Machine Learning-Based Real-Time Survival Prediction for Gastric Neuroendocrine Carcinoma

This study aimed to develop a dynamic survival prediction model utilizing conditional survival (CS) analysis and machine learning techniques for gastric neuroendocrine carcinomas (GNECs).

Data from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015) were analyzed and split into training and validation groups (7:3 ratio). CS profiles for patients with GNEC were examined in the full cohort. We utilized random survival forests (RSFs) and least absolute shrinkage and selection operator (LASSO) regression, alongside stepwise Cox regression, for variable selection. A CS-based nomogram was developed on the basis of key prognostic factors, followed by risk stratification and model validation.

We included 654 patients with GNEC in our study, with 457 assigned to the training set and 197 to the validation set. The CS analysis demonstrated that the probability of achieving 5-year CS improved from 48% immediately after diagnosis to 68%, 81%, 88%, and 94% after surviving an additional year (i.e., at 1, 2, 3, and 4 years, respectively). Through the use of RSFs and LASSO regression, combined with multivariable regression analysis, we identified the optimal combination of prognostic factors, which included age, tumor grade, tumor stage, surgery, and chemotherapy. Utilizing these prognostic indicators, we successfully developed a nomogram model that incorporated CS and effectively stratified these patients by risk. Subsequent performance analyses further validated the superior efficacy of the nomogram.

Our study highlights the value of CS in GNEC prognosis. The nomogram offers dynamic, individualized survival predictions, supporting personalized treatment strategies.