Resampling methods for randomly censored survival data

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1 Resampling methods for randomly censored survival data Markus Pauly Lehrstuhl für Mathematische Statistik und Wahrscheinlichkeitstheorie Mathematisches Institut Heinrich-Heine-Universität Düsseldorf Wien, 5 June 2014

2 Thanks to J. Beyersmann (Ulm) M. Brendel (Boehringer Ingelheim, Biberach) D. Dobler (Düsseldorf) A. Janssen (Düsseldorf) C.-D. Mayer (BioSS, Aberdeen) S. di Termini (Freiburg)

3 Outline 1 Introduction and Motivation 2 Classical tests 3 Weighted projection-type permutation tests 4 Simulations and Data Analysis 5 More complex Multi-State Models

4 Introduction and Motivation Typcial study in medicine: patients Sample sizes are only sufficient if efficiently analyzed! Problems in practice Incompleteness of observations; e.g. right-censored data Observed are 2-types of data Complete observations, so called survival times Incomplete observations; last observed survival time or drop out of study for other reasons

5 Introduction and Motivation Censoring Source: Janssen

6 Introduction and Motivation Typcial study in medicine: patients Sample sizes are only sufficient if efficiently analyzed! Problems in practice Incompleteness of observations; e.g. right-censored data Observed are 2-types of data Complete observations, so called survival times Incomplete observations; last observed survival time or drop out of study for other reasons Example ( kidney data ): Infection times in two groups of dialysis patients

7 Introduction and Motivation Different catheterization procedures: percutaneous and surgical placements Source: Klein/Moeschberger

8 Introduction and Motivation Infection times of dialysis patients

9 Introduction and Motivation Basic Survival Analysis 1-4 T 0 survival time S(t) = P(T > t) survival function with ν-density f Λ(t) = t 0 f (t)/s(t )dν(t) cumulative hazard function λ = f /S hazard rate Interpretation (for smooth f ) P(T (t, t + ɛ] T t) ɛλ(t).

10 Introduction and Motivation Basic Survival Analysis 2-4 Random Censoring by C G; C and T independent We only observe X := min(t, C) and = 1{T C} Estimator for S in this case: Kaplan-Meier estimator Ŝ Estimator for Λ: Nelson-Aalen estimator ˆΛ

11 Introduction and Motivation Basic Survival Analysis 3-4 Easiest case: Let (T i ) i be i.i.d. discrete r.v.s; indep. from (C i ) i (also i.i.d.) Define (e.g. failure rates in actuarial sciences) 1 Theorem: Λ(t) = Λ T (t) = r(t) = P(T 1 = t T 1 t) = P(T 1 = t) P(T 1 t) 0 s t r(s) and S(t) = S T (t) = 0 s t (1 r(s)) Kaplan-Meier and Nelson-Aalen estimators by plug-in: ˆr(s) = number of failures at time s number under risk at s 1 r(t) = 0 for P(T 1 t) = 0

12 Introduction and Motivation Basic Survival Analysis 4-4 In counting process notation: Define counting processes N(t) = n 1{X i t, i = 1}, Y (t) = i=1 n 1{X i t} i=1 N(t) = N(t) N(t ) Nelson-Aalen and Kaplan-Meier are given by ˆΛ(t) = 0 s t N(s) Y (s) Uncensored case: 1 Ŝ = e.d.f. and Ŝ(t) = 0 s t ( 1 N(S) Y (s) Properties (under reg): Consistent and asymptotic Gaussian )

13 Introduction and Motivation Plots of Kaplan Meier estimators for the two sample kidney data solid line = percutaneous

14 Introduction and Motivation Here: Randomly right censored data Patients that survive without infection are censored Standard model: Cox proportional hazard model 2 2 λ ϑ (t) = e ϑ λ 0 (t)

15 Introduction and Motivation Questions: Procedures significant different? Is one survival time (or hazard rate) stochastic greater? Answer of classical log-rank test (for proportional hazards) p-value > 0.05 Reason: time depending hazard ratios! Log rank test has problems detecting them!

