Evaluating treatment strategies and machine learning based treatment recommendation system for elderly patients with high grade gliomas

Background When selecting treatment strategies, elderly high-grade glioma (eHGG) patients face challenges due to aging, comorbidities, surgical complications, and limited tolerance for intensive treatments. This study aims to evaluate the benefit of treatment strategies and develop a treatment recommendation system for eHGG patients. Methods By propensity score matching and survival analysis, we compared the prognosis of treatment strategies, including surgery versus none, adjuvant therapies versus none, and gross total resection (GTR) versus subtotal resection (STR), among patients aged 65 and older with high-grade gliomas. A machine learning model, random survival forest, was developed to provide predictions on prognosis. The machine learning model was then used to create a personalized treatment recommendation system. An independent validation cohort was obtained from the First Affiliated Hospital of Chongqing Medical University to validate the machine learning model and the treatment recommendation system. The time-dependent AUC (tdAUC), C-index, and integrated Brier score (IBS) in the testing sets were obtained. Results Compared to the surgery-alone group, patients who received surgery plus adjuvant therapy had significantly better overall survival. Surgery plus adjuvant therapy improved survival compared to adjuvant therapy alone. Additionally, GTR combined with adjuvant therapy showed superior overall survival compared to STR with adjuvant therapy. Subgroup analysis indicated that patients with GBM, tumor size >3 cm, localized stage, white race, Grade IV tumors, and those aged 65–72 had better survival outcomes with GTR and adjuvant therapy. The C-index, tdAUC, and 1-IBS values for the external testing cohort were 0.813, 0.876, and 0.893. We successfully developed a web-based treatment recommendation system at https://gliomas.shinyapps.io/EHGG/ . This system allows users to input patient-specific features and obtain individualized treatment recommendations and detailed survival probabilities. Conclusion Aggressive treatment, including GTR and adjuvant therapy, can enhance survival outcomes in elderly patients with high-grade gliomas. The machine learning-based personalized treatment recommendation system presents a promising reference tool for treatment decisions.