Parameter Orthogonality in Mixed Regression Models for Survival Data

The implications of parameter orthogonality for the robustness of survival regression models are considered. The question of which of the proportional hazards or the accelerated life families of models would be more appropriate for analysis is usually ignored, and the proportional hazards family is applied, particularly in medicine, for convenience. Accelerated life models have conventionally been used in reliability applications. We propose a one-parameter family mixture survival model which includes both the accelerated life and the proportional hazards models. By orthogonalizing relative to the mixture parameter, we can show that, for small effects of the covariates, the regression parameters under the alternative families agree to within a constant. This recovers a known misspecification result. We use notions of parameter orthogonality to explore robustness to other types of misspecification including misspecified base-line hazards. The results hold in the presence of censoring. We also study the important question of when proportionality matters.     

On heteroscedastic hazards regression models: theory and application

A class of non-proportional hazards regression models is considered to have hazard specifications consisting of a power form of cross-effects on the base-line hazard function. The primary goal of these models is to deal with settings in which heterogeneous distribution shapes of survival times may be present in populations characterized by some observable covariates. Although effects of such heterogeneity can be explicitly seen through crossing cumulative hazards phenomena in k -sample problems, they are barely visible in a one-sample regression setting. Hence, heterogeneity of this kind may not be noticed and, more importantly, may result in severely misleading inference. This is because the partial likelihood approach cannot eliminate the unknown cumulative base-line hazard functions in this setting. For coherent statistical inferences, a system of martingale processes is taken as a basis with which, together with the method of sieves, an overidentified estimating equation approach is proposed. A Pearson's χ² type of goodness-of-fit testing statistic is derived as a by-product. An example with data on gastric cancer patients' survival times is analysed.     

Choice of Parametric Accelerated Life and Proportional Hazards Models for Survival Data: Asymptotic Results

We discuss the impact of misspecifying fully parametric proportional hazards and accelerated life models. For the uncensored case, misspecified accelerated life models give asymptotically unbiased estimates of covariate effect, but the shape and scale parameters depend on the misspecification. The covariate, shape and scale parameters differ in the censored case. Parametric proportional hazards models do not have a sound justification for general use: estimates from misspecified models can be very biased, and misleading results for the shape of the hazard function can arise. Misspecified survival functions are more biased at the extremes than the centre. Asymptotic and first order results are compared. If a model is misspecified, the size of Wald tests will be underestimated. Use of the sandwich estimator of standard error gives tests of the correct size, but misspecification leads to a loss of power. Accelerated life models are more robust to misspecification because of their log-linear form. In preliminary data analysis, practitioners should investigate proportional hazards and accelerated life models; software is readily available for several such models.     

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.     

Semi-parametric survival analysis via Dirichlet process mixtures of the First Hitting Time model

Time-to-event data often violate the proportional hazards assumption inherent in the popular Cox regression model. Such violations are especially common in the sphere of biological and medical data where latent heterogeneity due to unmeasured covariates or time varying effects are common. A variety of parametric survival models have been proposed in the literature which make more appropriate assumptions on the hazard function, at least for certain applications. One such model is derived from the First Hitting Time (FHT) paradigm which assumes that a subject’s event time is determined by a latent stochastic process reaching a threshold value. Several random effects specifications of the FHT model have also been proposed which allow for better modeling of data with unmeasured covariates. While often appropriate, these methods often display limited flexibility due to their inability to model a wide range of heterogeneities. To address this issue, we propose a Bayesian model which loosens assumptions on the mixing distribution inherent in the random effects FHT models currently in use. We demonstrate via simulation study that the proposed model greatly improves both survival and parameter estimation in the presence of latent heterogeneity. We also apply the proposed methodology to data from a toxicology/carcinogenicity study which exhibits nonproportional hazards and contrast the results with both the Cox model and two popular FHT models.

     

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.     

