A Dynamic Bayesian Model for Breast Cancer Survival Prediction

Objective:
Predicting breast cancer survival and targeting patients at high-risk of mortality is of crucial importance.
Methods:
We built a Bayesian Dynamic Cox (BDCox) model for predicting 5-year overall survival in breast cancer patients using data of the SEER Cancer Registry with 12,840 women. Four feature selection methods were used to identify predictors and enhance parsimony: fast backward variable selection, elastic net, Bayesian Model Average (BMA), and clinical expertise. All resulting models and a baseline full model containing all features were internally validated via bootstrapping and externally validated in the Shanghai Breast Cancer Survival Study.
Results:
BMA outperformed other feature selection methods in both internal and external validations. The BDCox model with 12 predictors had the best performance. Several predictors showed time-varying associations with survival that are in agreement with previous studies.
Conclusion:
The model developed using BDCox outperformed other prognostic models considered in our study. The internal validation results indicate that the BDCox model is capable of achieving high prediction accuracy (C-statistic: 0.802), and the external validation results showed excellent generalizability of the BDCox model (C-statistic: 0.739).
Significance:
We built a dynamic Bayesian model from the large population-based registry SEER for predicting 5-year breast cancer overall survival. The prediction performance of the BDCox model is significantly better than other survival models.