Competing risks in survival data analysis

Dutz, Almut; Löck, Steffen

doi:10.1016/j.radonc.2018.09.007

Cited by 35 publications

(28 citation statements)

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“…Competing risk regression models are crucial to estimate the actual individual risk in a time-to-event analysis. [ 26 , 27 ] In this study, both the SD model and the CS model illustrated the circumstances in which the positive association of GSD and cholecystectomy with new-onset PLC cases. There is a substantial difference between the CS model and the SD model, and the application of either model should be dependent on research purposes.…”

Section: Discussionmentioning

confidence: 77%

Risk of primary liver cancer associated with gallstones and cholecystectomy

et al. 2020

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Previous research has revealed a positive relationship between GSD, cholecystectomy and primary liver cancer (PLC). However, previous studies had several limitations including the retrospective design, narrow assessment of potential confounders and lack of competing risk models in time-to-event analyses. We conducted a large prospective cohort study to explore the relationship between GSD, cholecystectomy and PLC. A total of 95,021 participants who had not been diagnosed with PLC previously were enrolled from the Kailuan Cohort study. Demographic characteristics and biochemical parameters were recorded at baseline for all participants. We used Cox regression models and competing risk regression models to evaluate the association of GSD and cholecystectomy with the risk PLC. A total of 306 incidental PLC cases were identified during a median follow-up of 9.05 (8.75–9.22) years per participant. Compared with the normal group, the multivariable HRs (95%CI) for the association of GSD and cholecystectomy with PLC were 1.77 (1.05–2.94), 5.25 (1.95–14.17). In the CS model, the multivariable HRs (95%CI) was 1.76 (1.05–2.94) for the association of GSD and cholecystectomy with PLC and 5.25 (1.95–14.17) for GSD and cholecystectomy. Similar results were also obtained in the SD model with corresponding multivariate HRs (95%CI) of 1.75 (1.01–3.00), 5.22 (1.90–14.07) in the GSD group and cholecystectomy group, respectively. GSD and cholecystectomy were associated with an elevated risk of PLC. Registration number: ChiCTR–TNRC–11001489.

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Section: Discussionmentioning

confidence: 77%

Risk of primary liver cancer associated with gallstones and cholecystectomy

et al. 2020

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“…The estimated cumulative incidence curves and discontinuation ratio of each agent defined by specific reasons at 36 months were examined by Gray's test [27,28]. The discontinuation ratio of the agents at 36 months was analyzed and statistically compared using the Fine-Gray hazard competing risk regression model [27,28], adjusted by potential confounders that may influence drug retention as previously described (age, sex, disease duration, concomitant PSL and MTX usage, starting date, and number of switched bDMARDs) [1,9,11,12,29]. Statistical analyses were performed using EZR (Saitama Medical Center, Jichi Medical University, Saitama, Japan), a graphical user interface for R (The R Foundation for Statistical Computing, Vienna, Austria) [30].…”

Section: Discussionmentioning

confidence: 99%

Drug retention of 7 biologics and tofacitinib in biologics-naïve and biologics-switched patients with rheumatoid arthritis: the ANSWER cohort study

et al. 2020

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Background: This multi-center, retrospective study aimed to clarify retention rates and reasons for discontinuation of 7 biological disease-modifying antirheumatic drugs (bDMARDs) and tofacitinib (TOF), one of the janus kinase inhibitors, in bDMARDs-naïve and bDMARDs-switched patients with rheumatoid arthritis (RA). Methods: This study assessed 3897 patients and 4415 treatment courses with bDMARDs and TOF from 2001 to 2019 (2737 bDMARDs-naïve courses and 1678 bDMARDs-switched courses [59.5% of switched courses were their second agent], female 82.3%, baseline age 57.4 years, disease duration 8.5 years; rheumatoid factor positivity 78.4%; Disease Activity Score in 28 joints using erythrocyte sedimentation rate 4.3; concomitant prednisolone [PSL] dose 6.1 mg/day [usage 42.4%], and methotrexate [MTX] dose 8.5 mg/week [usage 60.9%]). Treatment courses included abatacept (ABT; n = 663), adalimumab (ADA; n = 536), certolizumab pegol (CZP; n = 226), etanercept (ETN; n = 856), golimumab (GLM; n = 458), infliximab (IFX; n = 724), tocilizumab (TCZ; n = 851), and TOF (n = 101/only bDMARDs-switched cases). Drug discontinuation reasons (categorized into lack of effectiveness, toxic adverse events, non-toxic reasons, or remission) and rates were estimated at 36 months using Gray's test and statistically evaluated after adjusted by potential clinical confounders (age, sex, disease duration, concomitant PSL and MTX usage, starting date, and number of switched bDMARDs) using the Fine-Gray model. Results: Cumulative incidence of drug discontinuation for each reason was as follows: lack of effectiveness in the bDMARDs-naïve group (from 13.7% [ABT] to 26.9% [CZP]; P < 0.001 between agents) and the bDMARDs-switched group (from 18.9% [TCZ] to 46.1% [CZP]; P < 0.001 between agents); toxic adverse events in the bDMARDs-naïve group (from 4.6% [ABT] to 11.2% [ETN]; P < 0.001 between agents) and the bDMARDs-switched group (from 5.0% [ETN] to 15.7% [TOF]; P = 0.004 between agents); and remission in the bDMARDs-naïve group (from 2.9% [ETN] to 10.0% [IFX]; P < 0.001 between agents) and the bDMARDs-switched group (from 1.1% [CZP] to 3.3% [GLM]; P = 0.9 between agents).

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“…Another issue that is often observed in observational studies with survival or time-to-event analysis is the competing risk bias. By definition, a competing risk is an event that modifies the chance of J o u r n a l P r e -p r o o f occurrence of the primary event of interest and can occur when a patient is at risk of more than one type of event [15]. Competing risk events are frequently observed in hospital epidemiology when the follow-up ends with hospital discharge.…”

Section: Introductionmentioning

confidence: 99%

Methodological evaluation of bias in observational coronavirus disease 2019 studies on drug effectiveness

Martinuka

Cube

Wolkewitz

2021

Clinical Microbiology and Infection

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Competing risks in survival data analysis

Cited by 35 publications

References 28 publications

Risk of primary liver cancer associated with gallstones and cholecystectomy

Risk of primary liver cancer associated with gallstones and cholecystectomy

Drug retention of 7 biologics and tofacitinib in biologics-naïve and biologics-switched patients with rheumatoid arthritis: the ANSWER cohort study

Methodological evaluation of bias in observational coronavirus disease 2019 studies on drug effectiveness

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