{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:58:54Z","timestamp":1790312334004,"version":"4.1.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":88,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Triple-negative breast cancer (TNBC) patients often ential hypertension, yet how systemic vascular stress synergizes with tumor aggressiveness to drive early recurrence remains poorly understood. A cohort of 549 TNBC patients with comorbid hypertension was analyzed. Fifteen multidimensional clinical and hemodynamic features were extracted. We constructed and compared four machine learning models, employing SHapley Additive exPlanations (SHAP) on the optimal model to decode non-linear interactions. XGBoost demonstrated superior discriminative performance for predicting early recurrence (AUC\u2009=\u20090.840), significantly outperforming logistic regression (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.004). SHAP dependence analysis revealed profound non-linear thresholds, with relapse risk escalating exponentially when systolic blood pressure exceeded 140\u00a0mmHg. Furthermore, SHAP interaction tensors identified a robust synergistic effect between widened pulse pressure and tumor invasiveness (e.g., tumor size and lymphovascular invasion), indicating that arterial stiffness critically exacerbates malignant dissemination. These findings suggest that systemic hemodynamic stress and endothelial injury synergistically amplify the inherent aggressiveness of TNBC. The interpretable XGBoost framework provides a reliable, multidimensional risk stratification tool to guide personalized cardio-oncology management and safely triage low-risk patients.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-59274-4","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T09:35:20Z","timestamp":1782466520000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Interpretable machine learning reveals the synergistic impact of essential hypertension on early recurrence in triple-negative breast cancer"],"prefix":"10.1038","volume":"16","author":[{"given":"Zhenhong","family":"Du","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Tu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingfeng","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"59274_CR1","doi-asserted-by":"publisher","DOI":"10.1002\/advs.201600356","volume":"4","author":"W Tian","year":"2017","unstructured":"Tian, W. et al. Periodic mesoporous organosilica coated prussian blue for MR\/PA dual-modal imaging-guided photothermal-chemotherapy of triple negative breast cancer. Adv. Sci. 4, 1600356 (2017).","journal-title":"Adv. Sci."},{"key":"59274_CR2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23126458","volume":"23","author":"A Wawruszak","year":"2022","unstructured":"Wawruszak, A., Luszczki, J., Okon, E., Czerwonka, A. & Stepulak, A. Antagonistic pharmacological interaction between sirtuin inhibitor cambinol and paclitaxel in triple-negative breast cancer cell lines: An isobolographic analysis. Int. J. Mol. Sci. 23, 6458 (2022).","journal-title":"Int. J. Mol. Sci."},{"key":"59274_CR3","doi-asserted-by":"publisher","first-page":"261","DOI":"10.4048\/jbc.2016.19.3.261","volume":"19","author":"YY Jung","year":"2016","unstructured":"Jung, Y. Y. et al. Histomorphological factors predicting the response to neoadjuvant chemotherapy in triple-negative breast cancer. J. Breast Cancer 19, 261\u2013267 (2016).","journal-title":"J. Breast Cancer"},{"key":"59274_CR4","doi-asserted-by":"publisher","first-page":"691","DOI":"10.20517\/cdr.2022.31","volume":"5","author":"AH Tang","year":"2022","unstructured":"Tang, A. H., Hoefer, R. A., Guye, M. L. & Bear, H. D. Persistent EGFR\/K-RAS\/SIAH pathway activation drives chemo-resistance and early tumor relapse in triple-negative breast cancer. Cancer Drug Resist. 5, 691\u2013702 (2022).","journal-title":"Cancer Drug Resist."},{"key":"59274_CR5","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14030646","volume":"14","author":"S Costantini","year":"2022","unstructured":"Costantini, S. et al. An integrated in silico, in vitro and tumor tissues study identified Selenoprotein S (SELENOS) and Valosin-containing protein (VCP\/p97) as novel potential associated prognostic biomarkers in triple negative breast cancer. Cancers 14, 646 (2022).","journal-title":"Cancers"},{"key":"59274_CR6","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1007\/s40119-021-00217-7","volume":"10","author":"MY Khan","year":"2021","unstructured":"Khan, M. Y. et al. Effectiveness of Telmisartan on blood pressure control in hypertensive patients in India: A real-world retrospective study from electronic medical records. Cardiol. Ther. 10, 255\u2013269 (2021).","journal-title":"Cardiol. Ther."},{"key":"59274_CR7","doi-asserted-by":"publisher","first-page":"273","DOI":"10.2147\/DMSO.S109007","volume":"9","author":"B Omech","year":"2016","unstructured":"Omech, B. et al. Prevalence and determinants of metabolic syndrome: a cross-sectional survey of general medical outpatient clinics using national cholesterol education program-adult treatment panel III criteria in Botswana. Diabetes Metab. Syndr. Obes. 9, 273\u2013279 (2016).","journal-title":"Diabetes Metab. Syndr. Obes."},{"key":"59274_CR8","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s12887-025-05420-2","volume":"25","author":"L Sun","year":"2025","unstructured":"Sun, L. et al. Relationship between platelet distribution width and non-dipping pattern in children with essential hypertension. BMC Pediatr. 25, 54 (2025).","journal-title":"BMC Pediatr."},{"key":"59274_CR9","doi-asserted-by":"publisher","DOI":"10.5306\/wjco.v17.i2.116251","volume":"17","author":"FN Depar","year":"2026","unstructured":"Depar, F. N. et al. Cancer stem cell markers, chemotherapy response, and survival in triple-negative breast cancer. World J. Clin. Oncol. 17, 116251 (2026).","journal-title":"World J. Clin. Oncol."},{"key":"59274_CR10","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s12979-014-0025-5","volume":"11","author":"NA Duggal","year":"2014","unstructured":"Duggal, N. A., Upton, J., Phillips, A. C., Hampson, P. & Lord, J. M. Depressive symptoms post hip fracture in older adults are associated with phenotypic and functional alterations in T cells. Immun. Ageing 11, 25 (2014).","journal-title":"Immun. Ageing"},{"key":"59274_CR11","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1093\/eurpub\/ckae172","volume":"35","author":"J Zhao","year":"2025","unstructured":"Zhao, J., Wen, X., Zheng, M., Su, L. & Guo, X. Causal association of physical activity with lymphoma risk: A Mendelian randomization analysis. Eur. J. Public Health 35, 121\u2013127 (2025).","journal-title":"Eur. J. Public Health"},{"key":"59274_CR12","doi-asserted-by":"publisher","DOI":"10.3389\/fmolb.2020.502573","volume":"7","author":"E Tsirvouli","year":"2020","unstructured":"Tsirvouli, E. et al. A middle-out modeling strategy to extend a colon cancer logical model improves drug synergy predictions in epithelial-derived cancer cell lines. Front. Mol. Biosci. 7, 502573 (2020).","journal-title":"Front. Mol. Biosci."},{"key":"59274_CR13","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1186\/s12859-026-06400-8","volume":"27","author":"A Qureshi","year":"2026","unstructured":"Qureshi, A. et al. DynaBiome: Interpretable unsupervised learning of gut microbiome dysbiosis via temporal deep models. BMC Bioinform. 27, 71 (2026).","journal-title":"BMC Bioinform."},{"key":"59274_CR14","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.71375","volume":"14","author":"A O\u2019Donnell","year":"2025","unstructured":"O\u2019Donnell, A., Cronin, M., Moghaddam, S. & Wolsztynski, E. A systematic review on machine learning techniques for survival analysis in cancer. Cancer Med. 14, e71375 (2025).","journal-title":"Cancer Med."},{"key":"59274_CR15","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s40635-019-0226-5","volume":"7","author":"J Grune","year":"2019","unstructured":"Grune, J., Tabuchi, A. & Kuebler, W. M. Alveolar dynamics during mechanical ventilation in the healthy and injured lung. Intensive Care Med Exp. 7, 34 (2019).","journal-title":"Intensive Care Med Exp."},{"key":"59274_CR16","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1007\/s00384-025-04887-w","volume":"40","author":"Z Zeng","year":"2025","unstructured":"Zeng, Z. et al. Neural influences in colorectal cancer progression and therapeutic strategies. Int J Colorectal Dis. 40, 120 (2025).","journal-title":"Int J Colorectal Dis."},{"key":"59274_CR17","doi-asserted-by":"publisher","first-page":"702","DOI":"10.5306\/wjco.v12.i8.702","volume":"12","author":"GA Valencia","year":"2021","unstructured":"Valencia, G. A. et al. PIK3CA mutation in non-metastatic triple-negative breast cancer as a potential biomarker of early relapse: A case report. World J. Clin. Oncol. 12, 702\u2013711 (2021).","journal-title":"World J. Clin. Oncol."},{"key":"59274_CR18","doi-asserted-by":"publisher","DOI":"10.3332\/ecancer.2023.1512","volume":"17","author":"S Subramaniam","year":"2023","unstructured":"Subramaniam, S. et al. Association between pre-existing cardiometabolic comorbidities and the pathological profiles of breast cancer at initial diagnosis: A cross sectional study. ecancermedicalscience 17, 1512 (2023).","journal-title":"ecancermedicalscience"},{"key":"59274_CR19","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.3390\/jcm14041081","volume":"14","author":"S Ciurescu","year":"2025","unstructured":"Ciurescu, S. et al. The prognostic value of systemic inflammation index in breast cancer: A retrospective study in western Romania. J. Clin. Med. 14, 1081 (2025).","journal-title":"J. Clin. Med."