{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T08:02:09Z","timestamp":1791446529572,"version":"4.3.3"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100015285","name":"Hebei Province Medical Science Research Key Project","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100015285","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The presence of lymph node metastasis (LNM) serves as a critical determinant of prognosis in colorectal cancer (CRC), often correlating with markedly unfavorable clinical outcomes. Consequently, this investigation sought to construct and rigorously validate a machine learning (ML) algorithm capable of estimating LNM probability within the CRC population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Through the application of logistic regression analysis, six independent predictors were identified: extramural vascular invasion (EMVI), T stage, fibrinogen (FIB), systolic blood pressure (SBP), thrombin time (TT), and alpha-fucosidase (AFU). Subsequently, diverse ML architectures were generated and assessed utilizing receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the evaluated algorithms, the stochastic gradient boosting (gbm) model exhibited superior discriminatory power, yielding area under the curve (AUC) metrics of 0.815 in the training cohort and 0.733 in the external validation set. Calibration assessments revealed a robust concordance between projected probabilities and actual observed events. Notably, the xgbTree algorithm also demonstrated commendable predictive efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We successfully established and verified an ML-based framework designed to forecast LNM risk in individuals with CRC. These computational tools offer clinicians a refined mechanism for the precise identification of nodal involvement, thereby laying the groundwork for formulating personalized therapeutic regimens.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1860520","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T04:20:14Z","timestamp":1784607614000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Machine learning to develop and validate a model for predicting the risk of lymph node metastasis in colorectal cancer patients"],"prefix":"10.3389","volume":"16","author":[{"given":"Changhe","family":"Xia","sequence":"first","affiliation":[{"name":"Department of Proctology, Qinhuangdao First Hospital","place":["Qinhuangdao, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Physical Examination Center, Qinhuangdao First Hospital","place":["Qinhuangdao, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changjiang","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Tangshan People\u2019s Hospital","place":["Tangshan, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yimin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Qinhuangdao First Hospital","place":["Qinhuangdao, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohong","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Qinhuangdao First Hospital","place":["Qinhuangdao, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhanxue","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feifei","family":"Wang","sequence":"additional","affiliation":[{"name":"The Second Department of General Surgery, The Fourth Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaoxi","family":"Zhou","sequence":"additional","affiliation":[{"name":"The Second Department of General Surgery, The Fourth Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guiying","family":"Wang","sequence":"additional","affiliation":[{"name":"The Second Department of General Surgery, The Fourth Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]},{"name":"Department of General Surgery, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]},{"name":"Hebei Key Laboratory of Etiology Tracing and Individualized Diagnosis and Treatment for Digestive system carcinoma, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.6027","article-title":"Diagnosis and treatment of metastatic colorectal cancer: a review","volume":"325","author":"Biller","year":"2021","journal-title":"JAMA"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.32604\/or.2023.028657","article-title":"Macrophage-derived SHP-2 inhibits the metastasis of colorectal cancer via Tie2-PI3K signals","volume":"31","author":"Wu","year":"2023","journal-title":"Oncol Res"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3389\/fcell.2020.00812","article-title":"MicroRNA: another pharmacological avenue for colorectal cancer","volume":"8","author":"Wu","year":"2020","journal-title":"Front Cell Dev Biol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpg.2023.101839","article-title":"Colorectal cancer: a health and economic problem","volume":"66","author":"Klimeck","year":"2023","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2021.03.213","article-title":"Deep submucosal invasion is not an independent risk factor for lymph node metastasis in T1 colorectal cancer: a meta-analysis","volume":"163","author":"Zwager","year":"2022","journal-title":"Gastroenterology"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.soc.2017.11.011","article-title":"Lymph node metastasis in colorectal cancer","volume":"27","author":"Jin","year":"2018","journal-title":"Surg Oncol Clin N Am"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.14702","article-title":"Treatment of locally advanced rectal cancer in the era of total neoadjuvant therapy: a systematic review and network meta-analysis","volume":"7","author":"Turri","year":"2024","journal-title":"JAMA Netw Open"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fcell.2021.781824","article-title":"Nomograms involving HER2 for predicting lymph node metastasis in early gastric cancer","volume":"9","author":"Mei","year":"2021","journal-title":"Front Cell Dev Biol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000002879","article-title":"Long-term