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Lavalley-Morelle A, Peiffer-Smadja N, Gressens SB, Souhail B, Lahens A, Bounhiol A, Lescure FX, Mentré F, Mullaert J. Multivariate joint model under competing risks to predict death of hospitalized patients for SARS-CoV-2 infection. Biom J 2024; 66:e2300049. [PMID: 37915123 DOI: 10.1002/bimj.202300049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/18/2023] [Accepted: 07/26/2023] [Indexed: 11/03/2023]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, several clinical prognostic scores have been proposed and evaluated in hospitalized patients, relying on variables available at admission. However, capturing data collected from the longitudinal follow-up of patients during hospitalization may improve prediction accuracy of a clinical outcome. To answer this question, 327 patients diagnosed with COVID-19 and hospitalized in an academic French hospital between January and July 2020 are included in the analysis. Up to 59 biomarkers were measured from the patient admission to the time to death or discharge from hospital. We consider a joint model with multiple linear or nonlinear mixed-effects models for biomarkers evolution, and a competing risks model involving subdistribution hazard functions for the risks of death and discharge. The links are modeled by shared random effects, and the selection of the biomarkers is mainly based on the significance of the link between the longitudinal and survival parts. Three biomarkers are retained: the blood neutrophil counts, the arterial pH, and the C-reactive protein. The predictive performances of the model are evaluated with the time-dependent area under the curve (AUC) for different landmark and horizon times, and compared with those obtained from a baseline model that considers only information available at admission. The joint modeling approach helps to improve predictions when sufficient information is available. For landmark 6 days and horizon of 30 days, we obtain AUC [95% CI] 0.73 [0.65, 0.81] and 0.81 [0.73, 0.89] for the baseline and joint model, respectively (p = 0.04). Statistical inference is validated through a simulation study.
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Affiliation(s)
| | - Nathan Peiffer-Smadja
- Université Paris Cité, INSERM, IAME, Paris, France
- Department of Infectious and Tropical Diseases, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France
| | - Simon B Gressens
- Department of Infectious and Tropical Diseases, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France
| | - Bérénice Souhail
- Department of Infectious and Tropical Diseases, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France
| | - Alexandre Lahens
- Department of Infectious and Tropical Diseases, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France
| | - Agathe Bounhiol
- Department of Infectious and Tropical Diseases, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France
| | - François-Xavier Lescure
- Université Paris Cité, INSERM, IAME, Paris, France
- Department of Infectious and Tropical Diseases, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France
| | - France Mentré
- Université Paris Cité, INSERM, IAME, Paris, France
- Department of Epidemiology, Biostatistics and Clinical Research, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France
| | - Jimmy Mullaert
- Université Paris Cité, INSERM, IAME, Paris, France
- Department of Epidemiology, Biostatistics and Clinical Research, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France
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2
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Fuh-Ngwa V, Zhou Y, Charlesworth JC, Ponsonby AL, Simpson-Yap S, Lechner-Scott J, Taylor BV. Developing a clinical-environmental-genotypic prognostic index for relapsing-onset multiple sclerosis and clinically isolated syndrome. Brain Commun 2021; 3:fcab288. [PMID: 34950873 PMCID: PMC8691056 DOI: 10.1093/braincomms/fcab288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 07/26/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022] Open
Abstract
Our inability to reliably predict disease outcomes in multiple sclerosis remains an issue for clinicians and clinical trialists. This study aims to create, from available clinical, genetic and environmental factors; a clinical–environmental–genotypic prognostic index to predict the probability of new relapses and disability worsening. The analyses cohort included prospectively assessed multiple sclerosis cases (N = 253) with 2858 repeated observations measured over 10 years. N = 219 had been diagnosed as relapsing-onset, while N = 34 remained as clinically isolated syndrome by the 10th-year review. Genotype data were available for 199 genetic variants associated with multiple sclerosis risk. Penalized Cox regression models were used to select potential genetic variants and predict risk for relapses and/or worsening of disability. Multivariable Cox regression models with backward elimination were then used to construct clinical–environmental, genetic and clinical–environmental–genotypic prognostic index, respectively. Robust time-course predictions were obtained by Landmarking. To validate our models, Weibull calibration models were used, and the Chi-square statistics, Harrell’s C-index and pseudo-R2 were used to compare models. The predictive performance at diagnosis was evaluated using the Kullback–Leibler and Brier (dynamic) prediction error (reduction) curves. The combined index (clinical–environmental–genotypic) predicted a quadratic time-dynamic disease course in terms of worsening (HR = 2.74, CI: 2.00–3.76; pseudo-R2=0.64; C-index = 0.76), relapses (HR = 2.16, CI: 1.74–2.68; pseudo-R2 = 0.91; C-index = 0.85), or both (HR = 3.32, CI: 1.88–5.86; pseudo-R2 = 0.72; C-index = 0.77). The Kullback–Leibler and Brier curves suggested that for short-term prognosis (≤5 years from diagnosis), the clinical–environmental components of disease were more relevant, whereas the genetic components reduced the prediction errors only in the long-term (≥5 years from diagnosis). The combined components performed slightly better than the individual ones, although their prognostic sensitivities were largely modulated by the clinical–environmental components. We have created a clinical–environmental–genotypic prognostic index using relevant clinical, environmental, and genetic predictors, and obtained robust dynamic predictions for the probability of developing new relapses and worsening of symptoms in multiple sclerosis. Our prognostic index provides reliable information that is relevant for long-term prognostication and may be used as a selection criterion and risk stratification tool for clinical trials. Further work to investigate component interactions is required and to validate the index in independent data sets.
