Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine.
Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine.
Int J Surg. 2024 May 1;110(5):2970-2977. doi: 10.1097/JS9.0000000000001222.
BACKGROUND: Although separate analysis of individual factor can somewhat improve the prognostic performance, integration of multimodal information into a single signature is necessary to stratify patients with clear cell renal cell carcinoma (ccRCC) for adjuvant therapy after surgery. METHODS: A total of 414 patients with whole slide images, computed tomography images, and clinical data from three patient cohorts were retrospectively analyzed. The authors performed deep learning and machine learning algorithm to construct three single-modality prediction models for disease-free survival of ccRCC based on whole slide images, cell segmentation, and computed tomography images, respectively. A multimodel prediction signature (MMPS) for disease-free survival were further developed by combining three single-modality prediction models and tumor stage/grade system. Prognostic performance of the prognostic model was also verified in two independent validation cohorts. RESULTS: Single-modality prediction models performed well in predicting the disease-free survival status of ccRCC. The MMPS achieved higher area under the curve value of 0.742, 0.917, and 0.900 in three independent patient cohorts, respectively. MMPS could distinguish patients with worse disease-free survival, with HR of 12.90 (95% CI: 2.443-68.120, P <0.0001), 11.10 (95% CI: 5.467-22.520, P <0.0001), and 8.27 (95% CI: 1.482-46.130, P <0.0001) in three different patient cohorts. In addition, MMPS outperformed single-modality prediction models and current clinical prognostic factors, which could also provide complements to current risk stratification for adjuvant therapy of ccRCC. CONCLUSION: Our novel multimodel prediction analysis for disease-free survival exhibited significant improvements in prognostic prediction for patients with ccRCC. After further validation in multiple centers and regions, the multimodal system could be a potential practical tool for clinicians in the treatment for ccRCC patients.
背景:尽管单独分析各个因素在一定程度上可以提高预后性能,但将多模态信息整合到单个签名中对于为手术后的透明细胞肾细胞癌(ccRCC)患者分层进行辅助治疗是必要的。
方法:对来自三个患者队列的 414 名具有全幻灯片图像、计算机断层扫描图像和临床数据的患者进行了回顾性分析。作者分别基于全幻灯片图像、细胞分割和计算机断层扫描图像,使用深度学习和机器学习算法构建了三个用于 ccRCC 无病生存的单一模式预测模型。通过将三个单一模式预测模型与肿瘤分期/分级系统相结合,进一步开发了一个多模式预测特征(MMPS)用于无病生存。还在两个独立的验证队列中验证了该预后模型的预后性能。
结果:单一模式预测模型在预测 ccRCC 的无病生存状态方面表现良好。MMPS 在三个独立的患者队列中分别获得了 0.742、0.917 和 0.900 的较高曲线下面积值。MMPS 能够区分无病生存较差的患者,其 HR 分别为 12.90(95%CI:2.443-68.120,P<0.0001)、11.10(95%CI:5.467-22.520,P<0.0001)和 8.27(95%CI:1.482-46.130,P<0.0001)。此外,MMPS 优于单一模式预测模型和当前临床预后因素,也可为 ccRCC 的辅助治疗提供补充。
结论:我们新的无病生存多模式预测分析在 ccRCC 患者的预后预测方面表现出显著的改善。在经过多个中心和地区的进一步验证后,该多模态系统可能成为临床医生治疗 ccRCC 患者的一种潜在实用工具。
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