On proportional hazards assumption under the random effects models

The proportional hazards mixed-effects model (PHMM) was proposed to handle dependent survival data. Motivated by its application in genetic epidemiology, we study the interpretation of its parameter estimates under violations of the proportional hazards assumption. The estimated fixed effect turns out to be an averaged regression effect over time, while the estimated variance component could be unaffected, inflated or attenuated depending on whether the random effect is on the baseline hazard, and whether the non-proportional regression effect decreases or increases over time. Using the conditional distribution of the covariates we define the standardized covariate residuals, which can be used to check the proportional hazards assumption. The model checking technique is illustrated on a multi-center lung cancer trial.     

Sequential tests for non-proportional hazards data

In clinical trials survival endpoints are usually compared using the log-rank test. Sequential methods for the log-rank test and the Cox proportional hazards model are largely reported in the statistical literature. When the proportional hazards assumption is violated the hazard ratio is ill-defined and the power of the log-rank test depends on the distribution of the censoring times. The average hazard ratio was proposed as an alternative effect measure, which has a meaningful interpretation in the case of non-proportional hazards, and is equal to the hazard ratio, if the hazards are indeed proportional. In the present work we prove that the average hazard ratio based sequential test statistics are asymptotically multivariate normal with the independent increments property. This allows for the calculation of group-sequential boundaries using standard methods and existing software. The finite sample characteristics of the new method are examined in a simulation study in a proportional and a non-proportional hazards setting.     

Partial orders with respect to continuous covariates and tests for the proportional hazards model

Several omnibus tests of the proportional hazards assumption have been proposed in the literature. In the two-sample case, tests have also been developed against ordered alternatives like monotone hazard ratio and monotone ratio of cumulative hazards. Here we propose a natural extension of these partial orders to the case of continuous and potentially time varying covariates, and develop tests for the proportional hazards assumption against such ordered alternatives. The work is motivated by applications in biomedicine and economics where covariate effects often decay over lifetime. The proposed tests do not make restrictive assumptions on the underlying regression model, and are applicable in the presence of time varying covariates, multiple covariates and frailty. Small sample performance and an application to real data highlight the use of the framework and methodology to identify and model the nature of departures from proportionality.     

Comparison of goodness of fit tests for the cox proportional hazards model

The proportional hazards regression model of Cox(1972) is widely used in analyzing survival data. We examine several goodness of fit tests for checking the proportionality of hazards in the Cox model with two-sample censored data, and compare the performance of these tests by a simulation study. The strengths and weaknesses of the tests are pointed out. The effects of the extent of random censoring on the size and power are also examined. Results of a simulation study demonstrate that Gill and Schumacher's test is most powerful against a broad range of monotone departures from the proportional hazards assumption, but it may not perform as well fail for alternatives of nonmonotone hazard ratio. For the latter kind of alternatives, Andersen's test may detect patterns of irregular changes in hazards.     

Proportional cause-specific reversed hazards model

The proportional reversed hazards model explains the multiplicative effect of covariates on the baseline reversed hazard rate function of lifetimes. In the present study, we introduce a proportional cause-specific reversed hazards model. The proposed regression model facilitates the analysis of failure time data with multiple causes of failure under left censoring. We estimate the regression parameters using a partial likelihood approach. We provide Breslow's type estimators for the cumulative cause-specific reversed hazard rate functions. Asymptotic properties of the estimators are discussed. Simulation studies are conducted to assess their performance. We illustrate the applicability of the proposed model using a real data set.     

Efficiently weighted estimating equations with application to proportional excess hazards

A general approach to estimation, that can lead to efficient estimation in two stages, is presented. The method will not always be available, but sufficient conditions for efficiency are provided together with four examples of its use: (1) estimation of the odds ratio in 1:M matched case-control studies with a dichotomous exposure variable; (2) estimation of the relative hazard in a two-sample survival setting; (3) estimation of the regression parameters in the proportional excess hazards model; and (4) estimation in a partly linear parametric additive hazards model. The method depends upon finding a family of weighted estimating equations, which includes a simple initial equation yielding a consistent estimate and also an equation that yields an efficient estimate, provided the optiomal weights are used.     

The Efficiency of Simple and Counter-matched Nested Case-control Sampling

This paper presents a study of the performance of simple and counter-matched nested case-control sampling relative to a full cohort study. First we review methods for estimating the regression parameters and the integrated baseline hazard for Cox's proportional hazards model from cohort and case-control data. Then the asymptotic distributional properties of these estimators are recapitulated, and relative efficiency results are presented both for regression and baseline hazard estimation.     

