Semiparametric accelerated failure time cure rate mixture models with competing risks

Sangbum Choi, Liang Zhu, Xuelin Huang

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Modern medical treatments have substantially improved survival rates for many chronic diseases and have generated considerable interest in developing cure fraction models for survival data with a non-ignorable cured proportion. Statistical analysis of such data may be further complicated by competing risks that involve multiple types of endpoints. Regression analysis of competing risks is typically undertaken via a proportional hazards model adapted on cause-specific hazard or subdistribution hazard. In this article, we propose an alternative approach that treats competing events as distinct outcomes in a mixture. We consider semiparametric accelerated failure time models for the cause-conditional survival function that are combined through a multinomial logistic model within the cure-mixture modeling framework. The cure-mixture approach to competing risks provides a means to determine the overall effect of a treatment and insights into how this treatment modifies the components of the mixture in the presence of a cure fraction. The regression and nonparametric parameters are estimated by a nonparametric kernel-based maximum likelihood estimation method. Variance estimation is achieved through resampling methods for the kernel-smoothed likelihood function. Simulation studies show that the procedures work well in practical settings. Application to a sarcoma study demonstrates the use of the proposed method for competing risk data with a cure fraction.

Original languageEnglish
Pages (from-to)48-59
Number of pages12
JournalStatistics in Medicine
Volume37
Issue number1
DOIs
Publication statusPublished - 2018 Jan 15

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Keywords

  • competing risks
  • cure fraction
  • kernel smoothing
  • mixture model
  • nonparametric likelihood
  • subdistribution

ASJC Scopus subject areas

  • Epidemiology
  • Statistics and Probability

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