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Yang X, Vladmirovich RI, Georgievna PM, Sergeevna AY, He M, Zeng Z, Qiang Y, Cao Y, Sergeevich KT. Personalized chemotherapy selection for patients with triple-negative breast cancer using deep learning. Front Med (Lausanne) 2024; 11:1418800. [PMID: 38966532 PMCID: PMC11222643 DOI: 10.3389/fmed.2024.1418800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/06/2024] [Indexed: 07/06/2024] Open
Abstract
Background Potential uncertainties and overtreatment exist in adjuvant chemotherapy for triple-negative breast cancer (TNBC) patients. Objectives This study aims to explore the performance of deep learning (DL) models in personalized chemotherapy selection and quantify the impact of baseline characteristics on treatment efficacy. Methods Patients who received treatment recommended by models were compared to those who did not. Overall survival for treatment according to model recommendations was the primary outcome. To mitigate bias, inverse probability treatment weighting (IPTW) was employed. A mixed-effect multivariate linear regression was employed to visualize the influence of certain baseline features of patients on chemotherapy selection. Results A total of 10,070 female TNBC patients met the inclusion criteria. Treatment according to Self-Normalizing Balanced (SNB) individual treatment effect for survival data model recommendations was associated with a survival benefit (IPTW-adjusted hazard ratio: 0.53, 95% CI, 0.32-8.60; IPTW-adjusted risk difference: 12.90, 95% CI, 6.99-19.01; IPTW-adjusted the difference in restricted mean survival time: 5.54, 95% CI, 1.36-8.61), which surpassed other models and the National Comprehensive Cancer Network guidelines. No survival benefit for chemotherapy was seen for patients not recommended to receive this treatment. SNB predicted older patients with larger tumors and more positive lymph nodes are the optimal candidates for chemotherapy. Conclusion These findings suggest that the SNB model may identify patients with TNBC who could benefit from chemotherapy. This novel analytical approach may provide debiased individual survival information and treatment recommendations. Further research is required to validate these models in clinical settings with more features and outcome measurements.
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Affiliation(s)
- Xinyi Yang
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | | | | | - Mingze He
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Zitong Zeng
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yinpeng Qiang
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yu Cao
- Department of Faculty Surgery No. 2, Sechenov University, Moscow, Russia
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Zhu E, Zhang L, Wang J, Hu C, Jing Q, Shi W, Xu Z, Ai P, Dai Z, Shan D, Ai Z. Personalized surgical recommendations and quantitative therapeutic insights for patients with metastatic breast cancer: Insights from deep learning. CANCER INNOVATION 2024; 3:e119. [PMID: 38947759 PMCID: PMC11212336 DOI: 10.1002/cai2.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 07/02/2024]
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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Affiliation(s)
- Enzhao Zhu
- School of MedicineTongji UniversityShanghaiChina
| | - Linmei Zhang
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Research Institute of Stomatology, Stomatological Hospital and Dental School of Tongji UniversityShanghaiChina
| | - Jiayi Wang
- School of MedicineTongji UniversityShanghaiChina
| | - Chunyu Hu
- Tenth People's Hospital of Tongji University, School of MedicineTongji UniversityShanghaiChina
| | - Qi Jing
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Weizhong Shi
- Shanghai Hospital Development CenterShanghaiChina
| | - Ziqin Xu
- Columbia UniversityNew YorkNYUSA
| | - Pu Ai
- School of MedicineTongji UniversityShanghaiChina
| | - Zhihao Dai
- School of Medicine, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Dan Shan
- Department of Biobehavioral SciencesColumbia UniversityNew YorkNYUSA
| | - Zisheng Ai
- Department of Medical Statistics, School of MedicineTongji UniversityShanghaiChina
- Clinical Research Center for Mental Disorders, Chinese‐German Institute of Mental Health, Shanghai Pudong New Area Mental Health Center, School of MedicineTongji UniversityShanghaiChina
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Zhu E, Wang J, Jing Q, Shi W, Xu Z, Ai P, Chen Z, Dai Z, Shan D, Ai Z. Individualized survival prediction and surgery recommendation for patients with glioblastoma. Front Med (Lausanne) 2024; 11:1330907. [PMID: 38784239 PMCID: PMC11111908 DOI: 10.3389/fmed.2024.1330907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/15/2024] [Indexed: 05/25/2024] Open
Abstract
Background There is a lack of individualized evidence on surgical choices for glioblastoma (GBM) patients. Aim This study aimed to make individualized treatment recommendations for patients with GBM and to determine the importance of demographic and tumor characteristic variables in the selection of extent of resection. Methods We proposed Balanced Decision Ensembles (BDE) to make survival predictions and individualized treatment recommendations. We developed several DL models to counterfactually predict the individual treatment effect (ITE) of patients with GBM. We divided the patients into the recommended (Rec.) and anti-recommended groups based on whether their actual treatment was consistent with the model recommendation. Results The BDE achieved the best recommendation effects (difference in restricted mean survival time (dRMST): 5.90; 95% confidence interval (CI), 4.40-7.39; hazard ratio (HR): 0.71; 95% CI, 0.65-0.77), followed by BITES and DeepSurv. Inverse probability treatment weighting (IPTW)-adjusted HR, IPTW-adjusted OR, natural direct effect, and control direct effect demonstrated better survival outcomes of the Rec. group. Conclusion The ITE calculation method is crucial, as it may result in better or worse recommendations. Furthermore, the significant protective effects of machine recommendations on survival time and mortality indicate the superiority of the model for application in patients with GBM. Overall, the model identifies patients with tumors located in the right and left frontal and middle temporal lobes, as well as those with larger tumor sizes, as optimal candidates for SpTR.
