An international multi-centre study to develop and validate federated learning-based prognostic models for anal cancer
Precision oncology relies on access to high-quality data for increasingly smaller patient subgroups. The international atomCAT consortium investigates the potential of federated learning to support this, using anal cancer as a rare cancer exemplar. Here, we show that federated multivariable Cox models trained across 14 centres (1428 patients) and externally validated in two additional centres (277 patients) achieve consistent calibration and discrimination during leave-one-centre-out and external validation (c-indices 0.68-0.79). Lower T stage, absence of nodal involvement, smaller tumour volume, female sex, younger age, and mitomycin- or cisplatin-based chemotherapy are associated with improved overall survival. Lower T stage, smaller tumour volume, and female sex are associated with improved locoregional control, while absence of nodal involvement and smaller tumour volume are associated with better freedom from distant metastases. These findings demonstrate that federated learning enables robust, privacy-preserving prognostic modelling for rare cancers using real-world data, supporting international collaboration without data sharing.
Authors
- Richard D. Adams (ORCID: https://orcid.org/0000-0003-2596-5100)
- Viola De Luca (ORCID: https://orcid.org/0000-0002-9914-0075)
- Łukasz Raszewski (ORCID: https://orcid.org/0000-0002-7146-6161)
- Claus Rödel
- J. Lilley (ORCID: https://orcid.org/0000-0003-0060-0316)
- J. Marsden (ORCID: https://orcid.org/0000-0002-7186-7870)
- J. Stroom (ORCID: https://orcid.org/0000-0002-2303-2393)
- Andrew Scarsbrook (ORCID: https://orcid.org/0000-0002-4243-032X)
- D. Sebag-Montefiore
- Per-Ivar Lønne (ORCID: https://orcid.org/0000-0002-4210-8031)
- Emiliano Spezi (ORCID: https://orcid.org/0000-0002-1452-8813)
- A.R. Walker
- Tomas Janssen (ORCID: https://orcid.org/0000-0003-2807-8670)
- Emmanouil Fokas (ORCID: https://orcid.org/0000-0003-1601-6165)
- Baukelien van Triest
- Loukia Georgiou
- Mariachiara Savino (ORCID: https://orcid.org/0000-0001-9666-4407)
- Thomas Jansen
- Michael J. Eble (ORCID: https://orcid.org/0000-0001-8540-5119)
- Thomas Rackley
- V. Vassiliou
- Oriol Parés (ORCID: https://orcid.org/0000-0002-8254-7733)
- Matthew Field (ORCID: https://orcid.org/0000-0002-6169-6721)
- Ioannis M. Stylianou (ORCID: https://orcid.org/0000-0001-8637-6954)
- Stelios Theophanous (ORCID: https://orcid.org/0000-0002-4148-3905)
- Maciej Trojanowski (ORCID: https://orcid.org/0000-0002-9124-1509)
- Rens van Haveren (ORCID: https://orcid.org/0000-0001-6092-1854)
- Lois Holloway (ORCID: https://orcid.org/0000-0003-4337-2165)
- David Thwaites (ORCID: https://orcid.org/0000-0002-9633-6259)
- Athina Sdrolia (ORCID: https://orcid.org/0000-0002-7277-4000)
- S. Manfrida (ORCID: https://orcid.org/0000-0003-4266-8255)
- Rohit Kochhar (ORCID: https://orcid.org/0009-0008-7770-1127)
- Eirik Malinen (ORCID: https://orcid.org/0000-0002-1308-9871)
- Elisavet Papageorgiou (ORCID: https://orcid.org/0000-0003-0487-3418)
- Ane Lindegaard Appelt (ORCID: https://orcid.org/0000-0003-2792-9218)
- Maaike Berbée
- Mark Lee (ORCID: https://orcid.org/0000-0003-4866-4116)
- G. Price
- Ann Henry (ORCID: https://orcid.org/0000-0002-5379-6618)
- Charlotte L. Deijen
- Nikola Dino Capocchiano (ORCID: https://orcid.org/0000-0003-3556-9232)
- Rajarshi Roy (ORCID: https://orcid.org/0000-0001-8149-3668)
- Antri Demetriou
- Adam Loveday
- Valentini
- Andrew Hoole
- Peter S. Colley
- Rashmi Jadon
- Shrikant Deshpande
- Joseph Mercer
- Dieter Martin
- R. Muirhead
- Ahmed Allam Mohamed
- Leonard Wee
- Andre Dekker
- Krystyna Adamska
- Anthony Espinoza
- Philip Chlap
- Carlotta Masciocchi
- Maria Antonietta Gambacorta
- Alexandros Kritikopoulos
- Ananya Choudhury
- Muhammad Amin
- Joanna Y. G. Lau
- Andrea Damiani
- Gisela Lima
- Alexandra Gilbert
- Marianne Grønlie Guren
- Patricia Lopes
Institutions
- Champalimaud Foundation (PT)
- Goethe University Frankfurt (DE)
- Oslo University Hospital (NO)
- The University of Sydney (AU)
- University of Leeds (GB)
- German Cancer Research Center (DE)
- University of Oslo (NO)
- University of Hull (GB)
- University of Wollongong (AU)
- Heidelberg University (DE)
- Velindre NHS Trust (GB)
- Leeds Teaching Hospitals NHS Trust (GB)
- St James's University Hospital (GB)
- University Hospitals of Leicester NHS Trust (GB)
- Cambridge University Hospitals NHS Foundation Trust (GB)
- Agostino Gemelli University Polyclinic (IT)
- UNSW Sydney (AU)
- University of Oxford (GB)
- Cancer Australia (AU)
- Integrated Oncology (United States) (US)
- Greater Poland Cancer Center (PL)
- St Vincent's Clinic (AU)
- Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NL)
- University Hospital Frankfurt (DE)
- The Christie NHS Foundation Trust (GB)
- Ingham Institute (AU)
- Bank of Cyprus Oncology Center (CY)
- Oxford University Hospitals NHS Trust (GB)
- Amsterdam University Medical Centers (NL)
- University Hospital Cologne (DE)
- Frankfurt Cancer Institute (DE)
- Maastro Clinic (NL)
- South Western Sydney Local Health District (AU)
- Deutsches Konsortium für Translationale Krebsforschung (DE)
- Western Sydney University (AU)
- Cardiff University (GB)
- RWTH Aachen University (DE)
Publication Details
- Journal
- Nature Communications
- Published
- 2026-03-14
- DOI
- https://doi.org/10.1038/s41467-026-70297-3
- Primary Topic
- Colorectal and Anal Carcinomas
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Cancer Research UK
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek