Preoperative identification of early extrahepatic recurrence after hepatectomy for colorectal liver metastases: A machine learning approach.
colorectal liver metastasis
early recurrence
extrahepatic recurrence
machine learning
online calculator
predictive model
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
19 Oct 2024
19 Oct 2024
Historique:
received:
27
06
2024
accepted:
06
10
2024
medline:
19
10
2024
pubmed:
19
10
2024
entrez:
19
10
2024
Statut:
aheadofprint
Résumé
Machine learning (ML) may provide novel insights into data patterns and improve model prediction accuracy. The current study sought to develop and validate an ML model to predict early extra-hepatic recurrence (EEHR) among patients undergoing resection of colorectal liver metastasis (CRLM). Patients with CRLM who underwent curative-intent resection between 2000 and 2020 were identified from an international multi-institutional database. An eXtreme gradient boosting (XGBoost) model was developed to estimate the risk of EEHR, defined as extrahepatic recurrence within 12 months after hepatectomy, using clinicopathological factors. The relative importance of factors was determined using Shapley additive explanations (SHAP) values. Among 1410 patients undergoing curative-intent resection, 131 (9.3%) patients experienced EEHR. Median OS among patients with and without EEHR was 35.4 months (interquartile range [IQR] 29.9-46.7) versus 120.5 months (IQR 97.2-134.0), respectively (p < 0.001). The ML predictive model had c-index values of 0.77 (95% CI, 0.72-0.81) and 0.77 (95% CI, 0.73-0.80) in the entire dataset and the validation data set with bootstrapping resamples, respectively. The SHAP algorithm demonstrated that T and N primary tumor categories, as well as tumor burden score were the three most important predictors of EEHR. An easy-to-use risk calculator for EEHR was developed and made available online at: https://junkawashima.shinyapps.io/EEHR/. An easy-to-use online calculator was developed using ML to help clinicians predict the chance of EEHR after curative-intent resection for CRLM. This tool may help clinicians in decision-making related to treatment strategies for patients with CRLM.
Sections du résumé
BACKGROUND
BACKGROUND
Machine learning (ML) may provide novel insights into data patterns and improve model prediction accuracy. The current study sought to develop and validate an ML model to predict early extra-hepatic recurrence (EEHR) among patients undergoing resection of colorectal liver metastasis (CRLM).
METHODS
METHODS
Patients with CRLM who underwent curative-intent resection between 2000 and 2020 were identified from an international multi-institutional database. An eXtreme gradient boosting (XGBoost) model was developed to estimate the risk of EEHR, defined as extrahepatic recurrence within 12 months after hepatectomy, using clinicopathological factors. The relative importance of factors was determined using Shapley additive explanations (SHAP) values.
RESULTS
RESULTS
Among 1410 patients undergoing curative-intent resection, 131 (9.3%) patients experienced EEHR. Median OS among patients with and without EEHR was 35.4 months (interquartile range [IQR] 29.9-46.7) versus 120.5 months (IQR 97.2-134.0), respectively (p < 0.001). The ML predictive model had c-index values of 0.77 (95% CI, 0.72-0.81) and 0.77 (95% CI, 0.73-0.80) in the entire dataset and the validation data set with bootstrapping resamples, respectively. The SHAP algorithm demonstrated that T and N primary tumor categories, as well as tumor burden score were the three most important predictors of EEHR. An easy-to-use risk calculator for EEHR was developed and made available online at: https://junkawashima.shinyapps.io/EEHR/.
CONCLUSIONS
CONCLUSIONS
An easy-to-use online calculator was developed using ML to help clinicians predict the chance of EEHR after curative-intent resection for CRLM. This tool may help clinicians in decision-making related to treatment strategies for patients with CRLM.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Author(s). World Journal of Surgery published by John Wiley & Sons Ltd on behalf of International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).
Références
Nathan, H., M. C. de Jong, C. Pulitano, D. Ribero, J. Strub, G. Mentha, J.‐F. Gigot, et al. 2010. “Conditional Survival after Surgical Resection of Colorectal Liver Metastasis: An International Multi‐Institutional Analysis of 949 Patients.” Journal of the American College of Surgeons 210(755–764): 756–764. https://doi.org/10.1016/j.jamcollsurg.2009.12.041.
Matsuoka, H., Z. Morise, C. Tanaka, T. Hayashi, Y. Ikeda, K. Maeda, K. Masumori, et al. 2019. “Repeat Hepatectomy with Systemic Chemotherapy Might Improve Survival of Recurrent Liver Metastasis from Colorectal Cancer—A Retrospective Observational Study.” World Journal of Surgical Oncology 17(1): 33. https://doi.org/10.1186/s12957‐019‐1575‐y.
