Purpose Machine learning (ML) is a strong candidate for making accurate predictions, as we can use large amount of data with powerful computational algorithms. We developed a ML based model to predict survival of patients with colorectal cancer (CRC) using data from two independent datasets.
Materials and Methods A total of 364,316 and 1,572 CRC patients were included from the Surveillance, Epidemiology, and End Results (SEER) and a Korean dataset, respectively. As SEER combines data from 18 cancer registries, internal validation was done using 18-Fold-Cross-Validation then external validation was performed by testing the trained model on the Korean dataset. Performance was evaluated using area under the receiver operating characteristic curve (AUROC), sensitivity and positive predictive values.
Results Clinicopathological characteristics were significantly different between the two datasets and the SEER showed a significant lower 5-year survival rate compared to the Korean dataset (60.1% vs. 75.3%, p < 0.001). The ML-based model using the Light gradient boosting algorithm achieved a better performance in predicting 5-year-survival compared to American Joint Committee on Cancer stage (AUROC, 0.804 vs. 0.736; p < 0.001). The most important features which influenced model performance were age, number of examined lymph nodes, and tumor size. Sensitivity and positive predictive values of predicting 5-year-survival for classes including dead or alive were reported as 68.14%, 77.51% and 49.88%, 88.1% respectively in the validation set. Survival probability can be checked using the web-based survival predictor (http://colorectalcancer.pythonanywhere.com).
Conclusion ML-based model achieved a much better performance compared to staging in individualized estimation of survival of patients with CRC.
Citations
Citations to this article as recorded by
Explainable AI for colorectal cancer mortality and risk factor prediction in Korea: A nationwide cancer cohort study Sang Won Park, Na Young Yeo, Tae-Hoon Kim, Myoung Nam Lim, Inhyeok Yim, Oh Beom Kwon, Seung-Joo Nam, Hui-Young Lee, Woo Jin Kim International Journal of Medical Informatics.2026; 205: 106125. CrossRef
A clinical visualization model for predicting distant metastasis and prognostic outcomes in mucinous adenocarcinoma of the appendix: a SEER database study Xiaoming Xu, Hualei Chen, Jingzhi Wang Expert Review of Anticancer Therapy.2026; 26(1): 131. CrossRef
Predicting Postresection Colorectal Liver Metastases Recurrence Using Advanced Graph Neural Networks with Explainability and Causal Inference Jubair Ahmed, Md. Abdur Rahman, Mohaimenul Azam Khan Raiaan, Sami Azam Advanced Intelligent Systems.2026;[Epub] CrossRef
Artificial Intelligence Remote Patient Monitoring for Predicting Overall Survival for Patients Undergoing Radical Cystectomy for Bladder Cancer: Exploratory Analysis of the Prospective Trial Yansong Liu, Pramit Khetrapal, Ronnie Strafford, Adamos Hadjivasilou, Nikhil Vasdev, Philip Charlesworth, Muhamaad Shamim Khan, Ahmed Abdulaal, Zhaoyan Dong, James W F Catto, Yukun Zhou, John D Kelly, Ivana Drobnjak JMIR AI.2026; 5: e68994. CrossRef
A Hybrid Deep and Machine Learning Framework with Feature Selection for Automated Classification of Acute Lymphoblastic Leukemia Husne Farah, Fahmida Islam, Shuvo Biswas, Mohammad Shorif Uddin Journal of Computer and Communications.2026; 14(03): 278. CrossRef
AI Trustworthiness in the Perioperative Period for Patients with Serious Illness: Scoping Narrative Review Bhagvat J Maheta, Rachel L Ross, Isabella Raspi, Christina Keny, Marti N Okech, Selen Bozkurt, Karleen F Giannitrapani JMIR Perioperative Medicine.2026; 9: e89936. CrossRef
Development and validation of a biomarker-based prediction model for metastasis in patients with colorectal cancer: Application of machine learning algorithms Erfan Ayubi, Sajjad Farashi, Leili Tapak, Saeid Afshar Heliyon.2025; 11(1): e41443. CrossRef
Predicting Factors Affecting Survival Rate in Patients Undergoing On‐Pump Coronary Artery Bypass Graft Surgery Using Machine Learning Methods: A Systematic Review Alireza Jafarkhani, Behzad Imani, Soheila Saeedi, Amir Shams Health Science Reports.2025;[Epub] CrossRef
Externally validated and clinically useful machine learning algorithms to support patient-related decision-making in oncology: a scoping review Catarina Sousa Santos, Mário Amorim-Lopes BMC Medical Research Methodology.2025;[Epub] CrossRef
Personalized surveillance in colorectal cancer: Integrating circulating tumor DNA and artificial intelligence into post-treatment follow-up Ionut Negoi World Journal of Gastroenterology.2025;[Epub] CrossRef
