Background
Precisely predicting the onset of brain metastasis in patients with lung adenocarcinoma is critical for making informed clinical treatment decisions. After brain metastasis occurs, the survival period of patients with lung adenocarcinoma is substantially reduced, and a dearth of models hinders accurate prediction of its onset in affected patients. In this study, we compared the performance of five models and identified the random forest model as the most effective for predicting brain metastasis in patients with lung adenocarcinoma.
Methods
This study enrolled patients diagnosed with lung adenocarcinoma between 2000 to 2018, sourced from the Surveillance, Epidemiology, and End Results (SEER) database. Correlation between variables was observed using a heatmap and the model's discriminative ability was assessed by calculating the Area Under the Receiver Operating Characteristic curve (AUROC). In addition, features were ranked according to their importance. Furthermore, the precision of the model was assessed by means of calibration curves, and a decision curve analysis was performed to evaluate its clinical usefulness.
Results
A total of 60,805 patients were included in this study. The heatmap analysis provided a preliminary assessment of the correlation between different feature variables, and all variables showed differences between cases with and without brain metastasis after standardization. The random forest model exhibited better predictive performance with an accuracy of 0.919 (95% CI: 0.915–0.926) and an AUROC of 0.92 (95% CI: 0.913–0.924). Regarding feature importance ranking, the most relevant features were radiation therapy, survival time, tumor size, age, and bone metastasis. The calibration curve showed the highest degree of consistency between the predicted probabilities and actual probabilities in the random forest model. The decision curve analysis revealed a considerable enhancement in net benefit for the models containing 10 features, 17 features, and all features, as compared to the basic model.
Conclusions
We developed predictive model using machine learning to predict brain metastasis in patients with lung adenocarcinoma, utilizing only commonly available clinical variables. The model showed good discrimination in predicting the occurrence of brain metastasis. It may contribute to clinical decision-making and treatment strategies.