Network, N. C. C. N. 2024. “NCCN Clinical Practice Guideline in Oncology: Colon Cancer.” NCCN Guidelines Version 1.2024: 23–34. https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf.
Endo, Y., B. O. Rueda, S. Woldesenbet, M. M. Munir, H. A. Lima, E. S. Katayama, C. F. Shaikh, et al. 2023. “The Impact of Recurrence Timing and Tumor Burden Score on Overall Survival Among Patients Undergoing Repeat Hepatectomy for Colorectal Liver Metastases.” Journal of Surgical Oncology 128(4): 560–568. https://doi.org/10.1002/jso.27314.
Creasy, J. M., E. Sadot, B. G. Koerkamp, J. F. Chou, M. Gonen, N. E. Kemeny, V. P. Balachandran, et al. 2018. “Actual 10‐year Survival after Hepatic Resection of Colorectal Liver Metastases: What Factors Preclude Cure?” Surgery 163(6): 1238–1244. https://doi.org/10.1016/j.surg.2018.01.004.
Wensink, G. E., K. Bolhuis, M. A. G. Elferink, R. J. A. Fijneman, O. Kranenburg, I. H. M. Borel Rinkes, M. Koopman, et al. 2023. “Predicting Early Extrahepatic Recurrence after Local Treatment of Colorectal Liver Metastases.” British Journal of Surgery 110(3): 362–371. https://doi.org/10.1093/bjs/znac461.
Battula, N., D. Tsapralis, D. Mayer, J. Isaac, P. Muiesan, R. P. Sutcliffe, S. Bramhall, D. Mirza, and R. Marudanayagam. 2014. “Repeat Liver Resection for Recurrent Colorectal Metastases: A Single‐centre, 13‐year Experience.” International Hepato‐Pancreato‐Biliary Association 16(2): 157–163. https://doi.org/10.1111/hpb.12096.
Butte, J. M., M. Gönen, P. J. Allen, T. Peter Kingham, C. T. Sofocleous, R. P. DeMatteo, Y. Fong, N. E. Kemeny, W. R. Jarnagin, and M. I. D’Angelica. 2015. “Recurrence after Partial Hepatectomy for Metastatic Colorectal Cancer: Potentially Curative Role of Salvage Repeat Resection.” Annals of Surgical Oncology 22(8): 2761–2771. https://doi.org/10.1245/s10434‐015‐4370‐1.
Viganò, L., L. Capussotti, R. Lapointe, E. Barroso, C. Hubert, F. Giuliante, J. N. M. Ijzermans, D. F. Mirza, D. Elias, and R. Adam. 2014. “Early Recurrence after Liver Resection for Colorectal Metastases: Risk Factors, Prognosis, and Treatment. A LiverMetSurvey‐Based Study of 6,025 Patients.” Annals of Surgical Oncology 21(4): 1276–1286. https://doi.org/10.1245/s10434‐013‐3421‐8.
Isoniemi, H., A. Uutela, A. Nordin, E. Lantto, I. Kellokumpu, A. Ovissi, J. Kosunen, et al. 2021. “Centralized Repeated Resectability Assessment of Patients with Colorectal Liver Metastases during First‐Line Treatment: Prospective Study.” British Journal of Surgery 108(7): 817–825. https://doi.org/10.1093/bjs/znaa145.
Stewart, C. L., S. Warner, K. Ito, M. Raoof, G. X. Wu, J. Kessler, J. Y. Kim, and Y. Fong. 2018. “Cytoreduction for Colorectal Metastases: Liver, Lung, Peritoneum, Lymph Nodes, Bone, Brain. When Does it Palliate, Prolong Survival, and Potentially Cure?” Current Problems in Surgery 55(9): 330–379. https://doi.org/10.1067/j.cpsurg.2018.08.004.
Tian, Y., Y. Wang, N. Wen, S. Wang, B. Li, and G. Liu. 2024. “Prognostic Factors Associated with Early Recurrence Following Liver Resection for Colorectal Liver Metastases: A Systematic Review and Meta‐Analysis.” BMC Cancer 24(1): 426. https://doi.org/10.1186/s12885‐024‐12162‐4.
Gong, X., M. Hu, and L. Zhao. 2018. “Big Data Toolsets to Pharmacometrics: Application of Machine Learning for Time‐to‐Event Analysis.” Clinical and Translational Science 11(3): 305–311. https://doi.org/10.1111/cts.12541.
