BACKGROUND: Lung cancer is characterized by high morbidity and mortality due to the lack of practical early diagnostic and prognostic tools. The present study uses machine learning algorithms to construct a clinical predictive model for non-small cell lung cancer (NSCLC) patients.

METHODS: Laboratory indices of the NSCLC patients at their initial visit were collected for quality control and exploratory analysis. By comparing the levels of the above indices between the survival and death groups, the statistically significant indices were selected for subsequent machine learning modeling. Ten machine learning algorithms were then employed to develop the predictive models with survival and recurrence as outcomes, respectively. Moreover, regression models were constructed using the random survival forest algorithm by incorporating the survival time dimension. Finally, critical variables in the optimal model were screened based on the interpretable algorithms to build a decision tree to facilitate clinical application.

RESULTS: 682 patients were enrolled according to the inclusion and exclusion criteria. The preliminary comparison results revealed that except for fast blood glucose, CD₃⁺T cell proportion, NK cell proportion, and CA72-4, there were significant statistical differences in other tumor markers, inflammation, metabolism, and immune-related indices between the survival and death groups (p < 0.01). Subsequently, indices with statistical differences were incorporated into machine learning modeling and evaluation. The results showed that among the ten prognostic models constructed using survival status as the outcome, the neural network model obtained the best predictive performance, with accuracy, sensitivity, specificity, AUC, and precision values of 0.993, 0.987, 1.000, 0.994, and 1.000, respectively. The corresponding SHAP16 algorithm revealed that the top five variables in terms of importance were interleukin6 (IL-6), soluble interleukin2 receptor (sIL-2R), cholesterol, CEA, and Cy211, respectively. The random survival forest model also confirmed the critical role of CEA, sIL-2R, and IL-6 in predicting the prognosis of NSCLC patients. A decision tree model with seven cut-off points based on the above three indices was eventually built for clinical application.

CONCLUSION: The neural network model exhibited ideal predictive performance in the survival status of NSCLC patients, and the decision tree model constructed based on selected important variables was conducive to rapid bedside prognosis assessment and decision-making.