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Affiliation(s)
- Enzhao Zhu
- School of Medicine, Tongji University, Shanghai, China
| | - Jiayi Wang
- School of Medicine, Tongji University, Shanghai, China
| | - Qi Jing
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Weizhong Shi
- Shanghai Hospital Development Center, Shanghai, China
| | - Ziqin Xu
- Department of Industrial Engineering and Operations Research, Columbia University, New York, NY, United States
| | - Pu Ai
- School of Medicine, Tongji University, Shanghai, China
| | - Zhihao Chen
- School of Business, East China University of Science and Technology, Shanghai, China
| | - Zhihao Dai
- School of Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Dan Shan
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Zisheng Ai
- Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
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Zhu E, Zhang L, Wang J, Hu C, Pan H, Shi W, Xu Z, Ai P, Shan D, Ai Z. Deep learning-guided adjuvant chemotherapy selection for elderly patients with breast cancer. Breast Cancer Res Treat 2024; 205:97-107. [PMID: 38294615 DOI: 10.1007/s10549-023-07237-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/29/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE The efficacy of adjuvant chemotherapy in elderly breast cancer patients is currently controversial. This study aims to provide personalized adjuvant chemotherapy recommendations using deep learning (DL). METHODS Six models with various causal inference approaches were trained to make individualized chemotherapy recommendations. Patients who received actual treatment recommended by DL models were compared with those who did not. Inverse probability treatment weighting (IPTW) was used to reduce bias. Linear regression, IPTW-adjusted risk difference (RD), and SurvSHAP(t) were used to interpret the best model. RESULTS A total of 5352 elderly breast cancer patients were included. The median (interquartile range) follow-up time was 52 (30-80) months. Among all models, the balanced individual treatment effect for survival data (BITES) performed best. Treatment according to following BITES recommendations was associated with survival benefit, with a multivariate hazard ratio (HR) of 0.78 (95% confidence interval (CI): 0.64-0.94), IPTW-adjusted HR of 0.74 (95% CI: 0.59-0.93), RD of 12.40% (95% CI: 8.01-16.90%), IPTW-adjusted RD of 11.50% (95% CI: 7.16-15.80%), difference in restricted mean survival time (dRMST) of 12.44 (95% CI: 8.28-16.60) months, IPTW-adjusted dRMST of 7.81 (95% CI: 2.93-11.93) months, and p value of the IPTW-adjusted Log-rank test of 0.033. By interpreting BITES, the debiased impact of patient characteristics on adjuvant chemotherapy was quantified, which mainly included breast cancer subtype, tumor size, number of positive lymph nodes, TNM stages, histological grades, and surgical type. CONCLUSION Our results emphasize the potential of DL models in guiding adjuvant chemotherapy decisions for elderly breast cancer patients.
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Affiliation(s)
- Enzhao Zhu
- School of Medicine, Tongji University, Shanghai, China
| | - Linmei Zhang
- Department of Periodontics, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Jiayi Wang
- School of Medicine, Tongji University, Shanghai, China
| | - Chunyu Hu
- School of Medicine, Tenth People's Hospital of Tongji University, Shanghai, China
| | - Huiqing Pan
- School of Medicine, Tongji University, Shanghai, China
| | - Weizhong Shi
- Shanghai Hospital Development Center, Shanghai, China
| | - Ziqin Xu
- Columbia University, New York, NY, USA
| | - Pu Ai
- School of Medicine, Tongji University, Shanghai, China
| | - Dan Shan
- Columbia University, New York, NY, USA
- National University of Ireland, Galway, Ireland
| | - Zisheng Ai
- Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China.
