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This study aimed to characterize survival patterns, identify prognostic factors, and develop an interpretable machine learning model for individualized survival prediction in MSA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this multicenter longitudinal cohort study, 391 MSA patients were analyzed. Prognostic factors were identified using Kaplan\u2013Meier and Cox regression analyses. Six survival models were trained with five\u2010fold cross\u2010validation, with Shapley Additive Explanations (SHAP) being used for feature selection and interpretability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During a median follow\u2010up of 4.9\u2009years, 149 deaths occurred, with a median survival of 6.9\u2009years. The random survival forest model achieved the best performance (C\u2010index 0.769; mean time\u2010dependent area under the curve [AUC] 0.815) with 11 predictors. An interactive web\u2010based platform and a risk score were developed for clinical application.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This interpretable machine learning model accurately predicted individualized survival in MSA and identified key prognostic factors. \u00a9 2026 International Parkinson and Movement Disorder Society.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mds.70404","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T01:54:03Z","timestamp":1781574843000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Interpretable Machine Learning Model for Individualized Survival Prediction of Multiple System Atrophy"],"prefix":"10.1002","author":[{"given":"Xiao","family":"Dong","sequence":"first","affiliation":[{"name":"Department of Neurology Xiangya Hospital, Central South University  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daji","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology Xiangya Hospital, Central South University  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linlin","family":"Wan","sequence":"additional","affiliation":[{"name":"Department of Neurology Xiangya Hospital, Central South University  Changsha China"},{"name":"Key Laboratory of Hunan Province in Neurodegenerative Disorders Central South University  Changsha China"},{"name":"National Clinical Research Center for Geriatric Diseases (Xiangya Hospital) Central South University  Changsha China"},{"name":"Department of Radiology Xiangya Hospital, Central South University  Changsha China"},{"name":"National International Collaborative Research Center for Medical Metabolomics Central South University  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology Xiangya Hospital, Central South University  Changsha China"},{"name":"Key Laboratory of Hunan Province in Neurodegenerative Disorders Central South University  Changsha China"},{"name":"National Clinical Research Center for Geriatric Diseases (Xiangya Hospital) Central South University  Changsha China"},{"name":"Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linliu","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Neurology Xiangya Hospital, Central South University  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhe","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Neurology The Second Xiangya Hospital, Central South University  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinze","family":"Wu","sequence":"additional","affiliation":[{"name":"Key Laboratory of Hunan Province in Neurodegenerative Disorders Central South University  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riwei","family":"Ouyang","sequence":"additional","affiliation":[{"name":"Department of Neurology Xiangya Hospital, Central South University  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiafei","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Neurology Xiangya Hospital, Central South University  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kefang","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Neurology Xiangya Hospital, Central South University  Changsha 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China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2812-4120","authenticated-orcid":false,"given":"Hong","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Neurology Xiangya Hospital, Central South University  Changsha China"},{"name":"Key Laboratory of Hunan Province in Neurodegenerative Disorders Central South University  Changsha China"},{"name":"National Clinical Research Center for Geriatric Diseases (Xiangya Hospital) Central South University  Changsha China"},{"name":"National International Collaborative Research Center for Medical Metabolomics Central South University  Changsha China"},{"name":"Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases  Changsha 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