16 Classical tests Classical two sample problem Observe independent random variables X i := min(t i, C i ) and i = 1{T i C i } for 1 i n within two groups i.i.d. i.i.d. T i F 1, 1 i n 1, T n1 +i F 2, 1 i n 2, (continuous) i.i.d. i.i.d. C i = G 1, 1 i n 1, C n1 +i G 2, 1 i n 2. (continuous) Null hypothesis H 0 : {T 1,..., T n i.i.d.} = {F 1 = F 2 } = {Λ 1 = Λ 2 } against 2-sided or 1-sided alternatives H 0 1 : {Λ 1 Λ 2 }, H 1 1 : {λ 1 λ 2 }, H 2 1 : {Λ 1 Λ 2 }. Unknown nuisance param: G 1, G 2 and under the null L(T 1 )

17 Classical tests Class of weighted logrank test statistics w n (t) := w( F n (t )), F n Kaplan Meier estimator of the pooled sample w : [0, 1] R weight function Test statistics (ABGK 1993) are Tn(wn) σ(w n) n T n (w n ) = n 1 n 2 0 w n (s) Y 1(s)Y 2 (s) Y (s) σ 2 (w n ) adequate variance estimator 3 w = 1 for classical logrank statistic w(u) = 1 u for Prentice-Wilcoxon statistic Tn(wn) or σ(w 1{T n) n(w n ) > 0} with { d ˆΛ 1n (s) d ˆΛ } 2n (s) 3 Gill (1980): σ 2 (w n) = n w 2 n 1 n 2 0 n Y 1Y 2 d ˆΛ Y n

18 Classical tests Remarks Intuitively: w determines power behaviour Example: Prentice-Wilcoxon with decreasing w(u) = 1 u More weight on early times! Should have good power against early hazard differences! In comparison: Classical logrank: Equal weight on all time points! Now: ARE comparison via reparametrization!

19 Classical tests Local parametrization (scores) Classical approach: classical likelihood based approach parametric path ϑ P ϑ in a nonparametric model P of distributions score functions d dϑ log dp ϑ dµ = g(ϑ) score test

20 Classical tests Local parametrization (hazards) approach based on hazards: F = 1 S Λ cumulative hazard function Now: hazard rates λ(u) = f (u) S(u) rather than densities f (u) parameters: relative risk = hazard rate ratio represented by γ : [0, 1] R under ass Rem: Holds for (ϑ 1) Λ ϑ (t) := t 0 1 lim ϑ 0 ϑ (dλ ϑ 1) = γ F 0. dλ 0 (1 + ϑγ F)dΛ 0, Λ 0 baseline hazard.

21 Classical tests Examples of semiparametric models γ 1 (u) = c γ 2 (u) = cu u 1 proport. hazards γ 3 (u) = c(1 u) u 1 late hazards γ 4 (u) = cu(1 u) u 1 early hazards u 1 central hazards

22 Classical tests Consider model given by γ F 0 Recall w n (t) := w( F n (t )), w : [0, 1] R weight function Janssen (1991) and Neuhaus (2000): ARE of Tn(wn) σ(w n) 1{T n(w n ) > 0} for local alternatives 4 in direction of γ F 0 given by ARE = w, γ 2 µ w 2 µ γ 2 µ = cos 2 (β) w, γ µ = 1 0 wγdµ, β angle between w and γ n µ measure on R + depending on G i, F 0 and lim 1 n n Bad ARE for some directions γ! 4 L(T 1,..., T n) = i Pc ni

23 Classical tests On the ARE ARE (ψ): asymptotic relative efficiency of a test ψ ARE(ψ) N opt N(ψ) (in the limit) N(ψ) = No. of needed obs. for ψ to achieve a given power N opt = Minimum no. of needed obs. Pitman s interpretation: 100(1 ARE)% of observations are wasted by using ψ Use of the full data information only for ARE = 1!

