞍结节病变显著相关。患有糖尿病的患者报告高术前 QoL 的可能性低五倍。低术前 QoL 与女性、与视力相关的表现、糖尿病、分泌性腺瘤和海绵窦部位显著相关。12 个月随访时术后 QoL 的最高四分位变化与基线高胆固醇血症、肢端肥大症和术中 CSF 漏出呈负相关。在蝶窦部位病变和术前内分泌功能不足的情况下，观察到了阳性关联。AdaBoost、逻辑回归和神经网络分类器的预测性能最强。
使用围手术期数据可以预测 12 个月随访时术后 QoL 的积极变化。进一步开发和实施这些模型可能有助于改善知情同意、治疗决策和患者 QoL。
