Developing machine learning algorithms for dynamic estimation of progression during active surveillance for prostate canceropen access
- Authors
- Lee, Changhee; Light, Alexander; Saveliev, Evgeny S.; Van der Schaar, Mihaela; Gnanapragasam, Vincent J.
- Issue Date
- Aug-2022
- Publisher
- NATURE PORTFOLIO
- Citation
- NPJ DIGITAL MEDICINE, v.5, no.1
- Journal Title
- NPJ DIGITAL MEDICINE
- Volume
- 5
- Number
- 1
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/61248
- DOI
- 10.1038/s41746-022-00659-w
- ISSN
- 2398-6352
- Abstract
- Active Surveillance (AS) for prostate cancer is a management option that continually monitors early disease and considers intervention if progression occurs. A robust method to incorporate "live" updates of progression risk during follow-up has hitherto been lacking. To address this, we developed a deep learning-based individualised longitudinal survival model using Dynamic-DeepHit-Lite (DDHL) that learns data-driven distribution of time-to-event outcomes. Further refining outputs, we used a reinforcement learning approach (Actor-Critic) for temporal predictive clustering (AC-TPC) to discover groups with similar time-to-event outcomes to support clinical utility. We applied these methods to data from 585 men on AS with longitudinal and comprehensive follow-up (median 4.4 years). Time-dependent C-indices and Brier scores were calculated and compared to Cox regression and landmarking methods. Both Cox and DDHL models including only baseline variables showed comparable C-indices but the DDHL model performance improved with additional follow-up data. With 3 years of data collection and 3 years follow-up the DDHL model had a C-index of 0.79 (+/- 0.11) compared to 0.70 (+/- 0.15) for landmarking Cox and 0.67 (+/- 0.09) for baseline Cox only. Model calibration was good across all models tested. The AC-TPC method further discovered 4 distinct outcome-related temporal clusters with distinct progression trajectories. Those in the lowest risk cluster had negligible progression risk while those in the highest cluster had a 50% risk of progression by 5 years. In summary, we report a novel machine learning approach to inform personalised follow-up during active surveillance which improves predictive power with increasing data input over time.
- Files in This Item
-
- Appears in
Collections - College of Software > Department of Artificial Intelligence > 1. Journal Articles
Items in ScholarWorks are protected by copyright, with all rights reserved, unless otherwise indicated.