Predicting prostate cancer specific-mortality with artificial intelligence-based Gleason grading
Ellery Wulczyn, Kunal Nagpal, Matthew Symonds, Melissa Moran, Markus Plass, Robert Reihs, Farah Nader, Fraser Tan, Yuannan Cai, Trissia Brown, Isabelle Flament-Auvigne, Mahul B. Amin, Martin C. Stumpe, Heimo Müller, Peter Regitnig, Andreas Holzinger, Greg S. Corrado, Lily H. Peng, Po-Hsuan Cameron Chen, David F. Steiner, Kurt Zatloukal, Yun Liu, Craig H. Mermel
Abstract
Abstract Background Gleason grading of prostate cancer is an important prognostic factor, but suffers from poor reproducibility, particularly among non-subspecialist pathologists. Although artificial intelligence (A.I.) tools have demonstrated Gleason grading on-par with expert pathologists, it remains an open question whether and to what extent A.I. grading translates to better prognostication. Methods In this study, we developed a system to predict prostate cancer-specific mortality via A.I.-based Gleason grading and subsequently evaluated its ability to risk-stratify patients on an independent retrospective cohort of 2807 prostatectomy cases from a single European center with 5–25 years of follow-up (median: 13, interquartile range 9–17). Results Here, we show that the A.I.’s risk scores produced a C -index of 0.84 (95% CI 0.80–0.87) for prostate cancer-specific mortality. Upon discretizing these risk scores into risk groups analogous to pathologist Grade Groups (GG), the A.I. has a C -index of 0.82 (95% CI 0.78–0.85). On the subset of cases with a GG provided in the original pathology report ( n = 1517), the A.I.’s C-indices are 0.87 and 0.85 for continuous and discrete grading, respectively, compared to 0.79 (95% CI 0.71–0.86) for GG obtained from the reports. These represent improvements of 0.08 (95% CI 0.01–0.15) and 0.07 (95% CI 0.00–0.14), respectively. Conclusions Our results suggest that A.I.-based Gleason grading can lead to effective risk stratification, and warrants further evaluation for improving disease management.