Linmei Zhang, Enzhao Zhu, Shaokang Cao, Zisheng Ai, Jiansheng Su
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引用次数: 0
Abstract
Purpose: The use of postoperative radiotherapy (PORT) in patients with oral squamous cell carcinoma (OCSCC) lacks clear boundaries due to the non-negligible toxicity accompanying its remarkable cancer-killing effect. This study aims at validating the ability of deep learning models to develop individualized PORT recommendations for patients with OCSCC and quantifying the impact of patient characteristics on treatment selection.
Methods: Participants were categorized into two groups based on alignment between model-recommended and actual treatment regimens, with their overall survival compared. Inverse probability treatment weighting was used to reduce bias, and a mixed-effects multivariate linear regression illustrated how baseline characteristics influenced PORT selection.
Results: 4990 patients with OCSCC met the inclusion criteria. Deep Survival regression with Mixture Effects (DSME) demonstrated the best performance among all the models and National Comprehensive Cancer Network guidelines. The efficacy of PORT is enhanced as the lymph node ratio (LNR) increases. Similar enhancements in efficacy are observed in patients with advanced age, large tumors, multiple positive lymph nodes, tongue involvement, and stage IVA. Early-stage (stage 0-II) OCSCC may safely omit PORT.
Conclusions: This is the first study to incorporate LNR as a tumor character to make personalized recommendations for patients. DSME can effectively identify potential beneficiaries of PORT and provide quantifiable survival benefits.
目的:术后放疗(PORT)在口腔鳞状细胞癌(OCSCC)患者中的应用缺乏明确的界限,原因是其显著的杀癌效果伴随着不可忽视的毒性。本研究旨在验证深度学习模型为 OCSCC 患者制定个性化 PORT 建议的能力,并量化患者特征对治疗选择的影响:根据模型推荐的治疗方案与实际治疗方案的一致性,将参与者分为两组,并比较他们的总生存率。采用反概率治疗加权法减少偏倚,混合效应多变量线性回归法说明基线特征如何影响 PORT 选择:4990名OCSCC患者符合纳入标准。带混合效应的深度生存回归(DSME)在所有模型和国家综合癌症网络指南中表现最佳。随着淋巴结比率(LNR)的增加,PORT 的疗效也随之提高。在高龄、大肿瘤、多阳性淋巴结、舌头受累和 IVA 期患者中也观察到类似的疗效增强。早期(0-II期)OCSCC可以安全地省略PORT:这是第一项将 LNR 作为肿瘤特征来为患者提供个性化建议的研究。DSME 可以有效识别 PORT 的潜在受益者,并提供可量化的生存获益。
期刊介绍:
Head & Neck is an international multidisciplinary publication of original contributions concerning the diagnosis and management of diseases of the head and neck. This area involves the overlapping interests and expertise of several surgical and medical specialties, including general surgery, neurosurgery, otolaryngology, plastic surgery, oral surgery, dermatology, ophthalmology, pathology, radiotherapy, medical oncology, and the corresponding basic sciences.