The analysis of randomized trials with time-to-event endpoints is nearly always plagued by the problem of censoring. As the censoring mechanism is usually unknown, analyses typically employ the assumption of non-informative censoring. While this assumption usually becomes more plausible as more baseline covariates are being adjusted for, such adjustment also raises concerns. Pre-specification of which covariates will be adjusted for (and how) is difficult, thus prompting the use of data-driven variable selection procedures, which may impede valid inferences to be drawn. The adjustment for covariates moreover adds concerns about model misspecification, and the fact that each change in adjustment set, also changes the censoring assumption and the treatment effect estimand. In this paper, we discuss these concerns and propose a simple variable selection strategy that aims to produce a valid test of the null in large samples. The proposal can be implemented using off-the-shelf software for (penalized) Cox regression, and is empirically found to work well in simulation studies and real data analyses.
When constructing models to summarize clinical data to be used for simulations, it is good practice to evaluate the models for their capacity to reproduce the data. This can be done by means of Visual Predictive Checks (VPC), which consist of (1) several reproductions of the original study by simulation from the model under evaluation, (2) calculating estimates of interest for each simulated study and (3) comparing the distribution of those estimates with the estimate from the original study. This procedure is a generic method that is straightforward to apply, in general. Here we consider the …
The Brier score is commonly used for evaluating probability predictions. In survival analysis, with right-censored observations of the event times, this score can be weighted by the inverse probability of censoring (IPCW) to retain its original interpretation. It is common practice to estimate the censoring distribution with the Kaplan-Meier estimator, even though it assumes that the censoring distribution is independent of the covariates. This paper discusses the general impact of the censoring estimates on the Brier score and shows that the estimation of the censoring distribution can be pro…
One goal in survival analysis of right-censored data is to estimate the marginal survival function in the presence of dependent censoring. When many auxiliary covariates are sufficient to explain the dependent censoring, estimation based on either a semiparametric model or a nonparametric model of the conditional survival function can be problematic due to the high dimensionality of the auxiliary information. In this paper, we use two working models to condense these high-dimensional covariates in dimension reduction; then an estimate of the marginal survival function can be derived nonparamet…
Randomized clinical trials with time-to-event outcomes have traditionally used the log-rank test followed by the Cox proportional hazards (PH) model to estimate the hazard ratio between the treatment groups. These are valid under the assumption that the right-censoring mechanism is non-informative, i.e. independent of the time-to-event of interest within each treatment group. More generally, the censoring time might depend on additional covariates, and inverse probability of censoring weighting (IPCW) can be used to correct for the bias resulting from the informative censoring. IPCW requires a…
Toward Valid Generative Clinical Trial Data with Survival Endpoints
Inria（法国国家信息与自动化技术研究院）；Université Paris Cité（巴黎城市大学）；Inserm（法国国家卫生研究院）；HeKA；AP-HP（巴黎大学医院）；Hôpital Européen Georges Pompidou（乔治·蓬皮杜欧洲医院）；Unité de Recherche Clinique APHP（APHP临床研究中心）；CIC1418（临床研究1418中心）；Epidémiologie Clinique Paris France（巴黎流行病学临床研究中心）
In the presence of prognostic covariates, inference about the treatment effect with time-to-event endpoints is mostly conducted via the stratified log-rank test or the score test based on the Cox proportional hazards model. In their ground-breaking work Ye and Shao (2020) have demonstrated theoretically that when the model is misspecified, the robust score test (Wei and Lin, 1989) as well as the unstratified log-rank test are conservative in trials with stratified randomization. This fact, however, was not established for the Pocock and Simon covariate-adaptive allocation other than through si…
Feature screening is an important method to reduce the dimension and capture informative variables in ultrahigh-dimensional data analysis. Many methods have been developed for feature screening. These methods, however, are challenged by complex features pertinent to the data collection as well as the nature of the data themselves. Typically, incomplete response caused by right-censoring and covariates measurement error are often accompanying with survival analysis. Even though there are many methods have been proposed for censored data, little work has been available when both incomplete respo…
The ICH E9 (R1) Estimands Guidance1 terminology does not completely address the conceptual needs of time-to-event estimands in the complex oncology context. We previously described how censoring and censoring mechanisms for time-to-event endpoints can be embedded into the ICH E9 (R1) Estimands Guidance terminology. This second paper by the Pharmaceutical Industry Working Group on Estimands in Oncology Censoring Mechanisms Subteam discusses special issues in the oncology clinical context that may require different approaches than some other therapeutic areas as well as an extensions of the ICH …
