Journal de médecine légale

Forecasting Serious Hematological Toxicity in Patients with Gastrointestinal Cancer Undergoing Chemotherapy based on 5-FU: An Application of Bayesian Network Modeling

Abstract

Oskitz Ruiz Deza

Approximately 30% of patients with gastrointestinal cancer undergoing 5-Fluorouracil (5-FU)-based chemotherapy experience severe toxicity. Presently, there is a dearth of effective tools for identifying individuals at risk within this context. This study aims to fill this gap by constructing a predictive model using a Bayesian network, a robust probabilistic graphical model known for its interpretable predictions. Employing a dataset encompassing 267 gastrointestinal cancer patients, the data underwent preprocessing and was partitioned into TRAIN and TEST sets in an 80%:20% ratio. Variable importance was assessed using the RandomForest algorithm, employing the MeanDecreaseGini coefficient. The Bayesian network model was designed using the bnlearn R library, utilizing a 10-fold cross-validation on the TRAIN set, and optimizing the network structure with the aic-cg method. Model performance was evaluated through accuracy, sensitivity, and specificity, employing cross-validation on the TRAIN set and independent validation on the TEST set. The model displayed favorable performance, achieving an average accuracy of 0.85 (±0.05) and 0.80 on the TRAIN and TEST datasets, respectively. Sensitivity and specificity were 0.82 (±0.14) and 0.87 (±0.07) for the TRAIN dataset, and 0.71 and 0.83 for the TEST dataset. A user-friendly tool was developed for clinical deployment. Despite some limitations, our Bayesian network model exhibited a strong capacity to predict the likelihood of severe hematological toxicity in gastrointestinal cancer patients undergoing 5-FU-based chemotherapy. Future investigations should concentrate on validating the model using larger patient cohorts and in diverse clinical scenarios.