Personalized surgical recommendations and quantitative therapeutic insights for patients with metastatic breast cancer: Insights from deep learning

Cancer Innovation Pub Date : 2024-04-15 DOI:10.1002/cai2.119
Enzhao Zhu, Linmei Zhang, Jiayi Wang, Chunyu Hu, Qi Jing, Weizhong Shi, Ziqin Xu, Pu Ai, Zhihao Dai, Dan Shan, Zisheng Ai
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Abstract

Background

The role of surgery in metastatic breast cancer (MBC) is currently controversial. Several novel statistical and deep learning (DL) methods promise to infer the suitability of surgery at the individual level.

Objective

The objective of this study was to identify the most applicable DL model for determining patients with MBC who could benefit from surgery and the type of surgery required.

Methods

We introduced the deep survival regression with mixture effects (DSME), a semi-parametric DL model integrating three causal inference methods. Six models were trained to make individualized treatment recommendations. Patients who received treatments in line with the DL models' recommendations were compared with those who underwent treatments divergent from the recommendations. Inverse probability weighting (IPW) was used to minimize bias. The effects of various features on surgery selection were visualized and quantified using multivariate linear regression and causal inference.

Results

In total, 5269 female patients with MBC were included. DSME was an independent protective factor, outperforming other models in recommending surgery (IPW-adjusted hazard ratio [HR] = 0.39, 95% confidence interval [CI]: 0.19–0.78) and type of surgery (IPW-adjusted HR = 0.66, 95% CI: 0.48–0.93). DSME was superior to other models and traditional guidelines, suggesting a higher proportion of patients benefiting from surgery, especially breast-conserving surgery. The debiased effect of patient characteristics, including age, tumor size, metastatic sites, lymph node status, and breast cancer subtypes, on surgery decision was also quantified.

Conclusions

Our findings suggested that DSME could effectively identify patients with MBC likely to benefit from surgery and the specific type of surgery needed. This method can facilitate the development of efficient, reliable treatment recommendation systems and provide quantifiable evidence for decision-making.

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为转移性乳腺癌患者提供个性化手术建议和量化治疗见解:深度学习的启示
背景 手术在转移性乳腺癌(MBC)中的作用目前还存在争议。有几种新型统计和深度学习(DL)方法有望在个体水平上推断手术的适宜性。 目标 本研究旨在确定最适用的深度学习模型,以确定可从手术中获益的 MBC 患者以及所需的手术类型。 方法 我们引入了具有混合效应的深度生存回归模型(DSME),这是一种整合了三种因果推断方法的半参数 DL 模型。我们对六个模型进行了训练,以提出个性化的治疗建议。接受符合 DL 模型建议的治疗的患者与接受不同于建议的治疗的患者进行了比较。使用反概率加权(IPW)将偏差最小化。使用多元线性回归和因果推理对各种特征对手术选择的影响进行了可视化和量化。 结果 共纳入 5269 例女性乳腺癌患者。DSME是一个独立的保护因素,在推荐手术方面优于其他模型(IPW调整后的危险比[HR] = 0.39,95%置信区间[CI]:0.19-0.78)和手术类型(IPW调整后的危险比[HR] = 0.66,95% 置信区间[CI]:0.48-0.93)方面优于其他模型。DSME优于其他模型和传统指南,表明有更高比例的患者从手术中获益,尤其是保乳手术。我们还量化了患者特征(包括年龄、肿瘤大小、转移部位、淋巴结状态和乳腺癌亚型)对手术决策的影响。 结论 我们的研究结果表明,DSME 可以有效识别可能从手术中获益的 MBC 患者以及所需的具体手术类型。这种方法有助于开发高效、可靠的治疗推荐系统,并为决策提供可量化的证据。
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