Evaluating the Performance of Machine Learning Models for Predicting 5-Year Breast Cancer Survival: A Systematic Review and Meta-Analysis.

BACKGROUND

Breast cancer is the most common malignancy among women worldwide and a leading cause of cancer-related mortality. Despite advances in diagnosis and treatment, accurately predicting 5-year survival remains challenging because of disease heterogeneity. This study systematically evaluated the performance of machine learning (ML) models for predicting 5-year breast cancer survival and synthesised their overall discriminative performance.

METHODS

A systematic search of PubMed, Scopus, and Web of Science (2010-2024) identified studies developing ML models for 5-year survival prediction. Study quality was assessed using PROBAST. Logit-transformed area under the receiver operating characteristic curve (AUC) estimates were quantitatively synthesised using a random-effects meta-analysis with the restricted maximum likelihood (REML) estimator. Heterogeneity was assessed using Cochran's Q and I2 statistics, publication bias using funnel plots and Egger's regression test, and subgroup analyses according to study characteristics. Statistical analyses were performed using IBM SPSS version 29.0 and R version 4.6.1.

RESULTS

Fifteen studies were included. A wide range of ML models, including Random Forest, Random Survival Forest, and gradient boosting methods, was evaluated. The pooled analysis demonstrated good discriminative performance, with an overall AUC of 0.83 (95% CI: 0.80-0.86). Substantial heterogeneity was observed across studies. Ensemble-based models generally showed consistent performance. Publication bias was detected, and several studies exhibited moderate-to-high risk of bias.

CONCLUSIONS

ML models show strong potential for predicting 5-year breast cancer survival and may support early risk stratification and clinical decision-making. However, greater methodological standardisation, rigorous external validation, and improved reporting are required before widespread clinical implementation.