24 Classical tests Example: ARE(ψ)= 1 2 twice as many obs. are necessary for ψ Clearly: Optimal procedures depend on the model which is in general unknown! Idea: Estimate the model! (locally)

25 Classical tests Closer look to weighted logrank statistics Consider emp. subspace V = {βw n : β R} and cone V + 1 = {βw n : β [0, )}, generated by w n. Lemma (Brendel et al., 2014) We have where T n (w n ) σ(w n ) = Π V1 (ˆγ n ) ˆµn ; T n(w n ) σ(w n ) 1{T n(w n ) > 0} = Π V + 1 (ˆγ n ) ˆµn, ˆµ n emp. estimator of µ, ˆγ n = emp. estimator of γ F 0 (locally a ) Π V (+) 1 = L 2 (ˆµ n )-projection into V (+) 1 a n all estimates depend on NA (and Y ); e.g. ˆγ n 1 n 2 (d Λ n 1 d Λ 2 )/d Λ n

26 Classical tests Interpretation ˆγ n estimates the γ F 0 -model (locally) Logrank stat measures distance of its projection into space/cone generated by w n Idea: Use larger spaces/cones to cover larger classes of alternatives!

27 Weighted projection-type permutation tests Projection approach Idea: Scientist chooses relevant weights 5 w in ( ) := w i ( F n ( )) 1 i r, e.g. to discover differences of the relative risk for proportional hazards (constant over time) early survival times central survival times late survival times. These generate larger linear space/cone: { r } { r } V := β i w in, β i R, and V + := β i w in, β i 0, i=1 i=1 5 Fn Kaplan Meier estimator of the pooled sample

28 Weighted projection-type permutation tests Projection statistics As in the one-dimensional case consider test statistics S n0 := Π V (ˆγ n ) 2ˆµ n and S n1 := Π V +(ˆγ n ) 2ˆµ n Theorem (Brendel et al., 2014) Under regularity conditions we have convergence in distribution under the null Π V (ˆγ n ) 2ˆµ n d χ 2 rank(σ) and Π V +(ˆγ n) 2ˆµ d n F Σ where F Σ is continuous and Σ = ( w i, w j µ ) i,j r.

29 Weighted projection-type permutation tests Projection-type tests Estimate Σ consistently by Σ Results in tests Theorem (Brendel et al., 2014) Both tests are φ 0n = 1{ Π V (ˆγ n ) 2ˆµ n χ 2 rank( Σ),1 α > 0}, φ 1n = 1{ Π V +(ˆγ n ) 2ˆµ n F 1 (1 α) > 0}, Σ asymptotical level α (even for G 1 G 2 ) and consistent for fixed alternatives if at least one of their associated weighted logrank tests is consistent. Posses broader power functions!

30 Weighted projection-type permutation tests Projection-type permutation tests Further modification: Use permutation version of the tests! Advantage: Finitely exact under {F 1 = F 2, G 1 = G 2 }. For c n0 = χ 2 and c rank( Σ),1 α n1 = F 1 (1 α): with Σ φ nk := 1{S nk c nk > cnk } + k n 1{S nk c nk = cnk } k = 0, 1, c nk = cond (1 α)-quantile of the perm dist of S nk c nk Role of S nk = S nk c nk ( Σ): Studentized-type statistics!

31 Weighted projection-type permutation tests Properties Theorem (Brendel et al., 2014) The permutation tests are asymptotically equivalent to their corresponding projection tests, i.e. lim E H n 0 ( φ 0,n φ 0,n ) = 0, lim E H n 0 ( φ 1,n φ 1,n ) = 0. Implies same power for contigouos alternatives! More math. details (as asymptotic admissability) in Brendel, Janssen, Mayer & Pauly (2014, SJS).

