A prospectively validated machine learning model for the prediction of survival and tumor subtype in pancreatic ductal adenocarcinoma

Abstract

PurposeTo develop a supervised machine learning algorithm capable of predicting above vs. below-median overall survival from medical imaging-derived radiomic features in a cohort of patients with pancreatic ductal adenocarcinoma (PDAC).\n\nMaterials and Methods102 patients with histopathologically proven PDAC were retrospectively assessed as the training cohort and 30 prospectively enrolled patients served as the external validation cohort. Tumors were segmented in pre-operative diffusion weighted-(DW)-MRI derived ADC maps and radiomic features were extracted. A Random Forest machine learning algorithm was fit to the training cohort and tested in the external validation cohort. The histopathological subtype of the tumor samples was assessed by immunohistochemistry in 21/30 patients of the external validation cohort. Individual radiomic feature importance was evaluated.\n\nResultsThe machine learning algorithm achieved a sensitivity of 87% and a specificity of 80% (ROC-AUC 90%) for the prediction of above- vs. below-median survival on the unseen data of the external validation cohort. Heterogeneity-related features were highly ranked by the model. Of the 21 patients for whom the histopathological subtype was determined, 8/9 patients predicted by the model to experience below-median overall survival exhibited the quasi-mesenchymal subtype, while 11/12 patients predicted to experience above-median survival exhibited a non-quasi-mesenchymal subtype (Fishers exact test P<0.001).\n\nConclusionThe application of machine-learning to the radiomic analysis of DW-MRI-derived ADC maps allowed the prediction of overall survival with high diagnostic accuracy in a prospectively collected cohort. The high overlap of clinically relevant histopathological subtypes with model predictions underlines the potential of quantitative imaging workflows in pre-operative subtyping and risk assessment in PDAC.