Establishing machine learning models to predict curative resection in early gastric cancer with undifferentiated histology: Development and usability study

Chang Seok Bang, Ji Yong Ahn, Jie Hyun Kim, Young Il Kim, Il Ju Choi, Woon Geon Shin

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10 Citations (Scopus)


Background: Undifferentiated type of early gastric cancer (U-EGC) is included among the expanded indications of endoscopic submucosal dissection (ESD); however, the rate of curative resection remains unsatisfactory. Endoscopists predict the probability of curative resection by considering the size and shape of the lesion and whether ulcers are present or not. The location of the lesion, indicating the likely technical difficulty, is also considered. Objective: The aim of this study was to establish machine learning (ML) models to better predict the possibility of curative resection in U-EGC prior to ESD. Methods: A nationwide cohort of 2703 U-EGCs treated by ESD or surgery were adopted for the training and internal validation cohorts. Separately, an independent data set of the Korean ESD registry (n=275) and an Asan medical center data set (n=127) treated by ESD were chosen for external validation. Eighteen ML classifiers were selected to establish prediction models of curative resection with the following variables: age; sex; location, size, and shape of the lesion; and whether ulcers were present or not. Results: Among the 18 models, the extreme gradient boosting classifier showed the best performance (internal validation accuracy 93.4%, 95% CI 90.4%-96.4%; precision 92.6%, 95% CI 89.5%-95.7%; recall 99.0%, 95% CI 97.8%-99.9%; and F1 score 95.7%, 95% CI 93.3%-98.1%). Attempts at external validation showed substantial accuracy (first external validation 81.5%, 95% CI 76.9%-86.1% and second external validation 89.8%, 95% CI 84.5%-95.1%). Lesion size was the most important feature in each explainable artificial intelligence analysis. Conclusions: We established an ML model capable of accurately predicting the curative resection of U-EGC before ESD by considering the morphological and ecological characteristics of the lesions.

Original languageEnglish
Article numbere25053
JournalJournal of medical Internet research
Issue number4
Publication statusPublished - 2021 Apr

Bibliographical note

Funding Information:
Funding for this research was provided by the Bio & Medical Technology Development Program of the National Research Foundation, the Korean government, Ministry of Science and ICT (grant number NRF2017M3A9E8033253), and the Korean College of Helicobacter and Upper Gastrointestinal Research Foundation Grant (2017-08). All investigators have access to the final data set. All the data are accessible and are available upon request by the corresponding author.

Publisher Copyright:
©Chang Seok Bang, Ji Yong Ahn, Jie-Hyun Kim, Young-Il Kim, Il Ju Choi, Woon Geon Shin.

All Science Journal Classification (ASJC) codes

  • Health Informatics


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