A competing-risks nomogram for sarcoma-specific death following local recurrence
A competing-risks nomogram for sarcoma-specific death following local recurrence
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DOI：
10.1002/sim.1574
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发表时间：
2003-11-30
影响因子：
2
通讯作者：
Brennan, MF
中科院分区：
文献类型：
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作者：
Kattan, MW;Heller, G;Brennan, MF
大多数分期系统侧重于分期的定义，因此，预测预后。在当前临床试验研究的时代，很明显，仅凭临床阶段不足以评估患者治疗失败的风险。随着生物标记物数量的增加，我们划分传统疾病分类系统的能力也在提高，我们预测患者成功的能力也在不断提高。量化个体患者风险的一种方法是通过nomogram。诺图是统计模型的图形表示，它提供了基于患者特异性协变量的治疗结果的概率。当响应变量是失效的时间，并且存在多个可能相互依赖的、相互竞争的失效原因时，我们将重点关注nomogram的使用。在这种情况下，通过直接应用Cox比例风险模型来估计失败概率提供了失败的概率（例如，死于癌症），假设不会发生依赖竞争原因导致的失败。在许多临床环境中，这是一个不切实际的假设。本研究的目的是说明在竞争风险的情况下，使用条件累积发生率函数来提供患者特定的失败概率预测。产生一个竞争风险图来估计最初治疗的软组织肉瘤已经局部复发的患者因肉瘤死亡的概率。版权所有：John Wiley Sons， Ltd。
The majority of staging systems focus on the definition of stage, and, therefore, prediction of prognosis. In the current era of clinical trial research, it has become apparent that the clinical stage alone is not sufficient to assess patient risk of treatment failure. As the number of biological markers increases, our ability to partition the traditional disease classification system improves, and our ability to predict patient success continues to increase. One approach to quantifying individual patient risk is through the nomogram. Nomograms are graphical representations of statistical models, which provide the probability of treatment outcome based on patient-specific covariates. We will focus on the use of the nomogram when the response variable is time to failure and there are multiple, possibly dependent, competing causes of failure. In this setting, estimation of the failure probability through direct application of the Cox proportional hazards model provides the probability of failure (for example, death from cancer) assuming failure from a dependent competing cause will not occur. In many clinical settings this is an unrealistic assumption. The purpose of this study is to illustrate the use of the conditional cumulative incidence function for providing a patient-specific prediction of the probability of failure in the setting of competing risks. A competing risks nomogram is produced to estimate the probability of death due to sarcoma for patients who have already developed a local recurrence of their initially treated soft-tissue sarcoma. Copyright (C) 2003 John Wiley Sons, Ltd.