A Machine Learning Model Based on Multi-Phase Contrast-enhanced CT for the Preoperative Prediction of the Muscle-Invasive Status of Bladder Cancer.

backgroundMuscle infiltration of bladder cancer has become the most important index to evaluate its prognosis. Machine learning is expected to accurately identify its muscle infiltration status on images.

objectiveThis study aimed to establish and validate a machine learning prediction model based on multi-phase contrast-enhanced CT (MCECT) for preoperatively evaluating the muscle-invasive status of bladder cancer.

methodsA retrospective study was conducted on bladder cancer patients who underwent surgical resection and pathological confirmation by MCECT scans. They were randomly divided into training and testing groups at a ratio of 8:2; we used an independent external testing set for verification. The radiomics features of lesions were extracted from MCECT images and radiomics signatures were established by dual sample T-test and least absolute shrinkage selection operator (LASSO) regression. Afterward, four machine learning classifier models were established. The receiver operating characteristic (ROC) curve, calibration, and decision curve analysis were employed to evaluate the efficiency of the model and analyze diagnostic performance using accuracy, precision, sensitivity, specificity, and F1-score.

resultsThe best predictive model was found to have logic regression as the classifier. The AUC value was 0.89 (5-fold cross-validation range 0.83-0.96) in the training group, 0.80 in the test group, and 0.87 in the external testing group. In the testing and external testing group, the diagnostic accuracy, precision, sensitivity, specificity, and F1-score were 0.759, 0.826, 0.863, 0.729, 0.785, and 0.794, 0.755, 0.953, 0.720, and 0.809, respectively.

conclusionThe machine learning model showed good accuracy in predicting the muscle infiltration status of bladder cancer before surgery.