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Table 5 Treatment outcome prediction

From: A systematic review of the applications of Expert Systems (ES) and machine learning (ML) in clinical urology

Art

Mdl

Dom

Subdomain

Variables

Output

System training

Validation methods

Statistical outcome

[79]

ANN

CaP

Outcome of RRP

Age, stage, bone scan, grade, PSA, treatment, bcl-2, p54

No response, response then relapse, response and no relapse

cohort of CaP single centre 21 patients

ROC, Sp, Se

20 patients randomly selected

Ac 85% (60% without markers), K, 0.65; Cl, P < 0.00001

[80]

ANN

CaP

BCF post RRP

Age Pathologic findings and GENN1

Disease progression

Gl 5–7, T1B-2C, Single centre 136

ROC, Sp, Se

Test set of 35 (20%)

AUC 0.71, Ac 74%, Se 82%, Sp 61%,

[80]

ANN

CaP

BCF post RRP

DNA polyploidy and quantitative nuclear grade

Disease progression

Gl 5–7, T1B-2C, Single centre 136

ROC, Sp, Se

AUC 0.74, Ac 80%, Se 75%, Sp 85%

[80]

ANN

CaP

BCF post RRP

Pathologic findings, age, DNA polyploidy and quantitative nuclear grade

Disease progression

Gl 5–7, T1B-2C, Single centre 136

Test set of 35 (20%)

AUC 0.73, Ac 78%, Se 84%, Sp 72%

[81]

ANN

CaP

BCF post RRP

Age, PSA, Gl and stage

BCF post RRP all

140 cases post RRP, one centre

ROC, Sp, Se

35 (20%) for validity

AUC 0.81, Se 74%, Sp 78%, PPV 71%, NPV 81%,

[82]

Fkn

CaP

Outcome of RRP

TM, Gl, PSA, P53, bcl-2, treatment method

No response

No progression after treatment, Relapse

41 men with CaP

LOO and compare predictive accuracy of ANN, Fkn

Predictive accuracy ranged from 61–88%

[68]

ANN

CaP

Outcome of RRP

tPSA, TZV, PSAd, Gl

Local or advanced disease

200 cases from multinational European cancer data base

AUC ROC

60 prospective set

AUC 0.91, Se 95%, Sp 64%,

[83]

ANN

CaP

Outcome of RRP, margin positive

tPSA, clinical stage, Gl (ANNA1)

Positive surgical margins

218 post RRP and pelvic lymph adenectomy in one centre

ROC AUC

48 cases 1/4 CV

AUC 0.7

[83]

ANN

CaP

Outcome of RRP, margin positive

tPSA, clinical stage, Gl, pMRI findings (ANNA2)

Positive surgical margins

218 post RRRP and pelvic lymph adenectomy in one centre

ROC AUC

48 cases 1/4 CV

AUC 0.87

[83]

ANN

CaP

Outcome of RRP, margin positive

tPSA, clinical stage, Gl, pMRI findings, % of cancer in biopsy, PSAd

ANNA3

Positive surgical margins

218 post RRP and pelvic lymph adenopathy in one centre

ROC AUC

48 cases 1/4 CV

AUC 0.87

[83]

ANN

CaP

Outcome of RRP, margin positive

tPSA, clinical stage, Gl, % of cancer in biopsy ANNA4

Positive surgical margins

218 post RRP and pelvic lymph adenopathy in one centre

ROC AUC

48 cases 1/4 CV

AUC 0.71

[84]

ANN

CaP

Outcome of RRP, margin and LN

tPSA, clinical TNM Gl ANNA1

Positive surgical margins, LN involvement

41 post RRP and pelvic lymph adenopathy in one centre

ROC AUC

160 cases randomly selected

AUC 0.86 for positive margin, 0.88 for LN + ve

[84]

ANN

CaP

Outcome of RRP, margin and LN

tPSA, clinical TNM Gl, pMRI findings ANNA2

Positive surgical margins, LN involvement

41 post RRP and pelvic lymph adenopathy in one centre

ROC AUC

160 cases randomly selected

AUC 0.9 for positive margin, 0.89 for LN + ve

[84]

