Preoperative risk stratification in endometrial cancer (ENDORISK) by a Bayesian network model : a development and validation study
Background Bayesian networks (BNs) are machine-learning–based computational models that visualize causal relationships and provide insight into the processes underlying disease progression, closely resembling clinical decision-making. Preoperative identification of patients at risk for lymph node me...
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creator | Reijnen, Casper Gogou, Evangelia Visser, Nicole C M Engerud, Hilde Ramjith, Jordache van der Putten, Louis J M Van de Vijver, Koen Santacana, Maria Bronsert, Peter Bulten, Johan Hirschfeld, Marc Colas, Eva Gil-Moreno, Antonio Reques, Armando Mancebo, Gemma Krakstad, Camilla Trovik, Jone Haldorsen, Ingfrid S Huvila, Jutta Koskas, Martin Weinberger, Vit Bednarikova, Marketa Hausnerova, Jitka van der Wurff, Anneke A M Matias-Guiu, Xavier Amant, Frederic Massuger, Leon F A G Snijders, Marc P L M Kusters-Vandevelde, Heidi V N Lucas, Peter J F Pijnenborg, Johanna M A |
description | Background
Bayesian networks (BNs) are machine-learning–based computational models that visualize causal relationships and provide insight into the processes underlying disease progression, closely resembling clinical decision-making. Preoperative identification of patients at risk for lymph node metastasis (LNM) is challenging in endometrial cancer, and although several biomarkers are related to LNM, none of them are incorporated in clinical practice. The aim of this study was to develop and externally validate a preoperative BN to predict LNM and outcome in endometrial cancer patients.
Methods and findings
Within the European Network for Individualized Treatment of Endometrial Cancer (ENITEC), we performed a retrospective multicenter cohort study including 763 patients, median age 65 years (interquartile range [IQR] 58–71), surgically treated for endometrial cancer between February 1995 and August 2013 at one of the 10 participating European hospitals. A BN was developed using score-based machine learning in addition to expert knowledge. Our main outcome measures were LNM and 5-year disease-specific survival (DSS). Preoperative clinical, histopathological, and molecular biomarkers were included in the network. External validation was performed using 2 prospective study cohorts: the Molecular Markers in Treatment in Endometrial Cancer (MoMaTEC) study cohort, including 446 Norwegian patients, median age 64 years (IQR 59–74), treated between May 2001 and 2010; and the PIpelle Prospective ENDOmetrial carcinoma (PIPENDO) study cohort, including 384 Dutch patients, median age 66 years (IQR 60–73), treated between September 2011 and December 2013. A BN called ENDORISK (preoperative risk stratification in endometrial cancer) was developed including the following predictors: preoperative tumor grade; immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PR), p53, and L1 cell adhesion molecule (L1CAM); cancer antigen 125 serum level; thrombocyte count; imaging results on lymphadenopathy; and cervical cytology. In the MoMaTEC cohort, the area under the curve (AUC) was 0.82 (95% confidence interval [CI] 0.76–0.88) for LNM and 0.82 (95% CI 0.77–0.87) for 5-year DSS. In the PIPENDO cohort, the AUC for 5-year DSS was 0.84 (95% CI 0.78–0.90). The network was well-calibrated. In the MoMaTEC cohort, 249 patients (55.8%) were classified with |
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fullrecord | <record><control><sourceid>ghent</sourceid><recordid>TN_cdi_ghent_librecat_oai_archive_ugent_be_8662482</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>oai_archive_ugent_be_8662482</sourcerecordid><originalsourceid>FETCH-ghent_librecat_oai_archive_ugent_be_86624823</originalsourceid><addsrcrecordid>eNqdjk9PAjEUxHuABBS-wzvigWSp_FuPCkZjAga9N2-3D3jQbUlb1uzVT06JfgIuM5n8MpNpie5oMs6HIzmbdcRdCIcsk3mWZ13x--nJnchj5JrAczhCiNe05TKps8AWyGpXUfSMBkq0JXkYLFeL9eb96-MBigYQnrGhwGjBUvxx_giV02TgKSFNNRl3qshGQKuhRsP6bzvEs256or1FE6j_7_dCvi6_X96Gu32qKMOFp_RFOWSFvtyno-q8u6KC1Hw6leO5fLypdAGvoF0n</addsrcrecordid><sourcetype>Institutional Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Preoperative