A dependent Dirichlet process model for survival data with competing risks

In this paper, we first propose a dependent Dirichlet process (DDP) model using a mixture of Weibull models with each mixture component resembling a Cox model for survival data. We then build a Dirichlet process mixture model for competing risks data without regression covariates. Next we extend this model to a DDP model for competing risks regression data by using a multiplicative covariate effect on subdistribution hazards in the mixture components. Though built on proportional hazards (or subdistribution hazards) models, the proposed nonparametric Bayesian regression models do not require the assumption of constant hazard (or subdistribution hazard) ratio. An external time-dependent covariate is also considered in the survival model. After describing the model, we discuss how both cause-specific and subdistribution hazard ratios can be estimated from the same nonparametric Bayesian model for competing risks regression. For use with the regression models proposed, we introduce an omnibus prior that is suitable when little external information is available about covariate effects. Finally we compare the models’ performance with existing methods through simulations. We also illustrate the proposed competing risks regression model with data from a breast cancer study. An R package “DPWeibull” implementing all of the proposed methods is available at CRAN.

     

Extended Hazard Regression Model for Reliability and Survival Analysis

We propose an extended hazard regression model which allows the spread parameter to be dependent on covariates. This allows a broad class of models which includes the most common hazard models, such as the proportional hazards model, the accelerated failure time model and a proportional hazards/accelerated failure time hybrid model with constant spread parameter. Simulations based on sub-classes of this model suggest that maximum likelihood performs well even when only small or moderate-size data sets are available and the censoring pattern is heavy. The methodology provides a broad framework for analysis of reliability and survival data. Two numerical examples illustrate the results.     

Marginal Likelihood Estimation for Proportional Odds Models with Right Censored Data

One majoraspect in medical research is to relate the survival times ofpatients with the relevant covariates or explanatory variables.The proportional hazards model has been used extensively in thepast decades with the assumption that the covariate effects actmultiplicatively on the hazard function, independent of time.If the patients become more homogeneous over time, say the treatmenteffects decrease with time or fade out eventually, then a proportionalodds model may be more appropriate. In the proportional oddsmodel, the odds ratio between patients can be expressed as afunction of their corresponding covariate vectors, in which,the hazard ratio between individuals converges to unity in thelong run. In this paper, we consider the estimation of the regressionparameter for a semiparametric proportional odds model at whichthe baseline odds function is an arbitrary, non-decreasing functionbut is left unspecified. Instead of using the exact survivaltimes, only the rank order information among patients is used.A Monte Carlo method is used to approximate the marginal likelihoodfunction of the rank invariant transformation of the survivaltimes which preserves the information about the regression parameter.The method can be applied to other transformation models withcensored data such as the proportional hazards model, the generalizedprobit model or others. The proposed method is applied to theVeteran's Administration lung cancer trial data.     

Reduced rank proportional hazards model for competing risks: An application to a breast cancer trial

In many cancer trials patients are at risk of recurrence and death after the appearance and the successful treatment of the first diagnosed tumour. In this situation competing risks models that model several competing causes of therapy or surgery failure are a natural framework to describe the evolution of the disease.Typically, regression models for competing risks outcomes are based on proportional hazards model for each of the cause-specific hazard rates. An immediate practical problem is then how to deal with the abundance of regression parameters. The aim of reduced rank proportional hazards models is to reduce the number of parameters that need to be estimated while at the same time keeping the distinction between different transitions. They have the advantage of describing the competing risks model in fewer parameters, cope with transitions where few events are present and facilitate the interpretation of these estimates.We shall illustrate the use of this technique on 2795 patients from a breast cancer trial (EORTC 10854).     

A Note on the Estimate of Treatment Effect from a Cox Regression Model When the Proportionality Assumption Is Violated

ABSTRACT

Cox proportional hazards regression model has been widely used to estimate the effect of a prognostic factor on a time-to-event outcome. In a survey of survival analyses in cancer journals, it was found that only 5% of studies using Cox proportional hazards model attempted to verify the underlying assumption. Usually an estimate of the treatment effect from fitting a Cox model was reported without validation of the proportionality assumption. It is not clear how such an estimate should be interpreted if the proportionality assumption is violated. In this article, we show that the estimate of treatment effect from a Cox regression model can be interpreted as a weighted average of the log-scaled hazard ratio over the duration of study. A hypothetic example is used to explain the weights.     

The proportional hazards model: applications in epidemiology

Cox's (1972) Proportioal hazards failure time model, already widely used in the analysis of clinical trials, also provides an elegant formalization of the epidemiologic concept of relative risk. When used to compare the disease experience of a study cohort with that of an external control population, it generalizes the notions of the standardized morbidity ratio (SMR) and the proportional morbidity ratio (PMR). For studies in which matched sets of cases and controls are sampled retrospectively from the population at risk, the model provides a flexible tool for the regression analysis of multiple risk factors.     

