Exploring the survival benefits of surgical treatment for pancreatic adenocarcinoma using the DeepSurv neural network...

To develop a DeepSurv model for predicting survival in pancreatic adenocarcinoma patients, evaluating the benefit of surgical versus non-surgical treatment across different stages, including stage IV subcategories. Clinical data were extracted from the SEER database (2000-2020). Patients were randomly divided into a model-building group and an experimental group. The DeepSurv model was trained and hyperparameter-optimized. Simulated paired data were created by switching treatment status. Predicted survival rates were compared using generalized estimating equations. SHAP values analyzed variable importance.The study included 16,068 patients. The final model achieved a C-index of 0.85. Surgical treatment yielded higher survival rates than non-surgical across all stages (p<0.001), though the benefit diminished in advanced stages. For stage IV, surgery improved survival in T1-3 and N0 stages (p<0.001) but not in T4 and N1. SHAP analysis ranked M stage as the most significant predictor of mortality, followed by T stage, overall stage, and surgical status. M1 metastasis was associated with a 14% increased mortality risk, while surgery reduced risk by 11%.Surgery reduces mortality across stages, with declining efficacy in advanced disease. For stage IV patients, surgery is beneficial except for those with T4 or N1 disease. Combining DeepSurv with SHAP analysis facilitates individualized prediction of surgical survival benefits.