ANN

CaP

Outcome of RRP, margin and LN

tPSA, clinical stage, Gl, pMRI findings, age

ANNA3

Positive surgical margins, LN involvement

41 post RRP and pelvic lymph adenopathy in one centre

ROC AUC

160 cases randomly selected

AUC 0.9 for positive margin, 0.9 for LN + ve

[85]

FRB

CaP

Outcome of RRP

Clinical stage, Gl, tPSA

Cancer stage (confined, capsule, vesicle and LN)

116 rules developed from nomograms

ROC Se, Sp

190 patients post RRP in one centre

AUC 0.76 (95% CI 0.7–0.8), Se 85%, Sp 61%)

[86]

ANN

CaP

Outcome of RRP, margin positive

TNM stage, age, Gl, tPSA

Capsule penetration

650 retrospective data for RRP at one centre

PPV, NPV 98 cases for testing and 1/2 CV

PPV 100%, NPV 95%

[86]

ANN

CaP

Outcome of RRP, margin positive

TNM stage, age, Gl, tPSA MLP

Capsule penetration

650 retrospective data for RRP at one centre

PPV, NPV 98 cases for testing and 1/2 CV

PPV 97%, NPV 95%

[86]

ANN

CaP

Outcome of RRP, margin positive

TNM stage, age, Gl, tPSA, Partial RNN (recurrent neural network)

Capsule penetration

650 retrospective data for RRP at one centre

PPV, NPV 98 cases for testing and 1/2 CV

PPV 97%, NPV 95%

[86]

ANN

CaP

Outcome of RRP, margin positive

TNM stage, age, Gl, tPSA, RBF-MLP

Capsule penetration

650 retrospective data for RRP at one centre

PPV, NPV 98 cases for testing and 1/2 CV

PPV 97%, NPV 94%

[87]

FRB

CaP

Outcome of RPP

Clinical stage, Gl, tPSA

Capsule penetration

Genetic algorithm on 331 patients post RRP in one centre

48 patients post RRP in one centre ROC

AUC 0.82 (95% CI 0.5–0.8)

[88]

ANN

CaP

Outcome of LAP RRP, BCF

Clinical and pathologic parameters, tPSA, margin status, TNM and Gl

BCF

1575 patients at one centre post lap RRPP

ROC AUC

LOO

AUC 0.75, Se 90%, Sp 35

[32]

FNM

CaP

Outcome post RRP

Age, FH, DRE, tPSA, Gl, MR findings

tPSA at 6 months

19 one centre post RRP

Correlation coefficient = 0.99

3 Cases

[89]

ANN

CaP

Outcome post RRP

Age, tPSA, staging, perineural infiltration, Gl, months of FU

BCF

1400 multicentre data

Se 85% Sp74%, PPV 77%

400 data

[90]

ANN

CaP

Outcome post RRP, organ confined

Gleason score, preoperative PSA and clinical stage,

Organ confined

468 cases for training

NPV 83%

47 cases 30% CV

[91]

ANN

CaP

Outcome of RRPP

PSA, BMI, DRE, TRUS, Gl score or grade

Capsule penetration

225 patients’ data post RRP from 3 centres

74 patients randomly selected ROC

AUC 0.79 LR 0.74 (P = 0.016) Partin AUC 0.7

[78]

ANN

Nlt

Stone regrowth after ESWL

Anatomy, position, stone analysis, urine analysis, previous stone, medical treatment

Stone recurrence

single centre data base, 65 cases

ROC, Sp, Se33 cases

Se 91%, Sp 92%, AUC 0.96

[92]

ANN

Nlt

Stone clearance with conservative treatment

Age, gender, duration, creatinine, nausea, vomiting, fever

Clearance or intervention

multi centre, Ureteric stone 125 cases

55 cases ROC, Sp, Se

AC 76% Predict 100% of stones passed

[75]

ANN

Nlt

lower pole stone ESWL

Gender, BMI, radiology, stone size and composition, urine analysis, 24 h urine, serum ca and creatinine

Clearance or intervention

321 patients with lower pole stone

211 random set ROC, Sp, Se, vs LR

AUC 0.97 Se 95%, Sp 92%,

[76]

