{"title":"Applying competing risks analysis to recurrences of primary breast cancer.","authors":"Silvia Mancini, Annibale Biggeri, Orietta Giuliani, Rosa Vattiato, Flavia Baldacchini, Alessandra Ravaioli, Federica Zamagni, Fabio Falcini, Lauro Bucchi","doi":"10.19191/EP23.6.A600.084","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>in time-to-event analysis, competing risks are observed when a subject is at risk of multiple types of events. A competing risk is an event that prevents the event of interest from happening or modifies its chance to occur.</p><p><strong>Objectives: </strong>the purposes of this article are to provide an overview of competing risks analysis and to illustrate its application to the follow-up of breast cancer patients in order to estimate the risk of disease recurrence.</p><p><strong>Design: </strong>cohort study.</p><p><strong>Setting and participants: </strong>population-based random sample of patients with stage I-III primary female breast cancer diagnosed in 2000-2013, aged 15 years or older, resident in the Forlì health care district (northern Italy), treated surgically and with available information regarding disease laterality.</p><p><strong>Main outcome measures: </strong>subhazard ratio, hazard ratio and cumulative incidence function for loco-regional recurrences and distant metastasis during 10 years of follow-up.</p><p><strong>Methods: </strong>breast cancer recurrences were evaluated taking into account death from any cause and occurrence of a second primary breast cancer as competing risks. Recent developments in competing risks methodology were used. The results obtained were compared with those from the Cox regression model, in which the competing risks were not accounted for.</p><p><strong>Conclusions: </strong>estimating the risk of recurrence without accounting for the competing risks resulted in a divergence of the hazard/subhazard functions. Competing risks analysis is preferable when the statistical assumption of independence of end-points may be violated.</p>","PeriodicalId":50511,"journal":{"name":"Epidemiologia & Prevenzione","volume":null,"pages":null},"PeriodicalIF":1.2000,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Epidemiologia & Prevenzione","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.19191/EP23.6.A600.084","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: in time-to-event analysis, competing risks are observed when a subject is at risk of multiple types of events. A competing risk is an event that prevents the event of interest from happening or modifies its chance to occur.
Objectives: the purposes of this article are to provide an overview of competing risks analysis and to illustrate its application to the follow-up of breast cancer patients in order to estimate the risk of disease recurrence.
Design: cohort study.
Setting and participants: population-based random sample of patients with stage I-III primary female breast cancer diagnosed in 2000-2013, aged 15 years or older, resident in the Forlì health care district (northern Italy), treated surgically and with available information regarding disease laterality.
Main outcome measures: subhazard ratio, hazard ratio and cumulative incidence function for loco-regional recurrences and distant metastasis during 10 years of follow-up.
Methods: breast cancer recurrences were evaluated taking into account death from any cause and occurrence of a second primary breast cancer as competing risks. Recent developments in competing risks methodology were used. The results obtained were compared with those from the Cox regression model, in which the competing risks were not accounted for.
Conclusions: estimating the risk of recurrence without accounting for the competing risks resulted in a divergence of the hazard/subhazard functions. Competing risks analysis is preferable when the statistical assumption of independence of end-points may be violated.
期刊介绍：
Epidemiologia & Prevenzione, oggi organo della Associazione italiana di epidemiologia, raccoglie buona parte delle migliori e originali esperienze italiane di ricerca epidemiologica e di studio degli interventi per la prevenzione e la sanità pubblica.
La rivista – indicizzata su Medline e dotata di Impact Factor – è un canale importante anche per la segnalazione al pubblico internazionale di contributi che altrimenti circolerebbero soltanto in Italia.
E&P in questi decenni ha svolto una funzione di riferimento per la sanità pubblica ma anche per i cittadini e le loro diverse forme di aggregazione. Il principio che l’ha ispirata era, e rimane, che l’epidemiologia ha senso se è funzionale alla prevenzione e alla sanità pubblica e che la prevenzione ha ben poche possibilità di realizzarsi se non si fonda su valide basi scientifiche e se non c’è la partecipazione di tutti i soggetti interessati.
Modalità di comunicazione aggiornate, metodologia statistica ed epidemiologica rigorosa, validità degli studi e solidità delle interpretazioni dei risultati sono la solida matrice su cui E&P è costruita. A questa si accompagna una forte responsabilità etica verso la salute pubblica, che oggi ha ampliato in forma irreversibile il suo orizzonte, e include in forma sempre più consapevole non solo gli esseri umani, ma l’intero pianeta e le modificazioni che l’uomo apporta all’universo in cui vive.
L’ambizione è che l’offerta di nuovi strumenti di comunicazione, informazione e formazione, soprattutto attraverso l''uso di internet, renda la rivista non solo un tradizionale veicolo di contenuti e analisi scientifiche, ma anche un potente strumento a disposizione di una comunità di interessi e di valori che ha a cuore la salute pubblica.
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