基于机器学习开发与验证肾癌患者术后肾功能不全风险的预测模型

Development and validation of a prediction model for the risk of postoperative renal dysfunction in patients with renal cancer based on machine learning

  • 摘要: 目的: 本研究基于术前常规临床数据采用机器学习构建肾细胞癌术后肾功能不全风险预测模型,为早期识别高危患者提供决策支持。方法: 纳入广西医科大学第一附属医院413例接受肾部分切除或根治性切除术的肾癌患者。采用LASSO回归从79项初始特征中筛选关键变量,采用XGBoost、随机森林、逻辑回归等9种机器学习算法构建预测模型。采用受试者工作特征曲线下面积(AUC)、校准曲线和决策曲线分析评估模型性能,采用SHAP方法解析预测因子贡献。结果: 逻辑回归模型在验证队列中表现最优,AUC为0.798(95%CI:0.646~0.948)。SHAP分析显示,估算肾小球滤过率、年龄和肿瘤最大径为关键预测因子。决策曲线分析显示该模型具有显著临床净收益,校准曲线显示良好预测校准度。结论: 基于逻辑回归构建的预测模型可有效识别肾细胞癌术后肾功能不全高危患者,具有简便性优势和临床使用潜力。

     

    Abstract: Objective: To construct a risk prediction model for postoperative renal dysfunction based on preoperative routine clinical data using machine learning techniques, providing decision support for the early identification of high-risk patients. Methods: A total of 413 postoperative renal dysfunction in renal cell carcinoma(RCC) patients who underwent partial or radical nephrectomy at the First Affiliated Hospital of Guangxi Medical University were included. Key variables were selected from 79 initial features using LASSO regression. Nine machine learning algorithms, including XGBoost, random forest, and logistic regression, were used to construct the prediction model. The model’s performance was evaluated using the area under the receiver operating characteristic curve(AUC), calibration curves, and decision curve analysis(DCA). The SHAP method was employed to analyze the contribution of predictive factors. Results: The logistic regression model performed best in the validation cohort, with an AUC of 0.798(95% CI: 0.646-0.948). SHAP analysis identified endogenous creatinine clearance, age, and the maximum tumor diameter as key predictive factors. DCA indicated that the model provides significant clinical net benefit, and the calibration curve suggested good predictive calibration. Conclusion: The logistic regression-based prediction model can effectively identify high-risk patients for postoperative renal dysfunction in RCC. Its simplicity offers significant advantages, and it has potential for clinical application.

     

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