Development and validation of a machine-learning model to predict lymph node metastasis of intrahepatic cholangiocarcinoma: A retrospective cohort study

Lymph node metastasis in intrahepatic cholangiocarcinoma significantly impacts overall survival, emphasizing the need for a predictive model. This study involved patients who underwent curative liver resection between different time periods. Three machine learning models were constructed with a training cohort (2010-2016) and validated with a separate cohort (2019-2023). A total of 170 patients were included in the training set and 101 in the validation cohort. The lymph node status of patients not undergoing lymph node dissection was predicted, followed by survival analysis. Among the models, the support vector machine (SVM) had the best discrimination, with an area under the curve (AUC) of 0.705 for the training set and 0.754 for the validation set, compared to the random forest (AUC: 0.780/0.693) and the logistic regression (AUC: 0.703/0.736). Kaplan-Meier analysis indicated that patients in the positive lymph node group or predicted positive group had significantly worse overall survival (OS: p < 0.001 for both) and disease-free survival (DFS: p < 0.001 for both) compared to negative groups. An online user-friendly calculator based on the SVM model has been developed for practical application.