risk stratification in endometrial cancer (ENDORISK) by a Bayesian network model : a development and validation study</title><source>Ghent University Academic Bibliography</source><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>Public Library of Science (PLoS)</source><creator>Reijnen, Casper ; Gogou, Evangelia ; Visser, Nicole C M ; Engerud, Hilde ; Ramjith, Jordache ; van der Putten, Louis J M ; Van de Vijver, Koen ; Santacana, Maria ; Bronsert, Peter ; Bulten, Johan ; Hirschfeld, Marc ; Colas, Eva ; Gil-Moreno, Antonio ; Reques, Armando ; Mancebo, Gemma ; Krakstad, Camilla ; Trovik, Jone ; Haldorsen, Ingfrid S ; Huvila, Jutta ; Koskas, Martin ; Weinberger, Vit ; Bednarikova, Marketa ; Hausnerova, Jitka ; van der Wurff, Anneke A M ; Matias-Guiu, Xavier ; Amant, Frederic ; Massuger, Leon F A G ; Snijders, Marc P L M ; Kusters-Vandevelde, Heidi V N ; Lucas, Peter J F ; Pijnenborg, Johanna M A</creator><creatorcontrib>Reijnen, Casper ; Gogou, Evangelia ; Visser, Nicole C M ; Engerud, Hilde ; Ramjith, Jordache ; van der Putten, Louis J M ; Van de Vijver, Koen ; Santacana, Maria ; Bronsert, Peter ; Bulten, Johan ; Hirschfeld, Marc ; Colas, Eva ; Gil-Moreno, Antonio ; Reques, Armando ; Mancebo, Gemma ; Krakstad, Camilla ; Trovik, Jone ; Haldorsen, Ingfrid S ; Huvila, Jutta ; Koskas, Martin ; Weinberger, Vit ; Bednarikova, Marketa ; Hausnerova, Jitka ; van der Wurff, Anneke A M ; Matias-Guiu, Xavier ; Amant, Frederic ; Massuger, Leon F A G ; Snijders, Marc P L M ; Kusters-Vandevelde, Heidi V N ; Lucas, Peter J F ; Pijnenborg, Johanna M A</creatorcontrib><description>Background
Bayesian networks (BNs) are machine-learning–based computational models that visualize causal relationships and provide insight into the processes underlying disease progression, closely resembling clinical decision-making. Preoperative identification of patients at risk for lymph node metastasis (LNM) is challenging in endometrial cancer, and although several biomarkers are related to LNM, none of them are incorporated in clinical practice. The aim of this study was to develop and externally validate a preoperative BN to predict LNM and outcome in endometrial cancer patients.
Methods and findings
Within the European Network for Individualized Treatment of Endometrial Cancer (ENITEC), we performed a retrospective multicenter cohort study including 763 patients, median age 65 years (interquartile range [IQR] 58–71), surgically treated for endometrial cancer between February 1995 and August 2013 at one of the 10 participating European hospitals. A BN was developed using score-based machine learning in addition to expert knowledge. Our main outcome measures were LNM and 5-year disease-specific survival (DSS). Preoperative clinical, histopathological, and molecular biomarkers were included in the network. External validation was performed using 2 prospective study cohorts: the Molecular Markers in Treatment in Endometrial Cancer (MoMaTEC) study cohort, including 446 Norwegian patients, median age 64 years (IQR 59–74), treated between May 2001 and 2010; and the PIpelle Prospective ENDOmetrial carcinoma (PIPENDO) study cohort, including 384 Dutch patients, median age 66 years (IQR 60–73), treated between September 2011 and December 2013. A BN called ENDORISK (preoperative risk stratification in endometrial cancer) was developed including the following predictors: preoperative tumor grade; immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PR), p53, and L1 cell adhesion molecule (L1CAM); cancer antigen 125 serum level; thrombocyte count; imaging results on lymphadenopathy; and cervical cytology. In the MoMaTEC cohort, the area under the curve (AUC) was 0.82 (95% confidence interval [CI] 0.76–0.88) for LNM and 0.82 (95% CI 0.77–0.87) for 5-year DSS. In the PIPENDO cohort, the AUC for 5-year DSS was 0.84 (95% CI 0.78–0.90). The network was well-calibrated. In the MoMaTEC cohort, 249 patients (55.8%) were classified with <5% risk of LNM, with a false-negative rate of 1.6%. A limitation of the study is the use of imputation to correct for missing predictor variables in the development cohort and the retrospective study design.