Castela Forte, J., G. Yeshmagambetova, M. L. van der Grinten, T. W. L. Scheeren, M. W. N. Nijsten, M. A. Mariani, R. H. Henning, and A. H. Epema. 2022. “Comparison of Machine Learning Models Including Preoperative, Intraoperative, and Postoperative Data and Mortality after Cardiac Surgery.” JAMA Network Open 5(10): e2237970. https://doi.org/10.1001/jamanetworkopen.2022.37970.
Moro, A., R. Mehta, D. I. Tsilimigras, K. Sahara, A. Z. Paredes, F. Bagante, A. Guglielmi, et al. 2020. “Prognostic Factors Differ According to KRAS Mutational Status: A Classification and Regression Tree Model to Define Prognostic Groups after Hepatectomy for Colorectal Liver Metastasis.” Surgery 168(3): 497–503. https://doi.org/10.1016/j.surg.2020.05.019.
Amin, M. B., F. L. Greene, S. B. Edge, C. C. Compton, J. E. Gershenwald, R. K. Brookland, L. Meyer, D. M. Gress, D. R. Byrd, and D. P. Winchester. 2017. “The Eighth Edition AJCC Cancer Staging Manual: Continuing to Build a Bridge from a Population‐based to a More “Personalized” Approach to Cancer Staging.” CA: A Cancer Journal for Clinicians 67(2): 93–99. https://doi.org/10.3322/caac.21388.
Fong, Y., J. Fortner, R. L. Sun, M. F. Brennan, and L. H. Blumgart. 1999. “Clinical Score for Predicting Recurrence after Hepatic Resection for Metastatic Colorectal Cancer.” Annals of Surgery 230(3): 309. https://doi.org/10.1097/00000658‐199909000‐00004.
Sasaki, K., D. Morioka, S. Conci, G. A. Margonis, Y. Sawada, A. Ruzzenente, T. Kumamoto, et al. 2018. “The Tumor Burden Score: A New "Metro‐Ticket" Prognostic Tool for Colorectal Liver Metastases Based on Tumor Size and Number of Tumors.” Annals of Surgery 267(1): 132–141. https://doi.org/10.1097/sla.0000000000002064.
Nagino, M., R. DeMatteo, H. Lang, D. Cherqui, M. Malago, S. Kawakatsu, M. L. DeOliveira, et al. 2021. “Proposal of a New Comprehensive Notation for Hepatectomy: The "New World" Terminology.” Annals of Surgery 274: 1–3. https://doi.org/10.1097/sla.0000000000004808.
Dindo, D., N. Demartines, and P.‐A. Clavien. 2004. “Classification of Surgical Complications.” Annals of Surgery 240(2): 205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae.
Sakai, N., K. Furukawa, T. Takayashiki, S. Kuboki, S. Takano, and M. Ohtsuka. 2021. “Recurrence Patterns and Their Effects on Clinical Outcomes after R1 Resection of Colorectal Liver Metastases: a Propensity Score–Matched Analysis.” Langenbeck's Archives of Surgery 406(8): 2739–2747. https://doi.org/10.1007/s00423‐021‐02096‐x.
Finkelstein, S. E., F. G. Fernandez, F. Dehdashti, B. A. Siegel, W. G. Hawkins, D. C. Linehan, and S. M. Strasberg. 2008. “Unique Site‐ and Time‐specific Patterns of Recurrence Following Resection of Colorectal Carcinoma Hepatic Metastases in Patients Staged by FDG‐PET.” Journal of Hepato‐Biliary‐Pancreatic Surgery 15(5): 483–487. https://doi.org/10.1007/s00534‐007‐1237‐2.
Lalmahomed, Z. S., B. Mostert, W. Onstenk, J. Kraan, N. Ayez, J. W. Gratama, D. Grünhagen, C. Verhoef, and S. Sleijfer. 2015. “Prognostic Value of Circulating Tumour Cells for Early Recurrence after Resection of Colorectal Liver Metastases.” British Journal of Cancer 112(3): 556–561. https://doi.org/10.1038/bjc.2014.651.
Yamashita, Y.‐I., E. Adachi, Y. Toh, K. Ohgaki, O. Ikeda, E. Oki, K. Minami, Y. Sakaguchi, E. Tsujita, and T. Okamura. 2011. “Risk Factors for Early Recurrence after Curative Hepatectomy for Colorectal Liver Metastases.” Surgery Today 41(4): 526–532. https://doi.org/10.1007/s00595‐010‐4471‐1.
