A semiparametric cure model for interval‐censored data

There is a growing interest in the analysis of survival data with a cured proportion particularly in tumor recurrences studies. Biologically, it is reasonable to assume that the recurrence time is mainly affected by the overall health condition of the patient that depends on some covariates such as age, sex, or treatment type received. We propose a semiparametric frailty‐Cox cure model to quantify the overall health condition of the patient by a covariate‐dependent frailty that has a discrete mass at zero to characterize the cured patients, and a positive continuous part to characterize the heterogeneous health conditions among the uncured patients. A multiple imputation estimation method is proposed for the right‐censored case, which is further extended to accommodate interval‐censored data. Simulation studies show that the performance of the proposed method is highly satisfactory. For illustration, the model is fitted to a set of right‐censored melanoma incidence data and a set of interval‐censored breast cosmesis data. Our analysis suggests that patients receiving treatment of radiotherapy with adjuvant chemotherapy have a significantly higher probability of breast retraction, but also a lower hazard rate of breast retraction among those patients who will eventually experience the event with similar health conditions. The interpretation is very different to those based on models without a cure component that the treatment of radiotherapy with adjuvant chemotherapy significantly increases the risk of breast retraction.     

Semiparametric transformation models for interval‐censored data in the presence of a cure fraction

Mixed case interval‐censored data arise when the event of interest is known only to occur within an interval induced by a sequence of random examination times. Such data are commonly encountered in disease research with longitudinal follow‐up. Furthermore, the medical treatment has progressed over the last decade with an increasing proportion of patients being cured for many types of diseases. Thus, interest has grown in cure models for survival data which hypothesize a certain proportion of subjects in the population are not expected to experience the events of interest. In this article, we consider a two‐component mixture cure model for regression analysis of mixed case interval‐censored data. The first component is a logistic regression model that describes the cure rate, and the second component is a semiparametric transformation model that describes the distribution of event time for the uncured subjects. We propose semiparametric maximum likelihood estimation for the considered model. We develop an EM type algorithm for obtaining the semiparametric maximum likelihood estimators (SPMLE) of regression parameters and establish their consistency, efficiency, and asymptotic normality. Extensive simulation studies indicate that the SPMLE performs satisfactorily in a wide variety of settings. The proposed method is illustrated by the analysis of the hypobaric decompression sickness data from National Aeronautics and Space Administration.     

Generalized parametric cure models for relative survival

Cure models are used in time-to-event analysis when not all individuals are expected to experience the event of interest, or when the survival of the considered individuals reaches the same level as the general population. These scenarios correspond to a plateau in the survival and relative survival function, respectively. The main parameters of interest in cure models are the proportion of individuals who are cured, termed the cure proportion, and the survival function of the uncured individuals. Although numerous cure models have been proposed in the statistical literature, there is no consensus on how to formulate these. We introduce a general parametric formulation of mixture cure models and a new class of cure models, termed latent cure models, together with a general estimation framework and software, which enable fitting of a wide range of different models. Through simulations, we assess the statistical properties of the models with respect to the cure proportion and the survival of the uncured individuals. Finally, we illustrate the models using survival data on colon cancer, which typically display a plateau in the relative survival. As demonstrated in the simulations, mixture cure models which are not guaranteed to be constant after a finite time point, tend to produce accurate estimates of the cure proportion and the survival of the uncured. However, these models are very unstable in certain cases due to identifiability issues, whereas LC models generally provide stable results at the price of more biased estimates.     

Estimating the cure proportion of malignant melanoma,an alternative approach to assess long term survival: A population-based study

ObjectivesA large proportion of patients with cutaneous malignant melanoma (CMM) do not experience excess mortality due to their disease. This group of patients is referred to as the cure proportion. Few studies have examined the possibility of cure for CMM. The aim of this study was to estimate the cure proportion of patients with CMM in a Swedish population.MethodsWe undertook a population-based study of 5850 CMM patients in two Swedish health care regions during 1996–2005. We used flexible parametric cure models to estimate cure proportions and median survival times (MSTs) of uncured by stage, sex, age and anatomical site.ResultsDisease stage at diagnosis was the most important factor for the probability of cure, with a cure proportion of approximately 1.0 for stage IA. While the probability of cure decreased with older age, the influence of age was smaller on the MST of uncured. Differences in prognosis between males and females were mainly attributed to differences in cure as opposed to differences in MST of uncured.ConclusionsThis population-based study showed approximately 100% cure among stage IA disease. Almost 50% of patients had stage IA disease and the high cure proportion for this large patient group is reassuring.     

