Improving prediction of treatment response and prognosis in colorectal cancer with AI-based medical image analysis

The heterogeneous response and prognosis of patients with colorectal cancer (CRC) to standard treatment regimens remains a challenge for clinical management. Individually weak prognostic markers, defined by gene mutations and protein expression, are difficult to apply in routine clinical practice because of their high acquisition cost and mediocre prediction accuracy. Visual evaluation of medical images, including radiology and digital pathology images, is an important part of CRC management. With the rapid development of artificial intelligence (AI), high-dimensional imaging features other than visual information are increasingly being used to develop imaging markers. At different stages of treatment, accurate predictions of treatment response and prognosis may help in selecting patients and tailoring their treatment. Here, we review the current state of AI applied to the medical imaging of CRC and describe its recent progress in short-term response and long-term survival prediction. In addition, we illustrate how these AI-based approaches may affect clinical decision-making. Although few approaches have been applied in routine clinical practice, their results are promising. Finally, we discuss the challenges in applying AI in clinical practice and possible future solutions from three perspectives: model interpretability, model generalizability, and patient privacy protection. This comprehensive assessment underscores the transformative potential of AI in CRC management and emphasizes the need for further exploration and integration into routine clinical workflows.