Incidence trends, overall survival, and metastasis prediction using multiple machine learning and deep learning techniques in pediatric and adolescent population with osteosarcoma and Ewing’s sarcoma: nomogram and webpage

The objective of this study was to analyze the incidence and overall survival (OS) of osteosarcoma (OSC) and Ewing’s sarcoma (EWS) in a pediatric and adolescent population, employing machine learning (ML) and deep learning (DL) models to predict the likelihood of metastasis.

Involving 2465 OSC and 1373 EWS patients aged 0–19 years, from 2004 to 2020. ML techniques—Lasso, Ridge Regression, Elastic Net, and Random Forest—were used alongside a deep learning model based on TensorFlow and Keras, to construct predictive models for metastasis. These models were optimized using grid search with cross-validation and evaluated on their performance metrics, including AUC, sensitivity, and accuracy. The variables’ importance in metastasis prediction was determined using SHAP values. Statistical analysis was performed using R software, and an online nomogram was developed for clinical use.

The age-adjusted incidence of OSC and EWS from 2004 to 2020 showed a significant uptrend. The deep learning model, iterated 50 times, outperformed the Random Forest model in both loss and accuracy stabilization. The nomogram created demonstrated accurate survival predictions, as evidenced by its calibration curves and the distinction between high and low-risk groups.

The increasing trend in age-adjusted incidence of OSC and EWS highlights the need for continued research and improved therapeutic strategies in this domain. The study employed ML and DL models to predict distant metastasis in pediatric and adolescent patients with OSC and EWS, providing a valuable tool for prognosis. The online nomogram developed as a part of this research enhances the models' clinical utility, offering an accessible means for clinicians to predict survival outcomes effectively.