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Dejardin D, Kraxner A, Schindler E, Städler N, Wolbers M. An overview of statistical methods for biomarkers relevant to early clinical development of cancer immunotherapies. Front Immunol 2024; 15:1351584. [PMID: 39234243 PMCID: PMC11371698 DOI: 10.3389/fimmu.2024.1351584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 07/29/2024] [Indexed: 09/06/2024] Open
Abstract
Over the last decade, a new paradigm for cancer therapies has emerged which leverages the immune system to act against the tumor. The novel mechanism of action of these immunotherapies has also introduced new challenges to drug development. Biomarkers play a key role in several areas of early clinical development of immunotherapies including the demonstration of mechanism of action, dose finding and dose optimization, mitigation and prevention of adverse reactions, and patient enrichment and indication prioritization. We discuss statistical principles and methods for establishing the prognostic, predictive aspect of a (set of) biomarker and for linking the change in biomarkers to clinical efficacy in the context of early development studies. The methods discussed are meant to avoid bias and produce robust and reproducible conclusions. This review is targeted to drug developers and data scientists interested in the strategic usage and analysis of biomarkers in the context of immunotherapies.
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Affiliation(s)
- David Dejardin
- Data Sciences, Product Development, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Anton Kraxner
- Roche Pharma Research and Early Development Oncology, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Emilie Schindler
- Roche Pharma Research and Early Development Oncology, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Nicolas Städler
- Roche Pharma Research and Early Development Oncology, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Marcel Wolbers
- Data Sciences, Product Development, F. Hoffmann-La Roche AG, Basel, Switzerland
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2
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Hussain Z, De Brouwer E, Boiarsky R, Setty S, Gupta N, Liu G, Li C, Srimani J, Zhang J, Labotka R, Sontag D. Joint AI-driven event prediction and longitudinal modeling in newly diagnosed and relapsed multiple myeloma. NPJ Digit Med 2024; 7:200. [PMID: 39075240 PMCID: PMC11286964 DOI: 10.1038/s41746-024-01189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 07/15/2024] [Indexed: 07/31/2024] Open
Abstract
Multiple myeloma management requires a balance between maximizing survival, minimizing adverse events to therapy, and monitoring disease progression. While previous work has proposed data-driven models for individual tasks, these approaches fail to provide a holistic view of a patient's disease state, limiting their utility to assist physician decision-making. To address this limitation, we developed a transformer-based machine learning model that jointly (1) predicts progression-free survival (PFS), overall survival (OS), and adverse events (AE), (2) forecasts key disease biomarkers, and (3) assesses the effect of different treatment strategies, e.g., ixazomib, lenalidomide, dexamethasone (IRd) vs lenalidomide, dexamethasone (Rd). Using TOURMALINE trial data, we trained and internally validated our model on newly diagnosed myeloma patients (N = 703) and externally validated it on relapsed and refractory myeloma patients (N = 720). Our model achieved superior performance to a risk model based on the multiple myeloma international staging system (ISS) (p < 0.001, Bonferroni corrected) and comparable performance to survival models trained separately on each task, but unable to forecast biomarkers. Our approach outperformed state-of-the-art deep learning models, tailored towards forecasting, on predicting key disease biomarkers (p < 0.001, Bonferroni corrected). Finally, leveraging our model's capacity to estimate individual-level treatment effects, we found that patients with IgA kappa myeloma appear to benefit the most from IRd. Our study suggests that a holistic assessment of a patient's myeloma course is possible, potentially serving as the foundation for a personalized decision support system.
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Affiliation(s)
- Zeshan Hussain
- CSAIL, MIT, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | - Cong Li
- Takeda LLC, Cambridge, MA, USA
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3
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Ye Q, Wang X, Xu X, Chen J, Christiani DC, Chen F, Zhang R, Wei Y. Serial platelet count as a dynamic prediction marker of hospital mortality among septic patients. BURNS & TRAUMA 2024; 12:tkae016. [PMID: 38882552 PMCID: PMC11179733 DOI: 10.1093/burnst/tkae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/04/2024] [Accepted: 03/14/2024] [Indexed: 06/18/2024]
Abstract
Background Platelets play a critical role in hemostasis and inflammatory diseases. Low platelet count and activity have been reported to be associated with unfavorable prognosis. This study aims to explore the relationship between dynamics in platelet count and in-hospital morality among septic patients and to provide real-time updates on mortality risk to achieve dynamic prediction. Methods We conducted a multi-cohort, retrospective, observational study that encompasses data on septic patients in the eICU Collaborative Research Database (eICU-CRD) and the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The joint latent class model (JLCM) was utilized to identify heterogenous platelet count trajectories over time among septic patients. We assessed the association between different trajectory patterns and 28-day in-hospital mortality using a piecewise Cox hazard model within each trajectory. We evaluated the performance of our dynamic prediction model through area under the receiver operating characteristic curve, concordance index (C-index), accuracy, sensitivity, and specificity calculated at predefined time points. Results Four subgroups of platelet count trajectories were identified that correspond to distinct in-hospital mortality risk. Including platelet count did not significantly enhance prediction accuracy at early stages (day 1 C-indexDynamic vs C-indexWeibull: 0.713 vs 0.714). However, our model showed superior performance to the static survival model over time (day 14 C-indexDynamic vs C-indexWeibull: 0.644 vs 0.617). Conclusions For septic patients in an intensive care unit, the rapid decline in platelet counts is a critical prognostic factor, and serial platelet measures are associated with prognosis.
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Affiliation(s)
- Qian Ye
- Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166, China
| | - Xuan Wang
- Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166, China
| | - Xiaoshuang Xu
- Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166, China
| | - Jiajin Chen
- Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166, China
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, 655 Huntington Avenue, Boston, MA 02115, USA
- Pulmonary and Critical Care Division, Massachusetts General Hospital, Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Feng Chen
- Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166, China
- China International Cooperation Center of Environment and Human Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166, China
| | - Ruyang Zhang
- Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166, China
| | - Yongyue Wei
- Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166, China
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, 38 Xueyuan Road, Haidian District, Beijing 100191, China
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4
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Zhou S, Huang X, Shen C, Kantarjian HM. Bayesian Learning of Personalized Longitudinal Biomarker Trajectory. ANNALS OF DATA SCIENCE 2024; 11:1031-1050. [PMID: 38855634 PMCID: PMC11160561 DOI: 10.1007/s40745-023-00486-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 07/09/2023] [Accepted: 07/13/2023] [Indexed: 06/11/2024]
Abstract
This work concerns the effective personalized prediction of longitudinal biomarker trajectory, motivated by a study of cancer targeted therapy for patients with chronic myeloid leukemia (CML). Continuous monitoring with a confirmed biomarker of residual disease is a key component of CML management for early prediction of disease relapse. However, the longitudinal biomarker measurements have highly heterogeneous trajectories between subjects (patients) with various shapes and patterns. It is believed that the trajectory is clinically related to the development of treatment resistance, but there was limited knowledge about the underlying mechanism. To address the challenge, we propose a novel Bayesian approach to modeling the distribution of subject-specific longitudinal trajectories. It exploits flexible Bayesian learning to accommodate complex changing patterns over time and non-linear covariate effects, and allows for real-time prediction of both in-sample and out-of-sample subjects. The generated information can help make clinical decisions, and consequently enhance the personalized treatment management of precision medicine.
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Affiliation(s)
- Shouhao Zhou
- Department of Public Health Sciences, Pennsylvinia State University, Hershey, 17033, PA, USA
| | - Xuelin Huang
- Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, 77030, TX, USA
| | - Chan Shen
- Department of Public Health Sciences, Pennsylvinia State University, Hershey, 17033, PA, USA
- Department of Surgery, Pennsylvinia State University, Hershey, 17033, PA, USA
| | - Hagop M. Kantarjian
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, 77030, TX, USA
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5
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Lancia G, Varkila MRJ, Cremer OL, Spitoni C. Two-step interpretable modeling of ICU-AIs. Artif Intell Med 2024; 151:102862. [PMID: 38579437 DOI: 10.1016/j.artmed.2024.102862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024]
Abstract
We present a novel methodology for integrating high resolution longitudinal data with the dynamic prediction capabilities of survival models. The aim is two-fold: to improve the predictive power while maintaining the interpretability of the models. To go beyond the black box paradigm of artificial neural networks, we propose a parsimonious and robust semi-parametric approach (i.e., a landmarking competing risks model) that combines routinely collected low-resolution data with predictive features extracted from a convolutional neural network, that was trained on high resolution time-dependent information. We then use saliency maps to analyze and explain the extra predictive power of this model. To illustrate our methodology, we focus on healthcare-associated infections in patients admitted to an intensive care unit.
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Affiliation(s)
- G Lancia
- Mathematics Department, Utrecht University, Budapestlaan, 6, Utrecht, 3584CD, The Netherlands.
| | - M R J Varkila
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht, 3584 CG, The Netherlands
| | - O L Cremer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht, 3584 CG, The Netherlands
| | - C Spitoni
- Mathematics Department, Utrecht University, Budapestlaan, 6, Utrecht, 3584CD, The Netherlands
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Wabe N, Meulenbroeks I, Huang G, Silva SM, Gray LC, Close JCT, Lord S, Westbrook JI. Development and internal validation of a dynamic fall risk prediction and monitoring tool in aged care using routinely collected electronic health data: a landmarking approach. J Am Med Inform Assoc 2024; 31:1113-1125. [PMID: 38531675 PMCID: PMC11031240 DOI: 10.1093/jamia/ocae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVES Falls pose a significant challenge in residential aged care facilities (RACFs). Existing falls prediction tools perform poorly and fail to capture evolving risk factors. We aimed to develop and internally validate dynamic fall risk prediction models and create point-based scoring systems for residents with and without dementia. MATERIALS AND METHODS A longitudinal cohort study using electronic data from 27 RACFs in Sydney, Australia. The study included 5492 permanent residents, with a 70%-30% split for training and validation. The outcome measure was the incidence of falls. We tracked residents for 60 months, using monthly landmarks with 1-month prediction windows. We employed landmarking dynamic prediction for model development, a time-dependent area under receiver operating characteristics curve (AUROCC) for model evaluations, and a regression coefficient approach to create point-based scoring systems. RESULTS The model identified 15 independent predictors of falls in dementia and 12 in nondementia cohorts. Falls history was the key predictor of subsequent falls in both dementia (HR 4.75, 95% CI, 4.45-5.06) and nondementia cohorts (HR 4.20, 95% CI, 3.87-4.57). The AUROCC across landmarks ranged from 0.67 to 0.87 for dementia and from 0.66 to 0.86 for nondementia cohorts but generally remained between 0.75 and 0.85 in both cohorts. The total point risk score ranged from -2 to 57 for dementia and 0 to 52 for nondementia cohorts. DISCUSSION Our novel risk prediction models and scoring systems provide timely person-centered information for continuous monitoring of fall risk in RACFs. CONCLUSION Embedding these tools within electronic health records could facilitate the implementation of targeted proactive interventions to prevent falls.
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Affiliation(s)
- Nasir Wabe
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Isabelle Meulenbroeks
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Guogui Huang
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Sandun Malpriya Silva
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Leonard C Gray
- Centre for Health Service Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Jacqueline C T Close
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW 2052, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Stephen Lord
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW 2052, Australia
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
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Rustand D, van Niekerk J, Krainski ET, Rue H, Proust-Lima C. Fast and flexible inference for joint models of multivariate longitudinal and survival data using integrated nested Laplace approximations. Biostatistics 2024; 25:429-448. [PMID: 37531620 PMCID: PMC11017128 DOI: 10.1093/biostatistics/kxad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/04/2023] Open
Abstract
Modeling longitudinal and survival data jointly offers many advantages such as addressing measurement error and missing data in the longitudinal processes, understanding and quantifying the association between the longitudinal markers and the survival events, and predicting the risk of events based on the longitudinal markers. A joint model involves multiple submodels (one for each longitudinal/survival outcome) usually linked together through correlated or shared random effects. Their estimation is computationally expensive (particularly due to a multidimensional integration of the likelihood over the random effects distribution) so that inference methods become rapidly intractable, and restricts applications of joint models to a small number of longitudinal markers and/or random effects. We introduce a Bayesian approximation based on the integrated nested Laplace approximation algorithm implemented in the R package R-INLA to alleviate the computational burden and allow the estimation of multivariate joint models with fewer restrictions. Our simulation studies show that R-INLA substantially reduces the computation time and the variability of the parameter estimates compared with alternative estimation strategies. We further apply the methodology to analyze five longitudinal markers (3 continuous, 1 count, 1 binary, and 16 random effects) and competing risks of death and transplantation in a clinical trial on primary biliary cholangitis. R-INLA provides a fast and reliable inference technique for applying joint models to the complex multivariate data encountered in health research.