32 Simulations and Data Analysis Set-up 1-2 Group I: T 1,..., T n1 i.i.d. F 0 (x) = (1 exp( x))1 (0, ) (x) For group II: 3 different scenarios; given by directions γ i = w i w 1 (u) = 1, w 2 (u) = 1 2u, w 3 (u) = u(1 u), 0 u 1, corresponding to proportional, crossing and central hazards Group II: T n1 +1,..., T n i.i.d. with Λ ϑ,i (t) = t ϑ w i (F 0 (x))dx

33 Simulations and Data Analysis Set-up 2-2 u.i.v. Censoring: C i Simulated power of for Exp(0.2) in both groups. 2-sided weighted logrank test in T n ( w i ) (optimal for direction w i ) Projection test φ 0,n (covering all 3 directions.) n 1 = n 2 = 50, α = 5% and different values of ϑ Realizations of F ϑ,i by von Neuman s Acceptance-Rejection -procedure

34 Simulations and Data Analysis Results for proportional hazards

35 Simulations and Data Analysis Results for crossing hazards

36 Simulations and Data Analysis Resultats for central hazards

37 Simulations and Data Analysis Analysis of the data example

38 Simulations and Data Analysis Analysis of the data example Choose from class of weights w r,g (x) = x r (1 x) g, 0 x 1 Fleming/Harrington (1991)

39 Simulations and Data Analysis Results Kidney Data test with weight p-value (r,g) = (1,5) (r,g) = (2,4) (r,g) = (4,2) (r,g) = (5,1) (r,g) = (0,0) (logrank test) projection test φ 1,n 0.02

40 Simulations and Data Analysis One more example: Survival times of patients with tongue cancer Differences: Group 1: euploide cells Group 2: aneuploide cells (i.e. cells with abnormal number of chromosomes) Question: Can aneuploide cells be used as a prognostic parameter for survival time?

41 Simulations and Data Analysis Source: Klein/Moeschberger

42 Simulations and Data Analysis Results Tongue Data test with weight p-value (r,g) = (1,5) (r,g) = (2,4) (r,g) = (4,2) (r,g) = (5,1) (r,g) = (0,0) (logrank test) projection test φ n 0.09

43 More complex Multi-State Models Competing Risks Model (easiest case) Often: More than one event of interest! (X t ) t 0 càdlàg, X t : Ω {0, 1, 2}. 0 = initial state, P(X 0 = 0) = 1, 1 and 2 absorbing states (competing events). T = inf{t > 0 X t 0} (event time) X T {1, 2} (event) Regulated by cause-specific hazard intensities α j (t) P( T [t, t + ), X T = j T t) α j (t) = α 0j (t) = lim, j = 1, 2. 0

44 More complex Multi-State Models Cumulative Incidence Functions Aim: Statistical inference for CIFs F j (t) = P( T t, X T = j) = t 0 P( T > u )α j (u)du, j = 1, 2,

45 More complex Multi-State Models Study with 1 i n independent patients, (X (i) t ) t 0 independently right-censored and left-truncated 6 Counting processes n Y (t) = i=1 Y i(t) = No. under risk at t N j (t) = n i=1 N j,i(t) = Observed j-events in [0, t] Aalen-Johansen estimator for the CIFs: F j (t) = t 0 P( T > u )dn j (u), j = 1, 2. Y (u) Remark: are local L 2 -martingales! s M j,i (s) = N j,i (s) Y i (u)α j (u) du 0 6 can be relaxed as explained in Andersen et al. (1993, Chapter III); only multiplicative intensity model needed

46 More complex Multi-State Models Martingale Representation Let t < τ. Under sup u [0,t] with inf u y(u) > 0, it follows W n (t) = n 1/2 { F 1 (t) F 1 (t)} n { t = n 1/2 F 1 (t) i=1 t 0 Y (u)/n y(u) 0 0 p S 2 (u)dm 1,i (u) + Y (u) d(m 1,i + M 2,i )(u) Y (u) t 0 } + o P (1) for t < τ, where S 2 = 1 F 2, see Andersen et al. (1993). D Consequence: W n U on D[0, t] by Rebolledo F 1 (u)dm 2,i (u) Y (u)

