ADJUSTING FOR AGE-RELATED COMPETING MORTALITY IN LONG-TERM CANCER CLINICAL-TRIALS

被引：13

作者：

CHEUVART, B

RYAN, L

机构：

[1] Department of Biostatistics, Harvard School of Public Health, Dana-Farber Cancer Institute, Boston, Massachusetts, 02115

来源：

STATISTICS IN MEDICINE | 1991年 / 10卷 / 01期

关键词：

D O I：

10.1002/sim.4780100112

中图分类号：

Q [生物科学];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Mortality related to causes other than the treated disease may have a significant impact on overall survival in long-term clinical trials. We present a model that adjusts for age-related competing mortality when cause of death is missing or only partially available. Through use of a piecewise exponential survival model, we extend relative survival methods to continuous follow-up data, allowing the competing mortality to differ from that of the general population by a scale parameter. An EM algorithm provides a simple way to compute the maximum likelihood estimators (MLEs) and to test hypotheses using widely available software. We compare the bias and relative efficiency of this model to a piecewise exponential Cox model for overall survival. Theoretical results are confirmed by simulations and illustrated with data from a clinical trial in colorectal cancer. This example also shows how age-related and disease-related mortality can be confounded in an analysis of overall survival. We conclude with a discussion of the advantages and disadvantages of the model.

引用

页码：65 / 77

页数：13

共 22 条

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