Title |
Advantages of a multi-state approach in surgical research: how intermediate events and risk factor profile affect the prognosis of a patient with locally advanced rectal cancer
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Published in |
BMC Medical Research Methodology, February 2018
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DOI | 10.1186/s12874-018-0476-z |
Pubmed ID | |
Authors |
G. Manzini, T. J. Ettrich, M. Kremer, M. Kornmann, D. Henne-Bruns, D. A. Eikema, P. Schlattmann, L. C. de Wreede |
Abstract |
Standard survival analysis fails to give insight into what happens to a patient after a first outcome event (like first relapse of a disease). Multi-state models are a useful tool for analyzing survival data when different treatments and results (intermediate events) can occur. Aim of this study was to implement a multi-state model on data of patients with rectal cancer to illustrate the advantages of multi-state analysis in comparison to standard survival analysis. We re-analyzed data from the RCT FOGT-2 study by using a multi-state model. Based on the results we defined a high and low risk reference patient. Using dynamic prediction, we estimated how the survival probability changes as more information about the clinical history of the patient becomes available. A patient with stage UICC IIIc (vs UICC II) has a higher risk to develop distant metastasis (DM) or both DM and local recurrence (LR) if he/she discontinues chemotherapy within 6 months or between 6 and 12 months, as well as after the completion of 12 months CTx with HR 3.55 (p = 0.026), 5.33 (p = 0.001) and 3.37 (p < 0.001), respectively. He/she also has a higher risk to die after the development of DM (HR 1.72, p = 0.023). Anterior resection vs. abdominoperineal amputation means 63% risk reduction to develop DM or both DM and LR (HR 0.37, p = 0.003) after discontinuation of chemotherapy between 6 and 12 months. After development of LR, a woman has a 4.62 times higher risk to die (p = 0.006). A high risk reference patient has an estimated 43% 5-year survival probability at start of CTx, whereas for a low risk patient this is 79%. After the development of DM 1 year later, the high risk patient has an estimated 5-year survival probability of 11% and the low risk patient one of 21%. Multi-state models help to gain additional insight into the complex events after start of treatment. Dynamic prediction shows how survival probabilities change by progression of the clinical history. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
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Unknown | 30 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
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Student > Master | 5 | 17% |
Student > Bachelor | 3 | 10% |
Other | 2 | 7% |
Student > Doctoral Student | 2 | 7% |
Student > Ph. D. Student | 2 | 7% |
Other | 2 | 7% |
Unknown | 14 | 47% |
Readers by discipline | Count | As % |
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Medicine and Dentistry | 11 | 37% |
Mathematics | 4 | 13% |
Agricultural and Biological Sciences | 1 | 3% |
Computer Science | 1 | 3% |
Unknown | 13 | 43% |