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arXiv 2308.03398stat.AP
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机器学习方法是否会生成相似的个体化治疗规则?一项基于真实数据的比较研究

Do machine learning methods lead to similar individualized treatment rules? A comparison study on real data

Florie Bouvier, Etienne Peyrot, Alan Balendran, Corentin Ségalas, Ian Roberts, François Petit, Raphaël Porcher

AI总结:

该研究在两项随机对照试验中对比22种构建个体化治疗规则的机器学习方法,发现不同方法生成的规则分歧大、不可互换,且普遍存在性能高估问题,为其临床实际应用带来隐忧。

摘要:

识别能从治疗中获益的患者是个性化医疗的核心方向,可借此制定个体化治疗规则(individualized treatment rules, ITRs)。目前已有众多机器学习方法被提出用于构建这类规则,但这些方法生成的ITRs相似程度如何,即是否会为相同个体推荐相同治疗,尚不明确。本研究在两项随机对照试验中,对比了22种最常用的方法。这些方法可分为两类:第一类方法先预测个体化治疗效应,再向预测有获益的个体推荐受试治疗,由此推导ITR;第二类方法无需估计个体化治疗效应,直接估计ITR。针对每项试验,研究采用多种指标评估ITR的性能,同时计算所有ITR之间的两两一致性。结果显示,不同方法得到的ITR在应接受治疗的患者群体上普遍存在较大分歧,同类方法之间的一致性更高。总体而言,在验证样本中评估ITR性能时,所有方法生成的ITR性能都有限,表明存在很高的乐观偏倚风险。对于非参数方法,这种乐观偏倚很可能源于过拟合。不同方法不会生成相似的ITR,因此不具备可互换性。方法的选择会强烈影响哪些患者会被推荐接受特定治疗,这为其实际应用带来了一些隐忧。

英文摘要:

Identifying patients who benefit from a treatment is a key aspect of personalized medicine, which allows the development of individualized treatment rules (ITRs). Many machine learning methods have been proposed to create such rules. However, to what extent the methods lead to similar ITRs, i.e., recommending the same treatment for the same individuals is unclear. In this work, we compared 22 of the most common approaches in two randomized control trials. Two classes of methods can be distinguished. The first class of methods relies on predicting individualized treatment effects from which an ITR is derived by recommending the treatment evaluated to the individuals with a predicted benefit. In the second class, methods directly estimate the ITR without estimating individualized treatment effects. For each trial, the performance of ITRs was assessed by various metrics, and the pairwise agreement between all ITRs was also calculated. Results showed that the ITRs obtained via the different methods generally had considerable disagreements regarding the patients to be treated. A better concordance was found among akin methods. Overall, when evaluating the performance of ITRs in a validation sample, all methods produced ITRs with limited performance, suggesting a high potential for optimism. For non-parametric methods, this optimism was likely due to overfitting. The different methods do not lead to similar ITRs and are therefore not interchangeable. The choice of the method strongly influences for which patients a certain treatment is recommended, drawing some concerns about their practical use.

机构、总结、中文摘要均由AI分析而来,可能存在错误,请以论文正文为准。

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