An integrated framework for risk profiling of breast cancer patients following surgery

An integrated decision support framework is proposed for clinical oncologists making prognostic assessments of patients with operable breast cancer. The framework may be delivered over a web interface. It comprises a triangulation of prognostic modelling, visualisation of historical patient data and an explanatory facility to interpret risk group assignments using empirically derived Boolean rules expressed directly in clinical terms.

The prognostic inferences in the interface are validated in a multicentre longitudinal cohort study by modelling retrospective data from 917 patients recruited at Christie Hospital, Wilmslow between 1983 and 1989 and predicting for 931 patients recruited in the same centre during 1990-1993. There were also 291 patients recruited between 1984 and 1998 at the Clatterbridge Centre for Oncology and the Linda McCartney Centre, Liverpool, UK.

There are three novel contributions relating this paper to breast cancer cases. First, the widely used Nottingham prognostic index (NPI) is enhanced with additional clinical features from which prognostic assessments can be made more specific for patients in need of adjuvant treatment. This is shown with a cross matching of the NPI and a new prognostic index which also provides a two-dimensional visualisation of the complete patient database by risk of negative outcome. Second, a principled rule-extraction method, orthogonal search rule extraction, generates readily interpretable explanations of risk group allocations derived from a partial logistic artificial neural network with automatic relevance determination (PLANN-ARD). Third, 95% confidence intervals for individual predictions of survival are obtained by Monte Carlo sampling from the PLANN-ARD model.