Longitudinal Patterns in Clinical and Imaging Measurements Predict Residual Survival in Glioblastoma Patients

The growing amount of longitudinal data for a large population of patients has necessitated the application of algorithms that can discover patterns to inform patient management. This study demonstrates how temporal patterns generated from a combination of clinical and imaging measurements improve residual survival prediction in glioblastoma patients. Temporal patterns were identified with sequential pattern mining using data from 304 patients. Along with patient covariates, the patterns were incorporated as features in logistic regression models to predict 2-, 6-, or 9-month residual survival at each visit. The modeling approach that included temporal patterns achieved test performances of 0.820, 0.785, and 0.783 area under the receiver operating characteristic curve for predicting 2-, 6-, and 9-month residual survival, respectively. This approach significantly outperformed models that used tumor volume alone (p < 0.001) or tumor volume combined with patient covariates (p < 0.001) in training. Temporal patterns involving an increase in tumor volume above 122 mm(3)/day, a decrease in KPS across multiple visits, moderate neurologic symptoms, and worsening overall neurologic function suggested lower residual survival. These patterns are readily interpretable and found to be consistent with known prognostic indicators, suggesting they can provide early indicators to clinicians of changes in patient state and inform management decisions.