PH-0543 Identifying treatment errors for lung cancer patients using EPID dosimetry and deep learning

2044 Background: Clinical TNM staging derived from computed tomography (CT) imaging is a key prognostic factor for lung cancer patients when making decisions about treatment, monitoring, and clinical trial eligibility. However, heterogeneity among patients, including by molecular subtypes, may result in variability of survival outcomes of patients with the same TNM stage that receive the same treatment. Artificial intelligence may offer additional, individualized prognostic information based on both known and unknown features present in CTs to facilitate more precise clinical decision making. We developed a novel deep learning-based technique to predict 2-year survival from pretreatment CTs of pathologically-confirmed lung cancer patients. Methods: A fully automated, end-to-end model was designed to localize the three-dimensional (3D) space comprising the lungs and heart, and to learn deep prognostic features using a 3D convolutional neural network (3DCNN). The 3DCNN was trained and validated using 1,841 CTs of 1,184 patients from five public datasets made available in The Cancer Imaging Archive. Spearman’s rank correlation (R) and concordance index (C-index) between the model output and survival status of each patient after 2-year follow-up from CT acquisition was assessed, in addition to sensitivity, specificity and accuracy stratified by staging. Results: 3DCNN showed an overall prediction accuracy of 75.0% (R = 0.32, C-index = 0.67, p < 0.0001), with higher performance achieved for stage I patients (Table) . 3DCNN showed better overall correlation with survival for 1,124 patients with available TNM staging, in comparison to TNM staging only (R = 0.19, C-index = 0.63, p < 0.0001); however, a weighted linear combination of both TNM staging and the 3DCNN yielded a superior correlation (R = 0.34, C-index = 0.73, p < 0.0001). Conclusions: Deep learning applied to pretreatment CT images provides personalized prognostic information that complements clinical staging and may help facilitate more precise prognostication of patients diagnosed with lung cancer. [Table: see text]

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Automated imaging-based stratification of early-stage lung cancer patients prior to receiving surgical resection using deep learning applied to CTs.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.1552 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 1552-1552

Author(s):

Felipe Soares Torres ◽

Shazia Akbar ◽

Srinivas Raman ◽

Kazuhiro Yasufuku ◽

Felix Baldauf-Lenschen ◽

...

Keyword(s):

Lung Cancer ◽

Deep Learning ◽

Cancer Patients ◽

Surgical Resection ◽

Mortality Risk ◽

Early Stage ◽

Stage I ◽

Early Stage Lung Cancer ◽

Lung Cancer Patients ◽

Stage Lung Cancer

1552 Background: Computed tomography (CT) imaging is an important tool to guide further investigation and treatment in patients with lung cancer. For patients with early stage lung cancer, surgery remains an optimal treatment option. Artificial intelligence applied to pretreatment CTs may have the ability to quantify mortality risk and stratify patients for more individualized diagnostic, treatment and monitoring decisions. Methods: A fully automated, end-to-end model was designed to localize the 36cm x 36cm x 36cm space centered on the lungs and learn deep prognostic features using a 3-dimensional convolutional neural network (3DCNN) to predict 5-year mortality risk. The 3DCNN was trained and validated in a 5-fold cross-validation using 2,924 CTs of 1,689 lung cancer patients from 6 public datasets made available in The Cancer Imaging Archive. We evaluated 3DCNN’s ability to stratify stage I & II patients who received surgery into mortality risk quintiles using the Cox proportional hazards model. Results: 260 of the 1,689 lung cancer patients in the withheld validation dataset were diagnosed as stage I or II, received a surgical resection within 6 months of their pretreatment CT and had known 5-year disease and survival outcomes. Based on the 3DCNN’s predicted mortality risk, patients in the highest risk quintile had a 14.2-fold (95% CI 4.3-46.8, p < 0.001) increase in 5-year mortality hazard compared to patients in the lowest risk quintile. Conclusions: Deep learning applied to pretreatment CTs provides personalised prognostic insights for early stage lung cancer patients who received surgery and has the potential to inform treatment and monitoring decisions.[Table: see text]

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