Median Tests for Censored Survival Data; a Contingency Table Approach

Summary The median failure time is often utilized to summarize survival data because it has a more straightforward interpretation for investigators in practice than the popular hazard function. However, existing methods for comparing median failure times for censored survival data either require estimation of the probability density function or involve complicated formulas to calculate the variance of the estimates. In this article, we modify a K ‐sample median test for censored survival data ( Brookmeyer and Crowley, 1982 , Journal of the American Statistical Association 77, 433–440) through a simple contingency table approach where each cell counts the number of observations in each sample that are greater than the pooled median or vice versa. Under censoring, this approach would generate noninteger entries for the cells in the contingency table. We propose to construct a weighted asymptotic test statistic that aggregates dependent χ² ‐statistics formed at the nearest integer points to the original noninteger entries. We show that this statistic follows approximately a χ² ‐distribution with k? 1 degrees of freedom. For a small sample case, we propose a test statistic based on combined p ‐values from Fisher’s exact tests, which follows a χ² ‐distribution with 2 degrees of freedom. Simulation studies are performed to show that the proposed method provides reasonable type I error probabilities and powers. The proposed method is illustrated with two real datasets from phase III breast cancer clinical trials.     

Testing homogeneity in Weibull-regression models

In survival studies with families or geographical units it may be of interest testing whether such groups are homogeneous for given explanatory variables. In this paper we consider score type tests for group homogeneity based on a mixing model in which the group effect is modelled as a random variable. As opposed to hazard-based frailty models, this model presents survival times that conditioned on the random effect, has an accelerated failure time representation. The test statistics requires only estimation of the conventional regression model without the random effect and does not require specifying the distribution of the random effect. The tests are derived for a Weibull regression model and in the uncensored situation, a closed form is obtained for the test statistic. A simulation study is used for comparing the power of the tests. The proposed tests are applied to real data sets with censored data.     

Consistent estimation of the expected Brier score in general survival models with right-censored event times

In survival analysis with censored data the mean squared error of prediction can be estimated by weighted averages of time-dependent residuals. Graf et al. (1999) suggested a robust weighting scheme based on the assumption that the censoring mechanism is independent of the covariates. We show consistency of the estimator. Furthermore, we show that a modified version of this estimator is consistent even when censoring and event times are only conditionally independent given the covariates. The modified estimators are derived on the basis of regression models for the censoring distribution. A simulation study and a real data example illustrate the results.     

An approach to model clustered survival data with dependent censoring

In this study we introduce a likelihood-based method, via the Weibull and piecewise exponential distributions, capable of accommodating the dependence between failure and censoring times. The methodology is developed for the analysis of clustered survival data and it assumes that failure and censoring times are mutually independent conditional on a latent frailty. The dependent censoring mechanism is accounted through the frailty effect and this is accomplished by means of a key parameter accommodating the correlation between failure and censored observations. The full specification of the likelihood in our work simplifies the inference procedures with respect to Huang and Wolfe since it reduces the computation burden of working with the profile likelihood. In addition, the assumptions made for the baseline distributions lead to models with continuous survival functions. In order to carry out inferences, we devise a Monte Carlo EM algorithm. The performance of the proposed models is investigated through a simulation study. Finally, we explore a real application involving patients from the Dialysis Outcomes and Practice Patterns Study observed between 1996 and 2015.     

Normal frailty probit model for clustered interval‐censored failure time data

Clustered interval‐censored data commonly arise in many studies of biomedical research where the failure time of interest is subject to interval‐censoring and subjects are correlated for being in the same cluster. A new semiparametric frailty probit regression model is proposed to study covariate effects on the failure time by accounting for the intracluster dependence. Under the proposed normal frailty probit model, the marginal distribution of the failure time is a semiparametric probit model, the regression parameters can be interpreted as both the conditional covariate effects given frailty and the marginal covariate effects up to a multiplicative constant, and the intracluster association can be summarized by two nonparametric measures in simple and explicit form. A fully Bayesian estimation approach is developed based on the use of monotone splines for the unknown nondecreasing function and a data augmentation using normal latent variables. The proposed Gibbs sampler is straightforward to implement since all unknowns have standard form in their full conditional distributions. The proposed method performs very well in estimating the regression parameters as well as the intracluster association, and the method is robust to frailty distribution misspecifications as shown in our simulation studies. Two real‐life data sets are analyzed for illustration.     