A family of multiplicative survival models incorporating a long-term survivorship parameter c as a function of covariates

A family of multiplicative survival models is obtained for the analysis of clinical trial data in which a substantial proportion c of patients respond favorably to treatment with longterm survivorship. The model (MWSM) representing the hazard function for all patients as a function of c and a Weibull density is developed in which the distributional parameters and c are regressed on covariates and estimated by the method of maximum likelihood. The MWSM hazard function is monotonically increasing, peaking, then decreasing thereafter if the shape parameter exceeds unity, and is monotonically decreasing otherwise. Mortality rates with similar behavior have been empirically observed in cancer clinical trial data. A nonproportional or proportional hazards model results depending upon whether or not any Weibull parameter is regressed on covariates. Tests of hypotheses and confidence intervals for c and p-quantiles are obtained.     

Inference on Survival Data with Covariate Measurement Error – An Imputation-based Approach

Abstract.  We propose a new method for fitting proportional hazards models with error-prone covariates. Regression coefficients are estimated by solving an estimating equation that is the average of the partial likelihood scores based on imputed true covariates. For the purpose of imputation, a linear spline model is assumed on the baseline hazard. We discuss consistency and asymptotic normality of the resulting estimators, and propose a stochastic approximation scheme to obtain the estimates. The algorithm is easy to implement, and reduces to the ordinary Cox partial likelihood approach when the measurement error has a degenerate distribution. Simulations indicate high efficiency and robustness. We consider the special case where error-prone replicates are available on the unobserved true covariates. As expected, increasing the number of replicates for the unobserved covariates increases efficiency and reduces bias. We illustrate the practical utility of the proposed method with an Eastern Cooperative Oncology Group clinical trial where a genetic marker, c- myc expression level, is subject to measurement error.     

A class of partially linear single‐index survival models

The authors define a class of “partially linear single‐index” survival models that are more flexible than the classical proportional hazards regression models in their treatment of covariates. The latter enter the proposed model either via a parametric linear form or a nonparametric single‐index form. It is then possible to model both linear and functional effects of covariates on the logarithm of the hazard function and if necessary, to reduce the dimensionality of multiple covariates via the single‐index component. The partially linear hazards model and the single‐index hazards model are special cases of the proposed model. The authors develop a likelihood‐based inference to estimate the model components via an iterative algorithm. They establish an asymptotic distribution theory for the proposed estimators, examine their finite‐sample behaviour through simulation, and use a set of real data to illustrate their approach.     

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.     

Robust estimation for longitudinal data under outcome‐dependent visit processes

In longitudinal data where the timing and frequency of the measurement of outcomes may be associated with the value of the outcome, significant bias can occur. Previous results depended on correct specification of the outcome process and a somewhat unrealistic visit process model. In practice, this will never exactly be the case, so it is important to understand to what degree the results hold when those assumptions are violated in order to guide practical use of the methods. This paper presents theory and the results of simulation studies to extend our previous work to more realistic visit process models, as well as Poisson outcomes. We also assess the effects of several types of model misspecification. The estimated bias in these new settings generally mirrors the theoretical and simulation results of our previous work and provides confidence in using maximum likelihood methods in practice. Even when the assumptions about the outcome process did not hold, mixed effects models fit by maximum likelihood produced at most small bias in estimated regression coefficients, illustrating the robustness of these methods. This contrasts with generalised estimating equations approaches where bias increased in the settings of this paper. The analysis of data from a study of change in neurological outcomes following microsurgery for a brain arteriovenous malformation further illustrate the results.     

Dynamic Random Effects Models for Times Between Repeated Events

We consider recurrent event data when the duration or gap times between successive event occurrences are of intrinsic interest. Subject heterogeneity not attributed to observed covariates is usually handled by random effects which result in an exchangeable correlation structure for the gap times of a subject. Recently, efforts have been put into relaxing this restriction to allow non-exchangeable correlation. Here we consider dynamic models where random effects can vary stochastically over the gap times. We extend the traditional Gaussian variance components models and evaluate a previously proposed proportional hazards model through a simulation study and some examples. Besides, semiparametric estimation of the proportional hazards models is considered. Both models are easily used. The Gaussian models are easily interpreted in terms of the variance structure. On the other hand, the proportional hazards models would be more appropriate in the context of survival analysis, particularly in the interpretation of the regression parameters. They can be sensitive to the choice of model for random effects but not to the choice of the baseline hazard function.     

