# Lecture 8 Stat D. Gillen

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1 Statistics Survival Analysis Presented February 23, 2016 Dan Gillen Department of Statistics University of California, Irvine 8.1

2 Example of two ways to stratify Suppose a confounder C has 3 levels on which we would like to stratify when comparing λ(t E) and λ(t Ē) where E is an indicator of exposure" Dummy variable stratification: Consider x E = { 1 E 0 Ē c 2 = { 1 level 2 0 else c 3 = { 1 level 3 0 else Now suppose we fit the following proportional hazards model: λ(t) = λ 0 (t)e β E x E +β 2 c 2 +β 3 c 3 8.2

3 Example of two ways to stratify From this, we have Level 1 of C: exposed : λ(t) = unexposed : λ(t) = HR= Level 2 of C: exposed : λ(t) = unexposed : λ(t) = HR= Level 3 of C: exposed : λ(t) = unexposed : λ(t) = HR= *Key point: Stratum-to-stratum differences in log λ(t) for unexposed have arbitrarily different magnitudes, but they are parallel (). 8.3

4 Example of two ways to stratify True" stratification: Alternatively we could also consider the following proportional hazards model: λ(t) = λ 0i (t)e β E x E, i = 1, 2, 3 In this case we have different baseline hazards for each stratum Note: This is the implicit model for the stratified logrank test 8.4

5 Example of two ways to stratify From the true stratification" model, we have exposed : λ(t) = Level 1 of C: unexposed : λ(t) = exposed : λ(t) = Level 2 of C: unexposed : λ(t) = HR= HR= Level 3 of C: exposed : λ(t) = unexposed : λ(t) = HR= *Key point: Stratum-to-stratum differences in log λ(t) for unexposed are completely arbitrary (ie. no s). 8.5

6 Example of two ways to stratify Graphically, we can think of the difference as follows: Dummy Variable λ(t) = λ 0 (t)e β E x E +β 2 c 2 +β 3 c 3 True" Stratification λ(t) = λ 0i (t)e β E x E 8.6

7 The stratified proportional hazards regression model The general stratified proportional hazards regression model is: λ i (t x i, stratum g) = λ g (t) exp(β T x i ) for strata g = 1,..., G. A semi-parametric model with a non-parametric baseline hazard function within each stratum Alternatively, it can be useful because the hazard can difficult to model as a function of complicated set of adjustment covariates 8.7

8 Considerations Under dummy variable stratification, the proportional stratum-to-stratum hazards may not be correct The confounder (adjustment/stratification variable) may be inadequately controlled, and may still confound Proportionality can be checked by examining stratum-specific log Λ(t) plots (coming up) True stratification is a more thorough adjustment as long as observations within each level are homogenous If the confounder can be measured continuously, control for confounding might be achieved with the continuous covariate adjustment 8.8

9 Considerations If the confounder is controlled using true stratification, there is no way to estimate a summary relative risk comparing two levels of the confounder True stratification generally requires more data to obtain the same precision in coefficient estimates (bias-variance trade-off) 8.9

10 Example: 6-MP Data Example: Recall that in the 6-MP leukemia data (Section 1.2 in K & M): 21 patient pairs Interest on the effect of the treatment 6-MP on survival, and Matching was on remission status (remstat) and hospital (pairid) Recall also, that matched pairs are like many strata Goal: Estimate the relative risk for 6-MP versus placebo, adjusting for hospital and remission status 8.10

11 Example: 6-MP Data We can conduct the stratified analysis accounting for matching by including a strata() term > fit <- coxph( Surv( time, irelapse ) ~ sixmp + strata(pairid), data=sixmplong ) > summary( fit ) Call: coxph(formula = Surv(time, irelapse) ~ sixmp + strata(pairid), data = sixmplong) n= 42 coef exp(coef) se(coef) z Pr(> z ) sixmp ** --- Signif. codes: 0 Ô***Õ Ô**Õ 0.01 Ô*Õ 0.05 Ô.Õ 0.1 Ô Õ 1 exp(coef) exp(-coef) lower.95 upper.95 sixmp Rsquare= (max possible= 0.5 ) Likelihood ratio test= 11.9 on 1 df, p= Wald test = 8.26 on 1 df, p= Score (logrank) test = 10.7 on 1 df, p=

12 Example: 6-MP Data Conclusion: the within-stratum estimated relative risk for 6-MP versus placebo is 0.17, 95% CI [0.05,.57], indicating that the risk of relapse is about 6 times higher in the placebo than in the 6-MP group, after adjusting for any effects due to hospital and remission status. 8.12

