An interpretable clinical-radiomics-deep learning model based on magnetic resonance imaging for predicting postoperative Gleason grading in prostate cancer: a dual-center study.

Objective: To develop and test an interpretable machine learning model that combines clinical data, radiomics, and deep learning features using different regions of interest (ROI) from magnetic resonance imaging (MRI) to predict postoperative Gleason grading in prostate cancer (PCa). Methods: A retrospective analysis was conducted on 96 PCa patients from the Third Hospital of Shanxi Medical University (training set) and 33 patients from Taiyuan Central Hospital (testing set) treated between August 2014 and July 2022. Clinical data, including prostate-specific antigen and MRI data, were collected. Tumor and whole-prostate ROIs were delineated on T Results: All combined models performed well in the test set (AUC ≥ 0.75), with the LightGBM model achieving the highest accuracy (0.848). SHAP analysis effectively illustrated the contribution of each feature. The CALC demonstrated good agreement between predicted probabilities and actual outcomes, and DCA further indicated that the models provided significant net benefits for clinical decision-making across various risk thresholds. Conclusion: This study developed and validated interpretable MRI-based machine learning models that combine clinical data with radiomics and deep learning features from different regions of interest, demonstrating good performance in predicting postoperative Gleason grading in PCa.