{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T08:22:11Z","timestamp":1787732531825,"version":"build-2784847793"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82004365"],"award-info":[{"award-number":["82004365"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007166","name":"Jiangsu Provincial Department of Education","doi-asserted-by":"publisher","award":["SJCX25_1062"],"award-info":[{"award-number":["SJCX25_1062"]}],"id":[{"id":"10.13039\/501100007166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008868","name":"Jiangsu Provincial Department of Science and Technology","doi-asserted-by":"publisher","award":["GCCXZX-2021-YJXM5"],"award-info":[{"award-number":["GCCXZX-2021-YJXM5"]}],"id":[{"id":"10.13039\/501100008868","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study aimed to develop and interpret a machine learning model for predicting postoperative recurrence of anal fistula using routine laboratory indicators and inflammation-related indices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 2,214 patients who underwent fistulectomy were included. Patients from wards 5, 11, 12, 13 and 14 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091,772) were divided by stratified random sampling according to recurrence status into training (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091,242) and testing (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009530) cohorts. Patients from wards 15 and 16 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009442), which were managed by separate clinical teams, were reserved as a ward-based internal validation cohort. Univariate and multiple fistula tracts. analyses were performed to identify recurrence-associated factors, and LASSO regression was used for feature selection. Multiple machine learning models were developed and compared, including logistic regression, support vector machine, GBM, neural network, XGBoost, AdaBoost, LightGBM, and CatBoost. Model performance was assessed using ROC curves, calibration curves, decision curve analysis, and classification metrics. SHAP analysis was applied for model interpretation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Multivariate logistic regression analysis showed that WBC, RBC, hs-CRP, and NCR were independent predictors of recurrence. LASSO regression selected 11 variables for model development. Among the candidate models, GBM demonstrated the most balanced predictive performance and was therefore selected as the final model. The AUCs of GBM in the training, testing, and validation sets were 0.777, 0.784, and 0.712, respectively. Calibration curves showed acceptable agreement between predicted and observed risks, while decision curve analysis indicated potential clinical benefit within low-to-moderate threshold probability ranges. SHAP analysis identified age, WBC, RBC, NCR, and hs-CRP as the main contributors to model prediction. Restricted cubic spline analysis revealed a significant nonlinear association between NCR and recurrence risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>WBC, RBC, hs-CRP, and NCR were independently associated with postoperative recurrence of anal fistula. The LASSO-based GBM model demonstrated stable predictive performance and acceptable clinical utility. Routine hematological parameters and inflammation-related indices, particularly NCR, may support individualized recurrence risk stratification and postoperative follow-up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1911496","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T08:04:42Z","timestamp":1787731482000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of a SHAP-interpretable GBM model for predicting postoperative recurrence of anal Fistula"],"prefix":"10.3389","volume":"13","author":[{"given":"Yunhao","family":"Zhou","sequence":"first","affiliation":[{"name":"Colorectal Disease Center, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine","place":["Nanjing, Jiangsu Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawei","family":"Wang","sequence":"additional","affiliation":[{"name":"Guang\u2019anmen Hospital, China Academy of Chinese Medical Sciences","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Tang","sequence":"additional","affiliation":[{"name":"Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaohua","family":"Huangfu","sequence":"additional","affiliation":[{"name":"Colorectal Disease Center, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine","place":["Nanjing, Jiangsu Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueping","family":"Zheng","sequence":"additional","affiliation":[{"name":"Colorectal Disease Center, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine","place":["Nanjing, Jiangsu Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1111\/codi.16741","article-title":"European Society of coloproctology: guidelines for diagnosis and treatment of cryptoglandular anal fistula","volume":"26","author":"Reza","year":"2024","journal-title":"Colorectal Dis"},{"key":"B2","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/j.suc.2025.08.012","article-title":"Anal abscess and Fistula","volume":"106","author":"Gandhi","year":"2026","journal-title":"Surg Clin North Am"},{"key":"B3","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1186\/s12876-023-02959-1","article-title":"Study on the factors influencing the prognosis after perianal abscess surgery","volume":"23","author":"Dong","year":"2023","journal-title":"BMC Gastroenterol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1007\/s00384-024-04602-1","article-title":"Predictors of recurrence and long-term patient reported outcomes following surgical repair of anal fistula, a retrospective analysis","volume":"39","author":"Khan","year":"2024","journal-title":"Int J Colorectal Dis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"6483","DOI":"10.1038\/s41598-020-63541-3","article-title":"Longterm outcome of anal fistula\u2014a retrospective study","volume":"10","author":"Andreou","year":"2020","journal-title":"Sci Rep"},{"key":"B6","doi-asserted-by":"publisher","first-page":"3327","DOI":"10.2147\/CMAR.S197911","article-title":"The systemic inflammation response index predicts survival and recurrence in patients with resectable pancreatic