Predicting radiation pneumonitis in lung cancer using machine learning and multimodal features: a systematic review and meta-analysis of diagnostic accuracy

Abstract

Objectives: To evaluate the diagnostic accuracy of machine learning models incorporating multimodal features for predicting radiation pneumonitis in lung cancer through a systematic review and meta-analysis.

Methods: Relevant studies were identified through a systematic search of PubMed, Web of Science, Embase, and the Cochrane Library from October 2003 to December 2023. Additional studies were located by reviewing bibliographies and relevant websites. Two independent researchers screened titles, abstracts, and full-text articles according to predefined inclusion and exclusion criteria. Data extraction was performed using standardized forms, and study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The primary outcomes, including combined sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC), were calculated using STATA MP-64 software(Stata Corporation LLC, College Station, USA) with a random-effects model. Meta-analysis was conducted to synthesize diagnostic accuracy measures, and analyses of heterogeneity and publication bias were performed.

Results: A total of 1,406 patients with primary lung cancer were included in this systematic review, drawing data from 9 studies. The pooled analysis revealed a sensitivity of 0.74 [0.58-0.85] and a specificity of 0.91 [0.87-0.95] for machine learning models in diagnosing radiation pneumonitis. The positive likelihood ratio (PLR) was 8.69 [5.21-14.50], the negative likelihood ratio (NLR) was 0.28 [0.16-0.49], and the diagnostic odds ratio (DOR) was 30.73 [11.96-78.97]. The area under the curve (AUC) was 0.93 [0.90-0.95], indicating excellent diagnostic performance. Meta-regression analysis identified that the number of machine learning models, year of publication, and study design contributed to heterogeneity among studies. No evidence of publication bias was found. Overall, machine learning models incorporating multimodal characteristics demonstrated 75% accuracy in predicting moderate to severe radiation pneumonitis.

Conclusion: In conclusion, by integrating the current machine learning (ML) algorithm's ability in big data mining, a predictive model can be constructed by combining multi-modal features such as genetics, imaging, and cell factors. By selecting multiple machine learning algorithm frameworks and competing for the best combination model based on research goals, the reliability and accuracy of the radiation pneumonitis prediction model can be greatly improved.

Trial registration: PROSPERO (CRD42024497599).

Keywords: Artificial intelligence; Lung cancer; Machine learning; Multiomics; Radiation pneumonitis; Radiation-induced lung injury; Radiomics.

Fig. 1

Flowchart of study selection

Fig. 2

Forest Plot Analysis of the Specificity and Sensitivity of Robotic Learning Algorithms Combining Multimodal Features for Predicting RP

Fig. 3

Summary of the Receiver Operating Characteristic (ROC) Curve with 95% Confidence and Prediction Regions for Robotic Learning Algorithms Combining Multimodal Features in Predicting RP

Fig. 4

Fagan Nomogram for Predicting RP in Robotic Learning Models Combining Multimodal Features

Fig. 5

A Risk of bias and applicability concerns graph: review authors' judgements about each domain presented as percentages across included studies. B Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study

Fig. 6

Meta-Regression Analysis Identifying the Causes of Heterogeneity in Diagnostic Accuracy

Fig. 7

Bivariate Box Plot Analysis of Heterogeneity Among Included Studies

Fig. 8

Deek's Funnel Plot Analysis for Machine Learning Models Combining Multimodal Features to Predict RP

Fig. 9

Deek's Funnel Plot Analysis for Machine Learning Models Predominantly Based on Radiomics Features to Predict RP