Multimodal data integration using machine learning to predict the risk of clear cell renal cancer metastasis: A retrospective multicentre study

Abstract Purpose: To develop and validate a predictive combined model for metastasis in patients with clear cell renal cell carcinoma (ccRCC) by integrating multimodal data. Materials and Methods: In this retrospective study, the clinical and imaging data (CT and ultrasound) of patients with ccRCC confirmed by pathology from three tertiary hospitals in different regions were collected from January 2013 to January 2023. We developed three models, including a clinical model, a radiomics model, and a combined model. The performance of the model was determined based on its discriminative power and clinical utility. The evaluation indicators included AUC value, accuracy, sensitivity, specificity, negative predictive value, positive predictive value and DCA(Decision Curve Analysis) curve. Results:A total of 251 patients were evaluated. Patients (n=166) from Shandong University Qilu Hospital (Jinan) were divided into the training cohort, of which 50 patients developed metastases; patients (n=37) from Shandong University Qilu Hospital (Qingdao) were used as testing set 1, of which 15 patients developed metastases; patients (n=48) from Changzhou Second People's Hospital were used as testing set 2, of which 13 patients developed metastases. In the training set, the combined model showed the highest performance (area under the receiver operating characteristic curve [AUC], 0.924) in predicting lymph node metastasis, while the clinical and radiomics models both had AUCs of 0.875 and 0.870, respectively. In the testing set 1, the combined model had the highest performance (AUC, 0.877) for predicting lymph node metastasis, while the AUCs of the clinical and radiomics models were 0.726 and 0.836, respectively. In the testing set 2, the combined model had the highest performance (AUC, 0.849) for predicting lymph node metastasis, while the AUCs of the clinical and radiomics models were 0.708 and 0.804, respectively. The DCA curve showed that the combined model had a significant prediction probability in predicting the risk of lymph node metastasis in ccRCC patients compared with the clinical model or the radiomics model. Conclusion: The combined model was superior to the clinical and radiomics models in predicting lymph node metastasis in ccRCC patients.