Modelling competing risks in cancer studies.
Competing risks arise commonly in the analysis of cancer studies. Most common are the competing risks of relapse and death in remission. These two risks are the primary reason that patients fail treatment. In most medical papers the effects of covariates on the three outcomes (relapse, death in remission and treatment failure) are model by distinct proportional hazards regression models. Since the hazards of relapse and death in remission must add to that of treatment failure, we argue that this model leads to internal inconsistencies. We argue that additive models for either the hazard rates or the cumulative incidence functions are more natural and that these models properly partition the effect of a covariate on treatment failure into its component parts. We illustrate the use and interpretation of additive models for the hazard rate or for the cumulative incidence function using data from a study of the efficacy of two preparative regimes for hematopoietic stem cell transplantation.
Klein
John P
JP
Division of Biostatistics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA. klein@mcw.edu
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000379:methods; D002066:Busulfan / Q000627:therapeutic use; D002986:Clinical Trials as Topic / Q000379:methods*; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009364:Neoplasm Recurrence, Local; D009369:Neoplasms / Q000188:drug therapy*; D016016:Proportional Hazards Models; D012307:Risk Factors; D017211:Treatment Failure; D014916:Whole-Body Irradiation / Q000592:standards
D000970:Antineoplastic Agents; D003520:Cyclophosphamide; D002066:Busulfan