outcomes of additional surgery after endoscopic resection versus primary surgery for T1 colorectal cancer","volume":"119","author":"Tamaru","year":"2024","journal-title":"Am J Gastroenterol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.jncc.2024.02.001","article-title":"The development and implementation of pathological parameters and molecular testing impact prognosis of colorectal adenocarcinoma","volume":"4","author":"Xu","year":"2024","journal-title":"J Natl Cancer Cent"},{"key":"B11","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1186\/s12885-022-09390-x","article-title":"Log odds of positive lymph nodes as a novel prognostic predictor for colorectal cancer: a systematic review and meta-analysis","volume":"22","author":"Li","year":"2022","journal-title":"BMC Cancer"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3109\/00365521.2011.574732","article-title":"Diagnostic accuracy of computed tomography for colon cancer staging: a systematic review","volume":"46","author":"Leufkens","year":"2011","journal-title":"Scand J Gastroenterol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.crad.2010.01.024","article-title":"Diagnostic precision of CT in local staging of colon cancers: a meta-analysis","volume":"65","author":"Dighe","year":"2010","journal-title":"Clin Radiol"},{"key":"B14","article-title":"Serum angiopoietin-like protein 2 improves preoperative detection of lymph node metastasis in colorectal cancer","volume":"35","author":"Toiyama","year":"2015","journal-title":"Anticancer Res"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2004.04.022","article-title":"Risk factors for an adverse outcome in early invasive colorectal carcinoma","volume":"127","author":"Ueno","year":"2004","journal-title":"Gastroenterology"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1097\/dcr.0000000000000168","article-title":"Predictors of lymph node metastasis in T1 colorectal carcinoma: an immunophenotypic analysis of 265 patients","volume":"57","author":"Nishida","year":"2014","journal-title":"Dis Colon Rectum"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.8766","article-title":"Predictive microRNAs for lymph node metastasis in endoscopically resectable submucosal colorectal cancer","volume":"7","author":"Jung","year":"2016","journal-title":"Oncotarget"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2023.01.035","article-title":"From patterns to patients: advances in clinical machine learning for cancer diagnosis, prognosis, and treatment","volume":"186","author":"Swanson","year":"2023","journal-title":"Cell"},{"key":"B19","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1186\/s13073-021-00968-x","article-title":"Deep learning in cancer diagnosis, prognosis and treatment selection","volume":"13","author":"Tran","year":"2021","journal-title":"Genome Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1655","DOI":"10.1016\/j.jamda.2022.06.020","article-title":"Machine learning-based prediction models for delirium: a systematic review and meta-analysis","volume":"23","author":"Xie","year":"2022","journal-title":"J Am Med Dir Assoc"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1111\/jcmm.18394","article-title":"Prognostic value of CDKN2A in head and neck squamous cell carcinoma via pathomics and machine learning","volume":"28","author":"Wang","year":"2024","journal-title":"J Cell Mol Med"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1002\/mp.13678","article-title":"Machine and deep learning methods for radiomics","volume":"47","author":"Avanzo","year":"2020","journal-title":"Med Phys"},{"key":"B23","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1038\/s41580-021-00407-0","article-title":"A guide to machine learning for biologists","volume":"23","author":"Greener","year":"2022","journal-title":"Nat Rev Mol Cell Biol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1056\/nejmra1814259","article-title":"Machine learning in medicine","volume":"380","author":"Rajkomar","year":"2019","journal-title":"N Engl J Med"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1097\/pas.0000000000000931","article-title":"Tumor budding and PDC grade are stage independent predictors of clinical outcome in mismatch repair deficient colorectal cancer","volume":"42","author":"Ryan","year":"2018","journal-title":"Am J Surg Pathol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5917","article-title":"Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer","volume":"95","author":"Smith","year":"2008","journal-title":"Br J Surg"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21388","article-title":"The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more \"personalized\" approach to cancer staging","volume":"67","author":"Amin","year":"2017","journal-title":"CA Cancer J Clin"},{"key":"B28","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s40644-015-0051-3","article-title":"Approximation of head and neck cancer volumes in contrast enhanced CT","volume":"15","author":"Dejaco","year":"2015","journal-title":"Cancer Imaging"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1111\/joim.12822","article-title":"eDoctor: machine learning and the future of medicine","volume":"284","author":"Handelman","year":"2018","journal-title":"J Intern Med"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.beth.2020.05.002","article-title":"Supervised machine learning: a brief primer","volume":"51","author":"Jiang","year":"2020","journal-title":"Behav Ther"},{"key":"B31","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1146\/annurev-clinpsy-032816-045037","article-title":"Machine learning approaches for clinical psychology and psychiatry","volume":"14","author":"Dwyer","year":"2018","journal-title":"Annu Rev Clin Psychol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1097\/ede.0b013e3181c30fb2","article-title":"Assessing the performance of prediction