A Multiple Imputation Approach to Regression Analysis for Doubly Censored Data with Application to AIDS Studies

Sun, Liao, and Pagano (1999) proposed an interesting estimating equation approach to Cox regression with doubly censored data. Here we point out that a modification of their proposal leads to a multiple imputation approach, where the double censoring is reduced to single censoring by imputing for the censored initiating times. For each imputed data set one can take advantage of many existing techniques and software for singly censored data. Under the general framework of multiple imputation, the proposed method is simple to implement and can accommodate modeling issues such as model checking, which has not been adequately discussed previously in the literature for doubly censored data. Here we illustrate our method with an application to a formal goodness-of-fit test and a graphical check for the proportional hazards model for doubly censored data. We reanalyze a well-known AIDS data set.     

A quantile‐slicing approach for sufficient dimension reduction with censored responses

Sufficient dimension reduction (SDR) that effectively reduces the predictor dimension in regression has been popular in high‐dimensional data analysis. Under the presence of censoring, however, most existing SDR methods suffer. In this article, we propose a new algorithm to perform SDR with censored responses based on the quantile‐slicing scheme recently proposed by Kim et al. First, we estimate the conditional quantile function of the true survival time via the censored kernel quantile regression (Shin et al.) and then slice the data based on the estimated censored regression quantiles instead of the responses. Both simulated and real data analysis demonstrate promising performance of the proposed method.     

Generalized pairwise comparisons for censored data: An overview

The method of generalized pairwise comparisons (GPC) is an extension of the well-known nonparametric Wilcoxon–Mann–Whitney test for comparing two groups of observations. Multiple generalizations of Wilcoxon–Mann–Whitney test and other GPC methods have been proposed over the years to handle censored data. These methods apply different approaches to handling loss of information due to censoring: ignoring noninformative pairwise comparisons due to censoring (Gehan, Harrell, and Buyse); imputation using estimates of the survival distribution (Efron, Péron, and Latta); or inverse probability of censoring weighting (IPCW, Datta and Dong). Based on the GPC statistic, a measure of treatment effect, the “net benefit,” can be defined. It quantifies the difference between the probabilities that a randomly selected individual from one group is doing better than an individual from the other group. This paper aims at evaluating GPC methods for censored data, both in the context of hypothesis testing and estimation, and providing recommendations related to their choice in various situations. The methods that ignore uninformative pairs have comparable power to more complex and computationally demanding methods in situations of low censoring, and are slightly superior for high proportions (>40%) of censoring. If one is interested in estimation of the net benefit, Harrell's c index is an unbiased estimator if the proportional hazards assumption holds. Otherwise, the imputation (Efron or Peron) or IPCW (Datta, Dong) methods provide unbiased estimators in case of proportions of drop-out censoring up to 60%.     

A Simple Two‐Sample Rank Test for Multivariate Survival Outcomes with Left Truncation and Right Censoring

A distribution‐free two‐sample rank test is proposed for testing for differences between survival distributions in the analysis of biomedical studies in which two groups of subjects are followed over time for a particular outcome, which may recur. This method is motivated by an observational HIV (human immunodeficiency virus) study in which a group of HIV‐seropositive women and a comparable group of HIV‐seronegative women were examined every 6 months for the presence of cervical intraepithelial neoplasia (CIN), the cervical cancer precursor. Women entered the study serially and were subject to random loss to follow‐up. Only women free of CIN at study entry were followed resulting in left‐truncated survival times. If a woman is found to be CIN infected at a later examination, she is treated and then followed until CIN recurs. The two groups of women were compared at both occurrences of CIN on the basis of rank statistics. For the first occurrence of CIN, survival times since the beginning of the study (based on calendar time) are compared. For a recurrence of CIN, survival times since the first development of CIN are compared. The proposed test statistic for an overall difference between the two groups follows a chi‐square distribution with two degrees of freedom. Simulation results demonstrate the usefulness of the proposed test proposed test statistic, which reduces to the Gehan statistic if each person is followed only to the first failure and there is no serial enrollment.     

