Using deep learning to predict survival outcome in non-surgical cervical cancer patients based on pathological images

PURPOSE: We analyzed clinical features and the representative HE-stained pathologic images to predict 5-year overall survival via the deep-learning approach in cervical cancer patients in order to assist oncologists in designing the optimal treatment strategies. METHODS: The research retrospectively collected 238 non-surgical cervical cancer patients treated with radiochemotherapy from 2014 to 2017. These patients were randomly divided into the training set (n = 165) and test set (n = 73). Then, we extract deep features after segmenting the HE-stained image into patches of size 224 × 224. A Lasso–Cox model was constructed with clinical data to predict 5-year OS. C-index evaluated this model performance with 95% CI, calibration curve, and ROC. RESULTS: Based on multivariate analysis, 2 of 11 clinical characteristics (C-index 0.68) and 2 of 2048 pathomic features (C-index 0.74) and clinical–pathomic model (C-index 0.83) of nomograms predict 5-year survival in the training set, respectively. In test set, compared with the pathomic and clinical characteristics used alone, the clinical–pathomic model had an AUC of 0.750 (95% CI 0.540–0.959), the clinical predictor model had an AUC of 0.729 (95% CI 0.551–0.909), and the pathomic model AUC was 0.703 (95% CI 0.487–0.919). Based on appropriate nomogram scores, we divided patients into high-risk and low-risk groups, and Kaplan–Meier survival probability curves for both groups showed statistical differences. CONCLUSION: We built a clinical–pathomic model to predict 5-year OS in non-surgical cervical cancer patients, which may be a promising method to improve the precision of personalized therapy.