Development of an artificial intelligence-generated, explainable treatment recommendation system for urothelial...

Decisions on the best available treatment in clinical oncology are based on expert opinions in multidisciplinary cancer conferences (MCC). Artificial intelligence (AI) could increase evidence-based treatment by generating additional treatment recommendations (TR). We aimed to develop such an AI system for urothelial carcinoma (UC) and renal cell carcinoma (RCC).

Comprehensive data of patients with histologically confirmed UC and RCC who received MCC recommendations in the years 2015 - 2022 were transformed into machine readable representations. Development of a two-step process to train a classifier to mimic TR was followed by identification of superordinate and detailed categories of TR. Machine learning (CatBoost, XGBoost, Random Forest) and deep learning (TabPFN, TabNet, SoftOrdering CNN, FCN) techniques were trained. Results were measured by F1-scores for accuracy weights.

AI training was performed with 1617 (UC) and 880 (RCC) MCC recommendations (77 and 76 patient input parameters). The AI system generated fully automated TR with excellent F1-scores for UC (e.g. 'Surgery' 0.81, 'Anti-cancer drug' 0.83, 'Gemcitabine/Cisplatin' 0.88) and RCC (e.g. 'Anti-cancer drug' 0.92 'Nivolumab' 0.78, 'Pembrolizumab/Axitinib' 0.89). Explainability is provided by clinical features and their importance score. Finally, TR and explainability were visualized on a dashboard.

This study demonstrates for the first time AI-generated, explainable TR in UC and RCC with excellent performance results as a potential support tool for high-quality, evidence-based TR in MCC. The comprehensive technical and clinical development sets global reference standards for future AI developments in MCC recommendations in clinical oncology. Next, prospective validation of the results is mandatory.