Conclusions
In this study, we illustrated how BNs can be used for individualizing clinical decision-making in oncology by incorporating easily accessible and multimodal biomarkers. The network shows the complex interactions underlying the carcinogenetic process of endometrial cancer by its graphical representation. A prospective feasibility study will be needed prior to implementation in the clinic.</description><identifier>ISSN: 1549-1277</identifier><identifier>ISSN: 1549-1676</identifier><language>eng</language><subject>CARCINOMA ; L1CAM ; LYMPH-NODE METASTASIS ; Medicine and Health Sciences ; PREDICTION</subject><creationdate>2020</creationdate><rights>Creative Commons Attribution 4.0 International Public License (CC-BY 4.0) info:eu-repo/semantics/openAccess</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,315,776,780,4010,27837</link.rule.ids></links><search><creatorcontrib>Reijnen, Casper</creatorcontrib><creatorcontrib>Gogou, Evangelia</creatorcontrib><creatorcontrib>Visser, Nicole C M</creatorcontrib><creatorcontrib>Engerud, Hilde</creatorcontrib><creatorcontrib>Ramjith, Jordache</creatorcontrib><creatorcontrib>van der Putten, Louis J M</creatorcontrib><creatorcontrib>Van de Vijver, Koen</creatorcontrib><creatorcontrib>Santacana, Maria</creatorcontrib><creatorcontrib>Bronsert, Peter</creatorcontrib><creatorcontrib>Bulten, Johan</creatorcontrib><creatorcontrib>Hirschfeld, Marc</creatorcontrib><creatorcontrib>Colas, Eva</creatorcontrib><creatorcontrib>Gil-Moreno, Antonio</creatorcontrib><creatorcontrib>Reques, Armando</creatorcontrib><creatorcontrib>Mancebo, Gemma</creatorcontrib><creatorcontrib>Krakstad, Camilla</creatorcontrib><creatorcontrib>Trovik, Jone</creatorcontrib><creatorcontrib>Haldorsen, Ingfrid S</creatorcontrib><creatorcontrib>Huvila, Jutta</creatorcontrib><creatorcontrib>Koskas, Martin</creatorcontrib><creatorcontrib>Weinberger, Vit</creatorcontrib><creatorcontrib>Bednarikova, Marketa</creatorcontrib><creatorcontrib>Hausnerova, Jitka</creatorcontrib><creatorcontrib>van der Wurff, Anneke A M</creatorcontrib><creatorcontrib>Matias-Guiu, Xavier</creatorcontrib><creatorcontrib>Amant, Frederic</creatorcontrib><creatorcontrib>Massuger, Leon F A G</creatorcontrib><creatorcontrib>Snijders, Marc P L M</creatorcontrib><creatorcontrib>Kusters-Vandevelde, Heidi V N</creatorcontrib><creatorcontrib>Lucas, Peter J F</creatorcontrib><creatorcontrib>Pijnenborg, Johanna M A</creatorcontrib><title>Preoperative risk stratification in endometrial cancer (ENDORISK) by a Bayesian network model : a development and validation study</title><description>Background
Bayesian networks (BNs) are machine-learning–based computational models that visualize causal relationships and provide insight into the processes underlying disease progression, closely resembling clinical decision-making. Preoperative identification of patients at risk for lymph node metastasis (LNM) is challenging in endometrial cancer, and although several biomarkers are related to LNM, none of them are incorporated in clinical practice. The aim of this study was to develop and externally validate a preoperative BN to predict LNM and outcome in endometrial cancer patients.