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Affiliation(s)
- Denis Rustand
- Statistics Program, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
| | - Janet van Niekerk
- Statistics Program, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
| | - Elias Teixeira Krainski
- Statistics Program, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
| | - Håvard Rue
- Statistics Program, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
| | - Cécile Proust-Lima
- Bordeaux Population Health Center, Inserm, UMR1219, Univ. Bordeaux, F-33000 Bordeaux, France
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8
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Liaqat M, Kamal S, Fischer F. Illustration of association between change in prostate-specific antigen (PSA) values and time to tumor status after treatment for prostate cancer patients: a joint modelling approach. BMC Urol 2023; 23:202. [PMID: 38057759 DOI: 10.1186/s12894-023-01374-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Prostate cancer (PCa) is the most prevalent tumor in men, and Prostate-Specific Antigen (PSA) serves as the primary marker for diagnosis, recurrence, and disease-free status. PSA levels post-treatment guide physicians in gauging disease progression and tumor status (low or high). Clinical follow-up relies on monitoring PSA over time, forming the basis for dynamic prediction. Our study proposes a joint model of longitudinal PSA and time to tumor shrinkage, incorporating baseline variables. The research aims to assess tumor status post-treatment for dynamic prediction, utilizing joint assessment of PSA measurements and time to tumor status. METHODS We propose a joint model for longitudinal PSA and time to tumor shrinkage, taking into account baseline BMI and post-treatment factors, including external beam radiation therapy (EBRT), androgen deprivation therapy (ADT), prostatectomy, and various combinations of these interventions. The model employs a mixed-effect sub-model for longitudinal PSA and an event time sub-model for tumor shrinkage. RESULTS Results emphasize the significance of baseline factors in understanding the relationship between PSA trajectories and tumor status. Patients with low tumor status consistently exhibit low PSA values, decreasing exponentially within one month post-treatment. The correlation between PSA levels and tumor shrinkage is evident, with the considered factors proving to be significant in both sub-models. CONCLUSIONS Compared to other treatment options, ADT is the most effective in achieving a low tumor status, as evidenced by a decrease in PSA levels after months of treatment. Patients with an increased BMI were more likely to attain a low tumor status. The research enhances dynamic prediction for PCa patients, utilizing joint analysis of PSA and time to tumor shrinkage post-treatment. The developed model facilitates more effective and personalized decision-making in PCa care.
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Affiliation(s)
- Madiha Liaqat
- College of Statistical and Actuarial Sciences (CSAS), University of the Punjab, Lahore, Pakistan
| | - Shahid Kamal
- College of Statistical and Actuarial Sciences (CSAS), University of the Punjab, Lahore, Pakistan
| | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Devaux A, Helmer C, Genuer R, Proust-Lima C. Random survival forests with multivariate longitudinal endogenous covariates. Stat Methods Med Res 2023; 32:2331-2346. [PMID: 37886845 DOI: 10.1177/09622802231206477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Predicting the individual risk of clinical events using the complete patient history is a major challenge in personalized medicine. Analytical methods have to account for a possibly large number of time-dependent predictors, which are often characterized by irregular and error-prone measurements, and are truncated early by the event. In this work, we extended the competing-risk random survival forests to handle such endogenous longitudinal predictors when predicting event probabilities. The method, implemented in the R package DynForest, internally transforms the time-dependent predictors at each node of each tree into time-fixed features (using mixed models) that can then be used as splitting candidates. The final individual event probability is computed as the average of leaf-specific Aalen-Johansen estimators over the trees. Using simulations, we compared the performances of DynForest to accurately predict an event with (i) a joint modeling alternative when considering two longitudinal predictors only, and with (ii) a regression calibration method that ignores the informative truncation by the event when dealing with a large number of longitudinal predictors. Through an application in dementia research, we also illustrated how DynForest can be used to develop a dynamic prediction tool for dementia from multimodal repeated markers, and quantify the importance of each marker.
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Affiliation(s)
- Anthony Devaux
- Univ. Bordeaux, INSERM, BPH, U1219, Bordeaux, France
- The George Institute for Global Health, UNSW Sydney, Australia
- School of Population Health, UNSW Sydney, Australia
| | | | - Robin Genuer
- Univ. Bordeaux, INSERM, INRIA, BPH, U1219, Bordeaux, France
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Moreau C, Riou J, Roux M. Predictive abilities comparison from multiple dynamic prediction models. Stat Methods Med Res 2023; 32:1811-1822. [PMID: 37489243 DOI: 10.1177/09622802231188521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
With the development of personalized medicine, the study of individual prognosis appears to be a major contemporary scientific issue. Dynamic models are particularly well adapted to such studies by allowing some potential changes in the follow-up to be taken into account. In particular, this leads to more accurate predictions by updating the available information throughout the patient monitoring. Some mathematical tools have been developed to quantify and compare the effectiveness of dynamic predictions using dynamic versions of the area under the receiver operating characteristic curve and the Brier score in the competing risks setting. Nevertheless, only two predictive abilities can be compared. This may be too restrictive in a clinical context where more and more information can be collected during patient follow-up thanks to recent technological advances. Here we propose a new procedure that allows multiple comparisons of the predictive abilities of different biomarkers, based on the dynamic area under the receiver operating characteristic curve or Brier score. Performances of our testing procedure were assessed by simulations. Moreover, a motivating application in hepatology will be presented. Finally, this work compares more than two dynamic predictive abilities of biomarkers and is available via R functions on GitHub.
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Affiliation(s)
- Clémence Moreau
- UPRES 3859, SFR 4208, HIFIH, Angers University, Angers, France
| | - Jérémie Riou
- UMR INSERM 1066, CNRS 6021, MINT, Angers University, Angers, France
- Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, Angers University Hospital, Angers, France
| | - Marine Roux
- UPRES 3859, SFR 4208, HIFIH, Angers University, Angers, France
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11
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Parr H, Porta N, Tree AC, Dearnaley D, Hall E. A Personalized Clinical Dynamic Prediction Model to Characterize Prognosis for Patients With Localized Prostate Cancer: Analysis of the CHHiP Phase 3 Trial. Int J Radiat Oncol Biol Phys 2023; 116:1055-1068. [PMID: 36822374 DOI: 10.1016/j.ijrobp.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE The CHHiP trial assessed moderately hypofractionated radiation therapy in localized prostate cancer. We utilized longitudinal prostate-specific antigen (PSA) measurements collected over time to evaluate and characterize patient prognosis. METHODS AND MATERIALS We developed a clinical dynamic prediction joint model to predict the risk of biochemical or clinical recurrence. Modeling included repeated PSA values and adjusted for baseline prognostic risk factors of age, tumor characteristics, and treatment received. We included 3071 trial participants for model development using a mixed-effect submodel for the longitudinal PSAs and a time-to-event hazard submodel for predicting recurrence of prostate cancer. We evaluated how baseline prognostic factor subgroups affected the nonlinear PSA levels over time and quantified the association of PSA on time to recurrence. We assessed bootstrapped optimism-adjusted predictive performance on calibration and discrimination. Additionally, we performed comparative dynamic predictions on patients with contrasting prognostic factors and investigated PSA thresholds over landmark times to correlate with prognosis. RESULTS Patients who developed recurrence had generally higher baseline and overall PSA values during follow-up and had an exponentially rising PSA in the 2 years before recurrence. Additionally, most baseline risk factors were significant in the mixed-effect and relative-risk submodels. PSA value and rate of change were predictive of recurrence. Predictive performance of the model was good across different prediction times over an 8-year period, with an overall mean area under the curve of 0.70, mean Brier score of 0.10, and mean integrated calibration index of 0.048; these were further improved for predictions after 5 years of accrued longitudinal posttreatment PSA assessments. PSA thresholds <0.23 ng/mL after 3 years were indicative of a minimal risk of recurrence by 8 years. CONCLUSIONS We successfully developed a joint statistical model to predict prostate cancer recurrence, evaluating prognostic factors and longitudinal PSA. We showed dynamically updated PSA information can improve prognostication, which can be used to guide follow-up and treatment management options.
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Affiliation(s)
- Harry Parr
- Clinical Trials and Statistics Unit, Institute of Cancer Research, London, United Kingdom
| | - Nuria Porta
- Clinical Trials and Statistics Unit, Institute of Cancer Research, London, United Kingdom
| | - Alison C Tree
- Royal Marsden NHS Foundation Trust, London, United Kingdom; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - David Dearnaley
- Royal Marsden NHS Foundation Trust, London, United Kingdom; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, Institute of Cancer Research, London, United Kingdom.
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Karamouza E, Glasspool RM, Kelly C, Lewsley LA, Carty K, Kristensen GB, Ethier JL, Kagimura T, Yanaihara N, Cecere SC, You B, Boere IA, Pujade-Lauraine E, Ray-Coquard I, Proust-Lima C, Paoletti X. CA-125 Early Dynamics to Predict Overall Survival in Women with Newly Diagnosed Advanced Ovarian Cancer Based on Meta-Analysis Data. Cancers (Basel) 2023; 15:1823. [PMID: 36980708 PMCID: PMC10047009 DOI: 10.3390/cancers15061823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
(1) Background: Cancer antigen 125 (CA-125) is a protein produced by ovarian cancer cells that is used for patients' monitoring. However, the best ways to analyze its decline and prognostic role are poorly quantified. (2) Methods: We leveraged individual patient data from the Gynecologic Cancer Intergroup (GCIG) meta-analysis (N = 5573) to compare different approaches summarizing the early trajectory of CA-125 before the prediction time (called the landmark time) at 3 or 6 months after treatment initiation in order to predict overall survival. These summaries included observed and estimated measures obtained by a linear mixed model (LMM). Their performances were evaluated by 10-fold cross-validation with the Brier score and the area under the ROC (AUC). (3) Results: The estimated value and the last observed value at 3 months were the best measures used to predict overall survival, with an AUC of 0.75 CI 95% [0.70; 0.80] at 24 and 36 months and 0.74 [0.69; 0.80] and 0.75 [0.69; 0.80] at 48 months, respectively, considering that CA-125 over 6 months did not improve the AUC, with 0.74 [0.68; 0.78] at 24 months and 0.71 [0.65; 0.76] at 36 and 48 months. (4) Conclusions: A 3-month surveillance provided reliable individual information on overall survival until 48 months for patients receiving first-line chemotherapy.
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Affiliation(s)
- Eleni Karamouza
- Gustave Roussy, Office of Biostatistics and Epidemiology, Université Paris-Saclay, 94805 Villejuif, France
- Oncostat, Labeled Ligue Contre le Cancer, CESP U1018, Inserm, Université Paris-Saclay, 94805 Villejuif, France
| | - Rosalind M. Glasspool
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow G12 0XH, UK
| | - Caroline Kelly
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow G12 0YN, UK
| | - Liz-Anne Lewsley
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow G12 0YN, UK
| | - Karen Carty
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow G12 0YN, UK
| | - Gunnar B. Kristensen
- Department of Gynecologic Oncology, Institute for Cancer Genetics and Informatics, Oslo University Hospital, 0424 Oslo, Norway
| | - Josee-Lyne Ethier
- Department of Medical Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Tatsuo Kagimura
- Foundation for Biomedical Research and Innocation, Translational Research Center for Medical Innovation, Kobe 650-0047, Japan
| | | | - Sabrina Chiara Cecere
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Napoli, Italy
| | - Benoit You
- EMR UCBL/HCL 3738, Faculté de Médecine Lyon-Sud, Université Lyon, Université Claude Bernard Lyon 1, 69100 Lyon, France
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, GINECO, GINEGEPS, 69495 Lyon, France
| | - Ingrid A. Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | | | | | - Cécile Proust-Lima
- UMR1219, Bordeaux Population Health Research Center, Inserm, University of Bordeaux, 33000 Bordeaux, France
| | - Xavier Paoletti
- Faculty of Medicine, University of Versailles Saint-Quentin, Université Paris Saclay, 78000 Versailles, France
- INSERM U900, Statistics for Personalized Medicine, Institut Curie, 92210 Saint-Cloud, France
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13
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Parr H, Hall E, Porta N. Joint models for dynamic prediction in localised prostate cancer: a literature review. BMC Med Res Methodol 2022; 22:245. [PMID: 36123621 PMCID: PMC9487103 DOI: 10.1186/s12874-022-01709-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prostate cancer is a very prevalent disease in men. Patients are monitored regularly during and after treatment with repeated assessment of prostate-specific antigen (PSA) levels. Prognosis of localised prostate cancer is generally good after treatment, and the risk of having a recurrence is usually estimated based on factors measured at diagnosis. Incorporating PSA measurements over time in a dynamic prediction joint model enables updates of patients' risk as new information becomes available. We review joint model strategies that have been applied to model time-dependent PSA trajectories to predict time-to-event outcomes in localised prostate cancer. METHODS We identify articles that developed joint models for prediction of localised prostate cancer recurrence over the last two decades. We report, compare, and summarise the methodological approaches and applications that use joint modelling accounting for two processes: the longitudinal model (PSA), and the time-to-event process (clinical failure). The methods explored differ in how they specify the association between these two processes. RESULTS Twelve relevant articles were identified. A range of methodological frameworks were found, and we describe in detail shared-parameter joint models (9 of 12, 75%) and joint latent class models (3 of 12, 25%). Within each framework, these articles presented model development, estimation of dynamic predictions and model validations. CONCLUSIONS Each framework has its unique principles with corresponding advantages and differing interpretations. Regardless of the framework used, dynamic prediction models enable real-time prediction of individual patient prognosis. They utilise all available longitudinal information, in addition to baseline prognostic risk factors, and are superior to traditional baseline-only prediction models.