Van Buuren, S., H. C. Boshuizen, and D. L. Knook. 1999. “Multiple Imputation of Missing Blood Pressure Covariates in Survival Analysis.” Statistics in Medicine 18(6): 681–694. https://doi.org/10.1002/(sici)1097‐0258(19990330)18:6<681::aid‐sim71>3.0.co;2‐r.
Cao, Y., M. P. Forssten, B. Sarani, S. Montgomery, and S. Mohseni. 2023. “Development and Validation of an XGBoost‐Algorithm‐Powered Survival Model for Predicting In‐Hospital Mortality Based on 545,388 Isolated Severe Traumatic Brain Injury Patients from the TQIP Database.” Journal of Personalized Medicine 13(9): 1401. https://doi.org/10.3390/jpm13091401.
Verma, A., J. Balian, J. Hadaya, A. Premji, T. Shimizu, T. Donahue, and P. Benharash. 2023. “Machine Learning Based Prediction of Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy.” Annals of Surgery. https://doi.org/10.1097/sla.0000000000006123.
Margonis, G. A., K. Sasaki, S. Gholami, Y. Kim, N. Andreatos, N. Rezaee, A. Deshwar, et al. 2018. “Genetic and Morphological Evaluation (GAME) Score for Patients with Colorectal Liver Metastases.” British Journal of Surgery 105(9): 1210–1220. https://doi.org/10.1002/bjs.10838.
Paredes, A. Z., J. M. Hyer, D. I. Tsilimigras, Amika Moro, Fabio Bagante, Alfredo Guglielmi, Andrea Ruzzenente, et al. 2020. “A Novel Machine‐Learning Approach to Predict Recurrence after Resection of Colorectal Liver Metastases.” Annals of Surgical Oncology 27(13): 5139–5147. https://doi.org/10.1245/s10434‐020‐08991‐9.
Brudvik, K. W., R. P. Jones, F. Giuliante, J. Shindoh, G. Passot, M. H. Chung, J. Song, et al. 2019. “RAS Mutation Clinical Risk Score to Predict Survival after Resection of Colorectal Liver Metastases.” Annals of Surgery 269(1): 120–126. https://doi.org/10.1097/sla.0000000000002319.
Buisman, F. E., D. Giardiello, N. E. Kemeny, E. W. Steyerberg, D. J. Höppener, B. Galjart, P. M. H. Nierop, et al. 2022. “Predicting 10‐year Survival after Resection of Colorectal Liver Metastases; An International Study Including Biomarkers and Perioperative Treatment.” European Journal of Cancer 168: 25–33. https://doi.org/10.1016/j.ejca.2022.01.012.
Tsilimigras, D. I., R. Mehta, D. Moris, K. Sahara, F. Bagante, A. Z. Paredes, A. Moro, et al. 2020. “A Machine‐Based Approach to Preoperatively Identify Patients with the Most and Least Benefit Associated with Resection for Intrahepatic Cholangiocarcinoma: An International Multi‐Institutional Analysis of 1146 Patients.” Annals of Surgical Oncology 27(4): 1110–1119. https://doi.org/10.1245/s10434‐019‐08067‐3.
Jabeur, S. B., S. Mefteh‐Wali, and J.‐L. Viviani. 2024. “Forecasting Gold Price with the XGBoost Algorithm and SHAP Interaction Values.” Annals of Operations Research 334(1–3): 679–699. https://doi.org/10.1007/s10479‐021‐04187‐w.
Kawashima, J., K. Sahara, F. Shen, A. Guglielmi, L. Aldrighetti, M. Weiss, T. W. Bauer, et al. 2024. “Predicting Risk of Recurrence after Resection of Stage I Intrahepatic Cholangiocarcinoma.” Journal of Gastrointestinal Surgery 28(1): 18–25. https://doi.org/10.1016/j.gassur.2023.10.002.
Oba, M., K. Hasegawa, Y. Matsuyama, J. Shindoh, Y. Mise, T. Aoki, Y. Sakamoto, Y. Sugawara, M. Makuuchi, and N. Kokudo. 2014. “Discrepancy between Recurrence‐free Survival and Overall Survival in Patients with Resectable Colorectal Liver Metastases: A Potential Surrogate Endpoint for Time to Surgical Failure.” Annals of Surgical Oncology 21(6): 1817–1824. https://doi.org/10.1245/s10434‐014‐3504‐1.
