Penalized Deep Partially Linear Cox Models with Application to CT Scans of Lung Cancer Patients

Lung cancer is a leading cause of cancer mortality globally, highlighting the importance of understanding its mortality risks to design effective patient-centered therapies. The National Lung Screening Trial (NLST) was a nationwide study aimed at investigating risk factors for lung cancer. The study employed computed tomography texture analysis (CTTA), which provides objective measurements of texture patterns on CT scans, to quantify the mortality risks of lung cancer patients. Partially linear Cox models are becoming a popular tool for modeling survival outcomes, as they effectively handle both established risk factors (such as age and other clinical factors) and new risk factors (such as image features) in a single framework. The challenge in identifying the texture features that impact cancer survival is due to their sensitivity to factors such as scanner type, segmentation, and organ motion. To overcome this challenge, we propose a novel Penalized Deep Partially Linear Cox Model (Penalized DPLC), which incorporates the SCAD penalty to select significant texture features and employs a deep neural network to estimate the nonparametric component of the model accurately. We prove the convergence and asymptotic properties of the estimator and compare it to other methods through extensive simulation studies, evaluating its performance in risk prediction and feature selection. The proposed method is applied to the NLST study dataset to uncover the effects of key clinical and imaging risk factors on patients' survival. Our findings provide valuable insights into the relationship between these factors and survival outcomes.

Individualized Risk Assessment of Preoperative Opioid Use by Interpretable Neural Network Regression

Preoperative opioid use has been reported to be associated with higher preoperative opioid demand, worse postoperative outcomes, and increased postoperative healthcare utilization and expenditures. Understanding the risk of preoperative opioid use helps establish patient-centered pain management. In the field of machine learning, deep neural network (DNN) has emerged as a powerful means for risk assessment because of its superb prediction power; however, the blackbox algorithms may make the results less interpretable than statistical models. Bridging the gap between the statistical and machine learning fields, we propose a novel Interpretable Neural Network Regression (INNER), which combines the strengths of statistical and DNN models. We use the proposed INNER to conduct individualized risk assessment of preoperative opioid use. Intensive simulations and an analysis of 34,186 patients expecting surgery in the Analgesic Outcomes Study (AOS) show that the proposed INNER not only can accurately predict the preoperative opioid use using preoperative characteristics as DNN, but also can estimate the patient specific odds of opioid use without pain and the odds ratio of opioid use for a unit increase in the reported overall body pain, leading to more straightforward interpretations of the tendency to use opioids than DNN. Our results identify the patient characteristics that are strongly associated with opioid use and is largely consistent with the previous findings, providing evidence that INNER is a useful tool for individualized risk assessment of preoperative opioid use.