南方医科大学学报 ›› 2026, Vol. 46 ›› Issue (7): 1714-1722.doi: 10.12122/j.issn.1673-4254.2026.07.24
• • 上一篇
朱君1(
), 谭顺谦1, 黄方俊2, 蔡光瑶3, 甄鑫1(
)
收稿日期:2025-12-03
出版日期:2026-07-20
发布日期:2026-07-20
通讯作者:
甄鑫
E-mail:2570540683@qq.com;xinzhen@smu.edu.cn
作者简介:朱 君,在读硕士研究生,E-mail:2570540683@qq.com
基金资助:
Jun ZHU1(
), Shunqian TAN1, Fangjun HUANG2, Guangyao CAI3, Xin ZHEN1(
)
Received:2025-12-03
Online:2026-07-20
Published:2026-07-20
Contact:
Xin ZHEN
E-mail:2570540683@qq.com;xinzhen@smu.edu.cn
Supported by:摘要:
目的 针对卵巢癌早期诊断中表格型医疗数据特征关联复杂、模型可解释性不足等问题,提出一种融合医疗先验知识的TabMap图像映射与深度学习预测框架。 方法 首先,根据临床语义将36个医疗诊断特征划分为血常规分区、生化指标分区、肿瘤标志物分区以及其他(凝血、炎症及临床变量)分区4个空间连续区域;其次,采用Gromov-Wasserstein最优传输算法求解特征空间与像素空间的最优耦合,生成保持拓扑结构的TabMap图像;然后,设计融合SE注意力机制和全局平均池化的轻量级卷积神经网络,通过类别加权损失和加权采样策略应对样本不平衡问题;最后,利用类激活映射技术可视化模型决策过程,实现可解释性分析。 结果 在真实卵巢癌数据集上的实验表明,本文方法的测试集准确率达到91.82%,精确率为89.96%,召回率为89.45%,F1分数为0.8970,平衡准确率为88.51%,相比传统机器学习方法准确率提升8.26%~14.93%,相比标准深度学习模型准确率提升2.28%~13.60%。可解释性分析显示,模型在肿瘤标志物分区以及凝血、炎症以及临床变量相关分区中呈现出明显的响应模式,与临床既有认知保持一致;特征重要性排序进一步强调了CA125、HE4等关键指标在模型决策中的核心作用。 结论 本研究提出的医疗先验引导TabMap方法有效融合了领域知识与数据驱动学习,在提升预测性能的同时增强了模型的临床可解释性,为表格型医疗数据的深度学习建模提供了新思路,具有良好的临床应用潜力。
朱君, 谭顺谦, 黄方俊, 蔡光瑶, 甄鑫. 医疗先验引导的TabMap深度学习模型用于卵巢癌预测及可解释性研究[J]. 南方医科大学学报, 2026, 46(7): 1714-1722.
Jun ZHU, Shunqian TAN, Fangjun HUANG, Guangyao CAI, Xin ZHEN. Medical prior-guided TabMap deep learning model for ovarian cancer prediction and interpretability analysis[J]. Journal of Southern Medical University, 2026, 46(7): 1714-1722.
