title: Exploring factors related to metastasis free survival in breast cancer patients using Bayesian cure models.
abstract: BACKGROUND
  Breast cancer is a fatal disease and the most frequently diagnosed cancer in women with an increasing pattern worldwide. The burden is mostly attributed to metastatic cancers that occur in one-third of patients and the treatments are palliative. It is of great interest to determine factors affecting time from cancer diagnosis to secondary metastasis.
  
  
  METHODS
  Cure rate models assume a Poisson distribution for the number of unobservable metastatic-component cells that are completely deleted from the non-metastasis patient body but some may remain and result in metastasis. Time to metastasis is defined as a function of the number of these cells and the time for each cell to develop a detectable sign of metastasis. Covariates are introduced to the model via the rate of metastatic-component cells. We used non-mixture cure rate models with Weibull and log-logistic distributions in a Bayesian setting to assess the relationship between metastasis free survival and covariates.
  
  
  RESULTS
  The median of metastasis free survival was 76.9 months. Various models showed that from covariates in the study, lymph node involvement ratio and being progesterone receptor positive were significant, with an adverse and a beneficial effect on metastasis free survival, respectively. The estimated fraction of patients cured from metastasis was almost 48%. The Weibull model had a slightly better performance than log-logistic.
  
  
  CONCLUSIONS
  Cure rate models are popular in survival studies and outperform other models under certain conditions. We explored the prognostic factors of metastatic breast cancer from a different viewpoint. In this study, metastasis sites were analyzed all together. Conducting similar studies in a larger sample of cancer patients as well as evaluating the prognostic value of covariates in metastasis to each site separately are recommended.
authors.affiliation: Department of Biostatistics, School of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran. E-mail : j_mansourian@hlth.mui.ac.ir.
authors.forename: Tohid
authors.initials: T
authors.lastname: Jafari-Koshki
authors.forename: Marjan
authors.initials: M
authors.lastname: Mansourian
authors.forename: Fariborz
authors.initials: F
authors.lastname: Mokarian
mesh_terms: D000328:Adult; D000368:Aged; D001499:Bayes Theorem; D001943:Breast Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D003627:Data Interpretation, Statistical; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D015996:Survival Rate