Interpretable machine learning for preoperative prediction of WHO/ISUP grade in clear cell renal cell carcinoma using contrast-enhanced CT-derived extracellular volume fraction.

Authors

Yating Wang, Ying Wang, Genji Bai, Wei Huang, Min Huang, Wei Chen

Published in

Frontiers in oncology. Volume 16. Pages 1851636. Epub Oct 13, 2026.

Abstract

To develop and validate an interpretable machine learning (ML) model that integrates extracellular volume fraction (ECV) derived from contrast-enhanced CT with clinical and imaging features for preoperative prediction of World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade in clear cell renal cell carcinoma (ccRCC).
A retrospective cohort of 263 patients with pathologically confirmed ccRCC from two institutions was analyzed. Patients from Hospital A (n=184) were randomly divided into training (n=128) and internal validation (n=56) cohorts, while patients from Hospital B (n=79) served as an independent external validation cohort. CT-derived ECV, arterial enhancement fraction (AEF), and conventional imaging features were extracted. Six machine learning models (Logistic Regression [LR], eXtreme Gradient Boosting [XGBoost], Gaussian Naive Bayes [GNB], Support Vector Machine [SVM], K-Nearest Neighbors [KNN], Light Gradient Boosting Machine [LightGBM]) were constructed, and the best-performing model was identified based on bootstrap resampling. Model interpretability was assessed using SHapley Additive exPlanations (SHAP).
Tumor size (low-grade: 4.99 ± 1.98 cm; high-grade: 6.20 ± 2.72 cm, P = 0.002), ECV (low-grade: 0.46 ± 0.09; high-grade: 0.57 ± 0.12, P<0.001), and AEF (low-grade: 1.37 ± 0.24; high-grade: 1.56 ± 0.25, P<0.001) were significantly higher in high-grade ccRCC, while hematocrit (HCT, low-grade: 0.41 ± 0.05; high-grade: 0.38 ± 0.06, P<0.001) was lower. The optimal LR model achieved robust performance: training cohort AUC = 0.995 (95% CI: 0.990-0.999), internal validation AUC = 0.903 (95% CI: 0.818-0.988), external test AUC = 0.857 (95% CI: 0.756-0.958). SHAP analysis showed ECV, tumor diameter, and AEF were the top 3 predictors.
An interpretable ML model incorporating CT-derived ECV and imaging features effectively predicts preoperative WHO/ISUP grade of ccRCC, providing a noninvasive tool for individualized risk stratification and clinical decision-making.

PMID:
42947876
Bibliographic data and abstract were imported from PubMed on 28 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.