Internal Evaluation of a Machine Learning-Based Random Forest Model for Clinically Relevant Postoperative Pancreatic Fistula After Pancreaticoduodenectomy: Limited Incremental Value of Inflammatory–Nutritional Markers
- 1Department of Surgical Oncology, Ankara City Hospital, 06800 Ankara, Türkiye
Abstract
Background and Objectives: This study evaluated whether preoperative neutrophil-to-lymphocyte ratio (NLR) improves prediction of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy. Materials and Methods: This single-center retrospective cohort included 120 of 158 patients operated on between January 2019 and March 2026; 38 lacked documented pancreatic duct diameter. CR-POPF followed the 2016 International Study Group on Pancreatic Surgery definition. A random forest incorporating duct diameter, estimated blood loss, and NLR was compared with a model omitting NLR and penalized logistic regression using 10-times-repeated stratified five-fold cross-validation. Post hoc clinicopathological sensitivity analyses added pancreatic texture and tumor origin, then tested inflammatory–nutritional markers individually. Discrimination, average precision, Brier score, calibration, and exploratory decision-curve analysis were assessed. Results: CR-POPF occurred in 16 patients (13.3%). Biochemical leak occurred in 28 (23.3%). The NLR-integrated model achieved an area under the receiver operating characteristic curve (AUC) of 0.721 (95% confidence interval [CI], 0.576–0.850), versus 0.760 for the comparator and 0.736 for penalized logistic regression. Expanded baseline AUC was 0.743; adding NLR yielded 0.715. Monocyte-to-lymphocyte ratio increased AUC numerically to 0.779, but the paired difference remained uncertain (ΔAUC, 0.037; 95% CI, −0.017 to 0.096). Other evaluated markers showed no clear incremental benefit. Postpancreatectomy acute pancreatitis occurred in seven (5.8%). Conclusions: NLR did not demonstrate incremental predictive value. The monocyte-to-lymphocyte ratio finding was hypothesis-generating. Small event numbers and predictor selection outside cross-validation limit interpretation; performance may remain optimistic. These findings do not support clinical implementation without independent external validation.
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BibTeX
@article{gunes2026internal,
title = {{Internal Evaluation of a Machine Learning-Based Random Forest Model for Clinically Relevant Postoperative Pancreatic Fistula After Pancreaticoduodenectomy: Limited Incremental Value of Inflammatory–Nutritional Markers}},
author = {Gizem Gunes and Adem Ozcan and Abdulkadir Unsal},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218379},
url = {https://www.mdpi.com/2077-0383/15/21/8379},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Internal Evaluation of a Machine Learning-Based Random Forest Model for Clinically Relevant Postoperative Pancreatic Fistula After Pancreaticoduodenectomy: Limited Incremental Value of Inflammatory–Nutritional Markers
AU - Gizem Gunes
AU - Adem Ozcan
AU - Abdulkadir Unsal
PY - 2026
DA - 2026/10/28
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218379
UR - https://www.mdpi.com/2077-0383/15/21/8379
AB - Background and Objectives: This study evaluated whether preoperative neutrophil-to-lymphocyte ratio (NLR) improves prediction of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy. Materials and Methods: This single-center retrospective cohort included 120 of 158 patients operated on between January 2019 and March 2026; 38 lacked documented pancreatic duct diameter. CR-POPF followed the 2016 International Study Group on Pancreatic Surgery definition. A random forest incorporating duct diameter, estimated blood loss, and NLR was compared with a model omitting NLR and penalized logistic regression using 10-times-repeated stratified five-fold cross-validation. Post hoc clinicopathological sensitivity analyses added pancreatic texture and tumor origin, then tested inflammatory–nutritional markers individually. Discrimination, average precision, Brier score, calibration, and exploratory decision-curve analysis were assessed. Results: CR-POPF occurred in 16 patients (13.3%). Biochemical leak occurred in 28 (23.3%). The NLR-integrated model achieved an area under the receiver operating characteristic curve (AUC) of 0.721 (95% confidence interval [CI], 0.576–0.850), versus 0.760 for the comparator and 0.736 for penalized logistic regression. Expanded baseline AUC was 0.743; adding NLR yielded 0.715. Monocyte-to-lymphocyte ratio increased AUC numerically to 0.779, but the paired difference remained uncertain (ΔAUC, 0.037; 95% CI, −0.017 to 0.096). Other evaluated markers showed no clear incremental benefit. Postpancreatectomy acute pancreatitis occurred in seven (5.8%). Conclusions: NLR did not demonstrate incremental predictive value. The monocyte-to-lymphocyte ratio finding was hypothesis-generating. Small event numbers and predictor selection outside cross-validation limit interpretation; performance may remain optimistic. These findings do not support clinical implementation without independent external validation.
SN - 2077-0383
ER -