},{"key":"59274_CR20","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1146\/annurev-bioeng-071813-105259","volume":"16","author":"RK Jain","year":"2014","unstructured":"Jain, R. K., Martin, J. D. & Stylianopoulos, T. The role of mechanical forces in tumor growth and therapy. Annu. Rev. Biomed. Eng. 16, 321\u2013346 (2014).","journal-title":"Annu. Rev. Biomed. Eng."},{"key":"59274_CR21","doi-asserted-by":"publisher","first-page":"1386772","DOI":"10.3389\/fonc.2024.1386772","volume":"14","author":"D Yang","year":"2024","unstructured":"Yang, D. et al. Vessel co-option: A unique vascular-immune niche in liver cancer. Front Oncol. 14, 1386772 (2024).","journal-title":"Front Oncol."},{"key":"59274_CR22","doi-asserted-by":"publisher","first-page":"287","DOI":"10.5483\/BMBRep.2023-0031","volume":"56","author":"OH Kim","year":"2023","unstructured":"Kim, O. H., Jeon, T. J., Shin, Y. K. & Lee, H. J. Role of extrinsic physical cues in cancer progression. BMB Rep. 56, 287\u2013295 (2023).","journal-title":"BMB Rep."},{"key":"59274_CR23","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s40885-023-00258-1","volume":"29","author":"HL Kim","year":"2023","unstructured":"Kim, H. L. Arterial stiffness and hypertension. Clin. Hypertens. 29, 31 (2023).","journal-title":"Clin. Hypertens."},{"key":"59274_CR24","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/s12195-021-00706-8","volume":"15","author":"AM Bosworth","year":"2022","unstructured":"Bosworth, A. M. et al. Influence of substrate stiffness on barrier function in an iPSC-derived in vitro blood-brain barrier model. Cell Mol. Bioeng. 15, 31\u201342 (2022).","journal-title":"Cell Mol. Bioeng."},{"key":"59274_CR25","doi-asserted-by":"publisher","first-page":"366","DOI":"10.25083\/rbl\/24.2\/366.373","volume":"24","author":"M Manea","year":"2019","unstructured":"Manea, M. et al. Cardiovascular risk in patients with inflamma-tory bowel diseases: A review. Rom. Biotechnol. Lett. 24, 366\u2013373 (2019).","journal-title":"Rom. Biotechnol. Lett."},{"key":"59274_CR26","doi-asserted-by":"publisher","first-page":"22994","DOI":"10.1021\/acsomega.5c00842","volume":"10","author":"MM Kiyani","year":"2025","unstructured":"Kiyani, M. M. et al. Association of homocysteine with cardiac markers and inflammatory indicators in cardiovascular diseases: A comparative study. ACS Omega 10, 22994\u201323000 (2025).","journal-title":"ACS Omega"},{"key":"59274_CR27","doi-asserted-by":"publisher","first-page":"2291","DOI":"10.1083\/jcb.201804161","volume":"217","author":"A Bansal","year":"2018","unstructured":"Bansal, A. & Simon, M. C. Glutathione metabolism in cancer progression and treatment resistance. J. Cell Biol. 217, 2291\u20132298 (2018).","journal-title":"J. Cell Biol."},{"key":"59274_CR28","doi-asserted-by":"publisher","first-page":"157","DOI":"10.3390\/ijms21010157","volume":"21","author":"S Cassim","year":"2019","unstructured":"Cassim, S. & Pouyssegur, J. Tumor microenvironment: A metabolic player that shapes the immune response. Int. J. Mol. Sci. 21, 157 (2019).","journal-title":"Int. J. Mol. Sci."},{"key":"59274_CR29","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1007\/s12307-019-00226-0","volume":"12","author":"M Rihan","year":"2019","unstructured":"Rihan, M. et al. Pyruvate Kinase M2: A metabolic bug in re-wiring the tumor microenvironment. Cancer Microenviron. 12, 149\u2013167 (2019).","journal-title":"Cancer Microenviron."},{"key":"59274_CR30","doi-asserted-by":"publisher","first-page":"135","DOI":"10.3390\/data8090135","volume":"8","author":"W Wang","year":"2023","unstructured":"Wang, W. & Pai, T.-W. Enhancing small tabular clinical trial dataset through hybrid data augmentation: Combining SMOTE and WCGAN-GP. Data 8, 135 (2023).","journal-title":"Data"},{"key":"59274_CR31","doi-asserted-by":"publisher","first-page":"240","DOI":"10.3390\/ijerph23020240","volume":"23","author":"J Albarracin-Mendez","year":"2026","unstructured":"Albarracin-Mendez, J., Morales-Avilez, D., Arias-Pallaroso, F., Bigoni-Ordonez, G. D. & Gomez-Ayora, A. Factors associated with nutritional status in grassroots recyclers in Ecuador: A machine learning approach. Int. J. Environ. Res. Public Health 23, 240 (2026).","journal-title":"Int. J. Environ. Res. Public Health"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-59274-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-59274-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-59274-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:02:45Z","timestamp":1790308965000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-59274-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["59274"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-59274-4","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,26]]},"assertion":[{"value":"4 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol received formal approval from the Institutional Review Board (IRB) of the First Affiliated Hospital of Chongqing Medical University (Approval No. 2020-202).","order":2,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"29425"}}