Taylor, A., A. Taylor, W. Langeberg, F. Mowat, D. Alexander, M. Choti, G. Poston, and G. Kanas. 2012. “Survival after Liver Resection in Metastatic Colorectal Cancer: Review and Meta‐Analysis of Prognostic Factors.” Clinical Epidemiology 4: 283–301. https://doi.org/10.2147/clep.s34285.
Wei, A. C., and W. R. Jarnagin. 2020. “Questioning Why More Patients with Colorectal Liver Metastases Are Not Referred for Metastasectomy.” JAMA Surgery 155(10): 909. https://doi.org/10.1001/jamasurg.2020.1460.
de Jong, M. C., S. C. Mayo, C. Pulitano, S. Lanella, D. Ribero, J. Strub, C. Hubert, et al. 2009. “Repeat Curative Intent Liver Surgery Is Safe and Effective for Recurrent Colorectal Liver Metastasis: Results from an International Multi‐Institutional Analysis.” Journal of Gastrointestinal Surgery 13(12): 2141–2151. https://doi.org/10.1007/s11605‐009‐1050‐0.
Valenzuela, C. D., O. Moaven, R. Gawdi, J. A. Stauffer, N. R. Del Piccolo, T. T. Cheung, C. U. Corvera, et al. 2022. “Outcomes after Repeat Hepatectomy for Colorectal Liver Metastases from the Colorectal Liver Operative Metastasis International Collaborative (COLOMIC).” Journal of Surgical Oncology 126(7): 1242–1252. https://doi.org/10.1002/jso.27056.
Boyev, A., C.‐W. D. Tzeng, H. Maki, E. M. Arvide, D. E. Mrema, A. J. Jain, A. Haddad, et al. 2024. “Local Therapy Improves Survival for Early Recurrence after Resection of Colorectal Liver Metastases.” Annals of Surgical Oncology 31(4): 2547–2556. https://doi.org/10.1245/s10434‐023‐14806‐4.
Imai, K., M.‐A. Allard, C. C. Benitez, E. Vibert, A. Sa Cunha, D. Cherqui, D. Castaing, H. Bismuth, H. Baba, and René Adam. 2016. “Early Recurrence after Hepatectomy for Colorectal Liver Metastases: What Optimal Definition and what Predictive Factors?” The Oncologist 21(7): 887–894. https://doi.org/10.1634/theoncologist.2015‐0468.
Moretto, R., M. M. Germani, B. Borelli, V. Conca, D. Rossini, P. Boraschi, F. Donati, et al. 2024. “Predicting Early Recurrence after Resection of Initially Unresectable Colorectal Liver Metastases: the Role of Baseline and Pre‐surgery Clinical, Radiological and Molecular Factors in a Real‐Life Multicentre Experience.” ESMO Open 9(4): 102991. https://doi.org/10.1016/j.esmoop.2024.102991.
Adam, R., R. J. de Haas, D. A. Wicherts, E. Vibert, C. Salloum, D. Azoulay, and D. Castaing. 2011. “Concomitant Extrahepatic Disease in Patients with Colorectal Liver Metastases: when Is There a Place for Surgery?” Annals of Surgery 253(2): 349–359. https://doi.org/10.1097/sla.0b013e318207bf2c.
D’Angelica, M., P. Kornprat, M. Gonen, R. P. DeMatteo, Y. Fong, L. H. Blumgart, and W. R. Jarnagin. 2011. “Effect on Outcome of Recurrence Patterns after Hepatectomy for Colorectal Metastases.” Annals of Surgical Oncology 18(4): 1096–1103. https://doi.org/10.1245/s10434‐010‐1409‐1.
Matsumoto, T., S. Hasegawa, K. Hida, K. Kawada, Y. Sakai, and K. Sugihara. 2019. “Role of Repeat Resection in Patients with Metastatic Colorectal Cancer: A Multicenter Retrospective Study.” Diseases of the Colon & Rectum 62(5): 561–567. https://doi.org/10.1097/dcr.0000000000001311.
Bosma, N. A., A. R. Keehn, R. Lee‐Ying, S. Karim, A. R. MacLean, and D. R. Brenner. 2021. “Efficacy of Perioperative Chemotherapy in Resected Colorectal Liver Metastasis: A Systematic Review and Meta‐Analysis.” European Journal of Surgical Oncology 47(12): 3113–3122. https://doi.org/10.1016/j.ejso.2021.07.024.
