1. Disease-specific survival for limited-stage small-cell lung cancer affected by statistical method of assessment
- Author
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Fei Yuan, Judith-Anne W. Chapman, Lee Sang-Joon, Edward Yu, Dennie V. Jones, Patricia Tai, and Changhong Yu
- Subjects
Adult ,Male ,medicine.medical_specialty ,Superior Vena Cava Syndrome ,Cancer Research ,Multivariate analysis ,Lung Neoplasms ,Comorbidity ,lcsh:RC254-282 ,Cohort Studies ,Models ,Risk Factors ,Internal medicine ,medicine ,80 and over ,Confidence Intervals ,Genetics ,Humans ,Carcinoma, Small Cell ,Lung cancer ,Survival rate ,Survival analysis ,Aged ,Aged, 80 and over ,Models, Statistical ,business.industry ,Proportional hazards model ,Carcinoma ,Small Cell ,Middle Aged ,Statistical ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Survival Analysis ,Confidence interval ,Saskatchewan ,Surgery ,Survival Rate ,Oncology ,Lymphatic Metastasis ,Cohort ,Multivariate Analysis ,Female ,business ,Research Article ,Cohort study ,Follow-Up Studies - Abstract
Background In general, prognosis and impact of prognostic/predictive factors are assessed with Kaplan-Meier plots and/or the Cox proportional hazard model. There might be substantive differences from the results using these models for the same patients, if different statistical methods were used, for example, Boag log-normal (cure-rate model), or log-normal survival analysis. Methods Cohort of 244 limited-stage small-cell lung cancer patients, were accrued between 1981 and 1998, and followed to the end of 2005. The endpoint was death with or from lung cancer, for disease-specific survival (DSS). DSS at 1-, 3- and 5-years, with 95% confidence limits, are reported for all patients using the Boag, Kaplan-Meier, Cox, and log-normal survival analysis methods. Factors with significant effects on DSS were identified with step-wise forward multivariate Cox and log-normal survival analyses. Then, DSS was ascertained for patients with specific characteristics defined by these factors. Results The median follow-up of those alive was 9.5 years. The lack of events after 1966 days precluded comparison after 5 years. DSS assessed by the four methods in the full cohort differed by 0–2% at 1 year, 0–12% at 3 years, and 0–1% at 5 years. Log-normal survival analysis indicated DSS of 38% at 3 years, 10–12% higher than with other methods; univariate 95% confidence limits were non-overlapping. Surgical resection, hemoglobin level, lymph node involvement, and superior vena cava (SVC) obstruction significantly impacted DSS. DSS assessed by the Cox and log-normal survival analysis methods for four clinical risk groups differed by 1–6% at 1 year, 15–26% at 3 years, and 0–12% at 5 years; multivariate 95% confidence limits were overlapping in all instances. Conclusion Surgical resection, hemoglobin level, lymph node involvement, and superior vena cava (SVC) obstruction all significantly impacted DSS. Apparent DSS for patients was influenced by the statistical methods of assessment. This would be clinically relevant in the development or improvement of clinical management strategies.
- Published
- 2007