Background: DNA methylation biomarkers have great potential in improving prognostic classification systems for patients with cancer. Machine learning (ML)- based analytic techniques might help overcome the challenges of analyzing high- dimensional data in relatively small sample sizes. This systematic review summarizes the current use of ML-based methods in epigenome-wide studies for the identification of DNA methylation signatures associated with cancer prognosis. Methods: We searched three electronic databases including PubMed, EMBASE, and Web of Science for articles published until 8 June 2022. ML-based methods and workflows used to identify DNA methylation signatures associated with cancer prognosis were extracted and summarized. Two authors independently assessed the methodological quality of included studies by a seven-item checklist adapted from relevant guidelines. Results: Seventy-six studies were included in this review. Three major types of ML- based workflows were identified: 1) unsupervised clustering, 2) supervised feature selection, and 3) deep learning-based feature transformation. For the three workflows, the most frequently used ML techniques were consensus clustering, least absolute shrinkage and selection operator (LASSO), and autoencoder, respectively. The systematic review revealed that the performance of these approaches has not 2 been adequately evaluated yet and that methodological and reporting flaws were common in the identified studies using ML techniques. Conclusions: There is great heterogeneity in ML-based methodological strategies used by epigenome-wide studies to identify DNA methylation markers associated with cancer prognosis. Benchmarking studies are needed to compare the relative performance of various approaches for specific cancer types. Adherence to relevant methodological and reporting guidelines are urgently needed.

The authors have declared no competing interest.

https://protocolexchange.researchsquare.com/article/pex-1738/v1

This study was funded by the International PhD Program Office, German Cancer Research Center (DKFZ), Heidelberg, Germany.

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