Abstract Survival analysis has been developed and applied in the number of areas including manufacturing, finance, economics and healthcare. In healthcare domain, usually clinical data are high-dimensional, sparse and complex and sometimes there exists few amount of time-to-event (labeled) instances. Therefore building an accurate survival model from electronic health records is challenging. With this motivation, we address this issue and provide a new survival analysis framework using deep learning and active learning with a novel sampling strategy. First, our approach provides better representation with lower dimensions from clinical features using labeled (time-to-event) and unlabeled (censored) instances and then actively trains the survival model by labeling the censored data using an oracle. As a clinical assistive tool, we introduce a simple effective treatment recommendation approach based on our survival model. In the experimental study, we apply our approach on SEER-Medicare data related to prostate cancer among African–Americans and white patients. The results indicate that our approach outperforms significantly than baseline models.
In the deep learning domain, there exist few studies which developed survival analysis framework using deep learning recently. @cite_12 proposed a new survival model using deep learning termed deep survival analysis. They used Deep Exponential Family (DEF) for capturing complex dependencies from clinical features including laboratory measurements, diagnosis, and medications codes. They applied their model on a large EHR dataset related to coronary heart disease. In the other research , authors introduced a new deep learning approach which can directly predict the survival times for graft patients using foundations of multi-task learning. They demonstrated that their model outperforms usual survival analysis models such as cox proportional hazard model in terms of prediction quality and concordance index.
@cite_12
2753919178 2496251701 2618421739 2415877456
Medical practitioners use survival models to explore and understand the relationships between patients’ covariates (e.g. clinical and genetic features) and the effectiveness of various treatment options. Standard survival models like the linear Cox proportional hazards model require extensive feature engineering or prior medical knowledge to model treatment interaction at an individual level. While nonlinear survival methods, such as neural networks and survival forests, can inherently model these high-level interaction terms, they have yet to be shown as effective treatment recommender systems. We introduce DeepSurv, a Cox proportional hazards deep neural network and state-of-the-art survival method for modeling interactions between a patient’s covariates and treatment effectiveness in order to provide personalized treatment recommendations. We perform a number of experiments training DeepSurv on simulated and real survival data. We demonstrate that DeepSurv performs as well as or better than other state-of-the-art survival models and validate that DeepSurv successfully models increasingly complex relationships between a patient’s covariates and their risk of failure. We then show how DeepSurv models the relationship between a patient’s features and effectiveness of different treatment options to show how DeepSurv can be used to provide individual treatment recommendations. Finally, we train DeepSurv on real clinical studies to demonstrate how it’s personalized treatment recommendations would increase the survival time of a set of patients. The predictive and modeling capabilities of DeepSurv will enable medical researchers to use deep neural networks as a tool in their exploration, understanding, and prediction of the effects of a patient’s characteristics on their risk of failure. The electronic health record (EHR) provides an unprecedented opportunity to build actionable tools to support physicians at the point of care. In this paper, we investigate survival analysis in the context of EHR data. We introduce deep survival analysis, a hierarchical generative approach to survival analysis. It departs from previous approaches in two primary ways: (1) all observations, including covariates, are modeled jointly conditioned on a rich latent structure; and (2) the observations are aligned by their failure time, rather than by an arbitrary time zero as in traditional survival analysis. Further, it (3) scalably handles heterogeneous (continuous and discrete) data types that occur in the EHR. We validate deep survival analysis model by stratifying patients according to risk of developing coronary heart disease (CHD). Specifically, we study a dataset of 313,000 patients corresponding to 5.5 million months of observations. When compared to the clinically validated Framingham CHD risk score, deep survival analysis is significantly superior in stratifying patients according to their risk. An accurate model of patient-specific kidney graft survival distributions can help to improve shared-decision making in the treatment and care of patients. In this paper, we propose a deep learning method that directly models the survival function instead of estimating the hazard function to predict survival times for graft patients based on the principle of multi-task learning. By learning to jointly predict the time of the event, and its rank in the cox partial log likelihood framework, our deep learning approach outperforms, in terms of survival time prediction quality and concordance index, other common methods for survival analysis, including the Cox Proportional Hazards model and a network trained on the cox partial log-likelihood. Previous research has shown that neural networks can model survival data in situations in which some patients' death times are unknown, e.g. right-censored. However, neural networks have rarely been shown to outperform their linear counterparts such as the Cox proportional hazards model. In this paper, we run simulated experiments and use real survival data to build upon the risk-regression architecture proposed by Faraggi and Simon. We demonstrate that our model, DeepSurv, not only works as well as other survival models but actually outperforms in predictive ability on survival data with linear and nonlinear risk functions. We then show that the neural network can also serve as a recommender system by including a categorical variable representing a treatment group. This can be used to provide personalized treatment recommendations based on an individual's calculated risk. We provide an open source Python module that implements these methods in order to advance research on deep learning and survival analysis.