Survival prediction and prognostic factors in colorectal cancer after curative surgery: insights from cox regression and neural networks

Medical research frequently relies on Cox regression to analyze the survival distribution of cancer patients. Nonetheless, in specific scenarios, neural networks hold the potential to serve as a robust alternative. In this study, we aim to scrutinize the effectiveness of Cox regression and neural network models in assessing the survival outcomes of patients who have undergone treatment for colorectal cancer. We conducted a retrospective study on 284 colorectal cancer patients who underwent surgery at Imam Khomeini clinic in Hamadan between 2001 and 2017. The data was used to train both Cox regression and neural network models, and their predictive accuracy was compared using diagnostic measures such as sensitivity, specificity, positive predictive value, accuracy, negative predictive value, and area under the receiver operating characteristic curve. The analyses were performed using STATA 17 and R4.0.4 software. The study revealed that the best neural network model had a sensitivity of 74.5% (95% CI 61.0–85.0), specificity of 83.3% (65.3–94.4), positive predictive value of 89.1% (76.4–96.4), negative predictive value of 64.1% (47.2–78.8), AUC of 0.79 (0.70–0.88), and accuracy of 0.776 for death prediction. For recurrence, the best neural network model had a sensitivity of 88.1% (74.4–96.0%), specificity of 83.7% (69.3–93.2%), positive predictive value of 84.1% (69.9–93.4%), negative predictive value of 87.8% (73.8–95.9%), AUC of 0.86 (0.78–0.93), and accuracy of 0.859. The Cox model had comparable results, with a sensitivity of 73.6% (64.8–81.2) and 85.5% (78.3–91.0), specificity of 89.6% (83.8–93.8) and 98.0% (94.4–99.6), positive predictive value of 84.0% (75.6–90.4) and 97.4% (92.6–99.5), negative predictive value of 82.0% (75.6–90.4) and 88.8% (0.83–93.1), AUC of 0.82 (0.77–0.86) and 0.92 (0.89–0.95), and accuracy of 0.88 and 0.92 for death and recurrence prediction, respectively. In conclusion, the study found that both Cox regression and neural network models are effective in predicting early recurrence and death in patients with colorectal cancer after curative surgery. The neural network model showed slightly better sensitivity and negative predictive value for death, while the Cox model had better specificity and positive predictive value for recurrence. Overall, both models demonstrated high accuracy and AUC, indicating their usefulness in predicting these outcomes.