models: a framework for traditional and novel measures","volume":"21","author":"Steyerberg","year":"2010","journal-title":"Epidemiology"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1177\/0272989x06295361","article-title":"Decision curve analysis: a novel method for evaluating prediction models","volume":"26","author":"Vickers","year":"2006","journal-title":"Med Decis Making"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-021-02464-3","article-title":"Combination of extramural venous invasion and lateral lymph node size detected with magnetic resonance imaging is a reliable biomarker for lateral lymph node metastasis in patients with rectal cancer","volume":"20","author":"Abe","year":"2022","journal-title":"World J Surg Oncol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/j.clcc.2022.10.005","article-title":"Pathologic implications of magnetic resonance imaging-detected extramural venous invasion of rectal cancer","volume":"22","author":"Lee","year":"2023","journal-title":"Clin Colorectal Cancer"},{"key":"B36","doi-asserted-by":"publisher","first-page":"651","DOI":"10.21037\/atm-20-7565","article-title":"Development and validation of a collagen signature-based nomogram for preoperatively predicting lymph node metastasis and prognosis in colorectal cancer","volume":"9","author":"Fu","year":"2021","journal-title":"Ann Transl Med"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1007\/s13304-024-01884-6","article-title":"Predicting lymph node metastasis in colorectal cancer patients: development and validation of a column chart model","volume":"76","author":"Niu","year":"2024","journal-title":"Updates Surg"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1002\/ctm2.30","article-title":"Development and external validation of a predictive scoring system associated with metastasis of T1-2 colorectal tumors to lymph nodes","volume":"10","author":"Mo","year":"2020","journal-title":"Clin Transl Med"},{"key":"B39","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1007\/s10151-024-03010-5","article-title":"A nomogram of inflammatory indexes for preoperatively predicting the risk of lymph node metastasis in colorectal cancer","volume":"28","author":"Wen","year":"2024","journal-title":"Tech Coloproctol"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.12659\/msm.942658","article-title":"Prognostic assessment of colorectal cancer patients after laparoscopic surgery: a comprehensive evaluation of the Glasgow prognostic score and fibrinogen-to-prealbumin ratio","volume":"30","author":"Liu","year":"2024","journal-title":"Med Sci Monit"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-009-9992-7","article-title":"Effect of preoperative hyperfibrinogenemia on recurrence of colorectal cancer without a systemic inflammatory response","volume":"33","author":"Yamashita","year":"2009","journal-title":"World J Surg"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2009.03680.x","article-title":"High platelet count associated with venous thromboembolism in cancer patients: results from the Vienna Cancer and Thrombosis Study (CATS)","volume":"8","author":"Simanek","year":"2010","journal-title":"J Thromb Haemost"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.2174\/1381612827666211011113308","article-title":"The potential therapeutic value of renin-angiotensin system inhibitors in the treatment of colorectal cancer","volume":"28","author":"Tabatabai","year":"2022","journal-title":"Curr Pharm Des"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6603098","article-title":"Thrombomodulin expression in colorectal carcinoma is protective and correlates with survival","volume":"94","author":"Hanly","year":"2006","journal-title":"Br J Cancer"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1159\/000012188","article-title":"Value of the serum alpha-L-fucosidase activity in the diagnosis of colorectal cancer","volume":"59","author":"Ayude","year":"2000","journal-title":"Oncology"},{"key":"B46","article-title":"Alpha-L-fucosidase enzyme in the prediction of colorectal cancer patients at high risk of tumor recurrence","volume":"24","author":"Fern\u00e1ndez-Rodr\u00edguez","year":"2000","journal-title":"Cancer Detect Prev"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1155\/2004\/834309","article-title":"Clinical interest of the combined use of serum CD26 and alpha-L-fucosidase in the early diagnosis of colorectal cancer","volume":"19","author":"Ayude","year":"2003","journal-title":"Dis Markers"},{"key":"B48","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/s41512-024-00177-1","article-title":"Understanding overfitting in random forest for probability estimation: a visualization and simulation study","volume":"8","author":"Barre\u00f1ada","year":"2024","journal-title":"Diagn Progn Res"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.4240\/wjgs.v15.i10.2234","article-title":"Predicting lymph node metastasis in colorectal cancer: an analysis of influencing factors to develop a risk model","volume":"15","author":"Lei","year":"2023","journal-title":"World J Gastrointest Surg"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.2147\/cmar.s337516","article-title":"Supervised learning based systemic inflammatory markers enable accurate additional surgery for pT1NxM0 colorectal cancer: a comparative analysis of two practical prediction models for lymph node metastasis","volume":"13","author":"Jin","year":"2021","journal-title":"Cancer Manag Res"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1860520\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T04:20:15Z","timestamp":1784607615000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1860520\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":50,"alternative-id":["10.3389\/fonc.2026.1860520"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1860520","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]},"article-number":"1860520"}}