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. 2018 Jul 3;8(1):10037.
doi: 10.1038/s41598-018-27946-5.

Probabilistic Prognostic Estimates of Survival in Metastatic Cancer Patients (PPES-Met) Utilizing Free-Text Clinical Narratives

Affiliations

Probabilistic Prognostic Estimates of Survival in Metastatic Cancer Patients (PPES-Met) Utilizing Free-Text Clinical Narratives

Imon Banerjee et al. Sci Rep. .

Abstract

We propose a deep learning model - Probabilistic Prognostic Estimates of Survival in Metastatic Cancer Patients (PPES-Met) for estimating short-term life expectancy (>3 months) of the patients by analyzing free-text clinical notes in the electronic medical record, while maintaining the temporal visit sequence. In a single framework, we integrated semantic data mapping and neural embedding technique to produce a text processing method that extracts relevant information from heterogeneous types of clinical notes in an unsupervised manner, and we designed a recurrent neural network to model the temporal dependency of the patient visits. The model was trained on a large dataset (10,293 patients) and validated on a separated dataset (1818 patients). Our method achieved an area under the ROC curve (AUC) of 0.89. To provide explain-ability, we developed an interactive graphical tool that may improve physician understanding of the basis for the model's predictions. The high accuracy and explain-ability of the PPES-Met model may enable our model to be used as a decision support tool to personalize metastatic cancer treatment and provide valuable assistance to the physicians.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Workflow of the proposed system - PPES-Met. IWE = intelligent word embedding. LSTM = long short term memory. Number in parentheses indicates dimension of input vector to LSTM.
Figure 2
Figure 2
Statistics of the dataset. (a) Sample distribution in the cohort. Distribution of visits in the cohort: linear scale (b) and logarithmic scale (c); Patients with less than 2 visits were not included in both MetDB and PrDB.
Figure 3
Figure 3
Overall quantitative performance. (a) Epoch based performance accuracy. (b) ROC curve on the test set without padding values. (c) ROC curves on the test set separated based on the primary site. (d) Precision-Recall curve on the test set without padding values. (e) Correlation between predicted probability and actual survival rates, compared with systematic therapy information in next 30 days shows that many patients are getting aggressive therapy when the rate of survival is limited while the rate of systemic therapy utilization plateaus at around 50% for patients with high expected survival.
Figure 4
Figure 4
Patient-level prognosis estimate – x-axis shows the visit index in ascending order starting from the first visit, y-axis shows the probability of survival. Blue line represents the ground truth: Survival - positive = 1, Survival - negative = 0. Green line represents the predicted survival probability score: in (a and b) predicted probability sequence follows the actual survival; in (c) predicted sequence follows the actual survival with a few exceptions; (d) predicted sequence follows the actual survival with high fluctuation. (e) Intelligible longitudinal survival curve of a patient.
Figure 5
Figure 5
Correlating negative survival with systemic therapy data: (on left) pie chat showing 38% getting therapy in 30 days when the patients did not survived 3 months; (on right) PPES-Met prediction: bar char showing mean predicted probability of survival for those patients is less than 10%.
Figure 6
Figure 6
Intelligent word embedding (IWE).
Figure 7
Figure 7
Configuration of the RNN model: unfolded configuration of the network (on left) and a summary of trainable parameters (on right).

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