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ASTRO 2022: Multimodal Deep Learning Versus NCCN Risk Stratification of Prostate Cancer

By: Julia Fiederlein
Posted: Monday, October 31, 2022

According to Jonathan D. Tward, MD, PhD, FASTRO, of the University of Utah Huntsman Cancer Institute, Salt Lake City, and colleagues, three-tiered multimodal artificial intelligence (MMAI) models integrating clinical and digital histopathology data from five phase III prostate cancer trials (NRG/RTOG 9202, 9408, 9413, 9910, and 0126) outperformed the three-tiered National Comprehensive Cancer Network (NCCN) risk stratification system in discrimination of distant metastasis risk. Their findings, which were presented during the 2022 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 2), may improve prognostication and inform clinical decision-making.

“The MMAI model identified sixfold more patients with a lower risk of distant metastasis compared with [the] NCCN [risk stratification system],” the investigators commented. “Conversely, patients in the MMAI unfavorable-risk group had substantially greater distant metastasis risk than [those in the] NCCN high-risk [group].”

The investigators applied the MMAI 5-year metastasis model across a population of 5,569 patients. They stratified deciles with similar rates of distant metastasis into three risk groups: favorable (1–6), moderate (7–9), and unfavorable (10).

The NCCN system grouped 10% of patients as low risk, 55% as intermediate risk, and 35% as high risk, with estimated 5-year distant metastasis rates of 1%, 3%, and 10%, respectively. On the other hand, the MMAI model classified 60% of patients as favorable risk, 30% as moderate risk, and 10% as unfavorable risk, with estimated 5-year distant metastasis rates of 1%, 6%, and 28%, respectively. The estimated 10-year distant metastasis rate was 3% in the low-risk, 6% in the intermediate-risk, and 17% in the high-risk NCCN groups; in the favorable-risk, moderate-risk, and unfavorable-risk MMAI groups, the rates were 3%, 12%, and 37%, respectively. A total of 83% of patients classified as NCCN intermediate risk and 13% of those classified as NCCN high risk were identified as MMAI favorable risk, both with a 10-year distant metastasis rate of 4%.

Disclosure: Dr. Tward reported no conflicts of interest.

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