47 More complex Multi-State Models Problems Covariance function ζ of the Gaussian process U unknown and lacks independent increments Solution: Apply Resampling version of W n 1. Possibility: Wild Bootstrap: Concrete: G j,i, 1 i n, 1 j 2, i.i.d. and data with (µ, σ 2 ) = (0, 1). Approx L(W n ) by cond dist of n { t Ŵ n (t) = n 1/2 F 1 (t) i=1 t 0 0 Ŝ 2 (u)g 1,i dn 1,i (u) Y (u) t + G 1,i dn 1,i (u) + G 2,i dn 2,i (u) Y (u) 0 F 1 (u)g 2,i dn 2,i (u) }. Y (u) Lin s resampling technique as special case for G j,i i.i.d. N(0, 1)

48 More complex Multi-State Models CCLT for Ŵn Theorem (Beyersmann et al., 2013) We have cond conv on D[0, t] given data Ŵ n D U in probability Results in various inference proc based on W n and crit. values from Ŵn as simultaneous CBs for Fj, see e.g. Beyersmann et al. (2013) or differences of CIFs from 2 ind groups tests for or = in the 2-sample case, see Bajrounaite and Klein (2007, 2008) and later... Q: Can we also apply other resampling techniques, e.g. the classical or even weighted bootstrap?

49 More complex Multi-State Models Answers A1: Application of Efron s or even the weighted bootstrap depends on the inference problem! Ex1: Testing for ordered CIFs in unpaired 2-sample problem works via studentization! (details in Dobler and Pauly, 2013) Ex2: Testing for equality does not work in general! Reason: Centering and too complicated limit distribution (e.g., weighted χ 2 ). A2: Yes, e.g. the Weird Bootstrap or the more general, data-dependent Wild Bootstrap (DDWB) Details:...

50 More complex Multi-State Models Rewrite n t Ŵ n (t) = n {G 1/2 1,i F 1 (t) = 2n i=1 t 0 2n i=1 0 G 1,i dn 1,i (u) Y (u) G 2n,i Z 2n,i (t). Ŝ 2 (u)dn 1,i (u) Y (u) + G 2,i t + G 2,i dn 2,i (u) Y (u) for i.i.d. (G 2n,i ) i with (µ, σ 2 ) = (0, 1). DDWB-weights D 2n,i conditionally independent given Z DDWB vers of AJE: Ŵ n D = 2n 2n i=1 D 2n,iZ 2n,i. Theorem (Dobler and Pauly) } 0 F 1 (u)dn 2,i (u) Y (u) If the weights satisfy a cond Lindeberg ass (and some regularity conditions), then we have cond conv on D[0, t] Ŵ D n D U in probability.

51 More complex Multi-State Models Examples Lin s Resampling technique and the (independent) Wild Bootstrap. The Weird Bootstrap of Andersen et al. (1993) corresponds to independent weights (D 2n,i ) i 2n = ((D i,j ) j=1,2 ) i n with 7 D i,j = ( B ( Y ( T i ), J( T i )/Y ( T i ) ) ) 1. Close in spirit to Wild Bootstrap with Poisson weights... 7 Ti = inf{s t : N i (s) > 0} t, where N i = N 1,i + N 2,i

52 More complex Multi-State Models Applications: 2-sample tests for CIFs 2 independent groups k = 1, 2, each with competing risks j = 1, 2. Null hypotheses 8 : H : {F (1) 1 st F (2) 1 } or H = : {F (1) 1 = F (2) 1 } Typical test statistic: Functional of n1 n 2 (1) (2) W n1 n 2 (t) = { F n 1 (t) F 1 (t)} Special case: T 1,n = I W n 1 n 2 (t)dt or T 2,n = I W 2 n 1 n 2 (t)dt 8 on interval I [0, τ)