- Clinical Research Center for Mental Disorders, Chinese-German Institute of Mental Health, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China.
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Zhu E, Zhang L, Liu Y, Ji T, Dai J, Tang R, Wang J, Hu C, Chen K, Yu Q, Lu Q, Ai Z. Determining individual suitability for neoadjuvant systemic therapy in breast cancer patients through deep learning. Clin Transl Oncol 2024:10.1007/s12094-024-03459-8. [PMID: 38678522 DOI: 10.1007/s12094-024-03459-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/08/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND The survival advantage of neoadjuvant systemic therapy (NST) for breast cancer patients remains controversial, especially when considering the heterogeneous characteristics of individual patients. OBJECTIVE To discern the variability in responses to breast cancer treatment at the individual level and propose personalized treatment recommendations utilizing deep learning (DL). METHODS Six models were developed to offer individualized treatment suggestions. Outcomes for patients whose actual treatments aligned with model recommendations were compared to those whose did not. The influence of certain baseline features of patients on NST selection was visualized and quantified by multivariate logistic regression and Poisson regression analyses. RESULTS Our study included 94,487 female breast cancer patients. The Balanced Individual Treatment Effect for Survival data (BITES) model outperformed other models in performance, showing a statistically significant protective effect with inverse probability treatment weighting (IPTW)-adjusted baseline features [IPTW-adjusted hazard ratio: 0.51, 95% confidence interval (CI), 0.41-0.64; IPTW-adjusted risk difference: 21.46, 95% CI 18.90-24.01; IPTW-adjusted difference in restricted mean survival time: 21.51, 95% CI 19.37-23.80]. Adherence to BITES recommendations is associated with reduced breast cancer mortality and fewer adverse effects. BITES suggests that patients with TNM stage IIB, IIIB, triple-negative subtype, a higher number of positive axillary lymph nodes, and larger tumors are most likely to benefit from NST. CONCLUSIONS Our results demonstrated the potential of BITES to aid in clinical treatment decisions and offer quantitative treatment insights. In our further research, these models should be validated in clinical settings and additional patient features as well as outcome measures should be studied in depth.
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Affiliation(s)
- Enzhao Zhu
- School of Medicine, Tongji University, Shanghai, China
| | - Linmei Zhang
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration & Tongji Research Institute of Stomatology & Department of Prosthodontics, Stomatological Hospital and Dental School, Tongji University, Shanghai, 200072, China
| | - Yixian Liu
- Department of Gynecology and Obstetrics, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Tianyu Ji
- School of Medicine, Tongji University, Shanghai, China
| | - Jianmeng Dai
- School of Medicine, Tongji University, Shanghai, China
| | - Ruichen Tang
- College of Electronic and Information Engineering, Tongji University, Shanghai, China
| | - Jiayi Wang
- School of Medicine, Tongji University, Shanghai, China
| | - Chunyu Hu
- Tenth People's Hospital of Tongji University, School of Medicine, Tongji University, Shanghai, China
| | - Kai Chen
- College of Electronic and Information Engineering, Tongji University, Shanghai, China
| | - Qianyi Yu
- School of Medicine, Tongji University, Shanghai, China
| | - Qiuyi Lu
- School of Medicine, Tongji University, Shanghai, China
| | - Zisheng Ai
- Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China.
- Clinical Research Center for Mental Disorders, School of Medicine, Chinese-German Institute of Mental Health, Shanghai Pudong New Area Mental Health Center, Tongji University, Shanghai, China.
