{"paper_id":"409d7a2e-468f-460d-bb73-d61efc927403","body_text":"Improving survival models in healthcare: a novel matching approach | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Improving survival models in healthcare: a novel matching approach Dimitris Bertsimas, Catherine Ning, Per Eystein Lønning, Hideo Baba, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5467577/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract We present, to our knowledge, the first methodological study aimed at enhancing the prognosticpower of Cox regression models, widely used in survival analysis, through optimized data selection. Ourapproach employs a novel two-stage mechanism: by framing the prognostic stratum matching problemintuitively, we select prognostically representative patient observations to create a more balanced trainingset. This enables the model to assign equal attention to distinct prognostic subgroups. We demonstratethe methodology using an observational dataset of 1,799 patients with resected colorectal cancer livermetastases, 1,197 of whom received adjuvant chemotherapy and 602 who did not. In our study, as is current standard practice, the comparator was training prognostic models on the entire cohort (referred to as ”model 1”). Models trained on the untreated and treated subgroups, matched through our approach (referred to as ”model 3A and 3B”, respectively), showed an improvement of up to 20% in bootstrapped C-indices compared tomodel 1. Notably, model 3 exhibited superior calibration, with a 6- to 10-fold improvement over model 1. Additional performance metrics aligned with these findings, and robustness was confirmed through biascorrectedbootstrapping. Given the ongoing development of numerous linear prognostic models and thegeneral applicability of our approach to any observational data, this method holds significant potentialto impact biomedical research and clinical practice where prognostic models are utilized. Health sciences/Medical research Health sciences/Medical research/Outcomes research Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5467577\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Article\",\"associatedPublications\":[],\"authors\":[{\"id\":389109504,\"identity\":\"b8795bdd-8854-4824-9de4-c17fed9bbb48\",\"order_by\":0,\"name\":\"Dimitris Bertsimas\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Massachusetts Institute of Technology\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Dimitris\",\"middleName\":\"\",\"lastName\":\"Bertsimas\",\"suffix\":\"\"},{\"id\":389109505,\"identity\":\"b5c9938f-cb44-4cd3-bc8c-b5c5825c2f00\",\"order_by\":1,\"name\":\"Catherine Ning\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Massachusetts Institute of Technology\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Catherine\",\"middleName\":\"\",\"lastName\":\"Ning\",\"suffix\":\"\"},{\"id\":389109506,\"identity\":\"e9ec5c9a-c049-467b-ae46-4d07b234f583\",\"order_by\":2,\"name\":\"Per Eystein Lønning\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Bergen\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Per\",\"middleName\":\"Eystein\",\"lastName\":\"Lønning\",\"suffix\":\"\"},{\"id\":389109507,\"identity\":\"0333ea41-065e-4319-b6f7-1a95eed1bb21\",\"order_by\":3,\"name\":\"Hideo Baba\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Kumamoto University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Hideo\",\"middleName\":\"\",\"lastName\":\"Baba\",\"suffix\":\"\"},{\"id\":389109508,\"identity\":\"bc35a7a0-adbb-430f-b9ed-3711abb0bc6a\",\"order_by\":4,\"name\":\"Itaru Endo\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Yokohama City University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Itaru\",\"middleName\":\"\",\"lastName\":\"Endo\",\"suffix\":\"\"},{\"id\":389109509,\"identity\":\"9edeb130-849c-4515-a692-f53dc28bf888\",\"order_by\":5,\"name\":\"Richard Burkhart\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Johns Hopkins University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Richard\",\"middleName\":\"\",\"lastName\":\"Burkhart\",\"suffix\":\"\"},{\"id\":389109510,\"identity\":\"bf829308-07d8-4d73-afa6-c3c659223812\",\"order_by\":6,\"name\":\"Federico N Aucejo\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Cleveland Clinic\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Federico\",\"middleName\":\"N\",\"lastName\":\"Aucejo\",\"suffix\":\"\"},{\"id\":389109511,\"identity\":\"5c0e2831-3708-4c7f-a210-f0095e75da40\",\"order_by\":7,\"name\":\"Felix Balzer\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Charité - 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