Metastatic castration-resistant prostate cancer (mCRPC) is a highly aggressive disease with poor prognosis and heterogeneous treatment response. In this work, we developed and externally validated a visit-level 180-day mortality risk model using longitudinal data from two Phase III cohorts (n=526 and n=640). Only visits with observable 180-day outcomes were labeled; right-censored cases were excluded from analysis. We compared five candidate architectures: Long Short-Term Memory, Gated Recurrent Unit (GRU), Cox Proportional Hazards, Random Survival Forest (RSF), and Logistic Regression. For each dataset, we selected the smallest risk-threshold that achieved an 85% sensitivity floor. The GRU and RSF models showed high discrimination capabilities initially (C-index: 87% for both). In external validation, the GRU obtained a higher calibration (slope: 0.93; intercept: 0.07) and achieved an PR-AUC of 0.87. Clinical impact analysis showed a median time-in-warning of 151.0 days for true positives (59.0 days for false positives) and 18.3 alerts per 100 patient-visits. Given late-stage frailty or cachexia and hemodynamic instability, permutation importance ranked BMI and systolic blood pressure as the strongest associations. These results suggest that longitudinal routine clinical markers can estimate short-horizon mortality risk in mCRPC and support proactive care planning over a multi-month window.

翻译：转移性去势抵抗性前列腺癌（mCRPC）是一种高度侵袭性疾病，预后不良且治疗反应存在异质性。本研究利用两个III期队列（n=526和n=640）的纵向数据，开发并外部验证了一个就诊级别的180天死亡风险模型。仅对具有可观测180天结局的就诊进行标注；右删失病例被排除在分析之外。我们比较了五种候选架构：长短期记忆网络、门控循环单元（GRU）、Cox比例风险模型、随机生存森林（RSF）和逻辑回归。针对每个数据集，我们选择了达到85%敏感度阈值的最小风险阈值。GRU和RSF模型最初均显示出较高的区分能力（C指数：均为87%）。在外部验证中，GRU获得了更高的校准度（斜率：0.93；截距：0.07），并实现了0.87的PR-AUC。临床影响分析显示，真阳性病例的中位预警时长为151.0天（假阳性为59.0天），每100次患者就诊产生18.3次警报。考虑到晚期患者的衰弱或恶病质以及血流动力学不稳定性，置换重要性排序将体重指数和收缩压列为最强关联因素。这些结果表明，纵向常规临床标志物能够评估mCRPC的短期死亡风险，并为长达数月的窗口期内的主动护理规划提供支持。