Mean residual life cure models for right-censored data with and without length-biased sampling

We propose a semiparametric mean residual life mixture cure model for right-censored survival data with a cured fraction. The model employs the proportional mean residual life model to describe the effects of covariates on the mean residual time of uncured subjects and the logistic regression model to describe the effects of covariates on the cure rate. We develop estimating equations to estimate the proposed cure model for the right-censored data with and without length-biased sampling, the latter is often found in prevalent cohort studies. In particular, we propose two estimating equations to estimate the effects of covariates in the cure rate and a method to combine them to improve the estimation efficiency. The consistency and asymptotic normality of the proposed estimates are established. The finite sample performance of the estimates is confirmed with simulations. The proposed estimation methods are applied to a clinical trial study on melanoma and a prevalent cohort study on early-onset type 2 diabetes mellitus.     

Flexible maximum likelihood methods for bivariate proportional hazards models

This article presents methodology for multivariate proportional hazards (PH) regression models. The methods employ flexible piecewise constant or spline specifications for baseline hazard functions in either marginal or conditional PH models, along with assumptions about the association among lifetimes. Because the models are parametric, ordinary maximum likelihood can be applied; it is able to deal easily with such data features as interval censoring or sequentially observed lifetimes, unlike existing semiparametric methods. A bivariate Clayton model (1978, Biometrika 65, 141-151) is used to illustrate the approach taken. Because a parametric assumption about association is made, efficiency and robustness comparisons are made between estimation based on the bivariate Clayton model and "working independence" methods that specify only marginal distributions for each lifetime variable.     

Semiparametric smoothing of discrete failure time data

An estimator of the hazard rate function from discrete failure time data is obtained by semiparametric smoothing of the (nonsmooth) maximum likelihood estimator, which is achieved by repeated multiplication of a Markov chain transition-type matrix. This matrix is constructed so as to have a given standard discrete parametric hazard rate model, termed the vehicle model, as its stationary hazard rate. As with the discrete density estimation case, the proposed estimator gives improved performance when the vehicle model is a good one and otherwise provides a nonparametric method comparable to the only purely nonparametric smoother discussed in the literature. The proposed semiparametric smoothing approach is then extended to hazard models with covariates and is illustrated by applications to simulated and real data sets.     

Accelerated failure time modeling via nonparametric mixtures

An accelerated failure time (AFT) model assuming a log-linear relationship between failure time and a set of covariates can be either parametric or semiparametric, depending on the distributional assumption for the error term. Both classes of AFT models have been popular in the analysis of censored failure time data. The semiparametric AFT model is more flexible and robust to departures from the distributional assumption than its parametric counterpart. However, the semiparametric AFT model is subject to producing biased results for estimating any quantities involving an intercept. Estimating an intercept requires a separate procedure. Moreover, a consistent estimation of the intercept requires stringent conditions. Thus, essential quantities such as mean failure times might not be reliably estimated using semiparametric AFT models, which can be naturally done in the framework of parametric AFT models. Meanwhile, parametric AFT models can be severely impaired by misspecifications. To overcome this, we propose a new type of the AFT model using a nonparametric Gaussian-scale mixture distribution. We also provide feasible algorithms to estimate the parameters and mixing distribution. The finite sample properties of the proposed estimators are investigated via an extensive stimulation study. The proposed estimators are illustrated using a real dataset.     

Dose-response curve estimation: a semiparametric mixture approach

In the estimation of a dose-response curve, parametric models are straightforward and efficient but subject to model misspecifications; nonparametric methods are robust but less efficient. As a compromise, we propose a semiparametric approach that combines the advantages of parametric and nonparametric curve estimates. In a mixture form, our estimator takes a weighted average of the parametric and nonparametric curve estimates, in which a higher weight is assigned to the estimate with a better model fit. When the parametric model assumption holds, the semiparametric curve estimate converges to the parametric estimate and thus achieves high efficiency; when the parametric model is misspecified, the semiparametric estimate converges to the nonparametric estimate and remains consistent. We also consider an adaptive weighting scheme to allow the weight to vary according to the local fit of the models. We conduct extensive simulation studies to investigate the performance of the proposed methods and illustrate them with two real examples.     

