Real-world data to build explainable trustworthy artificial intelligence models for prediction of immunotherapy efficacy in NSCLC patients
Open accessAbstract
Introduction: Artificial Intelligence (AI) methods are being increasingly investigated as a means to generate predictive models applicable in the clinical practice. In this study, we developed a model to predict the efficacy of immunotherapy (IO) in patients with advanced non-small cell lung cancer (NSCLC) using eXplainable AI (XAI) Machine Learning (ML) methods. Methods: We prospectively collected real-world data from patients with an advanced NSCLC condition receiving immune-checkpoint inhibitors (ICIs) either as a single agent or in combination with chemotherapy. With regards to six different outcomes - Disease Control Rate (DCR), Objective Response Rate (ORR), 6 and 24-month Overall Survival (OS6 and OS24), 3-months Progression-Free Survival (PFS3) and Time to Treatment Failure (TTF3) - we evaluated five different classification ML models: CatBoost (CB), Logistic Regression (LR), Neural Network (NN), Random Forest (RF) and Support Vector Machine (SVM). We used the Shapley Additive Explanation (SHAP) values to explain model predictions. Results: Of 480 patients included in the study 407 received immunotherapy and 73 chemo- and immunotherapy. From all the ML models, CB performed the best for OS6 and TTF3, (accuracy 0.83 and 0.81, respectively). CB and LR reached accuracy of 0.75 and 0.73 for the outcome DCR. SHAP for CB demonstrated that the feature that strongly influences models’ prediction for all three outcomes was Neutrophil to Lymphocyte Ratio (NLR). Performance Status (ECOG-PS) was an important feature for the outcomes OS6 and TTF3, while PD-L1, Line of IO and chemo-immunotherapy appeared to be more important in predicting DCR. Conclusions: In this study we developed a ML algorithm based on real-world data, explained by SHAP techniques, and able to accurately predict the efficacy of immunotherapy in sets of NSCLC patients.
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Prelaj et al. used SHAP and demonstrated that the most relevant features in their model are clinical biomarkers that have previously been shown to be important.
“For explainability, they used SHAP, which demonstrated that the most relevant features in their model are clinical biomarkers that have previously been shown to be important36.”
From Orchestrating explainable artificial intelligence for multimodal and longitudinal data in medical imaging (2024) · cites this paper as [36]
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- Authors
- Prelaj, A., Galli, E. G., Miskovic, V., Pesenti, M., Viscardi, G., Pedica, B., Mazzeo, L., Bottiglieri, A., Provenzano, L., Spagnoletti, A., Marinacci, R., De Toma, A., Proto, C., Ferrara, R., Brambilla, M., Occhipinti, M., Manglaviti, S., Galli, G., Signorelli, D., Giani, C., Beninato, T., Pircher, C. C., Rametta, A., Kosta, S., Zanitti, M., Di Mauro, M. R., Rinaldi, A., Di Gregorio, S., Antonia, M., Garassino, M. C., de Braud, F. G. M., Restelli, M., Lo Russo, G., Ganzinelli, M., Trovò, F., & Pedrocchi, A. L. G.
- Affiliations
- Fondazione Politecnico di Milano (IT)
- University of Campania "Luigi Vanvitelli" (IT)
- University of Milan (IT)
- Fondazione IRCCS Istituto Nazionale dei Tumori (IT)
- Policlinico San Matteo Fondazione (IT)
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
- Aalborg University (DK)
- University of Chicago (US)
- Corresponding author
- Prelaj, Arsela
- ORCID
- Prelaj, Arsela
- Miskovic, Vanja
- Pesenti, Mattia
- Viscardi, Giuseppe
- Mazzeo, Laura
- Bottiglieri, Achille
- Provenzano, Leonardo
- Spagnoletti, Andrea
- Proto, Claudia
- Ferrara, Roberto
- Brambilla, Marta
- Occhipinti, Mario
- Manglaviti, Sara
- Galli, Giulia
- Signorelli, Diego
- Giani, Claudia
- Beninato, Teresa
- Pircher, Chiara Carlotta
- Rametta, Alessandro
- Kosta, Sokol
- Rinaldi, Arturo
- Garassino, Marina Chiara
- Restelli, Marcello
- Ganzinelli, Monica
- Trovò, Francesco
- Pedrocchi, Alessandra Laura Giulia
- Venue
- Frontiers in Oncology
- Publisher
- Frontiers Media SA
- Published
- 2023-01-23
- Volume
- 12
- Pages
- 1078822-1078822
- ISSN
- 2234-943X (ISSN-L)
- PMC
- PMC9899835
- OpenAlex
- W4317718004
- Cited by
- 39
- References
- 35
- Citations by year
- 2026: 11 · 2025: 19 · 2024: 6 · 2023: 3
- FWCI
- 4.76
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Oncology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (publishedVersion, cc-by)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion, cc-by)
- Virtual Community of Pathological Anatomy (University of Castilla La Mancha) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiomics and Machine Learning in Medical Imaging
- Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
- Keywords
- non-small cell lung cancer, immunotherapy response prediction, immune checkpoint inhibitors, explainable AI, SHAP, CatBoost, real-world data, neutrophil-to-lymphocyte ratio, PD-L1 expression, overall survival, disease control rate, chemoimmunotherapy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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