In recent years, there has been growing interest in causal machine learning estimators for quantifying subject-specific effects of a binary treatment on time-to-event outcomes. Estimation approaches have been proposed which attenuate the inherent regularisation bias in machine learning predictions, with each of these estimators addressing measured confounding, right censoring, and in some cases, left truncation. However, the existing approaches are found to exhibit suboptimal finite-sample performance, with none of the existing estimators fully leveraging the temporal structure of the data, yielding non-smooth treatment effects over time. We address these limitations by introducing surv-iTMLE, a targeted learning procedure for estimating the difference in the conditional survival probabilities under two treatments. Unlike existing estimators, surv-iTMLE accommodates both left truncation and right censoring while enforcing smoothness and boundedness of the estimated treatment effect curve over time. Through extensive simulation studies under both right censoring and left truncation scenarios, we demonstrate that surv-iTMLE outperforms existing methods in terms of bias and smoothness of time-varying effect estimates in finite samples. We then illustrate surv-iTMLE's practical utility by exploring heterogeneity in the effects of immunotherapy on survival among non-small cell lung cancer (NSCLC) patients, revealing clinically meaningful temporal patterns that existing estimators may obscure.

An optimal dynamic treatment regime (DTR) consists of a sequence of decision rules in maximizing long-term benefits, which is applicable for chronic diseases such as HIV infection or cancer. In this paper, we develop a novel angle-based approach to search the optimal DTR under a multicategory treatment framework for survival data. The proposed method targets maximization the conditional survival function of patients following a DTR. In contrast to most existing approaches which are designed to maximize the expected survival time under a binary treatment framework, the proposed method solves the multicategory treatment problem given multiple stages for censored data. Specifically, the proposed method obtains the optimal DTR via integrating estimations of decision rules at multiple stages into a single multicategory classification algorithm without imposing additional constraints, which is also more computationally efficient and robust. In theory, we establish Fisher consistency of the proposed method under regularity conditions. Our numerical studies show that the proposed method outperforms competing methods in terms of maximizing the conditional survival function. We apply the proposed method to two real datasets: Framingham heart study data and acquired immunodeficiency syndrome (AIDS) clinical data.

There has been increasing interest in modelling survival data using deep learning methods in medical research. Current approaches have focused on designing special cost functions to handle censored survival data. We propose a very different method with two steps. In the first step, we transform each subject's survival time into a series of jackknife pseudo conditional survival probabilities and then use these pseudo probabilities as a quantitative response variable in the deep neural network model. By using the pseudo values, we reduce a complex survival analysis to a standard regression problem, which greatly simplifies the neural network construction. Our two-step approach is simple, yet very flexible in making risk predictions for survival data, which is very appealing from the practice point of view. The source code is freely available at http://github.com/lilizhaoUM/DNNSurv.