Methods and findings
Within the European Network for Individualized Treatment of Endometrial Cancer (ENITEC), we performed a retrospective multicenter cohort study including 763 patients, median age 65 years (interquartile range [IQR] 58–71), surgically treated for endometrial cancer between February 1995 and August 2013 at one of the 10 participating European hospitals. A BN was developed using score-based machine learning in addition to expert knowledge. Our main outcome measures were LNM and 5-year disease-specific survival (DSS). Preoperative clinical, histopathological, and molecular biomarkers were included in the network. External validation was performed using 2 prospective study cohorts: the Molecular Markers in Treatment in Endometrial Cancer (MoMaTEC) study cohort, including 446 Norwegian patients, median age 64 years (IQR 59–74), treated between May 2001 and 2010; and the PIpelle Prospective ENDOmetrial carcinoma (PIPENDO) study cohort, including 384 Dutch patients, median age 66 years (IQR 60–73), treated between September 2011 and December 2013. A BN called ENDORISK (preoperative risk stratification in endometrial cancer) was developed including the following predictors: preoperative tumor grade; immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PR), p53, and L1 cell adhesion molecule (L1CAM); cancer antigen 125 serum level; thrombocyte count; imaging results on lymphadenopathy; and cervical cytology. In the MoMaTEC cohort, the area under the curve (AUC) was 0.82 (95% confidence interval [CI] 0.76–0.88) for LNM and 0.82 (95% CI 0.77–0.87) for 5-year DSS. In the PIPENDO cohort, the AUC for 5-year DSS was 0.84 (95% CI 0.78–0.90). The network was well-calibrated. In the MoMaTEC cohort, 249 patients (55.8%) were classified with <5% risk of LNM, with a false-negative rate of 1.6%. A limitation of the study is the use of imputation to correct for missing predictor variables in the development cohort and the retrospective study design.
Conclusions
In this study, we illustrated how BNs can be used for individualizing clinical decision-making in oncology by incorporating easily accessible and multimodal biomarkers. The network shows the complex interactions underlying the carcinogenetic process of endometrial cancer by its graphical representation. A prospective feasibility study will be needed prior to implementation in the clinic.</description><subject>CARCINOMA</subject><subject>L1CAM</subject><subject>LYMPH-NODE METASTASIS</subject><subject>Medicine and Health Sciences</subject><subject>PREDICTION</subject><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>ADGLB</sourceid><recordid>eNqdjk9PAjEUxHuABBS-wzvigWSp_FuPCkZjAga9N2-3D3jQbUlb1uzVT06JfgIuM5n8MpNpie5oMs6HIzmbdcRdCIcsk3mWZ13x--nJnchj5JrAczhCiNe05TKps8AWyGpXUfSMBkq0JXkYLFeL9eb96-MBigYQnrGhwGjBUvxx_giV02TgKSFNNRl3qshGQKuhRsP6bzvEs256or1FE6j_7_dCvi6_X96Gu32qKMOFp_RFOWSFvtyno-q8u6KC1Hw6leO5fLypdAGvoF0n</recordid><startdate>2020</startdate><enddate>2020</enddate><creator>Reijnen, Casper</creator><creator>Gogou, Evangelia</creator><creator>Visser, Nicole C M</creator><creator>Engerud, Hilde</creator><creator>Ramjith, Jordache</creator><creator>van der Putten, Louis J M</creator><creator>Van de Vijver, Koen</creator><creator>Santacana, Maria</creator><creator>Bronsert, Peter</creator><creator>Bulten, Johan</creator><creator>Hirschfeld, Marc</creator><creator>Colas, Eva</creator><creator>Gil-Moreno, Antonio</creator><creator>Reques, Armando</creator><creator>Mancebo, Gemma</creator><creator>Krakstad, Camilla</creator><creator>Trovik, Jone</creator><creator>Haldorsen, Ingfrid S</creator><creator>Huvila, Jutta</creator><creator>Koskas, Martin</creator><creator>Weinberger, Vit</creator><creator>Bednarikova, Marketa</creator><creator>Hausnerova, Jitka</creator><creator>van der Wurff, Anneke A