To test if our artificial intelligence (AI)-postoperative GFR prediction is as accurate as a validated clinical model. The American Urologic Association recommends estimating postoperative glomerular filtration rate (GFR) in patients with renal masses and prioritizing partial nephrectomy (PN) when GFR would be< 45 ml/min/1.
73m2 if radical nephrectomy (RN) was performed. Previously validated models have limited clinical uptake.
We included 300 patients undergoing nephrectomy for renal tumors from KiTS19 challenge. Preoperative GFR was collected just before surgery, and new baseline GFR 3-12 months postoperatively. Split-renal function (SRF) was determined in a fully automated way from preoperative computed tomography, combining our deep learning segmentation model, then using those segmentation masks to estimate postoperative GFR=1.24×GFRPre-RN×SRFContralateral for RN and 89% of GFRpreoperative for PN. A clinical model estimated postoperative GFR=35+GFRpreoperativex0.65-18 (if RN)-agex0.25+3 (if tumor>7cm)-2 (if diabetes). We compared the AI and clinical model GFR estimations to the measured postoperative GFR using correlation coefficients and their ability to predict GFR<45 using logistic regression.
Median age was 60 years, 41% were female, and 62% had PN. Median tumor size was 4.2 cm, and 92% were malignant. Compared to the measured postoperative GFR, correlation coefficients were 0.75 and 0.77 for the AI and clinical models, respectively. The AI and clinical models performed similarly for predicting GFR<45 (areas under the curve 0.89 and 0.9, respectively).
Our fully automated prediction of new baseline renal function is as accurate as a validated clinical model without needing clinical details, clinician time, or measurements.
Urology. 2025 Feb 04 [Epub ahead of print]
Nour Abdallah, Nityam Rathi, Nicholas Heller, Andrew Wood, Rebecca Campbell, Tarik Benidir, Fabian Isensee, Resha Tejpaul, Chalairat Suk-Ouichai, Diego Aguilar Palacios, Alex You, Satish Viswanath, Brennan Flannery, Jihad Kaouk, Samuel Haywood, Venkatesh Krishnamurthi, Nikolaos Papanikolopoulos, Joseph Zabell, Robert Abouassaly, Erick M Remer, Steven Campbell, Christopher J Weight
Glickman Urological and Kidney Institute, Cleveland, Ohio, USA. Electronic address: ., Glickman Urological and Kidney Institute, Cleveland, Ohio, USA. Electronic address: ., Department of Computer Science and Engineering, University of Minnesota, Minneapolis, Minnesota, USA. Electronic address: ., Glickman Urological and Kidney Institute, Cleveland, Ohio, USA. Electronic address: ., Glickman Urological and Kidney Institute, Cleveland, Ohio, USA. Electronic address: ., Glickman Urological and Kidney Institute, Cleveland, Ohio, USA. Electronic address: ., German Cancer Research Center (DKFZ) Heidelberg, University of Heidelberg, Heidelberg, Germany. Electronic address: ., Department of Computer Science and Engineering, University of Minnesota, Minneapolis, Minnesota, USA. Electronic address: ., Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: ., Glickman Urological and Kidney Institute, Cleveland, Ohio, USA. Electronic address: ., Case Western Reserve University, Cleveland, Ohio, USA. Electronic address: ., Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA. Electronic address: ., Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA. Electronic address: ., Glickman Urological and Kidney Institute, Cleveland, Ohio, USA. Electronic address: ., Glickman Urological and Kidney Institute, Cleveland, Ohio, USA. Electronic address: ., Glickman Urological and Kidney Institute, Cleveland, Ohio, USA. Electronic address: ., Department of Computer Science and Engineering, University of Minnesota, Minneapolis, Minnesota, USA. Electronic address: ., Department of Urology, University of Minnesota Medical School, Minneapolis, Minnesota, USA. Electronic address: ., Glickman Urological and Kidney Institute, Cleveland, Ohio, USA. Electronic address: ., Glickman Urological and Kidney Institute, Cleveland, Ohio, USA; Department of Diagnostic Radiology, Imaging Institute Cleveland Clinic, Cleveland, Ohio, USA. Electronic address: ., Glickman Urological and Kidney Institute, Cleveland, Ohio, USA. Electronic address: ., Glickman Urological and Kidney Institute, Cleveland, Ohio, USA. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/39914676
Go Beyond the Abstract and Read a Commentary by Kieran Lewis & Steven C. Campbell, MD, PhD
Go Beyond the Abstract and Read a Commentary by Chalairat Suk-Ouichai, MD, MPH