Two-component mixture cure rate model with spline estimated nonparametric components

Summary In some survival analysis of medical studies, there are often long-term survivors who can be considered as permanently cured. The goals in these studies are to estimate the noncured probability of the whole population and the hazard rate of the susceptible subpopulation. When covariates are present as often happens in practice, to understand covariate effects on the noncured probability and hazard rate is of equal importance. The existing methods are limited to parametric and semiparametric models. We propose a two-component mixture cure rate model with nonparametric forms for both the cure probability and the hazard rate function. Identifiability of the model is guaranteed by an additive assumption that allows no time-covariate interactions in the logarithm of hazard rate. Estimation is carried out by an expectation-maximization algorithm on maximizing a penalized likelihood. For inferential purpose, we apply the Louis formula to obtain point-wise confidence intervals for noncured probability and hazard rate. Asymptotic convergence rates of our function estimates are established. We then evaluate the proposed method by extensive simulations. We analyze the survival data from a melanoma study and find interesting patterns for this study.     

Bayesian Semiparametric Models for Survival Data with a Cure Fraction

We propose methods for Bayesian inference for a new class of semiparametric survival models with a cure fraction. Specifically, we propose a semiparametric cure rate model with a smoothing parameter that controls the degree of parametricity in the right tail of the survival distribution. We show that such a parameter is crucial for these kinds of models and can have an impact on the posterior estimates. Several novel properties of the proposed model are derived. In addition, we propose a class of improper noninformative priors based on this model and examine the properties of the implied posterior. Also, a class of informative priors based on historical data is proposed and its theoretical properties are investigated. A case study involving a melanoma clinical trial is discussed in detail to demonstrate the proposed methodology.     

Parametric regression on cumulative incidence function

We propose parametric regression analysis of cumulative incidence function with competing risks data. A simple form of Gompertz distribution is used for the improper baseline subdistribution of the event of interest. Maximum likelihood inferences on regression parameters and associated cumulative incidence function are developed for parametric models, including a flexible generalized odds rate model. Estimation of the long-term proportion of patients with cause-specific events is straightforward in the parametric setting. Simple goodness-of-fit tests are discussed for evaluating a fixed odds rate assumption. The parametric regression methods are compared with an existing semiparametric regression analysis on a breast cancer data set where the cumulative incidence of recurrence is of interest. The results demonstrate that the likelihood-based parametric analyses for the cumulative incidence function are a practically useful alternative to the semiparametric analyses.     

Semiparametric estimation in copula models for bivariate sequential survival times

Sequentially observed survival times are of interest in many studies but there are difficulties in analyzing such data using nonparametric or semiparametric methods. First, when the duration of followup is limited and the times for a given individual are not independent, induced dependent censoring arises for the second and subsequent survival times. Non-identifiability of the marginal survival distributions for second and later times is another issue, since they are observable only if preceding survival times for an individual are uncensored. In addition, in some studies a significant proportion of individuals may never have the first event. Fully parametric models can deal with these features, but robustness is a concern. We introduce a new approach to address these issues. We model the joint distribution of the successive survival times by using copula functions, and provide semiparametric estimation procedures in which copula parameters are estimated without parametric assumptions on the marginal distributions. This provides more robust estimates and checks on the fit of parametric models. The methodology is applied to a motivating example involving relapse and survival following colon cancer treatment.     

Maximum likelihood methods for cure rate models with missing covariates

We propose maximum likelihood methods for parameter estimation for a novel class of semiparametric survival models with a cure fraction, in which the covariates are allowed to be missing. We allow the covariates to be either categorical or continuous and specify a parametric distribution for the covariates that is written as a sequence of one-dimensional conditional distributions. We propose a novel EM algorithm for maximum likelihood estimation and derive standard errors by using Louis's formula (Louis, 1982, Journal of the Royal Statistical Society, Series B 44, 226-233). Computational techniques using the Monte Carlo EM algorithm are discussed and implemented. A real data set involving a melanoma cancer clinical trial is examined in detail to demonstrate the methodology.     

An asymptotic theory for model selection inference in general semiparametric problems

Hjort & Claeskens (2003) developed an asymptotic theoryfor model selection, model averaging and subsequent inferenceusing likelihood methods in parametric models, along with associatedconfidence statements. In this article, we consider a semiparametricversion of this problem, wherein the likelihood depends on parametersand an unknown function, and model selection/averaging is tobe applied to the parametric parts of the model. We show thatall the results of Hjort & Claeskens hold in the semiparametriccontext, if the Fisher information matrix for parametric modelsis replaced by the semiparametric information bound for semiparametricmodels, and if maximum likelihood estimators for parametricmodels are replaced by semiparametric efficient profile estimators.Our methods of proof employ Le Cam's contiguity lemmas, leadingto transparent results. The results also describe the behaviourof semiparametric model estimators when the parametric componentis misspecified, and also have implications for pointwise-consistentmodel selectors.     

