Artificial neural network individualised prediction of time to colorectal cancer surgery

Abstract

Aim:Colorectal cancer pathway targets mandate prompt treatment although practicalities may mean patients wait for surgery. This variable period could be utilised for patient optimisation however there is currently no reliable predictive system for time to surgery. If individualised surgical waits were prospectively known, tailored prehabilitation could be introduced. Methods:A dedicated, prospectively populated elective laparoscopic surgery for colorectal cancer with curative intent database was utilised.Primary endpoint was the prediction of the individualised waiting time for surgery. A multi-layered perceptron artificial neural network (ANN) model was trained and tested alongside uni and multivariate analyses. Results:668 consecutive patients were included. 8.5% underwent neoadjuvant chemoradiotherapy. Mean time from diagnosis to surgery was 53 days (95%CI 48.3-57.8). ANN correctly identified those having surgery in <8 (97.7% and 98.8%) and <12 weeks (97.1% and 98.8%) of the training and testing cohorts with area under the receiver operating curves of 0.793 and 0.865 respectively. After neoadjuvant treatment, ASA physical status score was the most important potentially modifiable risk factor for prolonged waits (normalised importance 64%, OR 4.9 95%CI1.5-16). The ANN findings were accurately cross-validated with a logistic regression model. Conclusion:Artificial neural networks using demographic and diagnostic data successfully predicts individual time to colorectal cancer surgery. This could assistthe personalisation of pre-operative care including the incorporation of prehabilitation interventions