| Clinical characteristic parameters | Sample 1 | Sample 2 | Sample 3 | |
|---|---|---|---|---|
| Hematological parameters | White blood cell count (WBC#), venous blood | 5.2 | 6.69 | 5.67 |
| Lymphocyte percentage (Lymph%), venous blood | 38 | 33.2 | 25.6 | |
| Mean corpuscular volume (MCV), venous blood | 91.9 | 86.3 | 71.3 | |
| Mean corpuscular hemoglobin (MCH), venous blood | 29.6 | 27.6 | 20.7 | |
| Mean corpuscular hemoglobin concentration (MCHC), venous blood | 322 | 320 | 290 | |
| Basophil percentage (Baso%), venous blood | 0.6 | 1 | 1.2 | |
| Eosinophil count (Eos#), venous blood | 0.2 | 0.6 | 0.1 | |
| Platelet count (PLT#), venous blood | 281 | 201 | 496 | |
| Plateletcrit (PCT), venous blood | 0.25 | 0.21 | 0.48 | |
| Neutrophil count (Neut#), venous blood | 2.7 | 3.3 | 3.6 | |
| Neutrophil percentage (Neut%), venous blood | 52.7 | 49.5 | 63.1 | |
| Eosinophil percentage (Eos%), venous blood | 2.9 | 8.8 | 0.9 | |
| Biochemical parameters | Albumin-to-globulin ratio (ALB/GLO), venous blood | 1.73 | 1.48 | 1.44 |
| Albumin (ALB), venous blood | 46.9 | 41.8 | 42.3 | |
| Indirect bilirubin (IBIL), venous blood | 5.7 | 9 | 4.7 | |
| Globulin (GLO), venous blood | 27.08 | 28.15 | 29.33 | |
| Lactate dehydrogenase (LDH), venous blood | 194.1 | 143.5 | 135.9 | |
| Direct bilirubin (DBIL), venous blood | 2.6 | 3.3 | 2.1 | |
| Total cholesterol (TC), venous blood | 4.9 | 4.29 | 4.71 | |
| Total bilirubin (TBIL), venous blood | 8.3 | 12.3 | 6.8 | |
| Total protein (TP), venous blood | 73.98 | 69.95 | 71.63 | |
| Uric acid (UA), venous blood | 300.2 | 201.1 | 202 | |
| Low-density lipoprotein cholesterol (LDL-C), venous blood | 3.29 | 2.64 | 3.14 | |
| Triglycerides (TG), venous blood | 1.79 | 3.08 | 1.03 | |
| High-density lipoprotein cholesterol (HDL-C), venous blood | 1.1 | 0.86 | 1.29 | |
| Tumor markers | Alpha-fetoprotein (AFP), venous blood | 1.48 | 3.53 | 1.11 |
| Human epididymis protein 4 (HE4), venous blood | 139.7 | 80.2 | 51.2 | |
| Carbohydrate antigen 125 (CA125), venous blood | 16.38 | 83.6 | 11.72 | |
| Carbohydrate antigen 153 (CA153), venous blood | 11.99 | 14.94 | 15.51 | |
| Carbohydrate antigen 724 (CA724), venous blood | 2.25 | 0.852 | 0.858 | |
Other variables (coagulation, inflammatory, and clinical variables) | Urine pH | 6 | 6 | 6.5 |
| C-reactive protein (CRP), venous blood | 0.35 | 1.45 | 0.07 | |
| D-dimer, venous blood | 1.07 | 0.61 | 0.29 | |
| Antithrombin III activity (ATIII:A), venous blood | 89.3 | 99.9 | 104 | |
| Fibrinogen (Fbg), venous blood | 2.29 | 2.76 | 2.35 | |
| Age (years) | 51 | 57 | 56 | |
| Outcome label | Ovarian cancer status: 0/1 (No/Yes) | 1 | 0 | 0 |
表1 卵巢癌vs.对照人群37维临床特征数据集(2012-2021)样本示例表
Tab.1 Sample table of the 37-dimensional clinical feature dataset for ovarian cancer vs. controls (2012-2021)
| Clinical characteristic parameters | Sample 1 | Sample 2 | Sample 3 | |
|---|---|---|---|---|
| Hematological parameters | White blood cell count (WBC#), venous blood | 5.2 | 6.69 | 5.67 |
