Estimating survival in patients with operable skeletal metastases: an application of a bayesian belief network.
BACKGROUND: Accurate estimations of life expectancy are important in the management of patients with metastatic cancer affecting the extremities, and help set patient, family, and physician expectations. Clinically, the decision whether to operate on patients with skeletal metastases, as well as the...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2011-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3094405?pdf=render |
| _version_ | 1819265416918204416 |
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| author | Jonathan Agner Forsberg John Eberhardt Patrick J Boland Rikard Wedin John H Healey |
| author_facet | Jonathan Agner Forsberg John Eberhardt Patrick J Boland Rikard Wedin John H Healey |
| author_sort | Jonathan Agner Forsberg |
| collection | DOAJ |
| description | BACKGROUND: Accurate estimations of life expectancy are important in the management of patients with metastatic cancer affecting the extremities, and help set patient, family, and physician expectations. Clinically, the decision whether to operate on patients with skeletal metastases, as well as the choice of surgical procedure, are predicated on an individual patient's estimated survival. Currently, there are no reliable methods for estimating survival in this patient population. Bayesian classification, which includes bayesian belief network (BBN) modeling, is a statistical method that explores conditional, probabilistic relationships between variables to estimate the likelihood of an outcome using observed data. Thus, BBN models are being used with increasing frequency in a variety of diagnoses to codify complex clinical data into prognostic models. The purpose of this study was to determine the feasibility of developing bayesian classifiers to estimate survival in patients undergoing surgery for metastases of the axial and appendicular skeleton. METHODS: We searched an institution-owned patient management database for all patients who underwent surgery for skeletal metastases between 1999 and 2003. We then developed and trained a machine-learned BBN model to estimate survival in months using candidate features based on historical data. Ten-fold cross-validation and receiver operating characteristic (ROC) curve analysis were performed to evaluate the BNN model's accuracy and robustness. RESULTS: A total of 189 consecutive patients were included. First-degree predictors of survival differed between the 3-month and 12-month models. Following cross validation, the area under the ROC curve was 0.85 (95% CI: 0.80-0.93) for 3-month probability of survival and 0.83 (95% CI: 0.77-0.90) for 12-month probability of survival. CONCLUSIONS: A robust, accurate, probabilistic naïve BBN model was successfully developed using observed clinical data to estimate individualized survival in patients with operable skeletal metastases. This method warrants further development and must be externally validated in other patient populations. |
| first_indexed | 2024-12-23T20:45:02Z |
| format | Article |
| id | doaj.art-e865894f154d4a4999e01878ea5e4482 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-23T20:45:02Z |
| publishDate | 2011-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-e865894f154d4a4999e01878ea5e44822022-12-21T17:31:49ZengPublic Library of Science (PLoS)PLoS ONE1932-62032011-01-0165e1995610.1371/journal.pone.0019956Estimating survival in patients with operable skeletal metastases: an application of a bayesian belief network.Jonathan Agner ForsbergJohn EberhardtPatrick J BolandRikard WedinJohn H HealeyBACKGROUND: Accurate estimations of life expectancy are important in the management of patients with metastatic cancer affecting the extremities, and help set patient, family, and physician expectations. Clinically, the decision whether to operate on patients with skeletal metastases, as well as the choice of surgical procedure, are predicated on an individual patient's estimated survival. Currently, there are no reliable methods for estimating survival in this patient population. Bayesian classification, which includes bayesian belief network (BBN) modeling, is a statistical method that explores conditional, probabilistic relationships between variables to estimate the likelihood of an outcome using observed data. Thus, BBN models are being used with increasing frequency in a variety of diagnoses to codify complex clinical data into prognostic models. The purpose of this study was to determine the feasibility of developing bayesian classifiers to estimate survival in patients undergoing surgery for metastases of the axial and appendicular skeleton. METHODS: We searched an institution-owned patient management database for all patients who underwent surgery for skeletal metastases between 1999 and 2003. We then developed and trained a machine-learned BBN model to estimate survival in months using candidate features based on historical data. Ten-fold cross-validation and receiver operating characteristic (ROC) curve analysis were performed to evaluate the BNN model's accuracy and robustness. RESULTS: A total of 189 consecutive patients were included. First-degree predictors of survival differed between the 3-month and 12-month models. Following cross validation, the area under the ROC curve was 0.85 (95% CI: 0.80-0.93) for 3-month probability of survival and 0.83 (95% CI: 0.77-0.90) for 12-month probability of survival. CONCLUSIONS: A robust, accurate, probabilistic naïve BBN model was successfully developed using observed clinical data to estimate individualized survival in patients with operable skeletal metastases. This method warrants further development and must be externally validated in other patient populations.http://europepmc.org/articles/PMC3094405?pdf=render |
| spellingShingle | Jonathan Agner Forsberg John Eberhardt Patrick J Boland Rikard Wedin John H Healey Estimating survival in patients with operable skeletal metastases: an application of a bayesian belief network. PLoS ONE |
| title | Estimating survival in patients with operable skeletal metastases: an application of a bayesian belief network. |
| title_full | Estimating survival in patients with operable skeletal metastases: an application of a bayesian belief network. |
| title_fullStr | Estimating survival in patients with operable skeletal metastases: an application of a bayesian belief network. |
| title_full_unstemmed | Estimating survival in patients with operable skeletal metastases: an application of a bayesian belief network. |
| title_short | Estimating survival in patients with operable skeletal metastases: an application of a bayesian belief network. |
| title_sort | estimating survival in patients with operable skeletal metastases an application of a bayesian belief network |
| url | http://europepmc.org/articles/PMC3094405?pdf=render |
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