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Affiliation(s)
- Harry Parr
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - Nuria Porta
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
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14
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Zheng C, Liu L. Quantifying direct and indirect effect for longitudinal mediator and survival outcome using joint modeling approach. Biometrics 2022; 78:1233-1243. [PMID: 33871871 PMCID: PMC8523594 DOI: 10.1111/biom.13475] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/03/2021] [Accepted: 04/08/2021] [Indexed: 12/01/2022]
Abstract
Longitudinal biomarkers are widely used in biomedical and translational researches to monitor the progressions of diseases. Methods have been proposed to jointly model longitudinal data and survival data, but its causal mechanism is yet to be investigated rigorously. Understanding how much of the total treatment effect is through the biomarker is important in understanding the treatment mechanism and evaluating the biomarker. In this work, we propose a causal mediation analysis method to compute the direct and indirect effects, when a joint modeling approach is used to take the longitudinal biomarker as the mediator and the survival endpoint as the outcome. Such a joint modeling approach allows us to relax the commonly used "sequential ignorability" assumption. We demonstrate how to evaluate longitudinally measured biomarkers using our method with two case studies, an AIDS study and a liver cirrhosis study.
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Affiliation(s)
- Cheng Zheng
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Lei Liu
- Division of Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
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15
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Devaux A, Genuer R, Peres K, Proust-Lima C. Individual dynamic prediction of clinical endpoint from large dimensional longitudinal biomarker history: a landmark approach. BMC Med Res Methodol 2022; 22:188. [PMID: 35818025 PMCID: PMC9275051 DOI: 10.1186/s12874-022-01660-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background The individual data collected throughout patient follow-up constitute crucial information for assessing the risk of a clinical event, and eventually for adapting a therapeutic strategy. Joint models and landmark models have been proposed to compute individual dynamic predictions from repeated measures to one or two markers. However, they hardly extend to the case where the patient history includes much more repeated markers. Our objective was thus to propose a solution for the dynamic prediction of a health event that may exploit repeated measures of a possibly large number of markers. Methods We combined a landmark approach extended to endogenous markers history with machine learning methods adapted to survival data. Each marker trajectory is modeled using the information collected up to the landmark time, and summary variables that best capture the individual trajectories are derived. These summaries and additional covariates are then included in different prediction methods adapted to survival data, namely regularized regressions and random survival forests, to predict the event from the landmark time. We also show how predictive tools can be combined into a superlearner. The performances are evaluated by cross-validation using estimators of Brier Score and the area under the Receiver Operating Characteristic curve adapted to censored data. Results We demonstrate in a simulation study the benefits of machine learning survival methods over standard survival models, especially in the case of numerous and/or nonlinear relationships between the predictors and the event. We then applied the methodology in two prediction contexts: a clinical context with the prediction of death in primary biliary cholangitis, and a public health context with age-specific prediction of death in the general elderly population. Conclusions Our methodology, implemented in R, enables the prediction of an event using the entire longitudinal patient history, even when the number of repeated markers is large. Although introduced with mixed models for the repeated markers and methods for a single right censored time-to-event, the technique can be used with any other appropriate modeling technique for the markers and can be easily extended to competing risks setting. Supplementary Information The online version contains supplementary material available at (10.1186/s12874-022-01660-3).
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Affiliation(s)
| | - Robin Genuer
- INSERM, BPH, U1219, Univ. Bordeaux, Bordeaux, France.,INRIA Bordeaux Sud-Ouest, Talence, France
| | - Karine Peres
- INSERM, BPH, U1219, Univ. Bordeaux, Bordeaux, France
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16
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Early response dynamics predict treatment failure in patients with recurrent and/or metastatic head and neck squamous cell carcinoma treated with cetuximab and nivolumab. Oral Oncol 2022; 127:105787. [DOI: 10.1016/j.oraloncology.2022.105787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/09/2022] [Accepted: 02/20/2022] [Indexed: 12/18/2022]
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17
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Zhang N, Simonoff JS. Joint latent class trees: A tree-based approach to modeling time-to-event and longitudinal data. Stat Methods Med Res 2022; 31:719-752. [PMID: 35179059 DOI: 10.1177/09622802211055857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this paper, we propose a semiparametric, tree-based joint latent class model for the joint behavior of longitudinal and time-to-event data. Existing joint latent class approaches are parametric and can suffer from high computational cost. The most common parametric approach, the joint latent class model, further restricts analysis to using time-invariant covariates in modeling survival risks and latent class memberships. The proposed tree method (joint latent class tree) is fast to fit, and permits time-varying covariates in all of its modeling components. We demonstrate the prognostic value of using time-varying covariates, and therefore the advantage of joint latent class tree over joint latent class model on simulated data. We apply joint latent class tree to a well-known data set (the PAQUID data set) and confirm its superior prediction performance and orders-of-magnitude speedup over joint latent class model.
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Affiliation(s)
- Ningshan Zhang
- Technology, Operations and Statistics Department, Leonard N. Stern School of Business, 5894New York University, New York, USA
| | - Jeffrey S Simonoff
- Technology, Operations and Statistics Department, Leonard N. Stern School of Business, 5894New York University, New York, USA
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18
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Kim JS, Shah AA, Hummers LK, Zeger SL. Predicting clinical events using Bayesian multivariate linear mixed models with application to scleroderma. BMC Med Res Methodol 2021; 21:249. [PMID: 34773969 PMCID: PMC8590788 DOI: 10.1186/s12874-021-01439-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/12/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Scleroderma is a serious chronic autoimmune disease in which a patient's disease state manifests in several irregularly spaced longitudinal measures of lung, heart, skin, and other organ systems. Threshold crossings of pulmonary and cardiac measures indicate potentially life-threatening key clinical events including interstitial lung disease (ILD), cardiomyopathy, and pulmonary hypertension (PH). The statistical challenge is to accurately and precisely predict these events by using all of the clinical history for the patient at hand and for a reference population of patients. METHODS We use a Bayesian mixed model approach to simultaneously characterize each individual's future trajectories for several biomarkers. We estimate this model using a large population of patients from the Johns Hopkins Scleroderma Center Research Registry. The joint probabilities of critical lung and heart events are then calculated as a byproduct of the mixed model. RESULTS The performance of this approach is substantially better than standard, more common alternatives. In order to predict an individual's risks in a clinical setting, we also develop a cross-validated, sequential prediction (CVSP) algorithm. As additional data are observed during a patient's visit, the algorithm sequentially produces updated predictions for the future longitudinal trajectories and for ILD, cardiomyopathy, and PH. The updated prediction distributions with little additional computing, for example within an electronic health record (EHR). CONCLUSIONS This method that generates real-time personalized risk estimates has been implemented within the electronic health record system for clinical testing. To our knowledge, this work represents the first approach to compute personalized risk estimates for multiple scleroderma complications.
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Affiliation(s)
- Ji Soo Kim
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Ami A Shah
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura K Hummers
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Scott L Zeger
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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19
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Li N, Liu Y, Li S, Elashoff RM, Li G. A flexible joint model for multiple longitudinal biomarkers and a time-to-event outcome: With applications to dynamic prediction using highly correlated biomarkers. Biom J 2021; 63:1575-1586. [PMID: 34272887 DOI: 10.1002/bimj.202000085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 12/01/2020] [Accepted: 12/31/2020] [Indexed: 11/10/2022]
Abstract
In biomedical studies it is common to collect data on multiple biomarkers during study follow-up for dynamic prediction of a time-to-event clinical outcome. The biomarkers are typically intermittently measured, missing at some event times, and may be subject to high biological variations, which cannot be readily used as time-dependent covariates in a standard time-to-event model. Moreover, they can be highly correlated if they are from in the same biological pathway. To address these issues, we propose a flexible joint model framework that models the multiple biomarkers with a shared latent reduced rank longitudinal principal component model and correlates the latent process to the event time by the Cox model for dynamic prediction of the event time. The proposed joint model for highly correlated biomarkers is more flexible than some existing methods since the latent trajectory shared by the multiple biomarkers does not require specification of a priori parametric time trend and is determined by data. We derive an expectation-maximization (EM) algorithm for parameter estimation, study large sample properties of the estimators, and adapt the developed method to make dynamic prediction of the time-to-event outcome. Bootstrap is used for standard error estimation and inference. The proposed method is evaluated using simulations and illustrated on a lung transplant data to predict chronic lung allograft dysfunction (CLAD) using chemokines measured in bronchoalveolar lavage fluid of the patients.
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Affiliation(s)
- Ning Li
- Departments of Medicine and Biomathematics, University of California at Los Angeles, Los Angeles, CA, USA
| | - Yi Liu
- School of Mathematical Sciences, Ocean University of China, Qingdao, P. R. China
| | - Shanpeng Li
- Department of Biostatistics, University of California at Los Angeles, Los Angeles, CA, USA
| | - Robert M Elashoff
- Department of Biomathematics, University of California at Los Angeles, Los Angeles, CA, USA
| | - Gang Li
- Department of Biostatistics, University of California at Los Angeles, Los Angeles, CA, USA
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20
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Finelli A, Beer TM, Chowdhury S, Evans CP, Fizazi K, Higano CS, Kim J, Martin L, Saad F, Saarela O. Comparison of Joint and Landmark Modeling for Predicting Cancer Progression in Men With Castration-Resistant Prostate Cancer: A Secondary Post Hoc Analysis of the PREVAIL Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2112426. [PMID: 34129025 PMCID: PMC8207237 DOI: 10.1001/jamanetworkopen.2021.12426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Dynamic prediction models may help predict radiographic disease progression in advanced prostate cancer. OBJECTIVE To assess whether dynamic prediction models aid prognosis of radiographic progression risk, using ongoing longitudinal prostate-specific antigen (PSA) assessments. DESIGN, SETTING, AND PARTICIPANTS This prognostic study used data from the PREVAIL study to compare dynamic models for predicting disease progression. The PREVAIL study was a phase 3, multinational, double-blind, placebo-controlled randomized clinical trial of enzalutamide for prostate cancer conducted from September 2010 to September 2012. A total of 773 men with metastatic castration-resistant prostate cancer (CRPC) who had never received chemotherapy and had no baseline visceral disease were treated with enzalutamide. For illustration, 4 patients were selected based on PSA kinetics or PSA response in case studies. Data were analyzed from July 2018 to September 2019. MAIN OUTCOMES AND MEASURES Landmark and joint models were applied to dynamically predict radiographic progression-free survival (PFS) using longitudinal PSA profile, baseline PSA, lactate dehydrogenase, and hemoglobin levels. The main outcome was radiographic PFS as predicted using landmark and joint models. Current PSA and PSA change were considered longitudinal biomarkers possibly associated with radiographic PFS. Predictive performance was evaluated using Brier score for overall prediction errors (PEs) and area under the curve (AUC) for model discriminative capability. Case studies were illustrated using dynamic prediction plots. RESULTS A total of 763 men with metastatic CRPC treated with enzalutamide (mean [SD] age, 71.2 [8.5] years; mean [SD] body mass index [calculated as weight in kilograms divided by height in meters squared], 28.4 [4.6]) were included in the analysis. Current PSA and PSA change were associated with radiographic PFS in all models. Adding the PSA slope, compared with the landmark models using current PSA alone, improved the prediction of 5-month prospect of radiographic progression, with relative gains of 5.7% in prediction (PE [SE], 0.132 [0.008] vs 0.140 [0.008]) and 7.7% in discrimination (AUC [SE], 0.800 [0.018] vs 0.743 [0.018]) at month 10. In joint models with linear vs nonlinear PSA, prediction of 5-month risk of radiographic progression was improved when PSA trajectories were not assumed to be linear, with 8.0% relative gain in prediction (PE [SE], 0.150 [0.006] vs 0.138 [0.005]) and 19.4% relative gain in discrimination (AUC [SE], 0.653 [0.022] vs 0.780 [0.016]) at month 10. Predictions were affected by amount of marker information accumulated and prespecified assumptions. PSA changes affected progression risk more strongly at later vs earlier follow-up. CONCLUSIONS AND RELEVANCE This prognostic study found that prediction of radiographic PFS was improved when longitudinal PSA information was added to baseline variables. In a population of patients with metastatic CRPC, dynamic predictions using landmark or joint models may help identify patients at risk of progression.