| Lymphocyte percentage (Lymph%), venous blood | 38 | 33.2 | 25.6 | |
| Mean corpuscular volume (MCV), venous blood | 91.9 | 86.3 | 71.3 | |
| Mean corpuscular hemoglobin (MCH), venous blood | 29.6 | 27.6 | 20.7 | |
| Mean corpuscular hemoglobin concentration (MCHC), venous blood | 322 | 320 | 290 | |
| Basophil percentage (Baso%), venous blood | 0.6 | 1 | 1.2 | |
| Eosinophil count (Eos#), venous blood | 0.2 | 0.6 | 0.1 | |
| Platelet count (PLT#), venous blood | 281 | 201 | 496 | |
| Plateletcrit (PCT), venous blood | 0.25 | 0.21 | 0.48 | |
| Neutrophil count (Neut#), venous blood | 2.7 | 3.3 | 3.6 | |
| Neutrophil percentage (Neut%), venous blood | 52.7 | 49.5 | 63.1 | |
| Eosinophil percentage (Eos%), venous blood | 2.9 | 8.8 | 0.9 | |
| Biochemical parameters | Albumin-to-globulin ratio (ALB/GLO), venous blood | 1.73 | 1.48 | 1.44 |
| Albumin (ALB), venous blood | 46.9 | 41.8 | 42.3 | |
| Indirect bilirubin (IBIL), venous blood | 5.7 | 9 | 4.7 | |
| Globulin (GLO), venous blood | 27.08 | 28.15 | 29.33 | |
| Lactate dehydrogenase (LDH), venous blood | 194.1 | 143.5 | 135.9 | |
| Direct bilirubin (DBIL), venous blood | 2.6 | 3.3 | 2.1 | |
| Total cholesterol (TC), venous blood | 4.9 | 4.29 | 4.71 | |
| Total bilirubin (TBIL), venous blood | 8.3 | 12.3 | 6.8 | |
| Total protein (TP), venous blood | 73.98 | 69.95 | 71.63 | |
| Uric acid (UA), venous blood | 300.2 | 201.1 | 202 | |
| Low-density lipoprotein cholesterol (LDL-C), venous blood | 3.29 | 2.64 | 3.14 | |
| Triglycerides (TG), venous blood | 1.79 | 3.08 | 1.03 | |
| High-density lipoprotein cholesterol (HDL-C), venous blood | 1.1 | 0.86 | 1.29 | |
| Tumor markers | Alpha-fetoprotein (AFP), venous blood | 1.48 | 3.53 | 1.11 |
| Human epididymis protein 4 (HE4), venous blood | 139.7 | 80.2 | 51.2 | |
| Carbohydrate antigen 125 (CA125), venous blood | 16.38 | 83.6 | 11.72 | |
| Carbohydrate antigen 153 (CA153), venous blood | 11.99 | 14.94 | 15.51 | |
| Carbohydrate antigen 724 (CA724), venous blood | 2.25 | 0.852 | 0.858 | |
Other variables (coagulation, inflammatory, and clinical variables) | Urine pH | 6 | 6 | 6.5 |
| C-reactive protein (CRP), venous blood | 0.35 | 1.45 | 0.07 | |
| D-dimer, venous blood | 1.07 | 0.61 | 0.29 | |
| Antithrombin III activity (ATIII:A), venous blood | 89.3 | 99.9 | 104 | |
| Fibrinogen (Fbg), venous blood | 2.29 | 2.76 | 2.35 | |
| Age (years) | 51 | 57 | 56 | |
| Outcome label | Ovarian cancer status: 0/1 (No/Yes) | 1 | 0 | 0 |
| Model | Acc | Precision | Recall | F1-Score | BA |
|---|---|---|---|---|---|
| SVM | 77.45 | 75.32 | 73.28 | 0.7428 | 74.30 |
| RF | 81.23 | 79.45 | 77.56 | 0.7849 | 78.51 |
| LR | 76.89 | 74.67 | 72.34 | 0.7348 | 73.51 |
| XGBoost | 83.56 | 81.23 | 79.45 | 0.8033 | 80.34 |
| MLP | 78.22 | 78.34 | 76.45 | 0.7738 | 77.40 |
| CNN | 88.67 | 86.23 | 86.89 | 0.8655 | 85.06 |
| ResNet18 | 89.54 | 88.12 | 88.23 | 0.8817 | 86.18 |
| Ours | 91.82 | 89.96 | 89.45 | 0.8970 | 88.51 |
表2 不同模型在测试集上的性能对比
Tab.2 Performance comparison of different models on the test set