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Affiliation(s)
- Valery Fuh-Ngwa
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Yuan Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Jac C Charlesworth
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Anne-Louise Ponsonby
- Developing Brain Division, The Florey Institute for Neuroscience and Mental Health, University of Melbourne Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Steve Simpson-Yap
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia.,Neuroepidemiology Unit, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, VIC, 3053, Australia
| | - Jeannette Lechner-Scott
- Department of Neurology, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, 2310, Australia.,Department of Neurology, John Hunter Hospital, Newcastle, NSW, 2310, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
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3
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Papageorgiou G, Mokhles MM, Takkenberg JJM, Rizopoulos D. Individualized dynamic prediction of survival with the presence of intermediate events. Stat Med 2019; 38:5623-5640. [PMID: 31667885 PMCID: PMC6916395 DOI: 10.1002/sim.8387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/09/2019] [Accepted: 09/13/2019] [Indexed: 11/11/2022]
Abstract
Often, in follow-up studies, patients experience intermediate events, such as reinterventions or adverse events, which directly affect the shapes of their longitudinal profiles. Our work is motivated by two studies in which such intermediate events have been recorded during follow-up. In both studies, we are interested in the change of the longitudinal evolutions after the occurrence of the intermediate event and in utilizing this information to improve the accuracy of dynamic prediction of their risk. To achieve so, we propose a flexible joint modeling framework for longitudinal and time-to-event data, which includes features of the intermediate event as time-varying covariates in both the longitudinal and survival submodels. We consider a set of joint models that postulate different effects of the intermediate event in the longitudinal profile and the risk of the clinical endpoint, with different formulations for the association structure while allowing its functional form to change after the occurrence of the intermediate event. Based on these models, we derive dynamic predictions of conditional survival probabilities which are adaptive to different scenarios with respect to the occurrence of the intermediate event. We evaluate the predictive accuracy of these predictions with a simulation study using the time-dependent area under the receiver operating characteristic curve and the expected prediction error adjusted to our setting. The results suggest that accounting for the changes in the longitudinal profiles and the instantaneous risk for the clinical endpoint is important, and improves the accuracy of the dynamic predictions.
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Affiliation(s)
- Grigorios Papageorgiou
- Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Mostafa M Mokhles
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, The Netherlands
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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6
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Sène M, Taylor JM, Dignam JJ, Jacqmin-Gadda H, Proust-Lima C. Individualized dynamic prediction of prostate cancer recurrence with and without the initiation of a second treatment: Development and validation. Stat Methods Med Res 2014; 25:2972-2991. [PMID: 24847900 DOI: 10.1177/0962280214535763] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
With the emergence of rich information on biomarkers after treatments, new types of prognostic tools are being developed: dynamic prognostic tools that can be updated at each new biomarker measurement. Such predictions are of interest in oncology where after an initial treatment, patients are monitored with repeated biomarker data. However, in such setting, patients may receive second treatments to slow down the progression of the disease. This paper aims to develop and validate dynamic individual predictions that allow the possibility of a new treatment in order to help understand the benefit of initiating new treatments during the monitoring period. The prediction of the event in the next x years is done under two scenarios: (1) the patient initiates immediately a second treatment, (2) the patient does not initiate any treatment in the next x years. Predictions are derived from shared random-effect models. Applied to prostate cancer data, different specifications for the dependence between the prostate-specific antigen repeated measures, the initiation of a second treatment (hormonal therapy), and the risk of clinical recurrence are investigated and compared. The predictive accuracy of the dynamic predictions is evaluated with two measures (Brier score and prognostic cross-entropy) for which approximated cross-validated estimators are proposed.
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Affiliation(s)
- Mbéry Sène
- INSERM, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France.,Université de Bordeaux, ISPED, Bordeaux, France
| | - Jeremy Mg Taylor
- Department of Biostatistics, Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - James J Dignam
- Department of Health Studies, University of Chicago, Chicago, IL, USA.,Radiation Therapy Oncology Group, American College of Radiology, Philadelphia, PA, USA
| | - Hélène Jacqmin-Gadda
- INSERM, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France.,Université de Bordeaux, ISPED, Bordeaux, France
| | - Cécile Proust-Lima
- INSERM, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France .,Université de Bordeaux, ISPED, Bordeaux, France
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