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Affiliation(s)
- Antonio Finelli
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Tomasz M. Beer
- Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Simon Chowdhury
- St Thomas’ Hospitals and Sarah Cannon Research Institute, London, United Kingdom
| | - Christopher P. Evans
- Department of Urologic Surgery, UC Davis Comprehensive Cancer Center, University of California, Davis
| | - Karim Fizazi
- Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Celestia S. Higano
- University of Washington, Seattle
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Janet Kim
- Astellas Pharma Global Development, Northbrook, Illinois
| | - Lisa Martin
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Fred Saad
- Centre Hospitalier de l’Université de Montréal/CRCHUM, Montréal, Canada
| | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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21
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Andrinopoulou ER, Harhay MO, Ratcliffe SJ, Rizopoulos D. Reflections on modern methods: Dynamic prediction using joint models of longitudinal and time-to-event data. Int J Epidemiol 2021; 50:1731-1743. [PMID: 33729514 DOI: 10.1093/ije/dyab047] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 02/26/2021] [Indexed: 11/12/2022] Open
Abstract
Individualized prediction is a hallmark of clinical medicine and decision making. However, most existing prediction models rely on biomarkers and clinical outcomes available at a single time. This is in contrast to how health states progress and how physicians deliver care, which relies on progressively updating a prognosis based on available information. With the use of joint models of longitudinal and survival data, it is possible to dynamically adjust individual predictions regarding patient prognosis. This article aims to introduce the reader to the development of dynamic risk predictions and to provide the necessary resources to support their implementation and assessment, such as adaptable R code, and the theory behind the methodology. Furthermore, measures to assess the predictive performance of the derived predictions and extensions that could improve the predictions are presented. We illustrate personalized predictions using an online dataset consisting of patients with chronic liver disease (primary biliary cirrhosis).
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Affiliation(s)
| | - Michael O Harhay
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah J Ratcliffe
- Division of Biostatistics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
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22
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Roustaei N, Jamali J, Taghi Ayatollahi SM, Zare N. A Comparative Study of Different Joint Modeling Approaches for HIV/AIDS Patients in Southern Iran. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 49:1776-1786. [PMID: 33643954 PMCID: PMC7898094 DOI: 10.18502/ijph.v49i9.4099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: The prevalence of HIV/AIDS has been increasing in Iran, especially amongst the young population, recently. The joint model (JM) is a statistical method that represents an effective strategy to incorporate all information of repeated measurements and survival outcomes simultaneously. In many theoretical studies, the population under the study were heterogeneous. This study aimed at comparing three approaches by considering heterogeneity in the patients. Methods: This study was conducted on 750 archived files of patients infected with HIV in Fars Province, southern Iran, from 1994 to 2017. Proposed Approach (PA), Joint Latent Class Models (JLCM), and Separated Approach (SA) were compared to evaluate the influence covariates on the longitudinal and time-to-event outcomes in the heterogeneous HIV/AIDS patients. Results: Gender (P<0.001) and HCV (P<0.01) were two significant covariates in the classification of HIV/AIDS patients. Time had a significant effect on CD4 (P<0.001) in both classes in the three approaches. In PA and SA, females had higher CD4 than males (P<0.001) in the first class. In JLCM, females had higher CD4 than males (P<0.01) in both classes. The patients with higher Hgb had also higher CD4 (P<0.001) in both classes in the three approaches. HCV reduced the CD4 significantly in both classes in PA (P<0.05) and SA (P<0.001). Within the survival sub-model, HCV reduced survival rate significantly in the second class in PA (P<0.05), JLCM (P<0.01) and SA (P<0.001). Conclusion: PA was an appropriate approach for joint modeling longitudinal and survival outcomes for this heterogeneous population.
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Affiliation(s)
- Narges Roustaei
- Department of Epidemiology and Biostatistics, School of Health and Nutrition Sciences, Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Jamshid Jamali
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Najaf Zare
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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23
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Wu C, Li L, Li R. Dynamic prediction of competing risk events using landmark sub-distribution hazard model with multiple longitudinal biomarkers. Stat Methods Med Res 2020; 29:3179-3191. [PMID: 32419611 PMCID: PMC10469606 DOI: 10.1177/0962280220921553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The cause-specific cumulative incidence function quantifies the subject-specific disease risk with competing risk outcome. With longitudinally collected biomarker data, it is of interest to dynamically update the predicted cumulative incidence function by incorporating the most recent biomarker as well as the cumulating longitudinal history. Motivated by a longitudinal cohort study of chronic kidney disease, we propose a framework for dynamic prediction of end stage renal disease using multivariate longitudinal biomarkers, accounting for the competing risk of death. The proposed framework extends the local estimation-based landmark survival modeling to competing risks data, and implies that a distinct sub-distribution hazard regression model is defined at each biomarker measurement time. The model parameters, prediction horizon, longitudinal history and at-risk population are allowed to vary over the landmark time. When the measurement times of biomarkers are irregularly spaced, the predictor variable may not be observed at the time of prediction. Local polynomial is used to estimate the model parameters without explicitly imputing the predictor or modeling its longitudinal trajectory. The proposed model leads to simple interpretation of the regression coefficients and closed-form calculation of the predicted cumulative incidence function. The estimation and prediction can be implemented through standard statistical software with tractable computation. We conducted simulations to evaluate the performance of the estimation procedure and predictive accuracy. The methodology is illustrated with data from the African American Study of Kidney Disease and Hypertension.
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Affiliation(s)
- Cai Wu
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, USA
- Department of Biostatistics, University of Texas School of Public Health, Houston, USA
| | - Liang Li
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Ruosha Li
- Department of Biostatistics, University of Texas School of Public Health, Houston, USA
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24
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Xu Z, Sinha D, Bradley JR. Joint analysis of recurrence and termination: A Bayesian latent class approach. Stat Methods Med Res 2020; 30:508-522. [PMID: 33050774 DOI: 10.1177/0962280220962522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Like many other clinical and economic studies, each subject of our motivating transplant study is at risk of recurrent events of non-fatal tissue rejections as well as the terminating event of death due to total graft rejection. For such studies, our model and associated Bayesian analysis aim for some practical advantages over competing methods. Our semiparametric latent-class-based joint model has coherent interpretation of the covariate (including race and gender) effects on all functions and model quantities that are relevant for understanding the effects of covariates on future event trajectories. Our fully Bayesian method for estimation and prediction uses a complete specification of the prior process of the baseline functions. We also derive a practical and theoretically justifiable partial likelihood-based semiparametric Bayesian approach to deal with the analysis when there is a lack of prior information about baseline functions. Our model and method can accommodate fixed as well as time-varying covariates. Our Markov Chain Monte Carlo tools for both Bayesian methods are implementable via publicly available software. Our Bayesian analysis of transplant study and simulation study demonstrate practical advantages and improved performance of our approach.
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Affiliation(s)
- Zhixing Xu
- Department of Statistics, 7823Florida State University, Tallahassee, FL, USA
| | - Debajyoti Sinha
- Department of Statistics, 7823Florida State University, Tallahassee, FL, USA
| | - Jonathan R Bradley
- Department of Statistics, 7823Florida State University, Tallahassee, FL, USA
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25
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Ali Mohammadpour R, Alizadeh A, Barzegar MR, Akbarzadeh Pasha A. Association between prostate-specific antigen change over time and prostate cancer recurrence risk: A joint model. CASPIAN JOURNAL OF INTERNAL MEDICINE 2020; 11:324-328. [PMID: 32874441 PMCID: PMC7442453 DOI: 10.22088/cjim.11.3.324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Background Prostate specific antigen (PSA) is an important biomarker to monitor patients after treated with radiation therapy (RT). The aim of this study is to evaluate the relationship between the PSA data and prostate cancer recurrence using the joint modeling. Methods This historical cohort study was performed on 422 prostate cancer patients. Inclusion criteria included: patients with localized prostate cancer referring to Cancer Institute in Tehran (Iran) from 2007 to 2012, and under radiation therapy. Joint model has two components or sub-models. We showed the results by parameter estimating the longitudinal sub-model and survival sub-model. EM algorithm, Newton-Gauss and Gauss-Hermit law were used for final model parameters. R software version 3.2 was used for statistical analysis. Results In this study, considering the inclusion and exclusion criteria, out of 422 patients, the data on 314 cases were selected for analysis and the main result of joint model was obtained. PSA directly and significantly was associated with recurrence risk, therefore increasing 2.6 ml/lit PSA (one unit in transformed PSA) increases 39% recurrence risk (95% CI for RR: 1.09-1.77). Also, slope of PSA trend has significant association with prostate cancer recurrence risk (95% CI for RR: 1.05-1.41). Conclusion This study showed a significant relationship between PSA, and its slope with the recurrence risk by joint model, with regard to the pathological, demographic and clinical features in the Iranian population.
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Affiliation(s)
- Reza Ali Mohammadpour
- Department of Biostatistics, Faculty of Health, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ahad Alizadeh
- Student Research Committee, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
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Wu Y, Zhang X, He Y, Cui J, Ge X, Han H, Luo Y, Liu L, Wang X, Yu H. Predicting Alzheimer's disease based on survival data and longitudinally measured performance on cognitive and functional scales. Psychiatry Res 2020; 291:113201. [PMID: 32559670 DOI: 10.1016/j.psychres.2020.113201] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 01/12/2023]
Abstract
This study assessed how well longitudinally taken cognitive and functional scales from people with mild cognitive impairment (MCI) predict conversion to Alzheimer's disease (AD). Participants were individuals with baseline MCI from the Alzheimer's Disease Neuroimaging Initiative. Scales included the Alzheimer Disease Assessment Scale-Cognitive (ADAS-Cog) 11 and 13, the Mini Mental State Examination (MMSE), and the Functional Assessment Questionnaire (FAQ). A joint modelling approach compared performance on the four scales for dynamic prediction of risk for AD. The goodness of fit measures included log likelihood, the Akaike Information Criterion (AIC) and the Bayesian Information Criterion (BIC). The area under the curve (AUC) of the receiver operating characteristic assessed predictive accuracy. The parameter α in the ADAS-Cog11, ADAS-Cog13, MMSE, and FAQ joint models was statistically significant. Joint MMSE and FAQ models had better goodness of fit. FAQ had the best predictive accuracy. Cognitive and functional impairment assessment scales are strong screening predictors when repeated measures are available. They could be useful for predicting risk for AD in primary healthcare.
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Affiliation(s)
- Yan Wu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Xinnan Zhang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Yao He
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jing Cui
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Xiaoyan Ge
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Hongjuan Han
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Yanhong Luo
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Long Liu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Xuxia Wang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Hongmei Yu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China; Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment.
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Asar Ö, Fournier MC, Dantan E. Dynamic predictions of kidney graft survival in the presence of longitudinal outliers. Stat Methods Med Res 2020; 30:185-203. [DOI: 10.1177/0962280220945352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In kidney transplantation, dynamic predictions of graft survival may be obtained from joint modelling of longitudinal and survival data for which a common assumption is that random-effects and error terms in the longitudinal sub-model are Gaussian. However, this assumption may be too restrictive, e.g. in the presence of outliers, and more flexible distributions would be required. In this study, we relax the Gaussian assumption by defining a robust joint modelling framework with t-distributed random-effects and error terms to obtain dynamic predictions of graft survival for kidney transplant patients. We take a Bayesian paradigm for inference and dynamic predictions and sample from the joint posterior densities. While previous research reported improved performances of robust joint models compared to the Gaussian version in terms of parameter estimation, dynamic prediction accuracy obtained from such approach has not been yet evaluated. Our results based on a training sample from the French DIVAT kidney transplantation cohort illustrate that estimates for the slope parameters in the longitudinal and survival sub-models are sensitive to the distributional assumptions. From both an internal validation sample from the DIVAT cohort and an external validation sample from the Lille (France) and Leuven (Belgium) transplantation centers, calibration and discrimination performances appeared to be better under the robust joint models compared to the Gaussian version, illustrating the need to accommodate outliers in the dynamic prediction context. Simulation results support the findings of the validation studies.