| Model | Acc | Precision | Recall | F1-Score | BA |
|---|---|---|---|---|---|
| SVM | 77.45 | 75.32 | 73.28 | 0.7428 | 74.30 |
| RF | 81.23 | 79.45 | 77.56 | 0.7849 | 78.51 |
| LR | 76.89 | 74.67 | 72.34 | 0.7348 | 73.51 |
| XGBoost | 83.56 | 81.23 | 79.45 | 0.8033 | 80.34 |
| MLP | 78.22 | 78.34 | 76.45 | 0.7738 | 77.40 |
| CNN | 88.67 | 86.23 | 86.89 | 0.8655 | 85.06 |
| ResNet18 | 89.54 | 88.12 | 88.23 | 0.8817 | 86.18 |
| Ours | 91.82 | 89.96 | 89.45 | 0.8970 | 88.51 |
| Model | AUC | Z-statistic | P |
|---|---|---|---|
| SVM | 0.8156 | 4.89 | <0.001 |
| RF | 0.8489 | 3.96 | <0.001 |
| LR | 0.8078 | 5.12 | <0.001 |
| XGBoost | 0.8723 | 3.45 | <0.001 |
| MLP | 0.8245 | 4.67 | <0.001 |
| CNN | 0.9089 | 2.15 | 0.0312 |
| ResNet18 | 0.9167 | 2.03 | 0.0421 |
| Ours | 0.9385 | - | - |
表3 不同模型与本文方法统计显著性检验结果对比
Tab.3 Comparison of statistical significance test results of different models with the proposed method
| Model | AUC | Z-statistic | P |
|---|---|---|---|
| SVM | 0.8156 | 4.89 | <0.001 |
| RF | 0.8489 | 3.96 | <0.001 |
| LR | 0.8078 | 5.12 | <0.001 |
| XGBoost | 0.8723 | 3.45 | <0.001 |
| MLP | 0.8245 | 4.67 | <0.001 |
| CNN | 0.9089 | 2.15 | 0.0312 |
| ResNet18 | 0.9167 | 2.03 | 0.0421 |
| Ours | 0.9385 | - | - |
| Imbalance handling strategy | Acc | Precision | Recall | F1-Score | BA |
|---|---|---|---|---|---|
| Baseline (No imbalance handling) | 90.83 | 86.30 | 82.05 | 0.8412 | 83.64 |
| Weighted loss only | 91.04 | 86.74 | 85.90 | 0.8632 | 85.72 |
| Weighted random sampling only | 90.62 | 86.84 | 87.18 | 0.8701 | 86.57 |
| Weighted loss+weighted sampling (Proposed Method) | 91.82 | 89.96 | 89.45 | 0.8970 | 88.51 |
表4 样本不平衡策略对比分析
Tab.4 Comparison and analysis of sample imbalance strategies
| Imbalance handling strategy | Acc | Precision | Recall | F1-Score | BA |
|---|---|---|---|---|---|
| Baseline (No imbalance handling) | 90.83 | 86.30 | 82.05 | 0.8412 | 83.64 |
| Weighted loss only | 91.04 | 86.74 | 85.90 | 0.8632 | 85.72 |
| Weighted random sampling only | 90.62 | 86.84 | 87.18 | 0.8701 | 86.57 |
| Weighted loss+weighted sampling (Proposed Method) | 91.82 | 89.96 | 89.45 | 0.8970 | 88.51 |
| Feature mapping strategy | Acc | BA | Performance gain over TabMap |
|---|---|---|---|
| No prior partition+optimal transport (TabMap) | 88.67 | 85.06 | - |
| Random partition+optimal transport | 87.95 | 84.28 | -0.72% / -0.78% |
| Prior-guided partitio +optimal transport | 91.82 | 88.51 | +3.15% / +3.45% |
表5 医疗先验引导策略消融实验结果对比
Tab.5 Comparison of experimental results of medical prior-guided strategy ablation
| Feature mapping strategy | Acc | BA | Performance gain over TabMap |
|---|---|---|---|
| No prior partition+optimal transport (TabMap) | 88.67 | 85.06 | - |
| Random partition+optimal transport | 87.95 | 84.28 | -0.72% / -0.78% |
| Prior-guided partitio +optimal transport | 91.82 | 88.51 | +3.15% / +3.45% |
| Rank | Feature name | Activation strength | Assigned region | Clinical significance |
|---|---|---|---|---|