Endo, Y., L. Alaimo, Z. Moazzam, S. Woldesenbet, H. A. Lima, J. Yang, M. M. Munir, et al. 2024. “Optimal Policy Tree to Assist in Adjuvant Therapy Decision‐Making after Resection of Colorectal Liver Metastases.” Surgery 175(3): 645–653. https://doi.org/10.1016/j.surg.2023.06.045.
Kawaguchi, Y., H. A. Lillemoe, E. Panettieri, Y. S. Chun, C.‐W. D. Tzeng, T. A. Aloia, S. Kopetz, and J.‐N. Vauthey. 2019. “Conditional Recurrence‐free Survival after Resection of Colorectal Liver Metastases: Persistent Deleterious Association with RAS and TP53 Co‐mutation.” Journal of the American College of Surgeons 229(3): 286–294.e281. https://doi.org/10.1016/j.jamcollsurg.2019.04.027.
Dai, S., Y. Ye, X. Kong, J. Li, and K. Ding. 2021. “A Predictive Model for Early Recurrence of Colorectal‐Cancer Liver Metastases Based on Clinical Parameters.” Gastroenterology Report 9(3): 241–251. https://doi.org/10.1093/gastro/goaa092.
Mao, R., J.‐J. Zhao, X.‐Y. Bi, Y.‐F. Zhang, Z.‐Y. Li, J.‐G. Zhou, X.‐L. Wu, C. Xiao, H. Zhao, and J.‐Q. Cai. 2017. “A Postoperative Scoring System for Post‐hepatectomy Early Recurrence of Colorectal Liver Metastases.” Oncotarget 8(60): 102531–102539. https://doi.org/10.18632/oncotarget.20934.
Hokuto, D., T. Nomi, S. Yasuda, T. Yoshikawa, K. Ishioka, T. Yamada, T. Akahori, et al. 2018. “Risk Factors for Unresectable Recurrence after Up‐Front Surgery for Colorectal Liver Metastasis.” World Journal of Surgery 42(3): 884–891. https://doi.org/10.1007/s00268‐017‐4195‐0.
Kato, Y., K. Shigeta, K. Okabayashi, M. Tsuruta, R. Seishima, S. Matsui, T. Sasaki, Y. Koseki, and Y. Kitagawa. 2021. “Lymph Node Metastasis Is Strongly Associated with Lung Metastasis as the First Recurrence Site in Colorectal Cancer.” Surgery 170(3): 696–702. https://doi.org/10.1016/j.surg.2021.03.017.
Tsilimigras, D. I., M. J. Hyer, F. Bagante, A. Guglielmi, A. Ruzzenente, S. Alexandrescu, G. Poultsides, K. Sasaki, F. Aucejo, and T. M. Pawlik. 2021. “Resection of Colorectal Liver Metastasis: Prognostic Impact of Tumor Burden vs KRAS Mutational Status.” Journal of the American College of Surgeons 232(4): 590–598. https://doi.org/10.1016/j.jamcollsurg.2020.11.023.
Chen, Q., Y. Zhang, X. Li, Z. Huang, H. Zhao, and J. Cai. 2022. “Nomogram Incorporating Preoperative Testing Markers for the Prediction of Early Recurrence for Colorectal Liver Metastases with Neoadjuvant Chemotherapy Followed by Hepatectomy.” Journal of Cancer 13(6): 1758–1767. https://doi.org/10.7150/jca.65677.
Sasaki, K., G. A. Margonis, N. Andreatos, X.‐F. Zhang, S. Buettner, J. Wang, A. Deshwar, et al. 2017. “The Prognostic Utility of the “Tumor Burden Score” Based on Preoperative Radiographic Features of Colorectal Liver Metastases.” Journal of Surgical Oncology 116(4): 515–523. https://doi.org/10.1002/jso.24678.
Xie, L., J. Liu, S. Lu, T.‐H. Chang, and Q. Shi. 2022. “An Efficient Learning Framework for Federated XGBoost Using Secret Sharing and Distributed Optimization.” ACM Transactions on Intelligent Systems and Technology 13(5): 1–28. https://doi.org/10.1145/3523061.
Tseng, P.‐Y., Y.‐T. Chen, C.‐H. Wang, K.‐M. Chiu, Y.‐S. Peng, S.‐P. Hsu, K.‐L. Chen, C.‐Y. Yang, and O. K.‐S. Lee. 2020. “Prediction of the Development of Acute Kidney Injury Following Cardiac Surgery by Machine Learning.” Critical Care 24(1): 478. https://doi.org/10.1186/s13054‐020‐03179‐9.