An information ratio-based goodness-of-fit test for copula models on censored data

Copula is a popular method for modeling the dependence among marginal distributions in multivariate censored data. As many copula models are available, it is essential to check if the chosen copula model fits the data well for analysis. Existing approaches to testing the fitness of copula models are mainly for complete or right-censored data. No formal goodness-of-fit (GOF) test exists for interval-censored or recurrent events data. We develop a general GOF test for copula-based survival models using the information ratio (IR) to address this research gap. It can be applied to any copula family with a parametric form, such as the frequently used Archimedean, Gaussian, and D-vine families. The test statistic is easy to calculate, and the test procedure is straightforward to implement. We establish the asymptotic properties of the test statistic. The simulation results show that the proposed test controls the type-I error well and achieves adequate power when the dependence strength is moderate to high. Finally, we apply our method to test various copula models in analyzing multiple real datasets. Our method consistently separates different copula models for all these datasets in terms of model fitness.     

Cox regression model with randomly censored covariates

This paper deals with a Cox proportional hazards regression model, where some covariates of interest are randomly right‐censored. While methods for censored outcomes have become ubiquitous in the literature, methods for censored covariates have thus far received little attention and, for the most part, dealt with the issue of limit‐of‐detection. For randomly censored covariates, an often‐used method is the inefficient complete‐case analysis (CCA) which consists in deleting censored observations in the data analysis. When censoring is not completely independent, the CCA leads to biased and spurious results. Methods for missing covariate data, including type I and type II covariate censoring as well as limit‐of‐detection do not readily apply due to the fundamentally different nature of randomly censored covariates. We develop a novel method for censored covariates using a conditional mean imputation based on either Kaplan–Meier estimates or a Cox proportional hazards model to estimate the effects of these covariates on a time‐to‐event outcome. We evaluate the performance of the proposed method through simulation studies and show that it provides good bias reduction and statistical efficiency. Finally, we illustrate the method using data from the Framingham Heart Study to assess the relationship between offspring and parental age of onset of cardiovascular events.     

Cox model with interval‐censored covariate in cohort studies

In cohort studies the outcome is often time to a particular event, and subjects are followed at regular intervals. Periodic visits may also monitor a secondary irreversible event influencing the event of primary interest, and a significant proportion of subjects develop the secondary event over the period of follow‐up. The status of the secondary event serves as a time‐varying covariate, but is recorded only at the times of the scheduled visits, generating incomplete time‐varying covariates. While information on a typical time‐varying covariate is missing for entire follow‐up period except the visiting times, the status of the secondary event are unavailable only between visits where the status has changed, thus interval‐censored. One may view interval‐censored covariate of the secondary event status as missing time‐varying covariates, yet missingness is partial since partial information is provided throughout the follow‐up period. Current practice of using the latest observed status produces biased estimators, and the existing missing covariate techniques cannot accommodate the special feature of missingness due to interval censoring. To handle interval‐censored covariates in the Cox proportional hazards model, we propose an available‐data estimator, a doubly robust‐type estimator as well as the maximum likelihood estimator via EM algorithm and present their asymptotic properties. We also present practical approaches that are valid. We demonstrate the proposed methods using our motivating example from the Northern Manhattan Study.     

Flexible Regression Model Selection for Survival Probabilities: With Application to AIDS

Summary Clinicians are often interested in the effect of covariates on survival probabilities at prespecified study times. Because different factors can be associated with the risk of short‐ and long‐term failure, a flexible modeling strategy is pursued. Given a set of multiple candidate working models, an objective methodology is proposed that aims to construct consistent and asymptotically normal estimators of regression coefficients and average prediction error for each working model, that are free from the nuisance censoring variable. It requires the conditional distribution of censoring given covariates to be modeled. The model selection strategy uses stepup or stepdown multiple hypothesis testing procedures that control either the proportion of false positives or generalized familywise error rate when comparing models based on estimates of average prediction error. The context can actually be cast as a missing data problem, where augmented inverse probability weighted complete case estimators of regression coefficients and prediction error can be used ( Tsiatis, 2006 , Semiparametric Theory and Missing Data). A simulation study and an interesting analysis of a recent AIDS trial are provided.     

Defective regression models for cure rate modeling with interval‐censored data

Regression models in survival analysis are most commonly applied for right‐censored survival data. In some situations, the time to the event is not exactly observed, although it is known that the event occurred between two observed times. In practice, the moment of observation is frequently taken as the event occurrence time, and the interval‐censored mechanism is ignored. We present a cure rate defective model for interval‐censored event‐time data. The defective distribution is characterized by a density function whose integration assumes a value less than one when the parameter domain differs from the usual domain. We use the Gompertz and inverse Gaussian defective distributions to model data containing cured elements and estimate parameters using the maximum likelihood estimation procedure. We evaluate the performance of the proposed models using Monte Carlo simulation studies. Practical relevance of the models is illustrated by applying datasets on ovarian cancer recurrence and oral lesions in children after liver transplantation, both of which were derived from studies performed at A.C. Camargo Cancer Center in São Paulo, Brazil.     

