Prediction of postoperative morbidity after lung resection using an artificial neural network ensemble

https://doi.org/10.1016/S0933-3657(03)00059-9Get rights and content

Abstract

Objective: To propose an ensemble model of artificial neural networks (ANNs) to predict cardio-respiratory morbidity after pulmonary resection for non-small cell lung cancer (NSCLC).

Methods: Prospective clinical study was based on 489 NSCLC operated cases. An artificial neural network ensemble was developed using a training set of 348 patients undergoing lung resection between 1994 and 1999. Predictive variables used were: sex of the patient, age, body mass index, ischemic heart disease, cardiac arrhythmia, diabetes mellitus, induction chemotherapy, extent of resection, chest wall resection, perioperative blood transfusion, tumour staging, forced expiratory volume in 1 s percent (FEV1%), and predicted postoperative FEV1% (ppoFEV1%). The analysed outcome was the occurrence of postoperative cardio-respiratory complications prospectively recorded and codified. The artificial neural network ensemble consists of 100 backpropagation networks combined via a simple averaging method. The probabilities of complication calculated by ensemble model were obtained to the actual occurrence of complications in 141 cases operated on between January 2000 and December 2001 and a receiver operating characteristic (ROC) curve for this method was constructed.

Results: The prevalence of cardio-respiratory morbidity was 0.25 in the training and 0.30 in the validation series. The accuracy for morbidity prediction (area under the ROC curve) was 0.98 by the ensemble model.

Conclusion: In this series an artificial neural network ensemble offered a high performance to predict postoperative cardio-respiratory morbidity.

Introduction

Lung resection is currently the best therapeutic option for patients with localised bronchogenic carcinoma. In the last years, a number of articles have been published in which several independent variables frequently associated to lung cancer, such are chronic obstructive pulmonary disease (COPD), cardiac ischemia, and others, are correlated to mortality or morbidity after major pulmonary resection [2], [3], [12]. Although knowledge of these variables can help to prevent postoperative morbidity, the applicability of these data to individual decisions has not been demonstrated, since constructed predictive regression models usually do not have a high sensitivity or specificity [12], [23].

In order to increase the performance of risk-prediction models in thoracic surgery, some investigators have tested single neural networks. In the reports by Lippman and Shahian [19] and Tu et al. [22], the measured outcome was in-hospital mortality after coronary artery by-pass graft. The capacity of logistic regression (LR) and artificial neural network (ANN) models to predict the outcome was similar in both publications. To our knowledge, there is only one published report in which single neural networks has been applied successfully to predict the risk of lung resection in a small series of cases [8].

Combining the prediction of multiple classifiers to produced a single classifier (known as an ensemble) has been demonstrated to increase the accuracy and performance of prediction [20], [24], [25]. In this report we evaluate the performance of an artificial neural network ensemble to predict cardio-respiratory morbidity after pulmonary resection for non-small cell lung cancer (NSCLC).

Section snippets

Study population

From January 1994 to December 2001, 515 patients underwent lobectomy or pneumonectomy for NSCLC in our hospital. All cases have been operated upon by the same surgical team. Selection criteria for operation consisted in the absence of major co-morbidity refractory to medical therapy, pO2 at rest over 50 mmHg, pCO2 under 46 mmHg and postoperative FEV1% (ppoFEV1%) over 30% of the normal value. Calculation of the ppoFEV1% was based on the number of non-obstructed pulmonary segments to be resected

Results

Table 3 depicts the results of descriptive analysis of continuous variables in both subsets of patients. Significant differences were found for age (series B patients were slightly older), preoperative chemotherapy (more cases in series B underwent induction treatment) and pathological tumour staging (more advanced tumours in series A).

Overall mortality in the two populations was 29 cases (5.9%): 24 cases in series A (6.9%) and 5 in series B (3.5%;P=0.205). Overall cardio-respiratory morbidity

Discussion

Pulmonary resection remains the most effective therapy in patients having localised lung cancer. Due to its relation with tobacco abuse, lung cancer patients frequently have other associated cardio-pulmonary diseases such are COPD or cardiac ischemia, which are related to postoperative morbidity and mortality.

In the last years, several single-institution [2], [3] or multi-institutional reports [7], [12], [16] have been carried out to identify clinical predictors of morbidity or mortality after

Conclusion

In conclusion, in our series, artificial neural network ensemble offers a high performance for the prediction of cardio-respiratory morbidity. Our results must be considered with caution and their future applications for decision making in individual cases of lung resection surgery remain to be investigated.

Acknowledgements

We are indebted to anonymous reviewers who have greatly improved the manuscript with their suggestions.

References (25)

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