Fusion of machine learning models using fuzzy comprehensive evaluation for thymoma risk prediction: a multicenter analysis.

Thymoma, a tumor originating from thymic epithelial cells, can have its prognosis significantly improved through early risk assessment. We proposed a fuzzy comprehensive evaluation fusion model (FCE-FM) to assess tumor risk. In this retrospective study, we enrolled 286 thymoma patients from two centers between 2018 and 2024 and partitioned the study cohorts into a training set (n = 196), an internal test set (n = 50), and an external test set (n = 40). We developed a fuzzy comprehensive evaluation-based fusion model to predict tumor risk using demographics, radiomic and multi-planar deep features. The FCE-FM integrates five base classification models(Logistic Regression, Support Vector Machine, XGBoost, LightGBM, and GBDT) via fuzzy comprehensive evaluation(FCE), analytic hierarchy process (AHP), and triangular membership function techniques. Feature selection was performed sequentially using Spearman rank correlation followed by LASSO regression. A total of 26 deep learning features (5 transverse, 13 sagittal, and 8 coronal planar features) and 4 radiomic features, along with gender, were identified to construct the models. Model performance was evaluated using the area under the curve (AUC) and accuracy metrics.The SHapley Additive exPlanations (SHAP) methodology was utilized to rank feature importance. The FCE-FM model exhibited superior predictive performance, achieving AUC values of 0.982 (95% CI 0.964-0.996), 0.927 (95% CI 0.847-0.990), and 0.895 (95% CI 0.771-0.992) on the training, internal test, and external test sets, respectively. Corresponding accuracies were 0.949, 0.860, and 0.800 across these datasets. Notably, the model consistently outperformed five baseline classifiers in terms of AUC performance on both internal and external validation sets. The FCE-FM model exhibited high stability and accuracy in multi-center validation, demonstrating its robustness. This interpretable framework offers clinicians a reliable early warning tool for tumor risk assessment, enabling timely intervention to significantly improve patient prognosis.