论文标题
正确审查偏差对生存分析的影响
Effect of right censoring bias on survival analysis
论文作者
论文摘要
Kaplan-Meier的生存分析代表了肿瘤学中最客观的治疗功效衡量标准，尽管存在潜在的偏见，这在精确医学时代令人担忧。与临床试验的设计和执行固有的偏见无关，偏见可能是患者检查的结果或不完整的观察结果。与疾病/无疾病的生存不同，总体存活率基于定义明确的时间点，因此避免了间隔审查，但是由于不完整的随访，右审查仍可能是偏见的来源。我们研究了三种右审查的机制，发现其中一个机制，即失去随访的患者的替代物，能够影响Kaplan-Meier的生存，从危险比测量的完整后续数据集中，与完整的后续数据集相比，显着提高了生存率的估计。我们还提出了两个偏差索引，能够通过右审查相关的生存率高估。这些偏差索引可以检测到公共可用数据集中的偏见
Kaplan-Meier survival analysis represents the most objective measure of treatment efficacy in oncology, though subjected to potential bias, which is worrisome in an era of precision medicine. Independent of the bias inherent to the design and execution of clinical trials, bias may be the result of patient censoring, or incomplete observation. Unlike disease/progression free survival, overall survival is based on a well defined time point and thus avoids interval censoring, but right-censoring, due to incomplete follow-up, may still be a source of bias. We study three mechanisms of right-censoring and find that one of them, surrogate of patient lost to follow-up, is able to impact Kaplan-Meier survival, improving significantly the estimation of survival in comparison with complete follow-up datasets, as measured by the hazard ratio. We also present two bias indexes able to signal datasets with right-censoring associated overestimation of survival. These bias indexes can detect bias in public available datasets
