AUTHOR=Zhu Enzhao , Wang Jiayi , Jing Qi , Shi Weizhong , Xu Ziqin , Ai Pu , Chen Zhihao , Dai Zhihao , Shan Dan , Ai Zisheng 

TITLE=Individualized survival prediction and surgery recommendation for patients with glioblastoma

JOURNAL=Frontiers in Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1330907

DOI=10.3389/fmed.2024.1330907

ISSN=2296-858X

ABSTRACT=Background: There is a lack of individualized evidence on surgical choices for glioblastoma (GBM) patients.Aim: This study aimed to make individualized treatment recommendation for patients with GBM and to determine the importance of demographic and tumor characteristic variables in the selection of extent of resection.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.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.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 predicts patients with tumors located in the right and left frontal, as well as middle temporal lobes and those with larger tumor size are optimal candidates for SpTR.