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Affiliation(s)
- Özgür Asar
- Department of Biostatistics and Medical Informatics, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
| | | | - Etienne Dantan
- INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
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Liu Q, Tang G, Costantino JP, Chang CH. Landmark proportional subdistribution hazards models for dynamic prediction of cumulative incidence functions. J R Stat Soc Ser C Appl Stat 2020. [DOI: 10.1111/rssc.12433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Gong Tang
- University of Pittsburgh USA
- NRG Oncology Statistics and Data Management Center Pittsburgh USA
| | - Joseph P. Costantino
- University of Pittsburgh USA
- NRG Oncology Statistics and Data Management Center Pittsburgh USA
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Benzekry S. Artificial Intelligence and Mechanistic Modeling for Clinical Decision Making in Oncology. Clin Pharmacol Ther 2020; 108:471-486. [PMID: 32557598 DOI: 10.1002/cpt.1951] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/04/2020] [Indexed: 12/24/2022]
Abstract
The amount of "big" data generated in clinical oncology, whether from molecular, imaging, pharmacological, or biological origin, brings novel challenges. To mine efficiently this source of information, mathematical models able to produce predictive algorithms and simulations are required, with applications for diagnosis, prognosis, drug development, or prediction of the response to therapy. Such mathematical and computational constructs can be subdivided into two broad classes: biologically agnostic, statistical models using artificial intelligence techniques, and physiologically based, mechanistic models. In this review, recent advances in the applications of such methods in clinical oncology are outlined. These include machine learning applied to big data (omics, imaging, or electronic health records), pharmacometrics and quantitative systems pharmacology, as well as tumor kinetics and metastasis modeling. Focus is set on studies with high potential of clinical translation, and particular attention is given to cancer immunotherapy. Perspectives are given in terms of combinations of the two approaches: "mechanistic learning."
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Affiliation(s)
- Sebastien Benzekry
- MONC Team, Inria Bordeaux Sud-Ouest, Talence, France
- Institut de Mathématiques de Bordeaux, CNRS UMR 5251, Bordeaux University, Talence, France
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Zhao L, Murray S, Mariani LH, Ju W. Incorporating longitudinal biomarkers for dynamic risk prediction in the era of big data: A pseudo-observation approach. Stat Med 2020; 39:3685-3699. [PMID: 32717100 DOI: 10.1002/sim.8687] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 01/28/2023]
Abstract
Longitudinal biomarker data are often collected in studies, providing important information regarding the probability of an outcome of interest occurring at a future time. With many new and evolving technologies for biomarker discovery, the number of biomarker measurements available for analysis of disease progression has increased dramatically. A large amount of data provides a more complete picture of a patient's disease progression, potentially allowing us to make more accurate and reliable predictions, but the magnitude of available data introduces challenges to most statistical analysts. Existing approaches suffer immensely from the curse of dimensionality. In this article, we propose methods for making dynamic risk predictions using repeatedly measured biomarkers of a large dimension, including cases when the number of biomarkers is close to the sample size. The proposed methods are computationally simple, yet sufficiently flexible to capture complex relationships between longitudinal biomarkers and potentially censored events times. The proposed approaches are evaluated by extensive simulation studies and are further illustrated by an application to a data set from the Nephrotic Syndrome Study Network.
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Affiliation(s)
- Lili Zhao
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan Murray
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura H Mariani
- Department of Internal Medicine/Nephrology, University of Michigan, Ann Arbor, Michigan, USA
| | - Wenjun Ju
- Division of Nephrology, University of Michigan, Ann Arbor, Michigan, USA
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Abstract
Latent class models have been widely used in longitudinal studies to uncover unobserved heterogeneity in a population and find the characteristics of the latent classes simultaneously using the class allocation probabilities dependent on predictors. However, previous latent class models for longitudinal data suffer from uncertainty in the choice of the number of latent classes. In this study, we propose a Bayesian nonparametric latent class model for longitudinal data, which allows the number of latent classes to be inferred from the data. The proposed model is an infinite mixture model with predictor-dependent class allocation probabilities; an individual longitudinal trajectory is described by the class-specific linear mixed effects model. The model parameters are estimated using Markov chain Monte Carlo methods. The proposed model is validated using a simulated example and a real-data example for characterizing latent classes of estradiol trajectories over the menopausal transition using data from the Study of Women's Health Across the Nation.
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Affiliation(s)
- Wonmo Koo
- Department of Industrial and Systems Engineering, Korea Advanced Institute of Science and Technology (34968KAIST), Deajeon, Republic of Korea
| | - Heeyoung Kim
- Department of Industrial and Systems Engineering, Korea Advanced Institute of Science and Technology (34968KAIST), Deajeon, Republic of Korea
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Improved Landmark Dynamic Prediction Model to Assess Cardiovascular Disease Risk in On-Treatment Blood Pressure Patients: A Simulation Study and Post Hoc Analysis on SPRINT Data. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2905167. [PMID: 32382541 PMCID: PMC7195630 DOI: 10.1155/2020/2905167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/18/2020] [Accepted: 03/24/2020] [Indexed: 11/17/2022]
Abstract
Landmark model (LM) is a dynamic prediction model that uses a longitudinal biomarker in time-to-event data to make prognosis prediction. This study was designed to improve this model and to apply it to assess the cardiovascular risk in on-treatment blood pressure patients. A frailty parameter was used in LM, landmark frailty model (LFM), to account the frailty of the patients and measure the correlation between different landmarks. The proposed model was compared with LM in different scenarios respecting data missing status, sample size (100, 200, and 400), landmarks (6, 12, 24, and 48), and failure percentage (30, 50, and 100%). Bias of parameter estimation and mean square error as well as deviance statistic between models were compared. Additionally, discrimination and calibration capability as the goodness of fit of the model were evaluated using dynamic concordance index (DCI), dynamic prediction error (DPE), and dynamic relative prediction error (DRPE). The proposed model was performed on blood pressure data, obtained from systolic blood pressure intervention trial (SPRINT), in order to calculate the cardiovascular risk. Dynpred, coxme, and coxphw packages in the R.3.4.3 software were used. It was proved that our proposed model, LFM, had a better performance than LM. Parameter estimation in LFM was closer to true values in comparison to that in LM. Deviance statistic showed that there was a statistically significant difference between the two models. In the landmark numbers 6, 12, and 24, the LFM had a higher DCI over time and the three landmarks showed better performance in discrimination. Both DPE and DRPE in LFM were lower in comparison to those in LM over time. It was indicated that LFM had better calibration in comparison to its peer. Moreover, real data showed that the structure of prognostic process was predicted better in LFM than in LM. Accordingly, it is recommended to use the LFM model for assessing cardiovascular risk due to its better performance.
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Kwint M, Stam B, Proust-Lima C, Philipps V, Hoekstra T, Aalbersberg E, Rossi M, Sonke JJ, Belderbos J, Walraven I. The prognostic value of volumetric changes of the primary tumor measured on Cone Beam-CT during radiotherapy for concurrent chemoradiation in NSCLC patients. Radiother Oncol 2020; 146:44-51. [DOI: 10.1016/j.radonc.2020.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/05/2019] [Accepted: 02/05/2020] [Indexed: 02/09/2023]
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KHORASHADIZADEH F, TABESH H, PARSAEIAN M, ESMAILY H, RAHIMI FOROUSHANI A. Predicting the Survival of AIDS Patients Using Two Frameworks of Statistical Joint Modeling and Comparing Their Predictive Accuracy. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:949-958. [PMID: 32953683 PMCID: PMC7475620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 01/12/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND The present study aimed to estimate the survival of HIV-positive patients and compare the accuracy of two commonly used models, Shared Random-Effect Model (SREM) and Joint Latent Class Model (JLCM) for the analysis of time to death among these patients. METHODS Data on a retrospective survey among HIV-positive patients diagnosed during 1989-2014 who referred to the Behavioral Diseases Consultation Center of Mashhad University of Medical Sciences was used in this study. Participants consisted of HIV-positive high-risk volunteers, referrals of new HIV cases from prisons, blood transfusion organization and hospitals. Subjects were followed from diagnosis until death or the end of study. SREM and JLCM were used to predict the survival of HIV/AIDS patients. In both models age, sex and addiction were included as covariates. To compare the accuracy of these alternative models, dynamic predictions were calculated at specific time points. The receiver operating characteristic (ROC) curve was used to select the more accurate model. RESULTS Overall, 213 patients were eligible that met entry conditions for the present analysis. Based on BIC criteria, three heterogeneous sub-populations of patients were identified by JLCM and individuals were categorized in these classes ("High Risk", "Moderate Risk" and "Low Risk") according to their health status. JLCM had a better predictive accuracy than SREM. The average area under ROC curve for JLCM and SREM was 0.75 and 0.64 respectively. In both models CD4 count decreased with time. Based on the result of JLCM, men had higher hazard rate than women and the CD4 counts levels of patients decreased with increasing age. CONCLUSION Predicting risk of death (or survival) is vital for patients care in most medical research. In a heterogeneous population, such as HIV-positive patients fitting JLCM can significantly improve the accuracy of the risk prediction. Therefore, this model is preferred for these populations.
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Affiliation(s)
- Fatemeh KHORASHADIZADEH
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed TABESH
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahboubeh PARSAEIAN
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Habibollah ESMAILY
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas RAHIMI FOROUSHANI
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Arbeeva L, Nelson AE, Alvarez C, Cleveland RJ, Allen KD, Golightly YM, Jordan JM, Callahan LF, Schwartz TA. Application of Traditional and Emerging Methods for the Joint Analysis of Repeated Measurements With Time-to-Event Outcomes in Rheumatology. Arthritis Care Res (Hoboken) 2020; 72:615-621. [PMID: 30908869 PMCID: PMC6761043 DOI: 10.1002/acr.23881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/19/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The goal of this paper is to describe approaches for the joint analysis of repeatedly measured data with time-to-event end points, first separately and then in the framework of a single comprehensive model, emphasizing the efficiency of the latter approach. Data from the Johnston County Osteoarthritis (JoCo OA) Project will be used as an example to investigate the relationship between the change in repeatedly measured body mass index (BMI) and the time-to-event end point of incident worsening of radiographic knee OA that was defined as an increased Kellgren/Lawrence grade in at least 1 knee over time. METHODS First, we provide an overview of the methods for analyzing repeated measurements and time-to-event end points separately. Then, we describe traditional (Cox proportional hazards model [CoxPH]) and emerging (joint model [JM]) approaches, both of which allow combined analysis of repeated measures with a time-to-event end point in the framework of a single statistical model. Finally, we apply the models to JoCo OA data and interpret and compare the results from the different approaches. RESULTS Applications of the JM (but not the CoxPH) showed that the risk of worsening radiographic OA is higher when BMI is higher or increasing, thus illustrating the advantages of the JM for analyzing such dynamic measures in a longitudinal study. CONCLUSION Joint models are preferable for simultaneous analyses of repeated measurement and time-to-event outcomes, particularly in the context of chronic disease, where dependency between the time-to-event end point and the longitudinal trajectory of repeated measurements is inherent.
