| Summary: | Purpose: Severe toxicity is reported in about 30% of gastrointestinal cancer patients receiving 5-Fluorouracil (5-FU)-based chemotherapy. To date, limited tools exist to identify at risk patients
in this setting. The objective of this study was to address this need by designing a predictive model
using a Bayesian network, a probabilistic graphical model offering robust, explainable predictions.
Methods: We utilized a dataset of 267 gastrointestinal cancer patients, conducting preprocessing,
and splitting it into TRAIN and TEST sets (80%:20% ratio). The RandomForest algorithm assessed
variable importance based on MeanDecreaseGini coefficient. The bnlearn R library helped design a
Bayesian network model using a 10-fold cross-validation on the TRAIN set and the aic-cg method
for network structure optimization. The model’s performance was gauged based on accuracy, sensitivity, and specificity, using cross-validation on the TRAIN set and independent validation on the
TEST set. Results: The model demonstrated satisfactory performance with an average accuracy of
0.85 (±0.05) and 0.80 on TRAIN and TEST datasets, respectively. The sensitivity and specificity
were 0.82 (±0.14) and 0.87 (±0.07) for the TRAIN dataset, and 0.71 and 0.83 for the TEST dataset,
respectively. A user-friendly tool was developed for clinical implementation. Conclusions: Despite
several limitations, our Bayesian network model demonstrated a high level of accuracy in predicting
the risk of developing severe haematological toxicity in gastrointestinal cancer patients receiving
5-FU-based chemotherapy. Future research should aim at model validation in larger cohorts of
patients and different clinical settings.
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