A novel risk classification system based on the eighth edition of TNM frameworks for esophageal adenocarcinoma patients: A deep learning approach

OBJECTIVE: To develop and validate a deep learning predictive model with better performance in survival estimation of esophageal adenocarcinoma (EAC). METHOD: Cases diagnosed between January 2010 and December 2018 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. A deep learning survival neural network was developed and validated based on 17 variables, including demographic information, clinicopathological characteristics, and treatment details. Based on the total risk score derived from this algorithm, a novel risk classification system was constructed and compared with the 8th edition of the tumor, node, and metastasis (TNM) staging system. RESULTS: Of 7,764 EAC patients eligible for the study, 6,818 (87.8%) were men and the median (interquartile range, IQR) age was 65 (58–72) years. The deep learning model generated significantly superior predictions to the 8th edition staging system on the test data set (C-index: 0.773 [95% CI, 0.757–0.789] vs. 0.683 [95% CI, 0.667–0.699]; P < 0.001). Calibration curves revealed that the deep learning model was well calibrated for 1- and 3-year OS, most points almost directly distributing on the 45° line. Decision curve analyses (DCAs) showed that the novel risk classification system exhibited a more significant positive net benefit than the TNM staging system. A user-friendly and precise web-based calculator with a portably executable file was implemented to visualize the deep learning predictive model. CONCLUSION: A deep learning predictive model was developed and validated, which possesses more excellent calibration and discrimination abilities in survival prediction of EAC. The novel risk classification system based on the deep learning algorithm may serve as a useful tool in clinical decision making given its easy-to-use and better clinical applicability.