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Affiliation(s)
- Liubov Arbeeva
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amanda E. Nelson
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Carolina Alvarez
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Rebecca J. Cleveland
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Kelli D. Allen
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, NC, USA
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Division of Physical Therapy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Orthopedics, University of North Carolina, Chapel Hill, NC, USA
| | - Leigh F. Callahan
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Orthopedics, University of North Carolina, Chapel Hill, NC, USA
| | - Todd A. Schwartz
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Buttigliero C, Tucci M, Sonetto C, Vignani F, Di Stefano RF, Pisano C, Turco F, Lacidogna G, Guglielmini P, Numico G, Scagliotti GV, Di Maio M. Prognostic role of early PSA drop in castration resistant prostate cancer patients treated with abiraterone acetate or enzalutamide. MINERVA UROL NEFROL 2020; 72:737-745. [PMID: 32284527 DOI: 10.23736/s0393-2249.20.03708-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previous studies demonstrated a predictive value of prostate-specific antigen (PSA) kinetics for treatment outcome. Our retrospective study evaluates the prognostic role of early PSA drop in metastatic castration resistant prostate cancer (mCRPC) patients receiving abiraterone acetate (AA) or enzalutamide (E). METHODS All mCRPC patients treated with AA or E at the San Luigi Hospital in Orbassano between 2010 and 2018 and at the Ordine Mauriziano Hospital in Turin between 2014 and 2018 were included in this retrospective study. Only patients with an early PSA (measured 28-60 days after the beginning of the treatment) were included in the analysis. Patients were divided in early responders and non-early responders according to early PSA response (drop≥50% from baseline). Univariate and multivariate analyses for progression free survival (PFS) and overall survival (OS) were performed. RESULTS Of 144 patients with early PSA value, 61 (42.4%) patients received E (docetaxel-naïve 42, post-docetaxel 19) and 83 (57.6%) received AA (docetaxel-naïve 44, post-docetaxel 39). Seventy-five (52.1%) patients achieved early PSA drop. In docetaxel-naïve setting (N.=86), median PFS was 14.9 (with early PSA drop) vs. 8.8 months (without early PSA drop, P=0.001). In post-docetaxel setting (N.=58) median PFS was 11.9 vs. 4.5 months (P<0.001). Globally, median PFS was 14.9 vs. 6.3 months in patients with and without early PSA drop, respectively (P<0.001). In docetaxel-naïve setting, patients with early PSA drop had a median OS of 39.5 vs. 18.8 months (P=0.12). In post-docetaxel setting median OS was 29.6 vs. 10.7 months (P=0.01). Comprehensively, median OS was 31.9 vs. 16.3 (P=0.002) in patients with and without early PSA drop, respectively. At multivariate analysis, early PSA drop confirmed an independent association with PFS (HR 0.21; 95% CI: 0.12-0.38, P<0.001) and OS (HR 0.25; 95% CI: 0.12-0.50, P<0.001). CONCLUSIONS mCRPC patients treated with AA or E, in docetaxel-naïve or post-docetaxel setting, with early PSA drop had significantly better OS and PFS.
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Affiliation(s)
- Consuelo Buttigliero
- Division of Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Marcello Tucci
- Division of Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Cristina Sonetto
- Division of Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesca Vignani
- Division of Medical Oncology, Department of Oncology, Ordine Mauriziano Hospital, University of Turin, Turin, Italy
| | - Rosario F Di Stefano
- Division of Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Chiara Pisano
- Division of Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Fabio Turco
- Division of Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Gaetano Lacidogna
- Division of Medical Oncology, Department of Oncology, Ordine Mauriziano Hospital, University of Turin, Turin, Italy
| | - Pamela Guglielmini
- Unit of Oncology, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Gianmauro Numico
- Unit of Oncology, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Giorgio V Scagliotti
- Division of Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Massimo Di Maio
- Division of Medical Oncology, Department of Oncology, Ordine Mauriziano Hospital, University of Turin, Turin, Italy
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Halabi S, Li C, Luo S. Developing and Validating Risk Assessment Models of Clinical Outcomes in Modern Oncology. JCO Precis Oncol 2019; 3:PO.19.00068. [PMID: 31840130 PMCID: PMC6908945 DOI: 10.1200/po.19.00068] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2019] [Indexed: 11/20/2022] Open
Abstract
The identification of prognostic factors and building of risk assessment prognostic models will continue to play a major role in 21st century medicine in patient management and decision making. Investigators are often interested in examining the relationship between host, tumor-related, and environmental variables in predicting clinical outcomes. We make a distinction between static and dynamic prediction models. In static prediction modelling, typically variables collected at baseline are utilized in building models. On the other hand, dynamic predictive models leverage the longitudinal data of covariates collected during treatment or follow-up, and hence provide accurate predictions of patients prognoses. To date, most risk assessment models in oncology have been based on static models. In this article, we cover topics that are related to the analysis of prognostic factors, centering on factors that are both relevant at the time of diagnosis or initial treatment and during treatment. We describe the types of risk prediction and then provide a brief description of the penalized regression methods. We then review the state-of-the art methods for dynamic prediction and compare the strengths and the limitations of these methods. While static models will continue to play an important role in oncology, developing and validating dynamic models of clinical outcomes need to take a higher priority. It is apparent that a framework for developing and validating dynamic tools in oncology is still needed. One of the limitations in oncology that modelers may be constrained by the lack of access to the longitudinal biomarker data. It is highly recommended that the next generation of risk assessments consider the longitudinal biomarker data and outcomes so that prediction can be continually updated.
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Affiliation(s)
| | - Cai Li
- Duke University Medical Center, Durham, NC
| | - Sheng Luo
- Duke University Medical Center, Durham, NC
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38
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Liu Y, Lin L. Classification with minimum ambiguity under distribution heterogeneity. J STAT COMPUT SIM 2019. [DOI: 10.1080/00949655.2019.1615063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Yongxin Liu
- Zhongtai Securities Institute for Financial Studies, Shandong University, Jinan, People's Republic of China
| | - Lu Lin
- Zhongtai Securities Institute for Financial Studies, Shandong University, Jinan, People's Republic of China
- School of Statistics, Qufu Normal University, Qufu, People's Republic of China
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Furgal AKC, Sen A, Taylor JMG. Review and Comparison of Computational Approaches for Joint Longitudinal and Time-to-Event Models. Int Stat Rev 2019; 87:393-418. [PMID: 32042217 PMCID: PMC7009936 DOI: 10.1111/insr.12322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 02/25/2019] [Indexed: 12/15/2022]
Abstract
Joint models for longitudinal and time-to-event data are useful in situations where an association exists between a longitudinal marker and an event time. These models are typically complicated due to the presence of shared random effects and multiple submodels. As a consequence, software implementation is warranted that is not prohibitively time consuming. While methodological research in this area continues, several statistical software procedures exist to assist in the fitting of some joint models. We review the available implementation for frequentist and Bayesian models in the statistical programming languages R, SAS, and Stata. A description of each procedure is given including estimation techniques, input and data requirements, available options for customization, and some available extensions, such as competing risks models. The software implementations are compared and contrasted through extensive simulation, highlighting their strengths and weaknesses. Data from an ongoing trial on adrenal cancer patients is used to study different nuances of software fitting on a practical example.
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Affiliation(s)
- Allison K C Furgal
- Biostatistics Department, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Ananda Sen
- Biostatistics Department, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109
- Department of Family Medicine, Michigan Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, MI 48104
| | - Jeremy M G Taylor
- Biostatistics Department, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109
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Choi YH, Jacqmin-Gadda H, Król A, Parfrey P, Briollais L, Rondeau V. Joint nested frailty models for clustered recurrent and terminal events: An application to colonoscopy screening visits and colorectal cancer risks in Lynch Syndrome families. Stat Methods Med Res 2019; 29:1466-1479. [PMID: 31347460 DOI: 10.1177/0962280219863076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Joint models for recurrent and terminal events have not been yet developed for clustered data. The goals of our study are to develop a statistical framework for modelling clustered recurrent and terminal events and to perform dynamic predictions of the terminal event in family studies. We propose a joint nested frailty model for colonoscopy screening visits and colorectal cancer onset in Lynch Syndrome families. The screening and disease processes could each depend on individuals' screening history and other measured covariates and be correlated within families; our approach allows for familial correlations to affect both the visit process and the terminal event and the dependence between the two processes is specified through frailty distributions. We provide dynamic predictions of colorectal cancer risk for an individual conditional on his/her own screening history, his/her family history of screening and disease and other important clinical covariates. We apply our model to 18 Lynch Syndrome families from Newfoundland for individualized dynamic predictions of colorectal cancer risks. We demonstrate that the screening visits are non-ignorable for estimating the disease risks, and the joint nested frailty model improves dynamic prediction accuracies compared to existing joint frailty models after accounting for familial and individual screening and cancer histories.
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Affiliation(s)
- Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Helene Jacqmin-Gadda
- Biostatistics team, INSERM, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Agnieszka Król
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Patrick Parfrey
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Laurent Briollais
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Virginie Rondeau
- Biostatistics team, INSERM, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
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Total Hip Arthroplasty Performed for Coxarthrosis Preserves Long-Term Physical Function: A 40-Year Experience. HSS J 2019; 15:122-132. [PMID: 31327942 PMCID: PMC6609668 DOI: 10.1007/s11420-019-09676-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Measures of long-term success of total hip arthroplasty (THA) over the past 50 years have focused primarily on implant survival, with less evidence on long-term functional outcomes. QUESTIONS/PURPOSES We aimed to study 20-to-40-year functional outcomes after primary THA. We investigated the extent to which (1) functional outcomes after THA are maintained long term; (2) patient characteristics such as age, hip disease diagnosis, and comorbidities affect recovery of function and survivorship after THA; and (3) patients' overall function after THA is affected by the need for revision, the aging process, and associated comorbidities. METHODS We retrospectively reviewed outcomes of the senior author's patients between 1968 and 1993. Of 1207 patients, we identified 167 patients (99 female, 68 male; 276 primary THAs) who were at least 65 years old at follow-up and had at least 20 years of follow-up. Mean age at surgery was 55 years; mean follow-up time was 27 years. Bilateral THAs were performed in 109 patients (65%), and revisions in 81 patients (48.5%). Clinical outcomes including pain level, walking ability, range of motion, and overall function were determined by the Hospital for Special Surgery (HSS) hip scoring system. Contralateral and revision surgery, as well as patient age, sex, and body mass index, were included as covariates. To account for unequally spaced follow-up time points and competing causes of functional decline (e.g., age, contralateral hip disease, and need for revision THA), a latent class mixed model approach was used to identify unobserved classes of patients who had similar outcomes. Linear, quadratic, and piecewise-polynomial growth models were considered for class identification. The best fitting model was determined based on Bayesian information criterion. RESULTS A four-class model of this patient population was identified: (1) the Elderly Class, who had a mean age of 62 years at the time of primary THA; (2) the Bilateral Class, who underwent simultaneous or staged bilateral THA; (3) the Revision Class, who required at least one revision; and (4) the Youngest Class, who had a mean age of 49 years. After an initial period of improvement in all groups, the functional trajectory diverged according to classifications. Age was the strongest determinant of long-term outcome, with HSS hip scores in the Elderly Class declining after about 20 years. The Youngest Class maintained good-to-excellent hip function for over 30 years. Revision THA and contralateral THA accounted for a temporary decline in function, after which overall good function was regained for the long term. CONCLUSIONS All classes in the study population enjoyed good-to-excellent outcomes after THA for about 20 years. Thereafter, functional decline was attributed more to aging than to the need for revision. One or more revision THA did not negatively influence long-term clinical outcomes, suggesting that, even for younger patients, symptoms, rather than the avoidance of possible revision, should be the primary determining factor when indicating THA.