13 Example: 6-MP Data For comparison, let s consider the unmatched (incorrect) analysis > fit2 <- coxph( Surv( time, irelapse ) ~ sixmp, data=sixmplong ) > summary( fit2 ) Call: coxph(formula = Surv(time, irelapse) ~ sixmp, data = sixmplong) n= 42 coef exp(coef) se(coef) z Pr(> z ) sixmp *** --- Signif. codes: 0 Ô***Õ Ô**Õ 0.01 Ô*Õ 0.05 Ô.Õ 0.1 Ô Õ 1 exp(coef) exp(-coef) lower.95 upper.95 sixmp Rsquare= (max possible= ) Likelihood ratio test= 16.4 on 1 df, p=5.26e-05 Wald test = 14.5 on 1 df, p= Score (logrank) test = 17.2 on 1 df, p=3.28e

14 Example: 6-MP Data (Incorrect) Conclusion: the estimated relative risk for 6-MP versus placebo is 0.208, indicating that the risk of relapse is about 4.8 times higher in the placebo than in the 6-MP group. Incorrect because not at all clear what the reference population is 8.14

15 Partial Likelihood for the Stratified PH Partial Likelihood for the Stratified PH Recall that the partial likelihood for the ordinary proportional hazards model is ( ) exp(β T x (j) ) L P = i R failure times j (j) exp(β T x i ) L P compares the covariate x (j) of the failed subject to the covariates x i in the risk set R (j) at time t (j) The stratified partial likelihood combines partial likelihoods L Pg across strata g = 1,..., G: L P = G g=1 L Pg 8.15

16 Partial Likelihood for the Stratified PH Partial Likelihood for the Stratified PH Alternatively, who is in the effective risk set at time t (j)? A: The subject failing at t (j) and other subjects not yet failed, but also in the same stratum (i.e., in stratum g) Suppose t (j) is a failure time for a subject in stratum g Define R g (j) to be the set of subjects in stratum g and at risk for failure at t (j) Then the stratified partial likelihood (in the absence of ties) is ( ) exp(β T x (j) ) L P = i R failure times g exp(β T x i ) j (j) 8.16

17 Assumption Example: Bone marrow transplant data Ex: Bone marrow transplant data (Section 1.3 in K & M) Question: For leukemia patients, does high-risk versus low-risk sub-classification have any prognosticative meaning or value, after adjusting for other baseline clinical information? Data: time (in days) of disease-free survival waittime: the waiting time to transplant (days) fab: FAB grade of disease (4 or 5, coded 0 or 1) i.mtx: MTX, a graph-vs-host disease prophylactic treatment agep: age of the patient aged: age of the donor g: Indicator of whether patient has acute myeloid leukemia (AML) Prior model building already performed

18 Assumption Example: Bone marrow transplant data Ex: Bone marrow transplant data (Section 1.3 in K & M) Question: Adjusting for other covariates, does the effect of imtx follow a proportional hazards model? Method: If the proportional hazards holds, the log cumulative hazards for the two MTX groups, adjusting for other covariates x i, should be roughly parallel 8.18

19 Assumption Example: Bone marrow transplant data Consider strata defined by imtx = 0 or 1 and model λ i (t x i, imtx i ) = λ imtxi (t) exp(β T x i ) where x i contains the other covariates Recall from Lecture 4: If proportional hazards holds for imtx, then log Λ imtx=1 (t) = log(φ) + log Λ imtx=0 (t) where φ = exp(β T x) So, if the baseline log cumulative hazards are not parallel this is evidence of non-proportional hazards 8.19

20 Assumption Example: Bone marrow transplant data R will estimate the within-stratum baseline hazard when a stratified analysis is fit > ## > ##### > ##### Read in BMT data > ##### > ## > bmt <- read.csv( " STAT255/Data/bmt.csv" ) > ## > ##### Fit the stratified cox model and plot > ##### log-cum hazard estimates > ## > fit <- coxph( Surv(tnodis,inodis) ~ agep*aged + g + strata(imtx), data=bmt ) > plot( survfit(fit), fun="cloglog", + xlab="time from Transplantation (logarithmic scale)", + ylab="log-cumulative Hazard Function" ) 8.20

21 Assumption Example: Bone marrow transplant data Log Cumulative Hazard Function Time from Transplantation 8.21

22 Assumption Example: Bone marrow transplant data Conclusion: Hard to tell but not strong evidence of non-proportional hazards This is a good look at gross departures, but it is far from a formal test...more later! 8.22

23 β k is the change in the log-hazard function, i.e. the log-relative risk, associated with a unit difference in x k, for subjects in the same stratum and holding other covariates constant. Therefore, the contrast expressed by β k is adjusted for all other covariates in the model as well as any variables contained in the stratification variable. The key is that the effect of covariate x ik is the same in each stratum. If it is not, ie. there is an interaction between the stratification variable and the predictor of interest, stratum-specific estimates should be presented 8.23

24 With p covariates in the model, plots based on a model stratified on values of new covariate x i,p+1 can help assess the validity of the proportional hazards for x i,p+1. The stratified partial likelihood model works by only allowing subjects from the same stratum to be in the same risk set. 8.24

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