Proportional hazards models: a latent competing risk approach

We propose a novel semiparametric version of the widely used proportional hazards survival model. Features include an arbitrarily rich class of continuous base-line hazards, an attractive epidemiological interpretation of the hazard as a latent competing risk model and trivial handling of censoring. Models are fitted by using a data augmentation scheme. The methodology is applied to a data set recording times to first hospitalization following clinical diagnosis of acquired immune deficiency syndrome for a sample of 169 patients.     

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.     

Bayesian Survival Analysis in Proportional Hazard Models with Logistic Relative Risk

Abstract.  The traditional Cox proportional hazards regression model uses an exponential relative risk function. We argue that under various plausible scenarios, the relative risk part of the model should be bounded, suggesting also that the traditional model often might overdramatize the hazard rate assessment for individuals with unusual covariates. This motivates our working with proportional hazards models where the relative risk function takes a logistic form. We provide frequentist methods, based on the partial likelihood, and then go on to semiparametric Bayesian constructions. These involve a Beta process for the cumulative baseline hazard function and any prior with a density, for example that dictated by a Jeffreys-type argument, for the regression coefficients. The posterior is derived using machinery for Lévy processes, and a simulation recipe is devised for sampling from the posterior distribution of any quantity. Our methods are illustrated on real data. A Bernshtĕn–von Mises theorem is reached for our class of semiparametric priors, guaranteeing asymptotic normality of the posterior processes.     

Generalized Proportional Hazards Model Based on Modified Partial Likelihood

The proportional hazards (Cox) model is generalized by assuming that at any moment the ratio of hazard rates is depending not only on values of covariates but also on resources used until this moment. Relations with generalized multiplicative, frailty and linear transformation models are considered. A modified partial likelihood function is proposed, and properties of the estimators are investigated.     

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.

     

Estimation of extreme survival probabilities with cox model

We propose an extension of the regular Cox's proportional hazards model which allows the estimation of the probabilities of rare events. It is known that when the data are heavily censored, the estimation of the tail of the survival distribution is not reliable. To improve the estimate of the baseline survival function in the range of the largest observed data and to extend it outside, we adjust the tail of the baseline distribution beyond some threshold by an extreme value model under appropriate assumptions. The survival distributions conditioned to the covariates are easily computed from the baseline. A procedure allowing an automatic choice of the threshold and an aggregated estimate of the survival probabilities are also proposed. The performance is studied by simulations and an application on two data sets is given.     

A comparison of parametric and semi-parametric survival models with artificial neural networks

Survival models are used to examine data in the event of an occurrence. These are discussed in various types including parametric, non-parametric and semi-parametric models. Parametric models require a clear distribution of survival time, and semi-parametric models assume proportional hazards. Among these models, the non-parametric model of artificial neural network has the fewest assumptions and can be often replaced by other models. Given the importance of distribution Weibull survival models in this study of simulation shape parameter of the Weibull distribution have been assumed as 1, 2 and 3, and also the average rate at levels of 0%–75% have been censored. The values predicted by the neural network forecasting model with parametric survival and Cox regression models were compared. This comparison considering levels of complexity due to the hazard model using the ROC curve and the corresponding tests have been carried out.     

Weighted Mean Survival Test Statistics: a Class of Distance Tests for Censored Survival Data

A class of test statistics is introduced which is sensitive against the alternative of stochastic ordering in the two-sample censored data problem. The test statistics for evaluating a cumulative weighted difference in survival distributions are developed while taking into account the imbalances in base-line covariates between two groups. This procedure can be used to test the null hypothesis of no treatment effect, especially when base-line hazards cross and prognostic covariates need to be adjusted. The statistics are semiparametric, not rank based, and can be written as integrated weighted differences in estimated survival functions, where these survival estimates are adjusted for covariate imbalances. The asymptotic distribution theory of the tests is developed, yielding test procedures that are shown to be consistent under a fixed alternative. The choice of weight function is discussed and relies on stability and interpretability considerations. An example taken from a clinical trial for acquired immune deficiency syndrome is presented.