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Diallo A, Jacobi H, Cook A, Giunti P, Parkinson MH, Labrum R, Durr A, Brice A, Charles P, Marelli C, Mariotti C, Nanetti L, Panzeri M, Castaldo A, Rakowicz M, Rola R, Sulek A, Schmitz-Hübsch T, Schöls L, Hengel H, Baliko L, Melegh B, Filla A, Antenora A, Infante J, Berciano J, van de Warrenburg BP, Timmann D, Boesch S, Nachbauer W, Pandolfo M, Schulz JB, Bauer P, Jun-Suk K, Klockgether T, Tezenas du Montcel S. Prediction of Survival With Long-Term Disease Progression in Most Common Spinocerebellar Ataxia. Mov Disord 2019; 34:1220-1227. [PMID: 31211461 DOI: 10.1002/mds.27739] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/29/2019] [Accepted: 05/08/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Spinocerebellar ataxias are rare dominantly inherited neurodegenerative diseases that lead to severe disability and premature death. OBJECTIVE To quantify the impact of disease progression measured by the Scale for the Assessment and Rating of Ataxia on survival, and to identify different profiles of disease progression and survival. METHODS Four hundred sixty-two spinocerebellar ataxia patients from the EUROSCA prospective cohort study, suffering from spinocerebellar ataxia type 1, spinocerebellar ataxia type 2, spinocerebellar ataxia type 3, and spinocerebellar ataxia type 6, and who had at least two measurements of Scale for the Assessment and Rating of Ataxia score, were analyzed. Outcomes were change over time in Scale for the Assessment and Rating of Ataxia score and time to death. Joint model was used to analyze disease progression and survival. RESULTS Disease progression was the strongest predictor for death in all genotypes: An increase of 1 standard deviation in total Scale for the Assessment and Rating of Ataxia score increased the risk of death by 1.28 times (95% confidence interval: 1.18-1.38) for patients with spinocerebellar ataxia type 1; 1.19 times (1.12-1.26) for spinocerebellar ataxia type 2; 1.30 times (1.19-1.42) for spinocerebellar ataxia type 3; and 1.26 times (1.11-1.43) for spinocerebellar ataxia type 6. Three subgroups of disease progression and survival were identified for patients with spinocerebellar ataxia type 1: "severe" (n = 13; 12%), "intermediate" (n = 31; 29%), and "moderate" (n = 62; 58%). Patients in the severe group were more severely affected at baseline with higher Scale for the Assessment and Rating of Ataxia scores and frequency of nonataxia signs compared to those in the other groups. CONCLUSION Rapid ataxia progression is associated with poor survival of the most common spinocerebellar ataxia. Theses current results have implications for the design of future interventional studies of spinocerebellar ataxia. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Alhassane Diallo
- INSERM U 1136, Sorbonne Universités, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Heike Jacobi
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Arron Cook
- Department of Molecular Neuroscience, UCL, Institute of Neurology, London, United Kingdom
| | - Paola Giunti
- Department of Molecular Neuroscience, UCL, Institute of Neurology, London, United Kingdom
| | - Michael H Parkinson
- Department of Molecular Neuroscience, UCL, Institute of Neurology, London, United Kingdom
| | - Robyn Labrum
- Neurogenetics Laboratory, National Hospital of Neurology and Neurosurgery, UCLH, London, United Kingdom
| | - Alexandra Durr
- Sorbonne Université, Institut du Cerveau et de la Moelle épinière (ICM), AP-HP, Inserm, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | - Alexis Brice
- Sorbonne Université, Institut du Cerveau et de la Moelle épinière (ICM), AP-HP, Inserm, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | - Perrine Charles
- Service de Neurologie-CMRR, CHRU Gui de Chauliac, Montpellier, France
| | - Cecilia Marelli
- APHP, Genetics Department, Pitié-Salpêtrière University Hospital Paris, Paris, France
| | - Caterina Mariotti
- Unit of Medical Genetics and Neurogenetics (department), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Lorenzo Nanetti
- Unit of Medical Genetics and Neurogenetics (department), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marta Panzeri
- Unit of Medical Genetics and Neurogenetics (department), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Castaldo
- Unit of Medical Genetics and Neurogenetics (department), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Rakowicz
- First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Rafal Rola
- Department of Neurology, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Anna Sulek
- Department of Genetics, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Tanja Schmitz-Hübsch
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Charité-Universitätsmedizin Berlin, NeuroCure Clinical Research Center, Clinical Neuroimmunology Group, Berlin, Germany
| | - Ludger Schöls
- Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tübingen and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Tübingen, Germany.,Department of Neurology, University of Frankfurt, Frankfurt, Germany
| | - Holger Hengel
- Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tübingen and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Tübingen, Germany.,Department of Neurology, University of Frankfurt, Frankfurt, Germany
| | - Laszlo Baliko
- Department of Medical Genetics, and Szentagothai Research Center, University of Pécs, Pécs, Hungary
| | - Bela Melegh
- Department of Medical Genetics, and Szentagothai Research Center, University of Pécs, Pécs, Hungary.,Department of Neurology, Zala County Hospital, Zalaegerszeg, Hungary
| | - Alessandro Filla
- Department of Neuroscience, and Reproductive and Odontostomatological Sciences, Federico II University Naples, Naples, Italy
| | - Antonella Antenora
- Department of Neuroscience, and Reproductive and Odontostomatological Sciences, Federico II University Naples, Naples, Italy
| | - Jon Infante
- Service of Neurology, University Hospital Marqués de Valdecilla (IDIVAL), University of Cantabria (UC) and Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, Spain
| | - José Berciano
- Service of Neurology, University Hospital Marqués de Valdecilla (IDIVAL), University of Cantabria (UC) and Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, Spain
| | - Bart P van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dagmar Timmann
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Sylvia Boesch
- Department of Neurology, Medical University, Innsbruck, Innsbruck, Austria
| | - Wolfgang Nachbauer
- Department of Neurology, Medical University, Innsbruck, Innsbruck, Austria
| | - Massimo Pandolfo
- Université Libre de Bruxelles (ULB), Neurology Service-ULB Hôpital Erasme, ULB Laboratory of Experimental Neurology, Brussels, Belgium
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Aachen, Germany; JARA-Translational Brain Medicine, Aachen-Jülich, Germany
| | - Peter Bauer
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Kang Jun-Suk
- Department of Neurology, University of Frankfurt, Frankfurt, Germany
| | - Thomas Klockgether
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurology, University Hospital of Bonn, Bonn, Germany
| | - Sophie Tezenas du Montcel
- INSERM U 1136, Sorbonne Universités, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Paris, France.,Assistance Publique-Hôpitaux de Paris AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris, France
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Syrjälä E, Nevalainen J, Peltonen J, Takkinen HM, Hakola L, Åkerlund M, Veijola R, Ilonen J, Toppari J, Knip M, Virtanen SM. A Joint Modeling Approach for Childhood Meat, Fish and Egg Consumption and the Risk of Advanced Islet Autoimmunity. Sci Rep 2019; 9:7760. [PMID: 31123290 PMCID: PMC6533366 DOI: 10.1038/s41598-019-44196-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 05/07/2019] [Indexed: 12/19/2022] Open
Abstract
Several dietary factors have been suspected to play a role in the development of advanced islet autoimmunity (IA) and/or type 1 diabetes (T1D), but the evidence is fragmentary. A prospective population-based cohort of 6081 Finnish newborn infants with HLA-DQB1-conferred susceptibility to T1D was followed up to 15 years of age. Diabetes-associated autoantibodies and diet were assessed at 3- to 12-month intervals. We aimed to study the association between consumption of selected foods and the development of advanced IA longitudinally with Cox regression models (CRM), basic joint models (JM) and joint latent class mixed models (JLCMM). The associations of these foods to T1D risk were also studied to investigate consistency between alternative endpoints. The JM showed a marginal association between meat consumption and advanced IA: the hazard ratio adjusted for selected confounding factors was 1.06 (95% CI: 1.00, 1.12). The JLCMM identified two classes in the consumption trajectories of fish and a marginal protective association for high consumers compared to low consumers: the adjusted hazard ratio was 0.68 (0.44, 1.05). Similar findings were obtained for T1D risk with adjusted hazard ratios of 1.13 (1.02, 1.24) for meat and 0.45 (0.23, 0.86) for fish consumption. Estimates from the CRMs were closer to unity and CIs were narrower compared to the JMs. Findings indicate that intake of meat might be directly and fish inversely associated with the development of advanced IA and T1D, and that disease hazards in longitudinal nutritional epidemiology are more appropriately modeled by joint models than with naive approaches.
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Affiliation(s)
- Essi Syrjälä
- Health Sciences/Faculty of Social Sciences, Tampere University, Tampere, FI-33014, Finland.
| | - Jaakko Nevalainen
- Health Sciences/Faculty of Social Sciences, Tampere University, Tampere, FI-33014, Finland
| | - Jaakko Peltonen
- Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, FI-33014, Finland
| | - Hanna-Mari Takkinen
- Health Sciences/Faculty of Social Sciences, Tampere University, Tampere, FI-33014, Finland
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, FI-00271, Finland
| | - Leena Hakola
- Health Sciences/Faculty of Social Sciences, Tampere University, Tampere, FI-33014, Finland
| | - Mari Åkerlund
- Health Sciences/Faculty of Social Sciences, Tampere University, Tampere, FI-33014, Finland
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, FI-00271, Finland
| | - Riitta Veijola
- Department of Pediatrics, Medical Research Center, PEDEGO Research Unit, Oulu University Hospital and University of Oulu, Oulu, FI-90014, Finland
| | - Jorma Ilonen
- Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, FI-20520, Finland
- Department of Clinical Microbiology, Turku University Hospital, Turku, FI-20520, Finland
| | - Jorma Toppari
- Department of Pediatrics, Turku University Hospital, Turku, FI-20521, Finland
- Department of Physiology, Institute of Biomedicine, University of Turku, Turku, FI-20520, Finland
| | - Mikael Knip
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, FI-00281, Finland
- Research Programs Unit - Diabetes and Obesity, University of Helsinki, Helsinki, FI-00290, Finland
- Tampere Center for Child Health Research, Tampere University Hospital, Tampere, FI-33521, Finland
- Folkhälsan Research Center, Helsinki, FI-00290, Finland
| | - Suvi M Virtanen
- Health Sciences/Faculty of Social Sciences, Tampere University, Tampere, FI-33014, Finland
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, FI-00271, Finland
- Tampere University Hospital, Research, Development and Innovation Center, Tampere, FI-33521, Finland
- Center for Child Health Research, Tampere University and Tampere University Hospital, Tampere, FI-33014, Finland
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Li H, Gatsonis C. Combining biomarker trajectories to improve diagnostic accuracy in prospective cohort studies with verification bias. Stat Med 2019; 38:1968-1990. [PMID: 30590870 DOI: 10.1002/sim.8079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/20/2018] [Accepted: 12/04/2018] [Indexed: 11/10/2022]
Abstract
In this paper, we develop methods to combine multiple biomarker trajectories into a composite diagnostic marker using functional data analysis (FDA) to achieve better diagnostic accuracy in monitoring disease recurrence in the setting of a prospective cohort study. In such studies, the disease status is usually verified only for patients with a positive test result in any biomarker and is missing in patients with negative test results in all biomarkers. Thus, the test result will affect disease verification, which leads to verification bias if the analysis is restricted only to the verified cases. We treat verification bias as a missing data problem. Under both missing at random (MAR) and missing not at random (MNAR) assumptions, we derive the optimal classification rules using the Neyman-Pearson lemma based on the composite diagnostic marker. We estimate thresholds adjusted for verification bias to dichotomize patients as test positive or test negative, and we evaluate the diagnostic accuracy using the verification bias corrected area under the ROC curves (AUCs). We evaluate the performance and robustness of the FDA combination approach and assess the consistency of the approach through simulation studies. In addition, we perform a sensitivity analysis of the dependency between the verification process and disease status for the approach under the MNAR assumption. We apply the proposed method on data from the Religious Orders Study and from a non-small cell lung cancer trial.
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Affiliation(s)
- Hong Li
- Department of Public Health Science, Medical University of South Carolina, Charleston, South Carolina
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A Prognostic Tool for Individualized Prediction of Graft Failure Risk within Ten Years after Kidney Transplantation. J Transplant 2019; 2019:7245142. [PMID: 31093367 PMCID: PMC6476124 DOI: 10.1155/2019/7245142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/25/2019] [Indexed: 12/04/2022] Open
Abstract
Identification of patients at risk of kidney graft loss relies on early individual prediction of graft failure. Data from 616 kidney transplant recipients with a follow-up of at least one year were retrospectively studied. A joint latent class model investigating the impact of serum creatinine (Scr) time-trajectories and onset of de novo donor-specific anti-HLA antibody (dnDSA) on graft survival was developed. The capacity of the model to calculate individual predicted probabilities of graft failure over time was evaluated in 80 independent patients. The model classified the patients in three latent classes with significantly different Scr time profiles and different graft survivals. Donor age contributed to explaining latent class membership. In addition to the SCr classes, the other variables retained in the survival model were proteinuria measured one-year after transplantation (HR=2.4, p=0.01), pretransplant non-donor-specific antibodies (HR=3.3, p<0.001), and dnDSA in patient who experienced acute rejection (HR=15.9, p=0.02). In the validation dataset, individual predictions of graft failure risk provided good predictive performances (sensitivity, specificity, and overall accuracy of graft failure prediction at ten years were 77.7%, 95.8%, and 85%, resp.) for the 60 patients who had not developed dnDSA. For patients with dnDSA individual risk of graft failure was not predicted with a so good performance.
