Estimating optimal tailored active surveillance strategy under interval censoring

TL;DR

This paper introduces a nonparametric kernel-based method to estimate and optimize personalized active surveillance strategies in cancer care, accounting for interval censoring and patient dropouts, aiming to reduce invasive biopsies.

Contribution

It develops a novel estimation framework for true positive and negative rates under censoring and dropouts, enabling tailored, cost-effective surveillance strategies.

Findings

Method outperforms existing approaches in simulations.

Application to prostate cancer data demonstrates practical effectiveness.

Provides theoretical bounds for strategy generalization.

Abstract

Active surveillance (AS) using repeated biopsies to monitor disease progression has been a popular alternative to immediate surgical intervention in cancer care. However, a biopsy procedure is invasive and sometimes leads to severe side effects of infection and bleeding. To reduce the burden of repeated surveillance biopsies, biomarker-assistant decision rules are sought to replace the fix-for-all regimen with tailored biopsy intensity for individual patients. Constructing or evaluating such decision rules is challenging. The key AS outcome is often ascertained subject to interval censoring. Furthermore, patients will discontinue their participation in the AS study once they receive a positive surveillance biopsy. Thus, patient dropout is affected by the outcomes of these biopsies. In this work, we propose a nonparametric kernel-based method to estimate the true positive rates (TPRs) and true negative rates (TNRs) of a tailored AS strategy, accounting for interval censoring and immediate dropouts. Based on these estimates, we develop a weighted classification framework to estimate the optimal tailored AS strategy and further incorporate the cost-benefit ratio for cost-effectiveness in medical decision-making. Theoretically, we provide a uniform generalization error bound of the derived AS strategy accommodating all possible trade-offs between TPRs and TNRs. Simulation and application to a prostate cancer surveillance study show the superiority of the proposed method.