A Structured Nonparametric Framework for Nonlinear Accelerated Failure Time Models (KAN-AFT)
Department of Mathematics, School of Advanced Sciences, Vellore Institute of Technology（数学系，先进科学学院，维洛雷理工学院）；Applied Statistics Unit, Indian Statistical Institute（应用统计单位，印度统计研究所）
In heterogeneous cohorts and those where censoring by non-primary risks is informative many conventional survival analysis methods are not applicable; the proportional hazards assumption is usually violated at population level and the observed crude hazard rates are no longer estimators of what they would have been in the absence of other risks. In this paper, we develop a fully Bayesian survival analysis to determine the probabilistically optimal description of a heterogeneous cohort and we propose a novel means of recovering hazard rates and survival functions `decontaminated' of the effects…
We consider the situation of estimating Cox regression in which some covariates are subject to missing, and there exists additional information (including observed event time, censoring indicator and fully observed covariates) which may be predictive of the missing covariates. We propose to use two working regression models: one for predicting the missing covariates and the other for predicting the missing probabilities. For each missing covariate observation, these two working models are used to define a nearest neighbor imputing set. This set is then used to nonparametrically impute covariat…
In survival analysis, the hazard function often depends on a set of covariates. Martingale and deviance residual are most widely used for examining the validity of the function form of covariates by checking whether there is a discernible trend in their scatterplot against continuous covariates. However, visual inspection of martingale and deviance residuals is often subjective. In addition, these residuals lack a reference distribution due to censoring. It is therefore challenging to derive numerical statistical tests based on martingale or deviance residuals. In this paper, we extend the ide…
The restricted mean survival time is a clinically easy-to-interpret measure that does not require any assumption of proportional hazards. We focus on two ways to directly model the survival time and adjust the covariates. One is to calculate the pseudo-survival time for each subject using leave-one-out, and then perform a model analysis using all pseudo-values to adjust for covariates. The pseudo-survival time is used to reflect information of censored subjects in the model analysis. The other method adjusts for covariates using subjects for whom the time-to-event was observed while adjusting …
High-dimensional sparse modeling with censored survival data is of great practical importance, and several methods have been proposed for variable selection based on different models. However, the impact of biased sample caused by left-truncation and covariates measurement error to variable selection is not fully explored. In this paper, we mainly focus on the additive hazards model and analyze the high-dimensional survival data subject to left-truncation and measurement error in covariates. We develop the three-stage procedure to correct the error effect, select variables, and estimate the pa…
On a penalised likelihood approach for joint modelling of longitudinal covariates and partly interval-censored data -- an application to the Anti-PD1 brain collaboration trial
Medical studies that depend on electronic health records (EHR) data are often subject to measurement error, as the data are not collected to support research questions under study. These data errors, if not accounted for in study analyses, can obscure or cause spurious associations between patient exposures and disease risk. Methodology to address covariate measurement error has been well developed; however, time-to-event error has also been shown to cause significant bias but methods to address it are relatively underdeveloped. More generally, it is possible to observe errors in both the cova…
IMPORTANCE: Time-to-event outcomes are commonly used in clinical trials and biomarker discovery studies and have been primarily analyzed using Cox proportional hazards models. But it's unclear which statistical models should be recommended for feature selection tasks when time-to-event outcomes are of the primary interest. OBJECTIVE: To explore if Gaussian regression of log-transformed survival time could outperform Cox proportional hazards models in feature selection. DESIGN: In this simulation study, the true models are multivariate Cox proportional hazards models with 10 covariates. For all…
The primary analysis in two-arm clinical trials usually involves inference on a scalar treatment effect parameter; e.g., depending on the outcome, the difference of treatment-specific means, risk difference, risk ratio, or odds ratio. Most clinical trials are monitored for the possibility of early stopping. Because ordinarily the outcome on any given subject can be ascertained only after some time lag, at the time of an interim analysis, among the subjects already enrolled, the outcome is known for only a subset and is effectively censored for those who have not been enrolled sufficiently long…
