Transformative Pathways in Oncology: A Systematic Review and Framework for AI-Driven Cancer Progression Risk Analytics and Prediction

Artificial intelligence (AI) has emerged as a transformative analytical paradigm for modelling cancer progression using medical imaging and complementary clinical data. This systematic review collates and analyses AI-powered systems and techniques for cancer progression risk analytics and prediction. It provides an empirical examination of algorithmic approaches, imaging-derived feature domains, and clinical metrics that underpin progression prediction. Following the PRISMA 2020 reporting guidance, empirical English-language studies published between 2020 and the final search cutoff date of 15 May 2026 were identified from PubMed, EBSCOhost, Google Scholar and Web of Science. Forty (40) eligible studies spanning diverse cancer types were included, appraised using the MMAT and synthesised narratively. The evidence shows that both classical machine learning models and deep learning architectures are widely used to extract predictive information from radiological data. Radiomic descriptors of intratumoural heterogeneity, tumour morphology, functional imaging biomarkers and multiscale transform-based features consistently demonstrate strong associations with disease progression. Imaging-derived features were linked to clinically meaningful progression endpoints, including progression-free survival, disease-free survival, recurrence and metastasis, while clinical and molecular covariates supported risk stratification. This study further develops the AI-driven cancer progression risk analytics framework (AI CanPRAF), which integrates AI taxonomies, imaging phenotypes, clinical context, progression analytics and decision support into one clinically oriented model. The results demonstrate the growing role of multimodal AI systems in the development of clinically grounded cancer progression analytics and prediction solutions.