ANN

Nlt

Stone clearance with ESWL

Age, gender, body habitus, serum electrolytes, 24 h urine, radiological findings

Stone free

60 patients, one centre

Correlation co-efficient 22 cases

0.75

[77]

ANN

Nlt

Stone clearance with ESWL

Age, gender, anatomy, location, side, number, length, width, new or recurrent, stent

Stone clearance

Ureteric stone ESWL, One centre 688 cases

296 cases ROC, Sp, Se

Ac 78%, Se78%, Sp 75%, PPV 97%

[93]

ANN

Nlt

Outcome of conservative stone disease treatment

Age, gender, BMI, fever, previous treatments and stones, duration of the symptoms, dimension and position of the stone

Spontaneous expulsion or intervention

402 patients from one centre

50 patient, 1/4 cross validation

ROC Se, Sp

Se 95%, Sp 63%

[93]

SVM

Nlt

Outcome of conservative stone disease treatment

Age, gender, BMI, fever, previous treatments and stones, duration of the symptoms, dimension and position of the stone

Spontaneous expulsion or intervention

402 patients from one centre

50 patient, 1/4 cross validation

ROC Se, Sp

Se 85%, Sp 87%

[94]

ANN

Nlt

ESWL outcome prediction

The patients’ characteristics, stone location, burden, shape dimension, pre-ESWL procedure and cost of admission

unexpected post-ESWL visits

1026 patients received ESWL at one centre`

AUC 0.66

506 patients

[95]

ANN

PUJ

Outcome of PUJ repair

Demographic, clinical and radiological findings

Sonographic outcome of pyeloplasty

Single centre unilateral paediatric pyeloplasty n = 100

16 cases (16%)

ROC, Sp, Se

Ac 100%, Se 100%, Sp 100%

[96]

ANN

PUJ

Outcome of PUJ conservative treatment

Age, gender, renal pelvis diameter, laterality, separated renal function on DMSA, urine culture and infections

Observation or surgery

37 infants with PUJ obstruction

Prediction accuracy16 patients for validation

75% prediction accuracy

[97]

ANN

Neph

Post lap partial nephrectomy hospital stay

Age, co-morbidities, tumour size and extension

Hospital stay less than 2 days

334 one centre

5 institutes 77, 19 prospective

ROC

AUC 0.6, 0.5

[97]

ANN

Neph

Post lap nephrectomy hospital stay

Age, co-morbidities, tumour size and extension

Hospital stay less than 2 days

392 One centre

5 institutes 127, 29 prospective

ROC

AUC 0.7, 0.7

[98]Z

ANN

Bca

Pathological stage after surgery

Age, gender, tumour (size, number, grade, invasion, lymph vascular invasion, stage), lymph nodes

Prognosis and advanced stage

183 patients, one centre post cystectomy

ROC and compare with LR

1/3 cross validation

MANN

AUC 0.86, Se 88%, Sp 77%, PPV 93%, NPV 63%, Ac 85%

[98]

ANN

Bca

Pathological stage after surgery

Age, gender, tumour (size, number, grade, invasion, lymph vascular invasion, stage), lymph nodes

Prognosis and advanced stage

183 patients, one centre post cystectomy

ROC and compare with LR

1/3 cross validation

SANN

AUC 0.85, Se 84%, Sp 71%, PPV 91%, NPV 67%, Ac 83%

[99]

ANN

VUR

outcome of endo repair of VU reflux

Age, gender, implant type, implant volume, number of treatments, side, endo findings, type of cystography

Ultrasound finding

Single centre data base, paediatric VU reflux 174 data

87 cases for validation

ROC, Sp, Se

Se 71.4%, Sp 81.6%, PPV 58.8%, NPV 88.6% and success rate 78.9%,

  1. Is one of the common applications of urological expert system. They predicted treatment outcome of radical nephrectomy, radical cystectomy, radical prostatectomy, vesico ureteric reflux endoscopic repair, pelvi-ureteric junction obstruction conservative management, nephrolithiasis conservative management and extracorporeal shockwave treatment. The commonest domain was predicting negative surgical margins post radical prostatectomy