| 1 | Carbohydrate antigen 125 (CA125) | 0.7118 | Tumor Marker Region | The most important biomarker for ovarian cancer, with high sensitivity |
| 2 | Human epididymis Protein 4 (HE4) | 0.7040 | Tumor Marker Region | A specific biomarker for epithelial ovarian cancer |
| 3 | D-dimer | 0.7001 | Other (Coagulation, Inflammatory, and Clinical Variables) Region | Reflects a hypercoagulable state and is associated with tumor-related thrombotic risk |
| 4 | Fibrinogen (Fbg) | 0.6714 | Other (Coagulation, Inflammatory, and Clinical Variables) Region | An acute-phase reactant associated with tumor burden |
| 5 | C-reactive protein (CRP) | 0.6712 | Other (Coagulation, Inflammatory, and Clinical Variables) Region | An inflammatory marker reflecting the tumor microenvironment |
| 6 | Carbohydrate antigen 153 (CA153) | 0.6706 | Tumor Marker Region | An auxiliary biomarker for tumor differential diagnosis |
| 7 | Albumin (ALB) | 0.6685 | Biochemical Parameter Region | Reflects nutritional status and systemic inflammatory level |
| 8 | Age | 0.6682 | Other (Coagulation, Inflammatory, and Clinical Variables) Region | An important epidemiological risk factor for ovarian cancer |
| 9 | Carbohydrate antigen 724 (CA724) | 0.6676 | Tumor Marker Region | An auxiliary tumor biomarker |
| 10 | Alpha-fetoprotein (AFP) | 0.6571 | Tumor Marker Region | Used for differentiating germ cell tumors |
表6 基于类激活映射的关键特征重要性排名
Tab.6 Key feature importance ranking based on class activation mapping
| Rank | Feature name | Activation strength | Assigned region | Clinical significance |
|---|---|---|---|---|
| 1 | Carbohydrate antigen 125 (CA125) | 0.7118 | Tumor Marker Region | The most important biomarker for ovarian cancer, with high sensitivity |
| 2 | Human epididymis Protein 4 (HE4) | 0.7040 | Tumor Marker Region | A specific biomarker for epithelial ovarian cancer |
| 3 | D-dimer | 0.7001 | Other (Coagulation, Inflammatory, and Clinical Variables) Region | Reflects a hypercoagulable state and is associated with tumor-related thrombotic risk |
| 4 | Fibrinogen (Fbg) | 0.6714 | Other (Coagulation, Inflammatory, and Clinical Variables) Region | An acute-phase reactant associated with tumor burden |
| 5 | C-reactive protein (CRP) | 0.6712 | Other (Coagulation, Inflammatory, and Clinical Variables) Region | An inflammatory marker reflecting the tumor microenvironment |
| 6 | Carbohydrate antigen 153 (CA153) | 0.6706 | Tumor Marker Region | An auxiliary biomarker for tumor differential diagnosis |
| 7 | Albumin (ALB) | 0.6685 | Biochemical Parameter Region | Reflects nutritional status and systemic inflammatory level |
| 8 | Age | 0.6682 | Other (Coagulation, Inflammatory, and Clinical Variables) Region | An important epidemiological risk factor for ovarian cancer |
| 9 | Carbohydrate antigen 724 (CA724) | 0.6676 | Tumor Marker Region | An auxiliary tumor biomarker |
| 10 | Alpha-fetoprotein (AFP) | 0.6571 | Tumor Marker Region | Used for differentiating germ cell tumors |
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