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Explainable deep learning model WAL-net for individualized assessment of potentially reversible malnutrition in patients with cancer: a multicenter cohort study

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机构: [1]Department of Nephrology, Chongqing Key Laboratory of Prevention and Treatment of Kidney Disease, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing400037, China. [2]Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing400042, China. [3]Cancer Center of the First Hospital of Jilin University, Changchun, Jilin130021, China. [4]Department of Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian 350014, China. [5]Department of Integrated Chinese and Western Medicine, Cancer Hospital of the University of Chinese Academy of Science (Zhejiang Cancer Hospital), Hangzhou, Zhejiang310022, China. [6]Department of Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei430071, China. [7]Department of Colorectal Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang150001, China. [8]Department of Colorectal and Anal Surgery, Xiangya Hospital of Central South University, Changsha, Hunan410008, China. [9]Department of Palliative Care and Department of Geriatric Oncology, Chongqing University Cancer Hospital, Chongqing400030, China. [10]Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan610041, China. [11]Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei050031, China. [12]Department of Gastrointestinal Surgery and Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing100038, China. [13]Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan450001, China. [14]Key Laboratory of Cancer FSMP for State Market Regulation, Beijing100038, China. [15]Lead Contact and Principal Investigator of the Investigation on Nutrition Status and Its Clinical Outcome of Common Cancers (INSCOC) Project, China.
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关键词: Malnutrition GLIM Cancer Machine learning Recurrent neural network

摘要:
Persistent malnutrition is associated with poor clinical outcomes in cancer. However, assessing its reversibility can be challenging. The present study aimed to utilize machine learning (ML) to predict reversible malnutrition (RM) in patients with cancer. A multicenter cohort study including hospitalized oncology patients. Malnutrition was diagnosed using an international consensus. RM was defined as a positive diagnosis of malnutrition upon patient admission which turned negative one month later. Time-series data on body weight and skeletal muscle were modeled using a long short-term memory (LSTM) architecture to predict RM. The model was named as WAL-net, and its performance, explainability, clinical relevance and generalizability were evaluated. We investigated 4254 patients with cancer-associated malnutrition (discovery set=2977, test set=1277). There were 2783 men and 1471 women (median age=61 years). RM was identified in 754 (17.7%) patients. RM/non-RM groups showed distinct patterns of weight and muscle dynamics, and RM was negatively correlated with the progressive stages of cancer cachexia (r=-0.340, P<0.001). WAL-net was the state-of-the-art model among all ML algorithms evaluated, demonstrating favorable performance to predict RM in the test set (AUC=0.924, 95%CI=0.904-0.944) and an external validation set (n=798, AUC=0.909, 95%CI=0.876-0.943). Model-predicted RM using baseline information was associated with lower future risks of underweight, sarcopenia, performance status decline and progression of malnutrition (all P<0.05). This study presents an explainable deep learning model, the WAL-net, for early identification of RM in patients with cancer. These findings might help the management of cancer-associated malnutrition to optimize patient outcomes in multidisciplinary cancer care.

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出版当年[2025]版:
大类 | 3 区 医学
小类 | 3 区 营养学
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大类 | 3 区 医学
小类 | 3 区 营养学
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出版当年[2024]版:
Q2 NUTRITION & DIETETICS
最新[2024]版:
Q2 NUTRITION & DIETETICS

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第一作者机构: [1]Department of Nephrology, Chongqing Key Laboratory of Prevention and Treatment of Kidney Disease, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing400037, China.
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通讯机构: [12]Department of Gastrointestinal Surgery and Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing100038, China. [14]Key Laboratory of Cancer FSMP for State Market Regulation, Beijing100038, China. [15]Lead Contact and Principal Investigator of the Investigation on Nutrition Status and Its Clinical Outcome of Common Cancers (INSCOC) Project, China.
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