53 More complex Multi-State Models Applications: 2-sample tests for ordered CIFs We have T 1,n = I W D n 1 n 2 (t)dt T 1 N(0, σζ 2), σ2 ζ unknown9 Solution: Direct resampling with DDWB or Resampling of a studentized version with T 1,stud := T 1,n /V 1,n T1 /σ ζ N(0, 1) For the general weighted bootstrap (and also for the DDWB) it can be shown that D T 1,stud := T 1,n / V 1,n D N(0, 1) in probability. Gives plenty of consistent resampling tests for H. Example: Bootstrap or permutation test 9 σζ 2 = ζ(s, t)dsdt I I

54 More complex Multi-State Models Applications: 2-sample tests for equality of CIFs We have T 2,n = Wn 2 D 1 n 2 (t)dt I j=1 λ j Z 2 j with Z j i.i.d. N(0, 1), λ j unknown Solution: Direct resampling with DDWB works due to Theorem 4. Additional possibilities/extensions: DDWB of standardized test statistic T2,n stan = (T 2,n Ê(T2,n))/ŜD(T 2,n) works as well! Other approximation techniques also! Gives plenty of consistent tests for H =.

55 More complex Multi-State Models Remarks and Outlook Done: Weighted Bootstrap and DDWB for the AJE in CR Generalizing the wild bootstrap and Lin s resampling technique In addition: Comparison of the different testing procedures (For H ) DDWB for more complex Multi-State models (theory )...

56 Literature Literature Andersen, P.K., Borgan, O., Gill, R.D. & Keiding, N. (1993). Statistical Models Based on Counting Processes. Springer, New York. Behnen, K. & Neuhaus, G. (1989). Rank Tests with Estimated Scores and Their Application. B.G. Teubner, Stuttgart. Beyersmann, J., Di Termini, S. & Pauly, M. (2013). Weak convergence of the wild bootstrap for the Aalen-Johansen estimator of the cumulative incidence function of a competing risk. Scand. J. Stat. 40, Brendel, M. & Janssen, A. & Mayer, C.-D. & Pauly, M. (2014). Weighted logrank permutation tests for randomly right censored life science data. Scand. J. Stat., Early View. Dobler, D. & Pauly, M. (2013). How to Bootstrap Aalen-Johansen Processes for Competing Risks? Handicaps, Solutions and Limitations. Submitted. Ehm, W., Mammen, E. & Mueller, D.W. (1995). Power robustification of approximately linear tests. J.A.S.A Fleming, T.R. & Harrington, D.P. (1991). Counting Processes and Survival Analysis. Wiley, New York.

57 Literature Literature Janssen, A. & Mayer, C.-D. (2001). Conditional studentized survival tests for randomly censored models. Scand.J.Stat. 28, Klein, J.P. & Moeschberger, M.L. (2003). Survival analysis: Techniques for censored and truncated data. Springer, New York. Neuhaus, G. (1993). Conditional rank tests for the two-sample problem under random censorship. Ann.Stat. 21, Neuhaus, G. (2000). A method of constructing rank tests in Survival Analysis. J.Stat.Plan.Inf. 91, Pauly, M. (2011). Weighted resampling of martingale difference arrays with applications, Electronic Journal of Statistics, 5, Strasser, H. and Weber, C. (1999). The asymptotic theory of permutation statistics. Math. Methods Stat. 8, No. 2,

58 Thank you for your attention!

STAT Sample Problem: General Asymptotic Results

STAT Sample Problem: General Asymptotic Results STAT331 1-Sample Problem: General Asymptotic Results In this unit we will consider the 1-sample problem and prove the consistency and asymptotic normality of the Nelson-Aalen estimator of the cumulative