Testing for the Proportionality of Hazards in Two Samples Against the Increasing Cumulative Hazard Ratio Alternative

A number of tests of the proportional hazards hypothesis have been proposed in the past. In recent years, researchers have proposed tests geared specially for the alternative hypothesis of "increasing hazard ratio", keeping in mind the case of crossing hazards. This alternative may be too restrictive in many situations. In this paper we develop a test of the proportional hazards model for the weaker "increasing cumulative hazard ratio" alternative. The work is motivated by a data analytic example given by Gill & Schumacher (1987) where their test fails to reject the null hypothesis even though the faster ageing of one group is quite apparent from a plot. The normalized test statistic proposed here has an asymptotically normal distribution under either hypothesis. We also present two graphical methods related to our analytical test.     

Checking the Short‐Term and Long‐Term Hazard Ratio Model for Survival Data

Abstract. The short‐term and long‐term hazard ratio model includes the proportional hazards model and the proportional odds model as submodels, and allows a wider range of hazard ratio patterns compared with some of the more traditional models. We propose two omnibus tests for checking this model, based, respectively, on the martingale residuals and the contrast between the non‐parametric and model‐based estimators of the survival function. These tests are shown to be consistent against any departure from the model. The empirical behaviours of the tests are studied in simulations, and the tests are illustrated with some real data examples.     

On mantel-haenszel type estimators in simple nested case-control studies

We are concerned with nested case-control studies in this article. For proportional hazards model, a class of over-all estimators of hazard ratios is presented when simple samples are drawn from risk sets. These estimators have the form of the Mantel-Haenszel estimator of odds ratio, and are consistent not only for large strata, but also for sparse data. Consistent estimators of the variances of the proposed hazard ratio estimators are also developed. An example is given to illustrate the proposed estimators.     

A note on the asymptotic relative efficiency of estimators from the additive hazards model

In this note, the asymptotic variance formulas are explicitly derived and compared between the parametric and semiparametric estimators of a regression parameter and survival probability under the additive hazards model. To obtain explicit formulas, it is assumed that the covariate term including a regression coefficient follows a gamma distribution and the baseline hazard function is constant. The results show that the semiparametric estimator of the regression coefficient parameter is fully efficient relative to the parametric counterpart when the survival time and a covariate are independent, as in the proportional hazards model. Relative to a more realistic case of the parametric additive hazards model with a Weibull baseline, the loss of efficiency of the semiparametric estimator of survival probability is moderate.     

Estimating Cure Rates From Survival Data: An Alternative to Two-Component Mixture Models

This article considers the utility of the bounded cumulative hazard model in cure rate estimation, which is an appealing alternative to the widely used two-component mixture model. This approach has the following distinct advantages: (1) It allows for a natural way to extend the proportional hazards regression model, leading to a wide class of extended hazard regression models. (2) In some settings the model can be interpreted in terms of biologically meaningful parameters. (3) The model structure is particularly suitable for semiparametric and Bayesian methods of statistical inference. Notwithstanding the fact that the model has been around for less than a decade, a large body of theoretical results and applications has been reported to date. This review article is intended to give a big picture of these modeling techniques and associated statistical problems. These issues are discussed in the context of survival data in cancer.     

A nonparametric test to compare survival distributions with covariate adjustment

Summary.  The analysis of covariance is a technique that is used to improve the power of a k -sample test by adjusting for concomitant variables. If the end point is the time of survival, and some observations are right censored, the score statistic from the Cox proportional hazards model is the method that is most commonly used to test the equality of conditional hazard functions. In many situations, however, the proportional hazards model assumptions are not satisfied. Specifically, the relative risk function is not time invariant or represented as a log-linear function of the covariates. We propose an asymptotically valid k -sample test statistic to compare conditional hazard functions which does not require the assumption of proportional hazards, a parametric specification of the relative risk function or randomization of group assignment. Simulation results indicate that the performance of this statistic is satisfactory. The methodology is demonstrated on a data set in prostate cancer.     

Bayesian variable selection for proportional hazards models

The authors consider the problem of Bayesian variable selection for proportional hazards regression models with right censored data. They propose a semi-parametric approach in which a nonparametric prior is specified for the baseline hazard rate and a fully parametric prior is specified for the regression coefficients. For the baseline hazard, they use a discrete gamma process prior, and for the regression coefficients and the model space, they propose a semi-automatic parametric informative prior specification that focuses on the observables rather than the parameters. To implement the methodology, they propose a Markov chain Monte Carlo method to compute the posterior model probabilities. Examples using simulated and real data are given to demonstrate the methodology.