Development and Validation of Artificial Neural Networks for Survival Prediction Model for Patients with Spontaneous Hepatocellular Carcinoma Rupture After Transcatheter Arterial Embolization

Abstract

Background

Spontaneous rupture bleeding is a fatal hepatocellular carcinoma (HCC) complication and a significant determinant of survival outcomes. This study aimed to develop and validate a novel artificial neural network (ANN)-based survival prediction model for patients with spontaneous HCC rupture after transcatheter arterial embolization (TAE).

Methods

Patients with spontaneous HCC rupture bleeding who underwent TAE at our hospital between January 2010 and December 2018 were included in our study. The least absolute shrinkage and selection operator (LASSO) Cox regression model was used to screen clinical variables related to prognosis. We incorporated the above clinical variables identified by LASSO Cox regression into the ANNs model. Multilayer perceptron ANNs were used to develop the 1-year overall survival (OS) prediction model for patients with spontaneous HCC ruptured bleeding in the training set. The area under the receiver operating characteristic curve and decision curve analysis were used to compare the predictive capability of the ANNs model with that of existing conventional prediction models.

Results

The median survival time for the whole set was 11.8 months, and the 1-year OS rate was 47.5%. LASSO Cox regression revealed that sex, extrahepatic metastasis, macroscopic vascular invasion, tumor number, hepatitis B surface antigen, hepatitis B e antigen, tumor size, alpha-fetoprotein, fibrinogen, direct bilirubin, red blood cell, and γ-glutamyltransferase were risk factors for OS. An ANNs model with 12 input nodes, seven hidden nodes, and two corresponding prognostic outcomes was constructed. In the training set and the validation set, AUCs for the ability of the ANNs model to predict the 1-year OS of patients with spontaneous HCC rupture bleeding were 0.923 (95% CI, 0.890–0.956) and 0.930 (95% CI, 0.875–0.985), respectively, which were higher than that of the existing conventional models (all P < 0.0001).

Conclusion

The ANNs model that we established has better survival prediction performance.

Keywords:

• hepatocellular carcinoma spontaneous rupture bleeding
• HCC spontaneous rupture bleeding
• least absolute shrinkage and selection operator regression
• LASSO regression
• artificial neural networks
• ANNs
• survival
• prognosis

Acknowledgments

We would like to acknowledge with gratitude the contribution of the colleagues from the Department of Liver Surgery, West China Hospital of Sichuan University.

Data Sharing Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy restrictions.

Ethical Statement

The study was approved by the ethics committee of Sichuan University, and informed consent was taken from all the patients.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published, have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

All the authors disclose no conflicts of interest for this work.