Integrative Machine Learning Approach for Predicting Resistance to First-generation Receptor Ligands in Acromegaly.

CONTEXT: Acromegaly, caused by excess GH and IGF-1 due to pituitary adenomas, often necessitates first-generation somatostatin receptor ligands (fgSRLs) therapy when surgery fails. However, responses to fgSRLs therapy vary widely.

OBJECTIVE

To develop a machine learning (ML)-based calculator that predicts individual responses to fgSRLs therapy, enabling evidence-based acromegaly management.

DESIGN

A retrospective study (January 2010-July 2024) utilizing the Research Patient Data Registry to evaluate 10 ML algorithms and create a predictive calculator.

SETTING

Single-center study conducted at Mass General Brigham-affiliated hospitals.

PATIENTS: One hundred eleven acromegaly patients met inclusion criteria, classified as fgSRLs-responsive (n = 64) or fgSRLs-resistant (n = 47).

INTERVENTIONS: IGF-1 trajectories were analyzed using linear mixed-effects modeling. Ten ML algorithms were assessed to predict fgSRLs resistance. SHapley Additive exPlanations (SHAP) analysis identified key predictors for the development of a web-based clinical calculator.

MAIN OUTCOME MEASURES: Model performance was primarily evaluated using area under the receiver operating characteristic curve (AUROC), along with accuracy, precision, recall, specificity, F1 score, and decision curve analysis (DCA).

RESULTS

The CatBoost model exhibited optimal performance based on AUROC 0.896 (95% confidence interval: 0.751-0.990), with accuracy 82.4%, precision 86.7%, specificity 88.2%, and F1 score 81.2%. Key predictors of fgSRLs resistance identified via SHAP analysis included pre-fgSRLs treatment GH, Knosp grade, pre-fgSRLs treatment IGF-1 index, T2-weighted magnetic resonance imaging density, and comorbidity burden. The model demonstrated excellent calibration (Brier score 0.131) and clinical utility via DCA. A web-based calculator was developed for clinical use.

CONCLUSION

The CatBoost-based calculator effectively predicts fgSRLs treatment response in acromegaly patients. Prospective validation is required before clinical implementation.