Bayesian and deep-learning models applied to the early detection of ovarian cancer using multiple longitudinal biomarkers

BACKGROUND

Ovarian cancer is the most lethal of all gynecological cancers. Cancer Antigen 125 (CA125) is the best-performing ovarian cancer biomarker which however is still not effective as a screening test in the general population. Recent literature reports additional biomarkers with the potential to improve on CA125 for early detection when using longitudinal multimarker models.

METHODS

Our data comprised 180 controls and 44 cases with serum samples sourced from the multimodal arm of UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Our models were based on Bayesian change-point detection and recurrent neural networks.

RESULTS

We obtained a significantly higher performance for CA125-HE4 model using both methodologies (AUC 0.971, sensitivity 96.7% and AUC 0.987, sensitivity 96.7%) with respect to CA125 (AUC 0.949, sensitivity 90.8% and AUC 0.953, sensitivity 92.1%) for Bayesian change-point model (BCP) and recurrent neural networks (RNN) approaches, respectively. One year before diagnosis, the CA125-HE4 model also ranked as the best, whereas at 2 years before diagnosis no multimarker model outperformed CA125.

CONCLUSIONS

Our study identified and tested different combination of biomarkers using longitudinal multivariable models that outperformed CA125 alone. We showed the potential of multivariable models and candidate biomarkers to increase the detection rate of ovarian cancer.

Using a Recurrent Neural Network To Inform the Use of Prostate-specific Antigen (PSA) and PSA Density for Dynamic Monitoring of the Risk of Prostate Cancer Progression on Active Surveillance

The global uptake of prostate cancer (PCa) active surveillance (AS) is steadily increasing. While prostate-specific antigen density (PSAD) is an important baseline predictor of PCa progression on AS, there is a scarcity of recommendations on its use in follow-up. In particular, the best way of measuring PSAD is unclear. One approach would be to use the baseline gland volume (BGV) as a denominator in all calculations throughout AS (nonadaptive PSAD, PSAD_NA), while another would be to remeasure gland volume at each new magnetic resonance imaging scan (adaptive PSAD, PSAD_A). In addition, little is known about the predictive value of serial PSAD in comparison to PSA. We applied a long short-term memory recurrent neural network to an AS cohort of 332 patients and found that serial PSAD_NA significantly outperformed both PSAD_A and PSA for follow-up prediction of PCa progression because of its high sensitivity. Importantly, while PSAD_NA was superior in patients with smaller glands (BGV ≤55 ml), serial PSA was better in men with larger prostates of >55 ml.

Patient summary

Repeat measurements of prostate-specific antigen (PSA) and PSA density (PSAD) are the mainstay of active surveillance in prostate cancer. Our study suggests that in patients with a prostate gland of 55 ml or smaller, PSAD measurements are a better predictor of tumour progression, whereas men with a larger gland may benefit more from PSA monitoring.

Time series radiomics for the prediction of prostate cancer progression in patients on active surveillance

Serial MRI is an essential assessment tool in prostate cancer (PCa) patients enrolled on active surveillance (AS). However, it has only moderate sensitivity for predicting histopathological tumour progression at follow-up, which is in part due to the subjective nature of its clinical reporting and variation among centres and readers. In this study, we used a long short-term memory (LSTM) recurrent neural network (RNN) to develop a time series radiomics (TSR) predictive model that analysed longitudinal changes in tumour-derived radiomic features across 297 scans from 76 AS patients, 28 with histopathological PCa progression and 48 with stable disease. Using leave-one-out cross-validation (LOOCV), we found that an LSTM-based model combining TSR and serial PSA density (AUC 0.86 [95% CI: 0.78-0.94]) significantly outperformed a model combining conventional delta-radiomics and delta-PSA density (0.75 [0.64-0.87]; p = 0.048) and achieved comparable performance to expert-performed serial MRI analysis using the Prostate Cancer Radiologic Estimation of Change in Sequential Evaluation (PRECISE) scoring system (0.84 [0.76-0.93]; p = 0.710). The proposed TSR framework, therefore, offers a feasible quantitative tool for standardising serial MRI assessment in PCa AS. It also presents a novel methodological approach to serial image analysis that can be used to support clinical decision-making in multiple scenarios, from continuous disease monitoring to treatment response evaluation. KEY POINTS: •LSTM RNN can be used to predict the outcome of PCa AS using time series changes in tumour-derived radiomic features and PSA density. •Using all available TSR features and serial PSA density yields a significantly better predictive performance compared to using just two time points within the delta-radiomics framework. •The concept of TSR can be applied to other clinical scenarios involving serial imaging, setting out a new field in AI-driven radiology research.

Estimating integrated information in bidirectional neuron-astrocyte communication

There is growing evidence that suggests the importance of astrocytes as elements for neural information processing through the modulation of synaptic transmission. A key aspect of this problem is understanding the impact of astrocytes in the information carried by compound events in neurons across time. In this paper, we investigate how the astrocytes participate in the information integrated by individual neurons in an ensemble through the measurement of "integrated information." We propose a computational model that considers bidirectional communication between astrocytes and neurons through glutamate-induced calcium signaling. Our model highlights the role of astrocytes in information processing through dynamical coordination. Our findings suggest that the astrocytic feedback promotes synergetic influences in the neural communication, which is maximized when there is a balance between excess correlation and spontaneous spiking activity. The results were further linked with additional measures such as net synergy and mutual information. This result reinforces the idea that astrocytes have integrative properties in communication among neurons.

Integrated Information as a Measure of Cognitive Processes in Coupled Genetic Repressilators

Intercellular communication and its coordination allow cells to exhibit multistability as a form of adaptation. This conveys information processing from intracellular signaling networks enabling self-organization between other cells, typically involving mechanisms associated with cognitive systems. How information is integrated in a functional manner and its relationship with the different cell fates is still unclear. In parallel, drawn originally from studies on neuroscience, integrated information proposes an approach to quantify the balance between integration and differentiation in the causal dynamics among the elements in any interacting system. In this work, such an approach is considered to study the dynamical complexity in a genetic network of repressilators coupled by quorum sensing. Several attractors under different conditions are identified and related to proposed measures of integrated information to have an insight into the collective interaction and functional differentiation in cells. This research particularly accounts for the open question about the coding and information transmission in genetic systems.