Kiessling Jonas, Brunnberg Aston, Holte Gustaf, Eldrup Nikolaj, Sörelius Karl
Department of Mathematics (SCI-MAT), KTH Royal Institute of Technology, Stockholm, Sweden; H-Ai AB, Stockholm, Sweden.
Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Eur J Vasc Endovasc Surg. 2023 Apr;65(4):600-607. doi: 10.1016/j.ejvs.2023.01.028. Epub 2023 Jan 21.
Long term differences in survival after elective repair of abdominal aortic aneurysms (AAAs) between open surgical repair (OSR) and endovascular aneurysm repair (EVAR) are unclear, and hitherto artificial intelligence has not been used for this purpose. The aim was to compare the precision of survival estimates between the Kaplan-Meier (KM) method and the artificial intelligence derived method Neural Multi-Task Logistic Regression (N-MTLR), and to compare survival estimates as a function of patient age and time since surgery between OSR and EVAR using N-MTLR.
All AAAs between 2003 and 2018 in Denmark were identified in the Danish vascular registry. Survival was estimated using the KM and N-MTLR methods, and prediction performance was estimated with the Brier score.
7 912 patients were included in the study, n = 6 569 (83%) men, median age 72 years (range 35 - 92), with a median follow-up time of 45.7 months (range 0 - 120). The two treatment cohorts, OSR n = 5 495 (69%), and EVAR n = 2 417 (31%), differed significantly in patient characteristics. The Brier score for KM increased from 0.044 to 0.244, and for N-MTLR from 0.044 to 0.206, from 90 days to 10 years. The N-MTLR method was more accurate than KM from 90 days to 10 years after surgery, p ≤ .025. N-MTLR demonstrated significant increased probability for survival for OSR in patients aged 58 - 76 years at five years, and 65 - 73 at 10 years after surgery, and the opposite was found for the benefit of EVAR in patients aged 72 - 85 years at one year, 85 - 90 years at five years, and for 85 - 90 year olds at 10 years after surgery.
N-MTLR outperforms KM for the entire post-operative follow-up time. This N-MTLR model has the potential to render more precise patient specific survival estimates and establish survival differences between subgroups of patients that KM is unable to detect, demonstrated here for different age groups.
开放性手术修复（OSR）与血管腔内修复（EVAR）治疗腹主动脉瘤（AAA）后长期生存差异尚不明确，且人工智能尚未用于此目的。本研究旨在比较Kaplan-Meier（KM）法与人工智能衍生方法神经多任务逻辑回归（N-MTLR）生存估计的精度，并使用N-MTLR比较OSR和EVAR患者年龄及术后时间与生存估计的关系。
在丹麦血管登记处识别出2003年至2018年期间丹麦所有的AAA患者。采用KM法和N-MTLR法估计生存情况，并用Brier评分评估预测性能。
本研究共纳入7912例患者，其中男性6569例（83%），中位年龄72岁（范围35 - 92岁），中位随访时间45.7个月（范围0 - 120个月）。两个治疗队列，OSR组5495例（69%），EVAR组2417例（31%），患者特征存在显著差异。从术后90天到10年，KM法的Brier评分从0.044增加到0.244，N-MTLR法从0.044增加到0.206。术后90天到10年，N-MTLR法比KM法更准确，p≤0.025。N-MTLR显示，术后5年时年龄在58 - 76岁的OSR患者以及术后10年时年龄在65 - 73岁的OSR患者生存概率显著增加；而对于EVAR的益处，术后1年时年龄在72 - 85岁的患者、术后5年时年龄在85 - 90岁的患者以及术后10年时年龄在85 - 90岁的患者呈现相反情况。
在整个术后随访期间，N-MTLR的表现优于KM。该N-MTLR模型有可能提供更精确的患者特异性生存估计，并确定KM无法检测到的患者亚组之间的生存差异，本研究在不同年龄组中得到了验证。