Association of sarcopenia with all-cause and cause-specific mortality in cancer patients: development and validation of a 3-year and 5-year survival prediction model Feng Cui, Xiangji Dang, Daiyun Peng, Yuanhua She, Yubin Wang, Ruifeng Yang, Zhiyao Han, Yan Liu, Hanteng Yang BMC Cancer.2025;[Epub] CrossRef
Interpretable machine learning models based on body composition and inflammatory nutritional index (BCINI) to predict early postoperative recurrence of colorectal cancer: Multi-center study Yongjie Zhou, Jinhong Zhao, Fei Zou, Yongming Tan, Wei Zeng, Jiahui Jiang, Jiale Hu, Qiao Zeng, Lianggeng Gong, Lan Liu, Linhua Zhong Computer Methods and Programs in Biomedicine.2025; 269: 108874. CrossRef
Leveraging automated machine learning to predict colon cancer prognosis from clinical features and risk groups: a retrospective cohort study Jakob Woerner, Yonghyun Nam, Sang-Hyuk Jung, Manu Shivakumar, Matthew Lee, Eun Kyung Choe, Min Jung Kim, Rumi Shin, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park, Sung Chan Park, Dae Kyung Sohn, Jae Hwan Oh, Dokyoon Kim, Ji Won Park European Journal of Surgical Oncology.2025; 51(9): 110194. CrossRef
Integrating inflammation, nutrition, and artificial intelligence: A new era in colorectal cancer prognostic scoring Semra Demirli Atici, Aras Emre Canda, Mustafa Cem Terzi World Journal of Gastroenterology.2025;[Epub] CrossRef
Artificial intelligence for predicting long-term outcomes in patients with colorectal cancer (a systematic review and meta-analysis) R. Sh. Abdulaeva, V. I. Pavlova, T. G. Gevorkyan, Y. V. Belenkaya, M. Sh. Manukyan, S. S. Gordeev Koloproktologia.2025; 24(4): 125. CrossRef
New perspectives on cancer clinical research in the era of big data and machine learning Shujun Li, Hang Yi, Qihao Leng, You Wu, Yousheng Mao Surgical Oncology.2024; 52: 102009. CrossRef
SAGL: A self-attention-based graph learning framework for predicting survival of colorectal cancer patients Ping Yang, Hang Qiu, Xulin Yang, Liya Wang, Xiaodong Wang Computer Methods and Programs in Biomedicine.2024; 249: 108159. CrossRef
The development and validation of automated machine learning models for predicting lymph node metastasis in Siewert type II T1 adenocarcinoma of the esophagogastric junction Chenghao Lu, Lu Liu, Minyue Yin, Jiaxi Lin, Shiqi Zhu, Jingwen Gao, Shuting Qu, Guoting Xu, Lihe Liu, Jinzhou Zhu, Chunfang Xu Frontiers in Medicine.2024;[Epub] CrossRef
Machine learning for predicting colon cancer recurrence Erkan Kayikcioglu, Arif Hakan Onder, Burcu Bacak, Tekin Ahmet Serel Surgical Oncology.2024; 54: 102079. CrossRef
Precision prognosis of colorectal cancer: a multi-tiered model integrating microsatellite instability genes and clinical parameters Yonghong Wang, Ke Liu, Wanbin He, Jie Dan, Mingjie Zhu, Lei Chen, Wenjie Zhou, Ming Li, Jiangpeng Li Frontiers in Oncology.2024;[Epub] CrossRef
Light gradient boost tree classifier predictions on appendicitis with periodontal disease from biochemical and clinical parameters Pradeep Kumar Yadalam, Prathiksha Vedhavalli Thirukkumaran, Prabhu Manickam Natarajan, Carlos M. Ardila Frontiers in Oral Health.2024;[Epub] CrossRef
Enhanced prediction of preoperative mesenteric lymph node metastasis in colorectal cancer using machine learning with CT‐based data Lanni Zhou, Lizhu Ouyang, Baoliang Guo, Xiyi Huang, Shaomin Yang, Jialing Pan, Liwen Wang, Ming Chen, Fan Xie, Yunjing Li, Yongxing Du, Xinjie Chen, Qiugen Hu, Fusheng Ouyang MedComm – Future Medicine.2024;[Epub] CrossRef
An interactive web-based tool for predicting and exploring brain cancer survivability Gopal Nath, Austin Coursey, Yang Li, Srikanth Prabhu, Harish Garg, Shaymal C. Halder, Saptarshi Sengupta Healthcare Analytics.2023; 3: 100132. CrossRef
Statistical and machine learning approaches to predict the necessity for computed tomography in children with mild traumatic brain injury Tadashi Miyagawa, Marina Saga, Minami Sasaki, Miyuki Shimizu, Akira Yamaura, Alvan Ukachukwu PLOS ONE.2023; 18(1): e0278562. CrossRef
Machine learning for prediction of in-hospital mortality in lung cancer patients admitted to intensive care unit Tianzhi Huang, Dejin Le, Lili Yuan, Shoujia Xu, Xiulan Peng, Samuele Ceruti PLOS ONE.2023; 18(1): e0280606. CrossRef
Application of Artificial Intelligence in Gastrointestinal Cancer 洪铭 崔 Advances in Clinical Medicine.2023; 13(03): 3942. CrossRef
Clinicopathologic and prognostic factors of patients with T3/T4 colorectal signet ring cell carcinoma: a population-based study Fan Zhang, Boqi Xu, Yao Peng, Zhongqi Mao Journal of Cancer Research and Clinical Oncology.2023; 149(12): 9747. CrossRef
Using machine learning algorithms to predict 28-day mortality in critically ill elderly patients with colorectal cancer Chunxia Guo, Jun Pan, Shan Tian, Yuanjun Gao Journal of International Medical Research.2023;[Epub] CrossRef