Jacob Levy, Uche Amakiri, Ronnie L. Shammas, Francis D. Graziano, Jonas A. Nelson, Lillian A. Boe
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This study aims to provide a framework for applying LME and GEE models to analyze longitudinal PROs in surgical oncology research using a postmastectomy breast reconstruction cohort example.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A retrospective review was conducted on patients who underwent autologous or implant-based postmastectomy reconstruction from 2018 to 2021. Using longitudinally collected BREAST-Q data for up to 5 years, the study analyzed demographic and surgical factors associated with satisfaction with breasts (SAT) and sexual well-being (SEX) scores. Through the application of LME and GEE models, key features of longitudinal data were explored, the methodology and assumptions for each model were detailed, and their practical application was demonstrated.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The analysis included 3269 patients. In both models, Asian race [LME, <i>p</i> = 0.002; GEE, <i>p</i> < 0.001], neoadjuvant [LME, <i>p</i> = 0.007; GEE, <i>p</i> = 0.007], and adjuvant radiation [<i>p</i> < 0.001; <i>p</i> < 0.001] were linked to lower scores for SEX. Complications were negatively associated with SEX as well [<i>p</i> = 0.044; <i>p</i> = 0.007]. Similar results were observed for SAT. Autologous reconstruction was linked to higher SAT and SEX scores at all postoperative time points compared to implant-based reconstruction.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>This study demonstrates the utility of LME and GEE models in analyzing longitudinal PROs, providing insights into factors influencing breast reconstruction outcomes. 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引用次数: 0
摘要
背景：肿瘤学研究越来越重视患者报告的结果（PROs），以支持以患者为中心的护理。对PROs的长期评估需要纵向数据分析，而传统的横截面方法（如线性回归）无法充分解决这一问题。先进的统计模型，包括线性混合效应（LME）和广义估计方程（GEEs），对于捕捉纵向数据的复杂性至关重要。本研究旨在为应用LME和GEE模型分析外科肿瘤学研究中的纵向PROs提供一个框架，并以乳房切除术后乳房重建队列为例。方法：回顾性分析2018年至2021年接受自体或种植体乳房切除术后重建的患者。该研究使用长达5年的纵向收集的BREAST-Q数据，分析了与乳房满意度（SAT）和性幸福（SEX）评分相关的人口统计学和外科因素。通过LME和GEE模型的应用，探讨了纵向数据的主要特征，详细介绍了每个模型的方法和假设，并展示了它们的实际应用。结果：共纳入3269例患者。在两个模型中，亚洲种族[LME， p = 0.002；结论：本研究证明了LME和GEE模型在纵向PROs分析中的实用性，为影响乳房重建结果的因素提供了见解。这样的模型允许在外科肿瘤学的实际分析，支持个性化的病人护理的发展。
Longitudinal Modeling in Surgical Oncology Research: A Primer Examining Patient-Reported Outcomes
Background
Oncologic research increasingly prioritizes patient-reported outcomes (PROs) to support patient-centered care. Long-term evaluation of PROs requires longitudinal data analysis, which traditional cross-sectional methods, such as linear regression, cannot adequately address. Advanced statistical models, including linear mixed-effects (LME) and generalized estimating equations (GEEs), are essential to capture the complexity of longitudinal data. This study aims to provide a framework for applying LME and GEE models to analyze longitudinal PROs in surgical oncology research using a postmastectomy breast reconstruction cohort example.
Methods
A retrospective review was conducted on patients who underwent autologous or implant-based postmastectomy reconstruction from 2018 to 2021. Using longitudinally collected BREAST-Q data for up to 5 years, the study analyzed demographic and surgical factors associated with satisfaction with breasts (SAT) and sexual well-being (SEX) scores. Through the application of LME and GEE models, key features of longitudinal data were explored, the methodology and assumptions for each model were detailed, and their practical application was demonstrated.
Results
The analysis included 3269 patients. In both models, Asian race [LME, p = 0.002; GEE, p < 0.001], neoadjuvant [LME, p = 0.007; GEE, p = 0.007], and adjuvant radiation [p < 0.001; p < 0.001] were linked to lower scores for SEX. Complications were negatively associated with SEX as well [p = 0.044; p = 0.007]. Similar results were observed for SAT. Autologous reconstruction was linked to higher SAT and SEX scores at all postoperative time points compared to implant-based reconstruction.
Conclusions
This study demonstrates the utility of LME and GEE models in analyzing longitudinal PROs, providing insights into factors influencing breast reconstruction outcomes. Such models allow for practical analysis in surgical oncology, supporting the development of personalized patient care.
期刊介绍：
The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.
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