Predicting Distant Recurrences in Invasive Breast Carcinoma Patients Using Clinicopathological Data: A cross-institutional and AI-based study

Breast cancer ranks second in the most common cancer in women worldwide with 30% of cases resulting into recurrence of the disease at distant organs post the treatment. While clinicians have utilized several clinicopathological measurements for prediction of distant recurrences in invasive breast carcinoma (IBC), none of those studies have showcased the potential of combining clinicopathological evaluations of IBC tumors pre and post therapies using machine learning (ML) or artificially intelligent (AI) models to predict the distant recurrence of the disease in respective patients. The goal of our study was to determine whether classification-based ML/AI techniques can predict distant recurrences in IBC patients using key clinicopathological measurements that includes pathological staging of tumor and surrounding lymph nodes deemed both pre- and post-neoadjuvant therapy, imaging-based therapy responses, and the status of adjuvant therapy administered to patients. We trained and tested clinicopathological ML/AI model using dataset from Duke University and validated it using external dataset from Dartmouth Hitchcock Medical Center (DHMC). Random Forest (RF) model performed best compared to C-Support Vector Classifier (SVC) and Multi-Layer Perceptron (MLP) yielding AUC ranging 0.75-1.0 (p<0.002) across both the institutions, thereby demonstrating the cross-institutional portability and validity of ML/AI models in the field of clinical research in cancer.