{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T10:34:27Z","timestamp":1777890867239,"version":"3.51.4"},"reference-count":50,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endoscopic bile duct drainage is crucial for improving the survival and quality of life in patients with malignant biliary obstruction (MBO). This study aimed to identify key factors that affect postoperative survival in patients with MBO, develop a predictive model, and validate the performance of the model using external data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were retrospectively collected from The First Hospital of Jiaxing (between 2013 and 2021), The Second Hospital of Jiaxing (between 2014 and 2021), and Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine (between 2014 and 2021). Patient demographics, disease characteristics, and laboratory results of 337 patients were analyzed. Various machine learning models, including the gradient boosted survival tree, extreme gradient boosting (XGBoost), XGBoost accelerated failure time (XGBoost AFT), random survival forests, and Cox proportional hazards regression, were used. The model performance was assessed using the concordance index (C\u2010index), and SHapley Additive exPlanations (SHAP) values were used to interpret the model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The XGBoost AFT model exhibited the best performance, with C\u2010index values of 0.902, 0.722, and 0.705 for the training cohort, test cohort 1, and test cohort 2, respectively. The SHAP analysis revealed that distant metastasis, high total bilirubin level, prolonged prothrombin time, and high\u2010level obstruction significantly impacted survival. A Kaplan\u2013Meier survival analysis demonstrated that the model effectively stratified patients into the high\u2010risk and low\u2010risk groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study provides a robust model that can predict the postoperative survival in patients with MBO. This model was validated using external data, and the results offer valuable guidance for postoperative management and personalized treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71692","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T16:26:53Z","timestamp":1772987213000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predicting Postoperative Survival in Patients With Malignant Biliary Obstruction Using an Interpretable Machine Learning Model: A Multicenter Study"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9792-7018","authenticated-orcid":false,"given":"Zongdong","family":"Zhu","sequence":"first","affiliation":[{"name":"Zunyi Medical University  Zunyi Guizhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2789-8818","authenticated-orcid":false,"given":"Chenyang","family":"Bian","sequence":"additional","affiliation":[{"name":"Jiaxing University Master Degree Cultivation Base Zhejiang Chinese Medical University  Jiaxing Zhejiang China"},{"name":"Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University  Jiaxing Zhejiang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linjing","family":"Zhao","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine Shaanxi University of Traditional Chinese Medicine  Xianyang Shaanxi China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weiwei","family":"Li","sequence":"additional","affiliation":[{"name":"The Second Hospital of Jiaxing  Jiaxing Zhejiang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaixin","family":"Hu","sequence":"additional","affiliation":[{"name":"Jiaxing University Master Degree Cultivation Base Zhejiang Chinese Medical University  Jiaxing Zhejiang China"},{"name":"Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University  Jiaxing Zhejiang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5944-9879","authenticated-orcid":false,"given":"Qinggao","family":"Song","sequence":"additional","affiliation":[{"name":"Zunyi Medical University  Zunyi Guizhou China"},{"name":"Hospital of Stomatology Zunyi Medical University  Zunyi Guizhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huangbao","family":"Li","sequence":"additional","affiliation":[{"name":"Jiaxing University Master Degree Cultivation Base Zhejiang Chinese Medical University  Jiaxing Zhejiang China"},{"name":"Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University  Jiaxing Zhejiang China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15020490"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.4103\/EUS-D-21-00206"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.14186"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00534-007-1282-x"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(02)70356-8"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14164038"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.922386"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-023-02704-8"},{"issue":"6","key":"e_1_2_14_10_1","first-page":"7400","article-title":"The Clinical Efficacy and Safety of Different Biliary Drainages in Malignant Obstructive Jaundice Treatment","volume":"13","author":"Bao G.","year":"2021","journal-title":"American Journal of Translational