Preoperative prediction of perineural invasion and KRAS mutation in colon cancer using machine learning

Yu Li, Aydin Eresen*, Junjie Shangguan, Jia Yang, Al B. Benson, Vahid Yaghmai, Zhuoli Zhang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Purpose: Preoperative prediction of perineural invasion (PNI) and Kirsten RAS (KRAS) mutation in colon cancer is critical for treatment planning and patient management. We developed machine learning models for diagnosis of PNI and KRAS mutation in colon cancer patients by interpreting preoperative CT. Methods: This retrospective study included 207 patients who received surgical resection in our institution. The underlying tumor characteristics were described by analyzing CT image texture quantitatively. The key radiomics features were determined with similarity analysis followed by RELIEFF method among 306 CT imaging features. Eight kernel-based support vector machines classifiers were constructed using individual (II, III, or IV) or multi-stage (II + III + IV) patient cohorts for predicting PNI and KRAS mutation. The model performances were evaluated using accuracy, receiver operating curve, and decision curve analyses. Results: Multi-stage classifiers obtained AUC of 0.793 and 0.862 for detecting PNI and KRAS mutation for test cohort. Moreover, individual-stage classifiers demonstrated significantly improved diagnostic performance at all stages (IIAUC: [0.86; 0.99], IIIAUC: [0.99; 0.99], and IVAUC: [1.00; 1.00], respectively, for PNI and KRAS mutation in test cohort). Besides, stage II tumor is better described with coarse texture features while more detailed features are required for better characterization of advanced-stage tumors (III and IV) for diagnoses of PNI or KRAS mutation. Conclusion: Machine learning models developed using preoperative CT data can predict PNI and KRAS mutation in colon cancer patients with satisfactory performance. Individual-stage models better-characterized the relationship between CT features and PNI or KRAS mutation than multi-stage models and demonstrated good prediction scores.

Original languageEnglish (US)
Pages (from-to)3165-3174
Number of pages10
JournalJournal of Cancer Research and Clinical Oncology
Issue number12
StatePublished - Dec 2020


  • Colon cancer
  • Computed tomography
  • KRAS mutation
  • Machine learning
  • Perineural invasion

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


Dive into the research topics of 'Preoperative prediction of perineural invasion and KRAS mutation in colon cancer using machine learning'. Together they form a unique fingerprint.

Cite this