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      Breast Cancer Prognosis Using a Machine Learning Approach

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          Abstract

          Machine learning (ML) has been recently introduced to develop prognostic classification models that can be used to predict outcomes in individual cancer patients. Here, we report the significance of an ML-based decision support system (DSS), combined with random optimization (RO), to extract prognostic information from routinely collected demographic, clinical and biochemical data of breast cancer (BC) patients. A DSS model was developed in a training set ( n = 318), whose performance analysis in the testing set ( n = 136) resulted in a C-index for progression-free survival of 0.84, with an accuracy of 86%. Furthermore, the model was capable of stratifying the testing set into two groups of patients with low- or high-risk of progression with a hazard ratio (HR) of 10.9 ( p < 0.0001). Validation in multicenter prospective studies and appropriate management of privacy issues in relation to digital electronic health records (EHR) data are presently needed. Nonetheless, we may conclude that the implementation of ML algorithms and RO models into EHR data might help to achieve prognostic information, and has the potential to revolutionize the practice of personalized medicine.

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          Most cited references22

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          Predicting breast cancer survivability: a comparison of three data mining methods.

          The prediction of breast cancer survivability has been a challenging research problem for many researchers. Since the early dates of the related research, much advancement has been recorded in several related fields. For instance, thanks to innovative biomedical technologies, better explanatory prognostic factors are being measured and recorded; thanks to low cost computer hardware and software technologies, high volume better quality data is being collected and stored automatically; and finally thanks to better analytical methods, those voluminous data is being processed effectively and efficiently. Therefore, the main objective of this manuscript is to report on a research project where we took advantage of those available technological advancements to develop prediction models for breast cancer survivability. We used two popular data mining algorithms (artificial neural networks and decision trees) along with a most commonly used statistical method (logistic regression) to develop the prediction models using a large dataset (more than 200,000 cases). We also used 10-fold cross-validation methods to measure the unbiased estimate of the three prediction models for performance comparison purposes. The results indicated that the decision tree (C5) is the best predictor with 93.6% accuracy on the holdout sample (this prediction accuracy is better than any reported in the literature), artificial neural networks came out to be the second with 91.2% accuracy and the logistic regression models came out to be the worst of the three with 89.2% accuracy. The comparative study of multiple prediction models for breast cancer survivability using a large dataset along with a 10-fold cross-validation provided us with an insight into the relative prediction ability of different data mining methods. Using sensitivity analysis on neural network models provided us with the prioritized importance of the prognostic factors used in the study.
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            Understanding receiver operating characteristic (ROC) curves

            In this issue of the Journal, Auer and colleagues conclude that serum levels of neuron-specific enolase (NSE), a biochemical marker of ischemic brain injury, may have clinical utility for the prediction of survival to hospital discharge in patients experiencing the return of spontaneous circulation following at least 5 minutes of cardiopulmonary resuscitation. The authors used a receiver operating characteristic (ROC) curve to illustrate and evaluate the diagnostic (prognostic) performance of NSE. We explain ROC curve analysis in the following paragraphs.
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              The TNM classification of malignant tumours—towards common understanding and reasonable expectations

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                Author and article information

                Journal
                Cancers (Basel)
                Cancers (Basel)
                cancers
                Cancers
                MDPI
                2072-6694
                07 March 2019
                March 2019
                : 11
                : 3
                : 328
                Affiliations
                [1 ]BioBIM (InterInstitutional Multidisciplinary Biobank), IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166 Rome, Italy; silvia.riondino@ 123456sanraffaele.it (S.R.); fiorella.guadagni@ 123456sanraffaele.it (F.G.)
                [2 ]Department of Human Sciences & Quality of Life Promotion, San Raffaele Roma Open University, Via di Val Cannuta 247, 00166 Rome, Italy; noemi.scarpato@ 123456unisanraffaele.gov.it
                [3 ]Department of Enterprise Engineering, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; fabio.massimo.zanzotto@ 123456uniroma2.it
                [4 ]Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; mario.roselli@ 123456uniroma2.it
                Author notes
                [* ]Correspondence: patrizia.ferroni@ 123456sanraffaele.it or ferronipatrizia@ 123456gmail.com ; Tel.: +39-06-52253733; Fax: +39-(06)-52255668
                Author information
                https://orcid.org/0000-0002-9877-8712
                https://orcid.org/0000-0002-7301-3596
                https://orcid.org/0000-0002-2965-402X
                https://orcid.org/0000-0002-6573-8095
                Article
                cancers-11-00328
                10.3390/cancers11030328
                6468737
                30866535
                0b82c77f-ef0d-4091-b3e3-901e9161ac55
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 18 December 2018
                : 04 March 2019
                Categories
                Brief Report

                breast cancer prognosis,artificial intelligence,machine learning,decision support systems

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