Statistical Modeling of Agatston Score in Multi-Ethnic Study of Atherosclerosis (MESA)

The MESA (Multi-Ethnic Study of Atherosclerosis) is an ongoing study of the prevalence, risk factors, and progression of subclinical cardiovascular disease in a multi-ethnic cohort. It provides a valuable opportunity to examine the development and progression of CAC (coronary artery calcium), which is an important risk factor for the development of coronary heart disease. In MESA, about half of the CAC scores are zero and the rest are continuously distributed. Such data has been referred to as “zero-inflated data” and may be described using two-part models. Existing two-part model studies have limitations in that they usually consider parametric models only, make the assumption of known forms of the covariate effects, and focus only on the estimation property of the models. In this article, we investigate statistical modeling of CAC in MESA. Building on existing studies, we focus on two-part models. We investigate both parametric and semiparametric, and both proportional and nonproportional models. For various models, we study their estimation as well as prediction properties. We show that, to fully describe the relationship between covariates and CAC development, the semiparametric model with nonproportional covariate effects is needed. In contrast, for the purpose of prediction, the parametric model with proportional covariate effects is sufficient. This study provides a statistical basis for describing the behaviors of CAC and insights into its biological mechanisms.     

Analysis of covariance with incomplete data via semiparametric model transformations

We propose a method for fitting semiparametric models such as the proportional hazards (PH), additive risks (AR), and proportional odds (PO) models. Each of these semiparametric models implies that some transformation of the conditional cumulative hazard function (at each t) depends linearly on the covariates. The proposed method is based on nonparametric estimation of the conditional cumulative hazard function, forming a weighted average over a range of t-values, and subsequent use of least squares to estimate the parameters suggested by each model. An approximation to the optimal weight function is given. This allows semiparametric models to be fitted even in incomplete data cases where the partial likelihood fails (e.g., left censoring, right truncation). However, the main advantage of this method rests in the fact that neither the interpretation of the parameters nor the validity of the analysis depend on the appropriateness of the PH or any of the other semiparametric models. In fact, we propose an integrated method for data analysis where the role of the various semiparametric models is to suggest the best fitting transformation. A single continuous covariate and several categorical covariates (factors) are allowed. Simulation studies indicate that the test statistics and confidence intervals have good small-sample performance. A real data set is analyzed.     

A nonparametric mixture model for cure rate estimation

Nonparametric methods have attracted less attention than their parametric counterparts for cure rate analysis. In this paper, we study a general nonparametric mixture model. The proportional hazards assumption is employed in modeling the effect of covariates on the failure time of patients who are not cured. The EM algorithm, the marginal likelihood approach, and multiple imputations are employed to estimate parameters of interest in the model. This model extends models and improves estimation methods proposed by other researchers. It also extends Cox's proportional hazards regression model by allowing a proportion of event-free patients and investigating covariate effects on that proportion. The model and its estimation method are investigated by simulations. An application to breast cancer data, including comparisons with previous analyses using a parametric model and an existing nonparametric model by other researchers, confirms the conclusions from the parametric model but not those from the existing nonparametric model.     

A Novel Targeted Learning Method for Quantitative Trait Loci Mapping

We present a novel semiparametric method for quantitative trait loci (QTL) mapping in experimental crosses. Conventional genetic mapping methods typically assume parametric models with Gaussian errors and obtain parameter estimates through maximum-likelihood estimation. In contrast with univariate regression and interval-mapping methods, our model requires fewer assumptions and also accommodates various machine-learning algorithms. Estimation is performed with targeted maximum-likelihood learning methods. We demonstrate our semiparametric targeted learning approach in a simulation study and a well-studied barley data set.     

"Smooth" semiparametric regression analysis for arbitrarily censored time-to-event data

Summary .   A general framework for regression analysis of time-to-event data subject to arbitrary patterns of censoring is proposed. The approach is relevant when the analyst is willing to assume that distributions governing model components that are ordinarily left unspecified in popular semiparametric regression models, such as the baseline hazard function in the proportional hazards model, have densities satisfying mild "smoothness" conditions. Densities are approximated by a truncated series expansion that, for fixed degree of truncation, results in a "parametric" representation, which makes likelihood-based inference coupled with adaptive choice of the degree of truncation, and hence flexibility of the model, computationally and conceptually straightforward with data subject to any pattern of censoring. The formulation allows popular models, such as the proportional hazards, proportional odds, and accelerated failure time models, to be placed in a common framework; provides a principled basis for choosing among them; and renders useful extensions of the models straightforward. The utility and performance of the methods are demonstrated via simulations and by application to data from time-to-event studies.