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ORIGINAL PAPER
Predictors of distant metastasis in colorectal cancer: a multimodal statistical and machine‑learning analysis
 
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Collegium Medicum, Jan Kochanowski University, Kielce, Poland 2Meduniv Sp. z o.o., Kielce, Poland
 
These authors had equal contribution to this work
 
 
Submission date: 2025-10-04
 
 
Final revision date: 2025-11-09
 
 
Acceptance date: 2025-11-25
 
 
Publication date: 2025-12-30
 
 
Corresponding author
Wojciech Lewitowicz
Piotr Lewitowicz Collegium Medicum Jan Kochanowski University Meduniv Sp.z.o.o Kielce, Poland
 
 
Medical Studies 2025;41(4):344-349
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Distant metastasis (M1) is the principal determinant of outcome in colorectal cancer (CRC). Identifying robust molecular and clinical predictors at diagnosis may improve risk stratification.

Aim of the research:
To develop and compare complementary statistical and machine‑learning models for predicting metastatic status and to synthesize convergent predictors.

Material and methods:
In a single-centre cohort (N = 54, M1 = 26, M0 = 28), we modelled a binary outcome – any type of CRC metastasis (M_any) using multivariable logistic regression (LR), Random Forest (RF), LASSO-penalized logistic regression, and Support Vector Machine (SVM). In a secondary analysis, we fitted a multinomial logistic regression with three categories Early_No_Mets (pT1-2M0), Advanced_No_Mets (pT3-4M0), and Metastatic (M1). Discrimination was summarized as AUC; classification metrics used native validation schemes (LR in-sample; RF out-of-bag [OOB]; SVM 10-fold cross-validation [CV]). Reporting follows TRIPOD guidance.

Results:
LR identified TP53 mutation as the strongest predictor (OR = 3.47; 95% CI: 0.92–14.5; p = 0.073; AUC = 0.713). RF achieved OOB error of 40.74% (accuracy = 59.3%); top features were NRAS, TP53_pathway, TP53, WNT_pathway, and n_genes. LASSO (10‑fold CV) retained NRAS, TP53, and age (coefficients +1.15, +0.85, −0.02). SVM yielded AUC = 0.678, accuracy = 55.6%. The multinomial model revealed complete separation for NRAS in the Advanced_No_Mets group, precluding standard MLE inference.

Conclusions:
TP53 (gene/pathway) is a consistent risk signal across methods; NRAS carries high importance in ensemble/regularized models. Overall discrimination is modest, consistent with a small sample size; findings are hypothesis‑generating and warrant validation.
REFERENCES (18)
1.
Patel SG, Karlitz JJ, Yen T, Lieu CH, Boland CR. The rising tide of early-onset colorectal cancer: a comprehensive review of epidemiology, clinical features, biology, risk factors, prevention, and early detection. Lancet Gastroenterol Hepatol. 2022; 7(3): 262-274.
 
2.
Morgan E, Arnold M, Gini A, Lorenzoni V, Cabasag CJ, Laversanne M, Vignat J, Ferlay J, Murphy N, Bray F. Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimate from GLOBOCAN. Gut. 2023; 72(2): 338-344.
 
3.
Del Vecchio F, Mastroiaco V, Di Marco A, Compagnoni C, Capece D, Zazzeroni F, Capalbo C, Alesse E, Tessitore A. Next‑generation sequencing applications in colorectal cancer. J Transl Med. 2017; 15: 246.
 
4.
Hussen BM, Abdullah ST, Salihi A, Khdr Sabir D, Sidiq KR, Rasul MF Hidayat HJ, Ghafouri-Fard S, Taheri M, Jamali E. Emerging roles of NGS in clinical oncology and personalized medicine. Pathol Res Pract. 2022; 230: 153760.
 
5.
Spaander MCW, Zauber AG, Syngal S, Blaser MJ, Sung JJ, You YN, Kuipers EJ. Young‑onset colorectal cancer. Nat Rev Dis Primers. 2023; 9: 21.
 
6.
Mitsala A, Tsalikidis C, Pitiakoudis M, Simopoulos C, Tsaroucha AK. Artificial intelligence in colorectal cancer screening, diagnosis and treatment. A new era. Curr Oncol. 2021; 28(3): 1581-1607.
 
7.
Breiman L. Random forests. Mach Learn. 2001; 45: 5-32.
 
8.
Tibshirani R. Regression shrinkage and selection via the lasso. J R Statist Soc B. 1996; 58: 267-288.
 
9.
Albert A, Anderson JA. On the existence of MLE in logistic regression. Biometrika 1984; 71: 1–10.
 
10.
Firth D. Bias reduction of maximum likelihood estimates. Biometrika. 1993; 80: 27-38.
 
11.
Cortes C, Vapnik V. Support‑vector networks. Mach Learn. 1995; 20: 273-297.
 
12.
Matthews BW. Comparison of the predicted and observed secondary structure of T4 phage lysozyme. Biochim Biophys Acta. 1975; 405: 442-451.
 
13.
Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960; 20: 37-46.
 
14.
Youden WJ. Index for rating diagnostic tests. Cancer. 1950; 3: 32-35.
 
15.
Hanley JA, McNeil BJ. The meaning and use of the area under a ROC curve. Radiology. 1982; 143: 29-36.
 
16.
Collins GS, Reitsma JB, Altman DG, Moons KGM. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD). BMC Med. 2015; 13: 1.
 
17.
Collins GS, Reitsma JB, Altman DG, Moons KGM. Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD): the TRIPOD Statement. Ann Intern Med. 2015; 162(1): 55-63.
 
18.
Chen K, Qu Y, Han Y, Li Y, Gao H, Zheng D. Performance of machine learning in diagnosing KRAS (Kirsten rat sarcoma) mutations in colorectal cancer: systematic review and meta-analysis. J Med Internet Res. 2025; 27: e73528.
 
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ISSN:1899-1874
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