Insights from explainable AI in oesophageal cancer team decisions

Thavanesan, Navamayooran; Farahi, Arya; Parfitt, Charlotte; Belkhatir, Zehor; Azim, Tayyaba; Vallejos, Elvira Perez; Walters, Zoë; Ramchurn, Sarvapali; Underwood, Timothy J.; Vigneswaran, Ganesh

Abstract

Background
Clinician-led quality control into oncological decision-making is crucial for optimising patient care. Explainable artificial intelligence (XAI) techniques provide data-driven approaches to unravel how clinical variables influence this decision-making. We applied global XAI techniques to examine the impact of key clinical decision-drivers when mapped by a machine learning (ML) model, on the likelihood of receiving different oesophageal cancer (OC) treatment modalities by the multidisciplinary team (MDT).
Methods
Retrospective analysis of 893 OC patients managed between 2010 and 2022 at our tertiary unit, used a random forests (RF) classifier to predict four possible treatment pathways as determined by the MDT: neoadjuvant chemotherapy followed by surgery (NACT + S), neoadjuvant chemoradiotherapy followed by surgery (NACRT + S), surgery-alone, and palliative management. Variable importance and partial dependence (PD) analyses then examined the influence of targeted high-ranking clinical variables within the ML model on treatment decisions as a surrogate model of the MDT decision-making dynamic.
Results
Amongst guideline-variables known to determine treatments, such as Tumour-Node-Metastasis (TNM) staging, age also proved highly important to the RF model (16.1 % of total importance) on variable importance analysis. PD subsequently revealed that predicted probabilities for all treatment modalities change significantly after 75 years (p < 0.001). Likelihood of surgery-alone and palliative therapies increased for patients aged 75–85yrs but lowered for NACT/NACRT. Performance status divided patients into two clusters which influenced all predicted outcomes in conjunction with age.
Conclusion
XAI techniques delineate the relationship between clinical factors and OC treatment decisions. These techniques identify advanced age as heavily influencing decisions based on our model with a greater role in patients with specific tumour characteristics. This study methodology provides the means for exploring conscious/subconscious bias and interrogating inconsistencies in team-based decision-making within the era of AI-driven decision support.

Citation

Thavanesan, N., Farahi, A., Parfitt, C., Belkhatir, Z., Azim, T., Vallejos, E. P., Walters, Z., Ramchurn, S., Underwood, T. J., & Vigneswaran, G. (2024). Insights from explainable AI in oesophageal cancer team decisions. Computers in Biology and Medicine, 180, Article 108978. https://doi.org/10.1016/j.compbiomed.2024.108978

• Journal Article Type: Article
• Acceptance Date: Jul 31, 2024
• Online Publication Date: Aug 5, 2024
• Publication Date: 2024-09
• Deposit Date: Oct 9, 2024
• Publicly Available Date: Oct 9, 2024
• Journal: Computers in Biology and Medicine
• Print ISSN: 0010-4825
• Electronic ISSN: 1879-0534
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 180
• Article Number: 108978
• DOI: https://doi.org/10.1016/j.compbiomed.2024.108978
• Keywords: Machine learning, Oesophageal cancer, Multidisciplinary teams, Decision-making
• Public URL: https://nottingham-repository.worktribe.com/output/38118229
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0010482524010631?via%3Dihub