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Shili-Masmoudi S, Sogni P, de Ledinghen V, Esterle L, Valantin MA, Poizot-Martin I, Simon A, Rosenthal E, Lacombe K, Pialoux G, Bouchaud O, Gervais-Hasenknoff A, Goujard C, Piroth L, Zucman D, Dominguez S, Raffi F, Alric L, Bani-Sadr F, Lascoux-Combe C, Garipuy D, Miailhes P, Vittecoq D, Duvivier C, Aumaître H, Neau D, Morlat P, Dabis F, Salmon D, Wittkop L. Increased liver stiffness is associated with mortality in HIV/HCV coinfected subjects: The French nationwide ANRS CO13 HEPAVIH cohort study. PLoS One 2019; 14:e0211286. [PMID: 30682180 PMCID: PMC6347250 DOI: 10.1371/journal.pone.0211286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/10/2019] [Indexed: 12/22/2022] Open
Abstract
Background The association between liver stiffness measurements (LSM) and mortality has not been fully described. In particular the effect of LSM on all-cause mortality taking sustained virological response (SVR) into account needs further study. Methods HIV/HCV participants in the French nation-wide, prospective, multicenter ANRS CO13 HEPAVIH cohort, with ≥1 LSM by FibroScan (FS) and a detectable HCV RNA when the first valid FS was performed were included. Cox proportional hazards models with delayed entry were performed to determine factors associated with all-cause mortality. LSM and SVR were considered as time dependent covariates. Results 1,062 patients were included from 2005 to 2015 (69.8% men, median age 45.7 years (IQR 42.4–49.1)). 21.7% had baseline LSM >12.5 kPa. Median follow-up was 4.9 years (IQR 3.2–6.1). 727 (68.5%) were ever treated for HCV: 189 of them (26.0%) achieved SVR. 76 deaths were observed (26 liver-related, 10 HIV-related, 29 non-liver-non-HIV-related, 11 of unknown cause). At the age of 50, the mortality rate was 4.5% for patients with LSM ≤12.5 kPa and 10.8% for patients with LSM >12.5 kPa. LSM >12.5 kPa (adjusted Hazard Ratio [aHR] = 3.35 [2.06; 5.45], p<0.0001), history of HCV treatment (aHR = 0.53 [0.32; 0.90], p = 0.01) and smoking (past (aHR = 5.69 [1.56; 20.78]) and current (3.22 [0.93; 11.09]) versus never, p = 0.01) were associated with all-cause mortality independently of SVR, age, sex, alcohol use and metabolic disorders. Conclusion Any LSM >12.5 kPa was strongly associated with all-cause mortality independently of SVR and other important covariates. Our results suggest that close follow-up of these patients should remain a priority even after achieving SVR.
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Affiliation(s)
- Sarah Shili-Masmoudi
- Univ Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France
- Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévèque, Service d’Hépatologie, Bordeaux, France
| | - Philippe Sogni
- Assistance Publique des Hôpitaux de Paris, Hôpital Cochin, Service d’Hépatologie, Paris, France
- INSERM U-1223 –Institut Pasteur, Paris, France
- Université Paris Descartes, Paris, France
| | - Victor de Ledinghen
- Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévèque, Service d’Hépatologie, Bordeaux, France
- Univ Bordeaux, Inserm, UMR 1053, Bordeaux, France
| | - Laure Esterle
- Univ Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France
| | - Marc-Antoine Valantin
- Assistance Publique des Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Service Maladies infectieuses et tropicales, Paris, France
| | - Isabelle Poizot-Martin
- Aix Marseille Univ, APHM Sainte-Marguerite, Service d’Immuno-hématologie clinique, Marseille, France
- Inserm U912 (SESSTIM) Marseille, France
| | - Anne Simon
- Assistance Publique des Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Département de Médecine Interne et Immunologie Clinique, Paris, France
| | - Eric Rosenthal
- Centre Hospitalier Universitaire de Nice, Service de Médecine Interne et Cancérologie, Hôpital l’Archet, Nice, France
- Université de Nice-Sophia Antipolis, Nice, France
| | - Karine Lacombe
- Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Antoine, Service Maladies infectieuses et tropicales, Paris, France
- UMPC (Université Pierre et Marie Curie), UMR S1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Gilles Pialoux
- Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Service Maladies infectieuses et tropicales, Paris, France
| | - Olivier Bouchaud
- Assistance Publique des Hôpitaux de Paris, Hôpital Avicenne, Service Maladies infectieuses et tropicales, Bobigny, France
- Université Paris 13 Nord, Bobigny, France
| | - Anne Gervais-Hasenknoff
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Service des maladies infectieuses et tropicales, Paris, France
| | - Cécile Goujard
- Assistance Publique des Hôpitaux de Paris, Hôpital Bicêtre, Hôpitaux universitaires Paris Sud, Service Médecine interne et Immunologie clinique, Le Kremlin-Bicêtre, France
- Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Lionel Piroth
- Centre Hospitalier Universitaire de Dijon, Département d’Infectiologie, Dijon, France
- Université de Bourgogne, Dijon, France
| | | | - Stéphanie Dominguez
- Assistance Publique des Hôpitaux de Paris, Hôpital Henri Mondor, Service Immunologie clinique et maladies infectieuses, Immunologie clinique, Créteil, France
| | - François Raffi
- Centre Hospitalier Universitaire de Nantes, Service Maladies infectieuses et tropicales, Nantes, France
| | - Laurent Alric
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Médecine interne, Toulouse, France
- Université Toulouse III, Paul Sabatier, Toulouse, France
| | - Firouzé Bani-Sadr
- Centre Hospitalier Universitaire de Reims, Service de médecine interne, maladies infectieuses et immunologie clinique, Reims, France
- Université de Reims, Champagne-Ardenne, Reims, France
| | - Caroline Lascoux-Combe
- Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Louis, Service Maladies infectieuses et tropicales, Paris, France
| | - Daniel Garipuy
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Maladies infectieuses et tropicales, Toulouse, France
| | - Patrick Miailhes
- Service des Maladies Infectieuses et Tropicales, CHU Lyon, Hôpital de la Croix Rousse, Lyon, France
| | - Daniel Vittecoq
- Université Paris Sud, Le Kremlin-Bicêtre, France
- Assistance Publique des Hôpitaux de Paris, Hôpital Bicêtre, Hôpitaux universitaires Paris Sud, Service Maladies infectieuses et tropicales, Le Kremlin-Bicêtre, France
| | - Claudine Duvivier
- APHP-Hôpital Necker-Enfants malades, Service de Maladies Infectieuses et Tropicales, Paris, France
- Centre d'Infectiologie Necker-Pasteur, Paris, France
| | - Hugues Aumaître
- Centre Hospitalier de Perpignan, Service Maladies infectieuses et tropicales, Perpignan, France
| | - Didier Neau
- Centre Hospitalier Universitaire de Bordeaux, Service Maladies infectieuses et tropicales Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Philippe Morlat
- Univ Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France
- Centre Hospitalier Universitaire de Bordeaux, Service de médecine interne, hôpital Saint-André, Bordeaux, France
| | - François Dabis
- Univ Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France
- Centre Hospitalier Universitaire de Bordeaux, Pôle de Santé Publique, Bordeaux, France
| | - Dominique Salmon
- Université Paris Descartes, Paris, France
- Assistance Publique des Hôpitaux de Paris, Hôpital Cochin, Service Maladies infectieuses et tropicales, Paris, France
| | - Linda Wittkop
- Univ Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France
- Centre Hospitalier Universitaire de Bordeaux, Pôle de Santé Publique, Bordeaux, France
- * E-mail:
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47
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Grand MK, Vermeer KA, Missotten T, Putter H. A joint model for dynamic prediction in uveitis. Stat Med 2018; 38:1802-1816. [PMID: 30569523 DOI: 10.1002/sim.8069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/09/2018] [Accepted: 11/27/2018] [Indexed: 12/31/2022]
Abstract
Uveitis is characterised as a recurrent inflammation of the eye and an ongoing inflammation can have severe impact on the visual acuity of the patient. The Rotterdam Eye Hospital has been collecting data on every uveitis patient visiting the hospital since 2000. We propose a joint model for the inflammation and visual acuity with the purpose of making dynamic predictions. Dynamic prediction models allow predictions to be updated during the follow-up of the patient based on the patient's disease history. The joint model consists of a submodel for the inflammation, the event history outcome, and one for the visual acuity, the longitudinal outcome. The inflammation process is described with a two-state reversible multistate model, where transition times are interval censored. Correlated log-normal frailties are included in the multistate model to account for the within eye and within patient correlation. A linear mixed model is used for the visual acuity. The joint model is fitted in a two-stage procedure and we illustrate how the model can be used to make dynamic predictions. The performance of the method was investigated in a simulation study. The novelty of the proposed model includes the extension to a multistate outcome, whereas, previously, the standard has been to consider survival or competing risk outcomes. Furthermore, it is usually the case that the longitudinal outcome affects the event history outcome, but in this model, the relation is reversed.
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Affiliation(s)
- Mia Klinten Grand
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands.,Ophthalmic Imaging and Data Analysis Group, Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands
| | - Koenraad Arndt Vermeer
- Ophthalmic Imaging and Data Analysis Group, Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands
| | | | - Hein Putter
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
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48
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Sun J, Herazo-Maya JD, Molyneaux PL, Maher TM, Kaminski N, Zhao H. Regularized Latent Class Model for Joint Analysis of High-Dimensional Longitudinal Biomarkers and a Time-to-Event Outcome. Biometrics 2018; 75:69-77. [PMID: 30178494 DOI: 10.1111/biom.12964] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Although many modeling approaches have been developed to jointly analyze longitudinal biomarkers and a time-to-event outcome, most of these methods can only handle one or a few biomarkers. In this article, we propose a novel joint latent class model to deal with high dimensional longitudinal biomarkers. Our model has three components: a class membership model, a survival submodel, and a longitudinal submodel. In our model, we assume that covariates can potentially affect biomarkers and class membership. We adopt a penalized likelihood approach to infer which covariates have random effects and/or fixed effects on biomarkers, and which covariates are informative for the latent classes. Through extensive simulation studies, we show that our proposed method has improved performance in prediction and assigning subjects to the correct classes over other joint modeling methods and that bootstrap can be used to do inference for our model. We then apply our method to a dataset of patients with idiopathic pulmonary fibrosis, for whom gene expression profiles were measured longitudinally. We are able to identify four interesting latent classes with one class being at much higher risk of death compared to the other classes. We also find that each of the latent classes has unique trajectories in some genes, yielding novel biological insights.
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Affiliation(s)
- Jiehuan Sun
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, U.S.A
| | - Jose D Herazo-Maya
- Internal Medicine: Pulmonary, Critical Care & Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Philip L Molyneaux
- Fibrosis Research Group, National Heart and Lung Institute, Imperial College, London.,Royal Brompton Hospital, Interstitial Lung Disease Unit, London
| | - Toby M Maher
- Fibrosis Research Group, National Heart and Lung Institute, Imperial College, London.,Royal Brompton Hospital, Interstitial Lung Disease Unit, London
| | - Naftali Kaminski
- Internal Medicine: Pulmonary, Critical Care & Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Hongyu Zhao
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, U.S.A
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49
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Ferrer L, Putter H, Proust-Lima C. Individual dynamic predictions using landmarking and joint modelling: Validation of estimators and robustness assessment. Stat Methods Med Res 2018; 28:3649-3666. [DOI: 10.1177/0962280218811837] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
After the diagnosis of a disease, one major objective is to predict cumulative probabilities of events such as clinical relapse or death from the individual information collected up to a prediction time, usually including biomarker repeated measurements. Several competing estimators have been proposed, mainly from two approaches: joint modelling and landmarking. These approaches differ by the information used, the model assumptions and the complexity of the computational procedures. This paper aims to review the two approaches, precisely define the derived estimators of dynamic predictions and compare their performances notably in case of misspecification. The ultimate goal is to provide key elements for the use of individual dynamic predictions in clinical practice. Prediction of two competing causes of prostate cancer progression from the history of prostate-specific antigen is used as a motivated example. We formally define the quantity to estimate and its estimators, propose techniques to assess the uncertainty around predictions and validate them. We then conduct an in-depth simulation study compare the estimators in terms of prediction error, discriminatory power, efficiency and robustness to model assumptions. We show that prediction tools should be handled with care, in particular by properly specifying models and estimators.
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Affiliation(s)
- Loïc Ferrer
- INSERM, UMR1219, Univ. Bordeaux, ISPED, Bordeaux, France
| | - Hein Putter
- Leiden University Medical Center, Leiden, the Netherlands
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50
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Modeling physiological responses induced by an emotion recognition task using latent class mixed models. PLoS One 2018; 13:e0207123. [PMID: 30444877 PMCID: PMC6239287 DOI: 10.1371/journal.pone.0207123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 10/25/2018] [Indexed: 02/07/2023] Open
Abstract
Correctly recognizing emotions is an essential skill to manage interpersonal relationships in everyday life. Facial expression represents the most powerful mean to convey important information on emotional and cognitive states during interactions with others. In this paper, we analyze physiological responses triggered by an emotion recognition test, which requires the processing of facial cues. In particular, we evaluate the modulation of several Heart Rate Variability indices, collected during the Reading the Mind in the Eyes Test, accounting for test difficulty (derived from a Rasch analysis), test performances, demographic and psychological characteristics of the participants. The main idea is that emotion recognition is associated with the Autonomic Nervous System and, as a consequence, with the Heart Rate Variability. The principal goal of our study was to explore the complexity of the collected measures and their possible interactions by applying a class of flexible models, i.e., the latent class mixed models. Actually, this modelling strategy allows for the identification of clusters of subjects characterized by similar longitudinal trajectories. Both univariate and multivariate latent class mixed models were used. In fact, while the interpretation of the Heart Rate Variability indices is very difficult when considered individually, a joint evaluation provides a better description of the Autonomic Nervous System state.
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