arXiv:2605.16927cs.AI2026-05

让临床预测从静态风险转向动态轨迹,支持个性化治疗决策。

From Static Risk to Dynamic Trajectories: Toward World-Model-Inspired Clinical Prediction

论文配图:From Static Risk to Dynamic Trajectories: Toward World-Model-Inspired Clinical Prediction
图 1 · 摘自论文原文
  • 构建统一框架,融合疾病演化、治疗分配与观测偏差建模。
  • 实现治疗敏感的个体化轨迹预测,支持政策评估与反事实分析。
  • 适合临床AI研究者及医疗系统设计者参考,推动闭环医疗学习。

临床决策是一个反馈系统:风险评估影响治疗选择,治疗又改变疾病轨迹,并共同塑造临床监测行为。传统静态预测常失效——基于观察性数据训练的模型混淆了疾病生物学与医生行为,尤其在治疗混杂反馈、不规则或信息性观测下。本文聚焦干预感知的疾病轨迹建模,提出患者级纵向疾病演化估计与不同治疗下的轨迹变化评估方法。围绕六个核心组件组织领域:三个决策任务(事实预测、反事实估计、策略评估)与三个数据生成机制(疾病演化、治疗分配、观测过程),明确可识别性条件。首次提出跨离散/连续时间的统一框架,显式处理治疗分配、时变混杂与观测偏差。整合多状态/联合模型、时间点过程、深度序列架构与纵向因果推断等方法族,映射至对应组件,并通过重叠诊断、不确定性量化、离策略鲁棒性与目标试验验证对评估进行校准。该综述将预测提升为决策级临床证据,支持治疗敏感的个体化未来预测、政策部署前压力测试及证据不足时自动调整的闭环学习健康系统。

原文摘要 · Abstract (English)

Clinical decision-making is a feedback system where risk estimates influence treatment, which in turn changes disease trajectories, and both shape clinicians' measurement practices. Static prediction often fails clinically: models trained on observational care logs conflate disease biology with clinician behavior, particularly under treatment confounder feedback and irregular or informative observation. This Review focuses on intervention-aware disease trajectory modeling in clinical AI--methods estimating patient-specific longitudinal disease evolution and assessing trajectory changes under alternative treatments. We organize the field around six linked components: three decision tasks (factual forecasting, counterfactual estimation, policy evaluation) and three data-generating mechanisms (disease evolution, treatment assignment, observation process) that determine identifiability. We present the first unified framework bridging forecasting, counterfactual trajectories, and policy evaluation across discrete/continuous time, explicitly addressing treatment assignment, time-varying confounding, and observation bias. We synthesize key method families (multistate/joint models, temporal point-process, deep sequence architectures, longitudinal causal inference), map them to relevant components, and align evaluation with claim strength via overlap diagnostics, uncertainty quantification, off-policy robustness, and target-trial validation. This synthesis advances benchmark prediction to decision-grade clinical evidence, enabling treatment-sensitive individualized futures, pre-deployment policy stress-testing, and safer closed-loop learning health systems that adapt/abstain when evidence is insufficient.

临床预测因果推断动态建模决策支持

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