Research"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15112988"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.12729"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2008.04.005"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12029-013-9509-3"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinre.2012.12.002"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgast-2014-000014"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-023-02158-5"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464\u2010022\u201009698\u20106"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41416-021-01689-z"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xcrm.2024.101506"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-024-12146-4"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1158\/2159-8290.CD-23-1199"},{"key":"e_1_2_14_23_1","doi-asserted-by":"crossref","unstructured":"C.Rudin \u201cStop Explaining Black Box Machine Learning Models for High Stakes Decisions and Use Interpretable Models Instead \u201d1 no.5(2019):206\u2013215 https:\/\/doi.org\/10.48550\/arXiv.1811.10154.","DOI":"10.1038\/s42256-019-0048-x"},{"issue":"5","key":"e_1_2_14_24_1","first-page":"6785","article-title":"Attend and Predict: Understanding Gene Regulation by Selective Attention on Chromatin","volume":"30","author":"Singh R.","year":"2017","journal-title":"Adv Neural Inf Process Syst"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/bib\/bbab315"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/JS9.0000000000000881"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.4236\/jcc.2024.1211004"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.1080\/00223891.2018.1530680"},{"key":"e_1_2_14_29_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1982.03320430047030"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2022.106954"},{"key":"e_1_2_14_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2021.104813"},{"key":"e_1_2_14_32_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41698-023-00494-6"},{"key":"e_1_2_14_33_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15030625"},{"key":"e_1_2_14_34_1","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.120.251520"},{"issue":"4","key":"e_1_2_14_35_1","first-page":"571","article-title":"Management and Outcome of Jaundice Secondary to Malignancies of the Gall Bladder, Biliary Tree and Pancreas: A Single Centre Experience","volume":"30","author":"Salim A.","year":"2018","journal-title":"Journal of Ayub Medical College, Abbottabad"},{"issue":"67","key":"e_1_2_14_36_1","first-page":"21","article-title":"Predictive Factors for Survival in Patients With Inoperable Klatskin Tumors","volume":"53","author":"Arvanitakis M.","year":"2006","journal-title":"Hepato\u2010Gastroenterology"},{"key":"e_1_2_14_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2016.02.035"},{"key":"e_1_2_14_38_1","doi-asserted-by":"publisher","DOI":"10.4240\/wjgs.v16.i12.3650"},{"key":"e_1_2_14_39_1","doi-asserted-by":"publisher","DOI":"10.5114\/jcb.2022.123974"},{"key":"e_1_2_14_40_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13247731"},{"issue":"1","key":"e_1_2_14_41_1","first-page":"22","article-title":"Prognostic Factors of Mortality in the Malignant Biliary Obstruction Unresectable After the Insertion of an Endoscopic Stent","volume":"71","author":"Hern\u00e1ndez Guerrero A.","year":"2006","journal-title":"Revista de Gastroenterologia de Mexico"},{"key":"e_1_2_14_42_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23454"},{"key":"e_1_2_14_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpb.2018.06.1803"},{"key":"e_1_2_14_44_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-51304-3"},{"key":"e_1_2_14_45_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-024-12303-9"},{"key":"e_1_2_14_46_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12539-023-00569-9"},{"key":"e_1_2_14_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2022.104896"},{"key":"e_1_2_14_48_1","doi-asserted-by":"crossref","DOI":"10.1177\/17562848251359006","article-title":"Current Status and Further Directions of Endoscopic Ultrasound\u2010Directed Transgastric ERCP and Endoscopic Ultrasound\u2010Directed Transenteric ERCP in the Management of Pancreaticobiliary Diseases in Surgically Altered Anatomy: A Comprehensive Review","volume":"18","author":"Dell'Anna G.","year":"2025","journal-title":"Therapeutic Advances in Gastroenterology"},{"key":"e_1_2_14_49_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers16203457"},{"issue":"3","key":"e_1_2_14_50_1","first-page":"291","article-title":"Endoscopic Management of Malignant Biliary Obstructions","volume":"37","author":"Binda C.","year":"2024","journal-title":"Annals of Gastroenterology"},{"key":"e_1_2_14_51_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-1717-1391"}],"container-title":["Cancer Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.71692","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cam4.71692","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.71692","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T05:47:56Z","timestamp":1777614476000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cam4.71692"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":50,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1002\/cam4.71692"],"URL":"https:\/\/doi.org\/10.1002\/cam4.71692","archive":["Portico"],"relation":{},"ISSN":["2045-7634","2045-7634"],"issn-type":[{"value":"2045-7634","type":"print"},{"value":"2045-7634","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"2025-02-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71692"}}