M</creator><creator>Matias-Guiu, Xavier</creator><creator>Amant, Frederic</creator><creator>Massuger, Leon F A G</creator><creator>Snijders, Marc P L M</creator><creator>Kusters-Vandevelde, Heidi V N</creator><creator>Lucas, Peter J F</creator><creator>Pijnenborg, Johanna M A</creator><scope>ADGLB</scope></search><sort><creationdate>2020</creationdate><title>Preoperative risk stratification in endometrial cancer (ENDORISK) by a Bayesian network model : a development and validation study</title><author>Reijnen, Casper ; Gogou, Evangelia ; Visser, Nicole C M ; Engerud, Hilde ; Ramjith, Jordache ; van der Putten, Louis J M ; Van de Vijver, Koen ; Santacana, Maria ; Bronsert, Peter ; Bulten, Johan ; Hirschfeld, Marc ; Colas, Eva ; Gil-Moreno, Antonio ; Reques, Armando ; Mancebo, Gemma ; Krakstad, Camilla ; Trovik, Jone ; Haldorsen, Ingfrid S ; Huvila, Jutta ; Koskas, Martin ; Weinberger, Vit ; Bednarikova, Marketa ; Hausnerova, Jitka ; van der Wurff, Anneke A M ; Matias-Guiu, Xavier ; Amant, Frederic ; Massuger, Leon F A G ; Snijders, Marc P L M ; Kusters-Vandevelde, Heidi V N ; Lucas, Peter J F ; Pijnenborg, Johanna M A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-ghent_librecat_oai_archive_ugent_be_86624823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>CARCINOMA</topic><topic>L1CAM</topic><topic>LYMPH-NODE METASTASIS</topic><topic>Medicine and Health Sciences</topic><topic>PREDICTION</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Reijnen, Casper</creatorcontrib><creatorcontrib>Gogou, Evangelia</creatorcontrib><creatorcontrib>Visser, Nicole C M</creatorcontrib><creatorcontrib>Engerud, Hilde</creatorcontrib><creatorcontrib>Ramjith, Jordache</creatorcontrib><creatorcontrib>van der Putten, Louis J M</creatorcontrib><creatorcontrib>Van de Vijver, Koen</creatorcontrib><creatorcontrib>Santacana, Maria</creatorcontrib><creatorcontrib>Bronsert, Peter</creatorcontrib><creatorcontrib>Bulten, Johan</creatorcontrib><creatorcontrib>Hirschfeld, Marc</creatorcontrib><creatorcontrib>Colas, Eva</creatorcontrib><creatorcontrib>Gil-Moreno, Antonio</creatorcontrib><creatorcontrib>Reques, Armando</creatorcontrib><creatorcontrib>Mancebo, Gemma</creatorcontrib><creatorcontrib>Krakstad, Camilla</creatorcontrib><creatorcontrib>Trovik, Jone</creatorcontrib><creatorcontrib>Haldorsen, Ingfrid S</creatorcontrib><creatorcontrib>Huvila, Jutta</creatorcontrib><creatorcontrib>Koskas, Martin</creatorcontrib><creatorcontrib>Weinberger, Vit</creatorcontrib><creatorcontrib>Bednarikova, Marketa</creatorcontrib><creatorcontrib>Hausnerova, Jitka</creatorcontrib><creatorcontrib>van der Wurff, Anneke A M</creatorcontrib><creatorcontrib>Matias-Guiu, Xavier</creatorcontrib><creatorcontrib>Amant, Frederic</creatorcontrib><creatorcontrib>Massuger, Leon F A G</creatorcontrib><creatorcontrib>Snijders, Marc P L M</creatorcontrib><creatorcontrib>Kusters-Vandevelde, Heidi V N</creatorcontrib><creatorcontrib>Lucas, Peter J F</creatorcontrib><creatorcontrib>Pijnenborg, Johanna M A</creatorcontrib><collection>Ghent University Academic Bibliography</collection></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Reijnen, Casper</au><au>Gogou, Evangelia</au><au>Visser, Nicole C M</au><au>Engerud, Hilde</au><au>Ramjith, Jordache</au><au>van der Putten, Louis J M</au><au>Van de Vijver, Koen</au><au>Santacana, Maria</au><au>Bronsert, Peter</au><au>Bulten, Johan</au><au>Hirschfeld, Marc</au><au>Colas, Eva</au><au>Gil-Moreno, Antonio</au><au>Reques, Armando</au><au>Mancebo, Gemma</au><au>Krakstad, Camilla</au><au>Trovik, Jone</au><au>Haldorsen, Ingfrid S</au><au>Huvila, Jutta</au><au>Koskas, Martin</au><au>Weinberger, Vit</au><au>Bednarikova, Marketa</au><au>Hausnerova, Jitka</au><au>van der Wurff, Anneke A M</au><au>Matias-Guiu, Xavier</au><au>Amant, Frederic</au><au>Massuger, Leon F A G</au><au>Snijders, Marc P L M</au><au>Kusters-Vandevelde, Heidi V N</au><au>Lucas, Peter J F</au><au>Pijnenborg, Johanna M A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preoperative risk stratification in endometrial cancer (ENDORISK) by a Bayesian network model : a development and validation study</atitle><date>2020</date><risdate>2020</risdate><issn>1549-1277</issn><issn>1549-1676</issn><abstract>Background