A semiparametric mixture cure survival model for left‐truncated and right‐censored data

In follow‐up studies, the disease event time can be subject to left truncation and right censoring. Furthermore, medical advancements have made it possible for patients to be cured of certain types of diseases. In this article, we consider a semiparametric mixture cure model for the regression analysis of left‐truncated and right‐censored data. The model combines a logistic regression for the probability of event occurrence with the class of transformation models for the time of occurrence. We investigate two techniques for estimating model parameters. The first approach is based on martingale estimating equations (EEs). The second approach is based on the conditional likelihood function given truncation variables. The asymptotic properties of both proposed estimators are established. Simulation studies indicate that the conditional maximum‐likelihood estimator (cMLE) performs well while the estimator based on EEs is very unstable even though it is shown to be consistent. This is a special and intriguing phenomenon for the EE approach under cure model. We provide insights into this issue and find that the EE approach can be improved significantly by assigning appropriate weights to the censored observations in the EEs. This finding is useful in overcoming the instability of the EE approach in some more complicated situations, where the likelihood approach is not feasible. We illustrate the proposed estimation procedures by analyzing the age at onset of the occiput‐wall distance event for patients with ankylosing spondylitis.     

Nonparametric inference on cause‐specific quantile residual life

In medical research, investigators are often interested in inferring time‐to‐event distributions under competing risks. It is well known, however, that the naive approach based on the Kaplan–Meier method to estimate the proportion of cause‐specific events overestimates the true quantity. In this paper, we show that the quantile residual life function, a natural and popular summary measure of survival data, could be also seriously affected by the competing events. An existing two‐sample test statistic for inference on median residual life is modified for competing risks data, which does not involve estimation of the improper probability density function of the subdistribution of cause‐specific events under censoring. Simulation results demonstrate that the test statistic controls the type 1 error probabilities reasonably well. The proposed method is applied to a real data example from a large‐scale phase III breast cancer study.     

Hazard ratio estimation for two‐sample case under interval‐censored failure time data

This paper discusses two‐sample comparison in the case of interval‐censored failure time data. For the problem, one common approach is to employ some nonparametric test procedures, which usually give some p‐values but not a direct or exact quantitative measure of the survival or treatment difference of interest. In particular, these procedures cannot provide a hazard ratio estimate, which is commonly used to measure the difference between the two treatments or samples. For interval‐censored data, a few nonparametric test procedures have been developed, but it does not seem to exist as a procedure for hazard ratio estimation. Corresponding to this, we present two procedures for nonparametric estimation of the hazard ratio of the two samples for interval‐censored data situations. They are generalizations of the corresponding procedures for right‐censored failure time data. An extensive simulation study is conducted to evaluate the performance of the two procedures and indicates that they work reasonably well in practice. For illustration, they are applied to a set of interval‐censored data arising from a breast cancer study.     

Analysis of multivariate recurrent event data with time‐dependent covariates and informative censoring

Multivariate recurrent event data are usually encountered in many clinical and longitudinal studies in which each study subject may experience multiple recurrent events. For the analysis of such data, most existing approaches have been proposed under the assumption that the censoring times are noninformative, which may not be true especially when the observation of recurrent events is terminated by a failure event. In this article, we consider regression analysis of multivariate recurrent event data with both time‐dependent and time‐independent covariates where the censoring times and the recurrent event process are allowed to be correlated via a frailty. The proposed joint model is flexible where both the distributions of censoring and frailty variables are left unspecified. We propose a pairwise pseudolikelihood approach and an estimating equation‐based approach for estimating coefficients of time‐dependent and time‐independent covariates, respectively. The large sample properties of the proposed estimates are established, while the finite‐sample properties are demonstrated by simulation studies. The proposed methods are applied to the analysis of a set of bivariate recurrent event data from a study of platelet transfusion reactions.     

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.     

On the small-sample performance of Efron's and of Gill's version of the product limit estimator under nonproportional hazards

Various proposals have been made to extend the product limit estimator to survival times beyond the largest observation in case that observation is censored. Two extreme extensions are examined with respect to bias and mean squared error (MSE). Their quality depends considerably on the "censoring constellation." The MSE of one extension appears to be robust against a wide variety of nonproportionalities of the hazard rates of the distributions of lifelength and time to censoring.