The target of dynamic prediction is to provide individualized risk predictions over time which can be updated as new data become available. Motivated by establishing a dynamic prediction model for the progressive eye disease, age-related macular degeneration (AMD), we proposed a time-dependent Cox model-based survival neural network (tdCoxSNN) to predict its progression on a continuous time scale using longitudinal fundus images. tdCoxSNN extends the time-dependent Cox model by utilizing a neural network to model the non-linear effect of the time-dependent covariates on the survival outcome. Additionally, by incorporating the convolutional neural network (CNN), tdCoxSNN can take the longitudinal raw images as input. We evaluate and compare our proposed method with joint modeling and landmarking approaches through comprehensive simulations using two time-dependent accuracy metrics, the Brier Score and dynamic AUC. We applied the proposed approach to two real datasets. One is a large AMD study, the Age-Related Eye Disease Study (AREDS), in which more than 50,000 fundus images were captured over a period of 12 years for more than 4,000 participants. Another is a public dataset of the primary biliary cirrhosis (PBC) disease, in which multiple lab tests were longitudinally collected to predict the time-to-liver transplant. Our approach achieves satisfactory prediction performance in both simulation studies and the two real data analyses. tdCoxSNN was implemented in PyTorch, Tensorflow, and R-Tensorflow.

The individual data collected throughout patient follow-up constitute crucial information for assessing the risk of a clinical event, and eventually for adapting a therapeutic strategy. Joint models and landmark models have been proposed to compute individual dynamic predictions from repeated measures to one or two markers. However, they hardly extend to the case where the complete patient history includes much more repeated markers possibly. Our objective was thus to propose a solution for the dynamic prediction of a health event that may exploit repeated measures of a possibly large number of markers. We combined a landmark approach extended to endogenous markers history with machine learning methods adapted to survival data. Each marker trajectory is modeled using the information collected up to landmark time, and summary variables that best capture the individual trajectories are derived. These summaries and additional covariates are then included in different prediction methods. To handle a possibly large dimensional history, we rely on machine learning methods adapted to survival data, namely regularized regressions and random survival forests, to predict the event from the landmark time, and we show how they can be combined into a superlearner. Then, the performances are evaluated by cross-validation using estimators of Brier Score and the area under the Receiver Operating Characteristic curve adapted to censored data. We demonstrate in a simulation study the benefits of machine learning survival methods over standard survival models, especially in the case of numerous and/or nonlinear relationships between the predictors and the event. We then applied the methodology in two prediction contexts: a clinical context with the prediction of death for patients with primary biliary cholangitis, and a public health context with the prediction of death in the general elderly population at different ages. Our methodology, implemented in R, enables the prediction of an event using the entire longitudinal patient history, even when the number of repeated markers is large. Although introduced with mixed models for the repeated markers and methods for a single right censored time-to-event, our method can be used with any other appropriate modeling technique for the markers and can be easily extended to competing risks setting.