用大模型提炼肺癌治疗数据语义特征,提升预测准确率
Enhancing Lung Cancer Treatment Outcome Prediction through Semantic Feature Engineering Using Large Language Models
- 将大模型当作目标导向的知识整理器,生成任务匹配的临床特征
- 在184例患者数据上达到0.803的平均AUROC,优于所有基线
- 适合需要可解释性与临床流程兼容的AI辅助诊疗场景
肺癌治疗效果预测因真实世界电子健康数据的稀疏性、异质性和上下文过载而困难。传统模型难以捕捉多模态数据中的语义信息,而大规模微调方法又不适用于临床工作流。本文提出一种框架,利用大语言模型(LLMs)作为目标导向知识整理器(GKC),将实验室、基因组和用药数据转化为高保真、任务对齐的特征表示。不同于通用嵌入,GKC生成的表征针对预测目标定制,且作为离线预处理步骤,可自然融入医院信息管道。在184例肺癌患者队列上,该方法实现平均AUROC为0.803(95% CI: 0.799–0.807),优于专家设计特征、直接文本嵌入及端到端Transformer。消融实验进一步验证了三类模态联合使用的互补价值。结果表明,在稀疏临床数据中,语义表示质量是预测精度的关键决定因素。通过将大模型定位为知识整理引擎而非黑箱预测器,本研究展示了一条可扩展、可解释且适配临床流程的肿瘤学AI决策支持路径。
原文摘要 · Abstract (English)
Accurate prediction of treatment outcomes in lung cancer remains challenging due to the sparsity, heterogeneity, and contextual overload of real-world electronic health data. Traditional models often fail to capture semantic information across multimodal streams, while large-scale fine-tuning approaches are impractical in clinical workflows. We introduce a framework that uses Large Language Models (LLMs) as Goal-oriented Knowledge Curators (GKC) to convert laboratory, genomic, and medication data into high-fidelity, task-aligned features. Unlike generic embeddings, GKC produces representations tailored to the prediction objective and operates as an offline preprocessing step that integrates naturally into hospital informatics pipelines. Using a lung cancer cohort (N=184), we benchmarked GKC against expert-engineered features, direct text embeddings, and an end-to-end transformer. Our approach achieved a mean AUROC of 0.803 (95% CI: 0.799-0.807) and outperformed all baselines. An ablation study further confirmed the complementary value of combining all three modalities. These results show that the quality of semantic representation is a key determinant of predictive accuracy in sparse clinical data settings. By reframing LLMs as knowledge curation engines rather than black-box predictors, this work demonstrates a scalable, interpretable, and workflow-compatible pathway for advancing AI-driven decision support in oncology.
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