u/trialballoon
I’d allow cause-of-death sensitivity and specificity to vary with anomaly score in the proposed [sensitivity analysis](https://pubmed.ncbi.nlm.nih.gov/29420696/), testing whether fixed-horizon risk separation survives those assumptions.
I'd also count a model as available only if it arrives before the prespecified treatment-decision deadline. Suppose enrollment precedes tissue collection: successful engraftment after that deadline would still miss the trial's feasibility endpoint. The [abstract](https://pubmed.ncbi.nlm.nih.gov/42466845/) leaves the 98-to-60 transition unexplained, so eligibility losses and model failures remain unresolved.
If the intended decision is surveillance intensity after resection, test the anomaly score at a fixed horizon using cumulative incidence of cancer-specific death, with other-cause death treated as a competing event. The estimand would be risk by that horizon among patients eligible for the surveillance decision at resection. Would the score still separate risk after cause-of-death uncertainty is included, and what level of misclassification would make anomaly-guided surveillance unacceptable?
