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SCI 발표논문

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Cancers (Basel). 2020;12(10):cancers12102791.

Novel Model to Predict HCC Recurrence after Liver Transplantation Obtained Using Deep Learning: A Multicenter Study.

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제1저자 남준열 · 교신저자 이정훈

소속 (7)
  1. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea.
  2. DEEPNOID Inc., Seoul 08376, Korea.
  3. Department of Internal Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Korea.
  4. Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
  5. Center for Liver Cancer, National Cancer Center, Goyang-Si 10408, Gyeonggi-Do, Korea.
  6. Department of Surgery, Seoul National University College of Medicine, Seoul 03080, Korea.
  7. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.

Abstract

Several models have been developed using conventional regression approaches to extend the criteria for liver transplantation (LT) in hepatocellular carcinoma (HCC) beyond the Milan criteria. We aimed to develop a novel model to predict tumor recurrence after LT by adopting artificial intelligence (MoRAL-AI). This study included 563 patients who underwent LT for HCC at three large LT centers in Korea. Derivation (n = 349) and validation (n = 214) cohorts were independently established. The primary outcome was time-to-recurrence after LT. A MoRAL-AI was derived from the derivation cohort with a residual block-based deep neural network. The median follow-up duration was 74.7 months (interquartile-range, 18.5-107.4); 204 patients (36.2%) had HCC beyond the Milan criteria. The optimal model consisted of seven layers including two residual blocks. In the validation cohort, the MoRAL-AI showed significantly better discrimination function (c-index = 0.75) than the Milan (c-index = 0.64), MoRAL (c-index = 0.69), University of California San Francisco (c-index = 0.62), up-to-seven (c-index = 0.50), and Kyoto (c-index = 0.50) criteria (all p < 0.001). The largest weighted parameter in the MoRAL-AI was tumor diameter, followed by alpha-fetoprotein, age, and protein induced by vitamin K absence-II. The MoRAL-AI had better predictability of tumor recurrence after LT than conventional models. The MoRAL-AI can also evolve with further data.

Keywords

Milan criteriadeep learninghepatocellular carcinomaliver transplantation

Figures

Figure 1
Figure 1 The HCC recurrence nomogram. The expected HCC recurrence rates of 3 hypothetical patients were presented, according to clinical, radiological, and laboratory data of pre-transplantation.
Figure 2
Figure 2 The expected versus the observed HCC recurrence after liver transplantation according to the MoRAL-AI in the validation cohort. To confirm the model performance, three groups which were divided by three tumor recurrence probabilities were compared. Among three groups, the risk of tumor recurrence differed significantly. The dashed lines represent the observed HCC recurrence and dotted lines represent the expected HCC recurrence.
Figure 3
Figure 3 Weight of each prognostic factor in MoRAL-AI. The largest weighted factor in MoRAL-AI was tumor diameter, followed by AFP (alpha-fetoprotein), age, and PIVKA-II (protein induced by vitamin K absence-II).
Figure 4
Figure 4 The performance differences among the DNN (deep neural network) models according to the changes of including factors in deep learning. An additional several DNN models were developed and evaluated, according to including factors which were divided by two aspects of the tumor burden: image-based tumor burden vs. biochemical tumor burden.

그림 출처: PubMed Central 공개 논문 (PMC7650768)

Conflict of interest statement

The authors declare no conflict of interest.

그 밖의 정보
출판 형태
Journal Article
저널
Cancers · ISSN 2072-6694
전자 출판
2020-09-29
참고문헌
25편