Forecasting the prognosis of choroidal melanoma with an artificial neural network.
OBJECTIVE
To develop an artificial neural network (ANN) that will forecast the 5-year mortality from choroidal melanoma.


METHODS
Retrospective, comparative, observational cohort study.


METHODS
One hundred fifty-three eyes of 153 consecutive patients with choroidal melanoma (age, 58.4+/-14.6 years) who were treated with ruthenium 106 brachytherapy between 1988 and 1998 at the Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel.


METHODS
Patients were observed clinically and ultrasonographically (A- and B-mode standardized ultrasonography). Metastatic screening included liver function tests and liver imaging. Backpropagation ANNs composed of 3 or 4 layers of neurons with various types of transfer functions and training protocols were assessed for their ability to predict the 5-year mortality. The ANNs were trained on 77 randomly selected patients and tested on a different set of 76 patients. Artificial neural networks were compared based on their sensitivity, specificity, forecasting accuracy, area under the receiver operating curves, and likelihood ratios (LRs). The best ANN was compared with the results of logistic regression and the performance of an ocular oncologist.


RESULTS
The ability of the ANNs to forecast the 5-year mortality from choroidal melanoma.


RESULTS
Thirty-one patients died during the follow-up period of metastatic choroidal melanoma. The best ANN (one hidden layer of 16 neurons) had 84% forecasting accuracy and an LR of 31.5. The number of hidden neurons significantly influenced the ANNs' performance (P<0.001). The performance of the ANNs was not significantly influenced by the training protocol, the number of hidden layers, or the type of transfer function. In comparison, logistic regression reached 86% forecasting accuracy, with a very low LR (0.8), whereas the human expert forecasting ability was <70% (LR, 1.85).


CONCLUSIONS
Artificial neural networks can be used for forecasting the prognosis of choroidal melanoma and may support decision-making in treating this malignancy.
Kaiserman
Igor
I
Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel. Igor@Dr-Kaiserman.com
Rosner
Mordechai
M
Pe'er
Jacob
J
D001918:Brachytherapy; D002830:Choroid Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D015331:Cohort Studies; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D016571:Neural Networks, Computer; D011379:Prognosis; D012189:Retrospective Studies; D012429:Ruthenium Radioisotopes / Q000627:therapeutic use; D015996:Survival Rate
D012429:Ruthenium Radioisotopes