Survival Analysis (time-to-event analysis) in the presence of multiple possible adverse events, i.e., competing risks, is a challenging, yet very important problem in medicine, finance, manufacturing, etc. Extending classical survival analysis to competing risks is not trivial since only one event (e.g. one cause of death) is observed and hence, the incidence of an event of interest is often obscured by other related competing events. This leads to the nonidentifiability of the event times distribution parameters, which makes the problem significantly more challenging. In this work we introduce Siamese Survival Prognosis Network, a novel Siamese Deep Neural Network architecture that is able to effectively learn from data in the presence of multiple adverse events. The Siamese Survival Network is especially crafted to issue pairwise concordant time-dependent risks, in which longer event times are assigned lower risks. Furthermore, our architecture is able to directly optimize an approximation to the C-discrimination index, rather than relying on well-known metrics of cross-entropy etc., and which are not able to capture the unique requirements of survival analysis with competing risks. Our results show consistent performance improvements on a number of publicly available medical datasets over both statistical and deep learning state-of-the-art methods.
The authors tackle the problem of estimating risk in a survival analysis setting with competing risks. They propose directly optimizing the time-dependent discrimination index using a siamese survival network. Experiments on several real-world dataset reveal modest gains in comparison with the state of the art.
- The authors should clearly highlight what is their main technical contribution. For example, Eqs. 1-6 appear to be background material since the time-dependent discrimination index is taken from the literature, as the authors point out earlier. However, this is unclear from the writing. 
- One of the main motivations of the authors is to propose a model that is specially design to avoid the nonidentifiability issue in an scenario with competing risks. It is unclear why the authors solution is able to solve such an issue, specially given the modest reported gains in comparison with several competitive baselines. In other words, the authors oversell their own work, specially in comparison with the state of the art.
- The authors use off-the-shelf siamese networks for their settting and thus it is questionable there is any novelty there. The application/setting may be novel, but not the architecture of choice.
- From Eq. 4 to Eq. 5, the authors argue that the denominator does not depend on the model parameters and can be ignored. However, afterwards the objective does combine time-dependent discrimination indices of several competing risks, with different denominator values. This could be problematic if the risks are unbalanced.
- The competitive gain of the authors method in comparison with other competing methods is minor.
- The authors introduce F(t, D | x) as cumulative incidence function (CDF) at the beginning of section 2, however, afterwards they use R^m(t, x), which they define as risk of the subject experiencing event m before t. Is the latter a proxy for the former? How are they related?