用患者长期就诊数据预测晚期前列腺癌180天内死亡风险,模型可提前预警。
Externally Validated Longitudinal GRU Model for Visit-Level 180-Day Mortality Risk in Metastatic Castration-Resistant Prostate Cancer
- 基于纵向临床数据,用GRU模型实现每轮就诊的死亡风险评估。
- 外部验证中模型敏感度达85%,预测准确率PR-AUC达0.87。
- 识别出体重指数和血压是关键预警指标,适合临床早期干预。
转移性去势抵抗性前列腺癌(mCRPC)是一种预后差且治疗反应异质性强的高侵袭性疾病。本研究利用两个Ⅲ期临床队列(n=526 和 n=640)的纵向数据,构建并外部验证了就诊级180天死亡风险模型。仅对有明确180天结局的就诊记录进行标注,右删失病例被排除。比较了五种模型架构:长短期记忆网络、门控循环单元(GRU)、Cox比例风险模型、随机生存森林(RSF)和逻辑回归。在每个数据集上,选择最小风险阈值以保证85%的敏感度下限。初始阶段GRU与RSF均表现出高区分能力(C-index均为87%)。在外部验证中,GRU模型校准更优(斜率:0.93;截距:0.07),且达到0.87的PR-AUC。临床影响分析显示,真阳性病例的预警时间中位数为151.0天,假阳性为59.0天,平均每100次就诊产生18.3次预警。由于晚期患者常伴衰弱或恶病质及血流动力学不稳,置换重要性分析表明体重指数(BMI)和收缩压是最强关联因素。结果表明,基于常规临床纵向指标可有效估计mCRPC患者的短时死亡风险,支持跨月度的主动照护规划。
原文摘要 · Abstract (English)
Metastatic castration-resistant prostate cancer (mCRPC) is a highly aggressive disease with poor prognosis and heterogeneous treatment response. In this work, we developed and externally validated a visit-level 180-day mortality risk model using longitudinal data from two Phase III cohorts (n=526 and n=640). Only visits with observable 180-day outcomes were labeled; right-censored cases were excluded from analysis. We compared five candidate architectures: Long Short-Term Memory, Gated Recurrent Unit (GRU), Cox Proportional Hazards, Random Survival Forest (RSF), and Logistic Regression. For each dataset, we selected the smallest risk-threshold that achieved an 85% sensitivity floor. The GRU and RSF models showed high discrimination capabilities initially (C-index: 87% for both). In external validation, the GRU obtained a higher calibration (slope: 0.93; intercept: 0.07) and achieved an PR-AUC of 0.87. Clinical impact analysis showed a median time-in-warning of 151.0 days for true positives (59.0 days for false positives) and 18.3 alerts per 100 patient-visits. Given late-stage frailty or cachexia and hemodynamic instability, permutation importance ranked BMI and systolic blood pressure as the strongest associations. These results suggest that longitudinal routine clinical markers can estimate short-horizon mortality risk in mCRPC and support proactive care planning over a multi-month window.
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