Bias in progression-free survival analysis due to intermittent assessment of progression

Stat Med. 2015 Oct 30;34(24):3181-93. doi: 10.1002/sim.6529. Epub 2015 May 24.

Abstract

Cancer clinical trials are routinely designed to assess the effect of treatment on disease progression and death, often in terms of a composite endpoint called progression-free survival. When progression status is known only at periodic assessment times, the progression time is interval censored, and complications arise in the analysis of progression-free survival. Despite the advances in methods for dealing with interval-censored data, naive methods such as right-endpoint imputation are widely adopted in this setting. We examine the asymptotic and empirical properties of estimators of the marginal progression-free survival functions and associated treatment effects under this scheme. Specifically, we explore the determinants of the asymptotic bias and point out that there is typically a loss in power of tests for treatment effects.

Keywords: illness-death process; intermittent observation; model misspecification; multistate model; progression-free survival.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bias*
  • Cohort Studies
  • Computer Simulation
  • Disease Progression*
  • Disease-Free Survival*
  • Humans
  • Male
  • Markov Chains
  • Proportional Hazards Models*
  • Prostatic Neoplasms
  • Randomized Controlled Trials as Topic