Bayesian networks (BNs) are machine-learning–based computational models that visualize causal relationships and provide insight into the processes underlying disease progression, closely resembling clinical decision-making. Preoperative identification of patients at risk for lymph node metastasis (LNM) is challenging in endometrial cancer, and although several biomarkers are related to LNM, none of them are incorporated in clinical practice. The aim of this study was to develop and externally validate a preoperative BN to predict LNM and outcome in endometrial cancer patients.
Methods and findings
Within the European Network for Individualized Treatment of Endometrial Cancer (ENITEC), we performed a retrospective multicenter cohort study including 763 patients, median age 65 years (interquartile range [IQR] 58–71), surgically treated for endometrial cancer between February 1995 and August 2013 at one of the 10 participating European hospitals. A BN was developed using score-based machine learning in addition to expert knowledge. Our main outcome measures were LNM and 5-year disease-specific survival (DSS). Preoperative clinical, histopathological, and molecular biomarkers were included in the network. External validation was performed using 2 prospective study cohorts: the Molecular Markers in Treatment in Endometrial Cancer (MoMaTEC) study cohort, including 446 Norwegian patients, median age 64 years (IQR 59–74), treated between May 2001 and 2010; and the PIpelle Prospective ENDOmetrial carcinoma (PIPENDO) study cohort, including 384 Dutch patients, median age 66 years (IQR 60–73), treated between September 2011 and December 2013. A BN called ENDORISK (preoperative risk stratification in endometrial cancer) was developed including the following predictors: preoperative tumor grade; immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PR), p53, and L1 cell adhesion molecule (L1CAM); cancer antigen 125 serum level; thrombocyte count; imaging results on lymphadenopathy; and cervical cytology. In the MoMaTEC cohort, the area under the curve (AUC) was 0.82 (95% confidence interval [CI] 0.76–0.88) for LNM and 0.82 (95% CI 0.77–0.87) for 5-year DSS. In the PIPENDO cohort, the AUC for 5-year DSS was 0.84 (95% CI 0.78–0.90). The network was well-calibrated. In the MoMaTEC cohort, 249 patients (55.8%) were classified with <5% risk of LNM, with a false-negative rate of 1.6%. A limitation of the study is the use of imputation to correct for missing predictor variables in the development cohort and the retrospective study design.
Conclusions
In this study, we illustrated how BNs can be used for individualizing clinical decision-making in oncology by incorporating easily accessible and multimodal biomarkers. The network shows the complex interactions underlying the carcinogenetic process of endometrial cancer by its graphical representation. A prospective feasibility study will be needed prior to implementation in the clinic.</abstract><oa>free_for_read</oa></addata></record> |
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source | Ghent University Academic Bibliography; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Public Library of Science (PLoS) |
subjects | CARCINOMA L1CAM LYMPH-NODE METASTASIS Medicine and Health Sciences PREDICTION |
title | Preoperative risk stratification in endometrial cancer (ENDORISK) by a Bayesian network model : a development and validation study |
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