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.     

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.     

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.     

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.     

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.     

Bayesian analysis of censored response data in family‐based genetic association studies

Biomarkers are subject to censoring whenever some measurements are not quantifiable given a laboratory detection limit. Methods for handling censoring have received less attention in genetic epidemiology, and censored data are still often replaced with a fixed value. We compared different strategies for handling a left‐censored continuous biomarker in a family‐based study, where the biomarker is tested for association with a genetic variant, , adjusting for a covariate, X. Allowing different correlations between X and , we compared simple substitution of censored observations with the detection limit followed by a linear mixed effect model (LMM), Bayesian model with noninformative priors, Tobit model with robust standard errors, the multiple imputation (MI) with and without in the imputation followed by a LMM. Our comparison was based on real and simulated data in which 20% and 40% censoring were artificially induced. The complete data were also analyzed with a LMM. In the MICROS study, the Bayesian model gave results closer to those obtained with the complete data. In the simulations, simple substitution was always the most biased method, the Tobit approach gave the least biased estimates at all censoring levels and correlation values, the Bayesian model and both MI approaches gave slightly biased estimates but smaller root mean square errors. On the basis of these results the Bayesian approach is highly recommended for candidate gene studies; however, the computationally simpler Tobit and the MI without are both good options for genome‐wide studies.     

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.     

Regression analysis of doubly censored failure time data using the additive hazards model

Doubly censored failure time data arise when the survival time of interest is the elapsed time between two related events and observations on occurrences of both events could be censored. Regression analysis of doubly censored data has recently attracted considerable attention and for this a few methods have been proposed (Kim et al., 1993, Biometrics 49, 13-22; Sun et al., 1999, Biometrics 55, 909-914; Pan, 2001, Biometrics 57, 1245-1250). However, all of the methods are based on the proportional hazards model and it is well known that the proportional hazards model may not fit failure time data well sometimes. This article investigates regression analysis of such data using the additive hazards model and an estimating equation approach is proposed for inference about regression parameters of interest. The proposed method can be easily implemented and the properties of the proposed estimates of regression parameters are established. The method is applied to a set of doubly censored data from an AIDS cohort study.     

Analysis of interval‐censored recurrent event processes subject to resolution

Interval‐censored recurrent event data arise when the event of interest is not readily observed but the cumulative event count can be recorded at periodic assessment times. In some settings, chronic disease processes may resolve, and individuals will cease to be at risk of events at the time of disease resolution. We develop an expectation‐maximization algorithm for fitting a dynamic mover‐stayer model to interval‐censored recurrent event data under a Markov model with a piecewise‐constant baseline rate function given a latent process. The model is motivated by settings in which the event times and the resolution time of the disease process are unobserved. The likelihood and algorithm are shown to yield estimators with small empirical bias in simulation studies. Data are analyzed on the cumulative number of damaged joints in patients with psoriatic arthritis where individuals experience disease remission.