ductal adenocarcinoma","volume":"11","author":"Li","year":"2019","journal-title":"Cancer Manag Res"},{"key":"B7","doi-asserted-by":"publisher","first-page":"7057","DOI":"10.2147\/JIR.S481515","article-title":"Association between the Aggregate Index of systemic inflammation and clinical outcomes in patients with acute myocardial infarction: a retrospective study","volume":"17","author":"Jiang","year":"2024","journal-title":"J Inflamm Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"415","DOI":"10.14740\/jocmr4227","article-title":"Lymphocyte-to-C-Reactive protein ratio: a novel predictor of adverse outcomes in COVID-19","volume":"12","author":"Ullah","year":"2020","journal-title":"J Clin Med Res"},{"key":"B9","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1007\/s13304-024-02054-4","article-title":"Prospective analysis of preoperative C-reactive protein and neutrophil-to-lymphocyte ratio as predictors of postoperative complications in bile duct injury repair","volume":"77","author":"Martinez-Mier","year":"2025","journal-title":"Updates Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"103023","DOI":"10.1016\/j.eclinm.2024.103023","article-title":"Development and validation of a model to predict cognitive impairment in traumatic brain injury patients: a prospective observational study","volume":"80","author":"Yuan","year":"2025","journal-title":"eClinicalMed"},{"key":"B11","doi-asserted-by":"publisher","first-page":"E208","DOI":"10.1148\/rg.210142","article-title":"Perianal Fistula and abscess: an imaging guide for beginners","volume":"42","author":"Ram\u00edrez Pedraza","year":"2022","journal-title":"Radiographics"},{"key":"B12","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1097\/DCR.0000000000002473","article-title":"The American society of colon and rectal surgeons clinical practice guidelines for the management of anorectal abscess, Fistula-in-ano, and rectovaginal Fistula","volume":"65","author":"Gaertner","year":"2022","journal-title":"Dis Colon Rectum"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1722109","DOI":"10.3389\/fpubh.2025.1722109","article-title":"Postoperative recurrence prediction model for perianal abscess using machine learning algorithms","volume":"13","author":"Wang","year":"2025","journal-title":"Front Public Health"},{"key":"B14","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1016\/j.jss.2025.07.059","article-title":"Can inflammatory Index parameters be an indicator of complexity in perianal Fistula?","volume":"314","author":"Celik","year":"2025","journal-title":"J Surg Res"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1586","DOI":"10.12998\/wjcc.v8.i9.1586","article-title":"Recurrent anal fistulas: when, why, and how to manage?","volume":"8","author":"Emile","year":"2020","journal-title":"World J Clin Cases"},{"key":"B16","doi-asserted-by":"publisher","first-page":"6212","DOI":"10.1158\/1078-0432.CCR-14-0442","article-title":"Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma","volume":"20","author":"Hu","year":"2014","journal-title":"Clin Cancer Res"},{"key":"B17","doi-asserted-by":"publisher","first-page":"2158","DOI":"10.1002\/cncr.30057","article-title":"A novel systemic inflammation response index (SIRI) for predicting the survival of patients with pancreatic cancer after chemotherapy","volume":"122","author":"Qi","year":"2016","journal-title":"Cancer"},{"key":"B18","doi-asserted-by":"publisher","first-page":"4134","DOI":"10.3390\/jcm10184134","article-title":"The Aggregate Index of systemic inflammation (AISI): a novel prognostic biomarker in idiopathic pulmonary fibrosis","volume":"10","author":"Zinellu","year":"2021","journal-title":"J Clin Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"72","DOI":"10.4174\/astr.2022.103.2.72","article-title":"Preoperative lymphocyte-to-C-reactive protein ratio predicts hepatocellular carcinoma recurrence after surgery","volume":"103","author":"Utsumi","year":"2022","journal-title":"Ann Surg Treat Res"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e91123","DOI":"10.7759\/cureus.91123","article-title":"Prognostic value of C-reactive protein and neutrophil-to-lymphocyte ratio in predicting postoperative infections after gastrointestinal surgery: a meta-analysis","volume":"17","author":"Shaukat","year":"2025","journal-title":"Cureus"},{"key":"B21","doi-asserted-by":"publisher","first-page":"481","DOI":"10.24875\/CIRU.22000544","article-title":"Preoperative neutrophil-to-C-reactive protein ratio as a predictor of post-operative complications of pancreas cancer","volume":"92","author":"Eyvaz","year":"2024","journal-title":"Cir Cir"},{"key":"B22","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1186\/s12876-023-02963-5","article-title":"A magnetic resonance imaging-based decision-making tool for predicting complex anal fistulas healing in the early postoperative period","volume":"23","author":"Xu","year":"2023","journal-title":"BMC Gastroenterol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"490","DOI":"10.3393\/ac.2022.00346.0049","article-title":"Garg scoring system to predict long-term healing in cryptoglandular anal fistulas: a prospective validation study","volume":"40","author":"Dawka","year":"2024","journal-title":"Ann Coloproctol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e1354","DOI":"10.1002\/hsr2.1354","article-title":"Predictors of outcome in cryptoglandular anal fistula according to magnetic resonance imaging: a systematic review","volume":"6","author":"Teymouri","year":"2023","journal-title":"Health Sci Rep"},{"key":"B25","doi-asserted-by":"publisher","first-page":"321","DOI":"10.5152\/dir.2018.18340","article-title":"The contribution of preoperative MRI to the surgical management of anal fistulas","volume":"24","author":"Konan","year":"2018","journal-title":"Diagn Interv Radiol"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1911496\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T08:04:44Z","timestamp":1787731484000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1911496\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":25,"alternative-id":["10.3389\/fsurg.2026.1911496"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1911496","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]},"article-number":"1911496"}}