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Zhu E, Wang J, Shi W, Jing Q, Ai P, Shan D, Ai Z. Optimizing adjuvant treatment options for patients with glioblastoma. Front Neurol 2024; 15:1326591. [PMID: 38456152 PMCID: PMC10919147 DOI: 10.3389/fneur.2024.1326591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/09/2024] [Indexed: 03/09/2024] Open
Abstract
Background This study focused on minimizing the costs and toxic effects associated with unnecessary chemotherapy. We sought to optimize the adjuvant therapy strategy, choosing between radiotherapy (RT) and chemoradiotherapy (CRT), for patients based on their specific characteristics. This selection process utilized an innovative deep learning method. Methods We trained six machine learning (ML) models to advise on the most suitable treatment for glioblastoma (GBM) patients. To assess the protective efficacy of these ML models, we employed various metrics: hazards ratio (HR), inverse probability treatment weighting (IPTW)-adjusted HR (HRa), the difference in restricted mean survival time (dRMST), and the number needed to treat (NNT). Results The Balanced Individual Treatment Effect for Survival data (BITES) model emerged as the most effective, demonstrating significant protective benefits (HR: 0.53, 95% CI, 0.48-0.60; IPTW-adjusted HR: 0.65, 95% CI, 0.55-0.78; dRMST: 7.92, 95% CI, 7.81-8.15; NNT: 1.67, 95% CI, 1.24-2.41). Patients whose treatment aligned with BITES recommendations exhibited notably better survival rates compared to those who received different treatments, both before and after IPTW adjustment. In the CRT-recommended group, a significant survival advantage was observed when choosing CRT over RT (p < 0.001). However, this was not the case in the RT-recommended group (p = 0.06). Males, older patients, and those whose tumor invasion is confined to the ventricular system were more frequently advised to undergo RT. Conclusion Our study suggests that BITES can effectively identify GBM patients likely to benefit from CRT. These ML models show promise in transforming the complex heterogeneity of real-world clinical practice into precise, personalized treatment recommendations.
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Affiliation(s)
- Enzhao Zhu
- School of Medicine, Tongji University, Shanghai, China
| | - Jiayi Wang
- School of Medicine, Tongji University, Shanghai, China
| | - Weizhong Shi
- Shanghai Hospital Development Center, Shanghai, China
| | - Qi Jing
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Pu Ai
- School of Medicine, Tongji University, Shanghai, China
| | - Dan Shan
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Zisheng Ai
- Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China
- Clinical Research Center for Mental Disorders, Chinese-German Institute of Mental Health, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
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Pan H, Wang J, Shi W, Xu Z, Zhu E. Quantified treatment effect at the individual level is more indicative for personalized radical prostatectomy recommendation: implications for prostate cancer treatment using deep learning. J Cancer Res Clin Oncol 2024; 150:67. [PMID: 38302801 PMCID: PMC10834597 DOI: 10.1007/s00432-023-05602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/25/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND There are potential uncertainties and overtreatment existing in radical prostatectomy (RP) for prostate cancer (PCa) patients, thus identifying optimal candidates is quite important. PURPOSE This study aims to establish a novel causal inference deep learning (DL) model to discern whether a patient can benefit more from RP and to identify heterogeneity in treatment responses among PCa patients. METHODS We introduce the Self-Normalizing Balanced individual treatment effect for survival data (SNB). Six models were trained to make individualized treatment recommendations for PCa patients. Inverse probability treatment weighting (IPTW) was used to avoid treatment selection bias. RESULTS 35,236 patients were included. Patients whose actual treatment was consistent with SNB recommendations had better survival outcomes than those who were inconsistent (multivariate hazard ratio (HR): 0.76, 95% confidence interval (CI), 0.64-0.92; IPTW-adjusted HR: 0.77, 95% CI, 0.61-0.95; risk difference (RD): 3.80, 95% CI, 2.48-5.11; IPTW-adjusted RD: 2.17, 95% CI, 0.92-3.35; the difference in restricted mean survival time (dRMST): 3.81, 95% CI, 2.66-4.85; IPTW-adjusted dRMST: 3.23, 95% CI, 2.06-4.45). Keeping other covariates unchanged, patients with 1 ng/mL increase in PSA levels received RP caused 1.77 months increase in the time to 90% mortality, and the similar results could be found in age, Gleason score, tumor size, TNM stages, and metastasis status. CONCLUSIONS Our highly interpretable and reliable DL model (SNB) may identify patients with PCa who could benefit from RP, outperforming other models and clinical guidelines. Additionally, the DL-based treatment guidelines obtained can provide priori evidence for subsequent studies.
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Affiliation(s)
- Huiqing Pan
- School of Medicine, Tongji University, Shanghai, China
| | - Jiayi Wang
- School of Medicine, Tongji University, Shanghai, China
| | - Weizhong Shi
- Shanghai Hospital Development Center, Shanghai, China
| | - Ziqin Xu
- Columbia University, New York, USA
| | - Enzhao Zhu
- School of Medicine, Tongji University, Shanghai, China.
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