Parametrik hızlandırılmış başarısızlık (ölüm) zamanı (HBZ) modelleri ile erken evre meme kanseri hastalarında uygulama

ÖZET Amaç: Cox Orantılı Hazard (COH) modeli sağkalım analizinde en sık kullanılan çok değişkenli regresyon modelidir. Ancak uygulamada orantılı hazard (OH) varsayımını sağlamak her zaman mümkün olmamaktadır. Bu durumda Parametrik Hızlandırılmış Başarısızlık (Ölüm) Zamanı (HBZ) modelleri uygulanır. Bu çalışmada HBZ ve COH modelleri meme kanseri tanısı olan hastalara uygulanarak sonuçlar karşılaştırılmıştır. Gereç ve Yöntem: Bu çalışmada 697 erken evre meme kanserli hastanın retrospektif sağkalım verileri analiz edilmiştir. Bağımlı değişken olan genel sağkalım ve 13 bağımsız değişkenle test edilmiştir. Anlamlı çıkan değişkenler çoklu regresyon analizi olan COH modeli ile yapılan regresyonla tahmin edilmeye çalışılmıştır. HBZ modeli için verilerin olası log-normal, log-lojistik, Weibull ve üstel dağılımlarına ait Hazard Fonksiyonlarına bakılmıştır. Bulgular: Yaş grupları, tümör derecesi, nöral invazyon ve ekstra kapsül tutulumu COH varsayımını sağlamamasına rağmen, istatistiksel olarak anlamlı çıkan 9 bağımsız değişken çok değişkenli COX modeline girdiğinde sadece metastatik lenf nodu sayısı ve menopoz değişkenleri anlamlı bulunmuştur. HBZ modeli için, bağımlı değişken olan genel sağkalıma ait, AIC değerine ve hazard fonksiyonu dağılımlarına göre en uygun HBZ modelinin Log-lojistik olduğu görülmüştür. Log-lojistik regresyonu sonucunda ise metastatik lenf nodu sayısı, menopoz ve tümör boyutu değişkenleri anlamlı çıkmıştır. Sonuç: Literatürde COH modeli en sık kullanılan sağkalım modellerinin başında gelir. Hazardların orantılı olmadığı durumlarda COH regresyon modeli yerine HBZ regresyon modeli gibi modellerin kullanımı daha uygun olabilir.

Anahtar Kelimeler:

Sağkalım Analizi, Cox Orantılı Hazard Modeli, Parametrik Hızlandırılmış Başarısızlık (Ölüm) Zamanı (HBZ), Parametrik Orantılı Modeli, log-lojistik

Application of parametric Accelerated Failure Time (AFT) model in early stage breast cancer patients

ABSTRACT Purpose: Cox Proportional Hazard (CPH) model is the most commonly used multivariate regression model for survival analysis. However, it is not always possible to obtain the proportional hazard (PH) assumption. In this case, Parametric Accelerated Failure Time (AFT) models may be applied. In this study, AFT and CPH models were applied to patients with early stage breast cancer and the results were compared. Materials and Methods: Retrospective survival data of 697 patients with early stage breast cancer were analyzed in this study. 13 independent variables and overall survival time as the dependent variable were tested. Multiple CPH regression analysis were performed for significant variables . For the AFT model, hazard functions of the data belonging to log-normal, log-logistic, Weibull and of exponential distributions were examined. Results: Although age groups, tumor grade, neural invasion and extra capsule involvement did not provide the assumption of COH, when statistically significant 9 independent variables were applied to the multivariate COX model, metastatic lymph nodes and menopausal status were found to be significant. According to AIC value and hazard function distributions, the most appropriate AFT model was with log-logistic. AFT model with log-logistic regression, number of metastatic lymph nodes, menopausal status and tumor size were found to be significant. Conclusion: In the literature, the CPH model is one of the most commonly used survival models. In cases where the assumption of the proportionality of hazards were violated; it may be more appropriate to use alternative models such as the AFT regression model.

Keywords:

Survival Analysis, Cox Proportional Hazard Model, Accelerated Failure Time (AFT) Model, Parametric Proportional Model, log-logistic,

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