arXiv:2508.19563v3 Announce Type: replace-cross Abstract: Large Language Models (LLMs) are being applied in a wide array of settings, well beyond the typical language-oriented use cases. In particular, LLMs are increasingly used as a plug-and-play method for fitting data and generating predictions. Prior work has shown that LLMs, via in-context learning or supervised fine-tuning, can perform competitively with many tabular supervised learning techniques in terms of predictive performance. However, we identify a critical vulnerability of using LLMs for data fitting -- making changes to data representation that are completely irrelevant to the underlying learning task can drastically alter LLMs' predictions on the same data. For example, simply changing variable names can sway the size of prediction error by as much as 82% in certain settings. Such prediction sensitivity with respect to task-irrelevant variations manifests under both in-context learning and supervised fine-tuning, for both close-weight and open-weight general-purpose LLMs. Moreover, by examining the attention scores of an open-weight LLM, we discover a non-uniform attention pattern: training examples and variable names/values which happen to occupy certain positions in the prompt receive more attention when output tokens are generated, even though different positions are expected to receive roughly the same attention. This partially explains the sensitivity in the presence of task-irrelevant variations. We also consider a state-of-the-art tabular foundation model (TabPFN) trained specifically for data fitting. Despite being explicitly designed to achieve prediction robustness, TabPFN is still not immune to task-irrelevant variations. Overall, despite LLMs' impressive predictive capabilities, currently they lack even the basic level of robustness to be used as a principled data-fitting tool.

Background: Despite artificial intelligence (AI) models demonstrating high predictive accuracy for early cholangiocarcinoma recurrence, their clinical application faces challenges, such as reproducibility, generalizability, hidden biases, and uncertain performance across diverse datasets and populations, raising concerns about their practical applicability. Objective: This meta-analysis aims to systematically assess the diagnostic performance of AI models using computed tomography (CT) imaging to predict early recurrence of cholangiocarcinoma. Methods: A systematic search was conducted in PubMed, Embase, and Web of Science for studies published up to May 2025. Studies were selected based on the Participants, Index test, Target condition, Reference standard, Outcomes, and Setting (PITROS) framework. Participants included patients diagnosed with cholangiocarcinoma (including intrahepatic and extrahepatic locations). The index test was AI techniques applied to CT imaging for early recurrence prediction (defined as within 1 year), while the target condition was early recurrence of cholangiocarcinoma (positive group: recurrence; negative group: no recurrence). The reference standard was pathological diagnosis or imaging follow-up confirming recurrence. Outcomes included sensitivity, specificity, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC), assessed in both internal and external validation cohorts. The setting comprised retrospective or prospective studies using hospital datasets. Methodological quality was assessed using an optimized version of the revised Quality Assessment of Diagnostic Accuracy Studies-2 tool. Heterogeneity was assessed using the I² statistic. Pooled sensitivity, specificity, DOR, and AUC were calculated using a bivariate random-effects model. Results: A total of 9 studies with 30 datasets involving 1537 patients were included. In internal validation cohorts, CT-based AI models showed a pooled sensitivity of 0.87 (95% CI 0.81-0.92), specificity of 0.85 (95% CI 0.79-0.89), DOR of 37.71 (95% CI 18.35-77.51), and AUC of 0.93 (95% CI 0.90-0.94). In external validation cohorts, pooled sensitivity was 0.87 (95% CI 0.81-0.91), specificity was 0.82 (95% CI 0.77-0.86), DOR was 30.81 (95% CI 18.79-50.52), and AUC was 0.85 (95% CI 0.82-0.88). The AUC was significantly lower in external validation cohorts compared to internal validation cohorts (P<.001). Conclusions: Our results show that CT-based AI models predict early cholangiocarcinoma recurrence with high performance in internal validation sets and moderate performance in external validation sets. However, the high heterogeneity observed may impact the robustness of these results. Future research should focus on prospective studies and establishing standardized gold standards to further validate the clinical applicability and generalizability of AI models.

Nature, Published online: 03 July 2024; doi:10.1038/s41586-024-07620-9

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