AI Prognostication in Nonsmall Cell Lung Cancer: A Systematic Review

The systematic literature review was performed on the use of artificial intelligence (AI) algorithms in nonsmall cell lung cancer (NSCLC) prognostication. Studies were evaluated for the type of input data (histology and whether CT, PET, and MRI were used), cancer therapy intervention, prognosis performance, and comparisons to clinical prognosis systems such as TNM staging. Further comparisons were drawn between different types of AI, such as machine learning (ML) and deep learning (DL). Syntheses of therapeutic interventions and algorithm input modalities were performed for comparison purposes. The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The initial database identified 3880 results, which were reduced to 513 after the automatic screening, and 309 after the exclusion criteria. The prognostic performance of AI for NSCLC has been investigated using histology and genetic data, and CT, PET, and MR imaging for surgery, immunotherapy, and radiation therapy patients with and without chemotherapy. Studies per therapy intervention were 13 for immunotherapy, 10 for radiotherapy, 14 for surgery, and 34 for other, multiple, or no specific therapy. The results of this systematic review demonstrate that AI-based prognostication methods consistently present higher prognostic performance for NSCLC, especially when directly compared with traditional prognostication techniques such as TNM staging. The use of DL outperforms ML-based prognostication techniques. DL-based prognostication demonstrates the potential for personalized precision cancer therapy as a supplementary decision-making tool. Before it is fully utilized in clinical practice, it is recommended that it be thoroughly validated through well-designed clinical trials.