论文标题
多州模型,结合了多余危害和多个时间尺度的估计
A multi-state model incorporating estimation of excess hazards and multiple time scales
论文作者
论文摘要
随着癌症患者生存的提高,治疗的迟到的影响正在成为下一个临床挑战。例如,化学疗法和放射疗法可能会增加第二种恶性肿瘤和心血管疾病的发病率和死亡率的风险。为了提供临床相关的人群级别的迟到影响,(1)同时估计发病率和死亡率的风险,(2)将这些风险划分为在缺乏癌症和由于癌症及其治疗而导致的癌症和成分的成分中,以及(3)将年龄的多个时间尺度纳入了年龄,及时诊断。多状态模型为同时研究发病率和死亡率提供了一个框架,但不能解决划分风险的问题。但是,可以通过应用相对生存框架来实现此分区,允许直接量化多余的风险。本文提出了这两个框架的组合,提供了一种解决(1) - (3)的方法。使用最近开发的多状态建模方法,我们将多余危害的估计纳入多状态模型。中间和吸收状态风险都可以分配,并且允许不同的过渡具有不同的和/或多个时间尺度。我们使用有关霍奇金淋巴瘤患者的数据和循环系统疾病的过多风险来说明了我们的方法,并提供了用户友好的Stata软件,并随附示例代码。
As cancer patient survival improves, late effects from treatment are becoming the next clinical challenge. Chemotherapy and radiotherapy, for example, potentially increase the risk of both morbidity and mortality from second malignancies and cardiovascular disease. To provide clinically relevant population-level measures of late effects, it is of importance to (1) simultaneously estimate the risks of both morbidity and mortality, (2) partition these risks into the component expected in the absence of cancer and the component due to the cancer and its treatment, and (3) incorporate the multiple time scales of attained age, calendar time, and time since diagnosis. Multi-state models provide a framework for simultaneously studying morbidity and mortality, but do not solve the problem of partitioning the risks. However, this partitioning can be achieved by applying a relative survival framework, by allowing is to directly quantify the excess risk. This paper proposes a combination of these two frameworks, providing one approach to address (1)-(3). Using recently developed methods in multi-state modeling, we incorporate estimation of excess hazards into a multi-state model. Both intermediate and absorbing state risks can be partitioned and different transitions are allowed to have different and/or multiple time scales. We illustrate our approach using data on Hodgkin lymphoma patients and excess risk of diseases of the circulatory system, and provide user-friendly Stata software with accompanying example code.