Federated penalized piecewise exponential model for horizontally distributed survival data: FedPPEM

Abstract Cox proportional hazard regressions are frequently employed to develop prognostic models for time-to-event data, considering both patient-specific and disease-specific characteristics. In high-dimensional clinical modeling, these biological features can exhibit high collinearity due to inter-feature relationships, potentially causing instability and numerical issues during estimation without regularization. For rare diseases such as acute myeloid leukemia (AML), the sparsity and scarcity of data further complicate estimation. In such cases, data augmentation through multi-site collaboration can alleviate these problems. However, this often necessitates sharing individual patient data (IPD) across sites, which presents challenges due to regulatory barriers aimed at protecting patient privacy. To overcome these challenges, we propose a privacy-preserving algorithm that eliminates sharing IPD across sites and fits a federated penalized piecewise exponential model (FedPPEM) to estimate potential effects of clinical features using summary statistics. This algorithm yields results nearly identical to those from pooled IPD, including effect size and standard error estimates. We demonstrate the model’s performance in quantifying effects of clinical features and genetic risk classification on overall survival using real-world data from ∼1200 newly diagnosed AML patients across 33 U.S. sites. Although applied in AML context, this model is disease-agnostic and can be implemented in other diseases and clinical contexts.