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Comparison of prognostic markers for censored outcomes: application in the NSABP B-14 study

Yan, Peng (2011) Comparison of prognostic markers for censored outcomes: application in the NSABP B-14 study. Master's Thesis, University of Pittsburgh.

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    Abstract

    Prognostic markers for risk of recurrence or mortality are becoming very popular and important in the decision making process of cancer patients and their physicians. Those with good prognostics can avoid unnecessary chemotherapies and the resulted agony. The receiver operating characteristic (ROC) curves are often used to assess and compare prognostic markers for binary outcomes. However, they cannot be directly used in assessing prognostic markers for time-to-event outcomes, which are usually subject to censoring. Recently several statistical methods such as the C¨Cindex, time-dependent ROC curve and the predictiveness curve have been developed for this purpose. In early stage estrogen receptor-positive (ER+) breast cancer, the 21-gene panel Oncotype DX assay and the Adjuvant!, based on age, tumor size and grade and other clinical variables, are widely used tools for patient prognosis and provide guidance in decision making. The recurrence score (RS) from the Oncotype DX assay and a risk index (RI) summarized from Adjuvant! both provide quantitative evaluation of recurrence risk. Here we applied those recently developed statistical methods to compare the prognostic utility of RS and RI in ER+, node-negative (N0), and tamoxifen-treated breast cancer patients enrolled on the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14 trial. We showed that the RS was a stronger prognostic marker than RI, and combining RS with clinical variables also improved the prognostic utility in the NSABP B-14 trial. The results will help to improve treatment decision for breast cancer patients in public health practice.


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    Item Type: University of Pittsburgh ETD
    ETD Committee:
    ETD Committee TypeCommittee MemberEmail
    Committee ChairTang, Gongtang@nsabp.pitt.edu
    Committee MemberRen, Dianxudir8@pitt.edu
    Committee MemberKong, Lanlkong@pitt.edu
    Title: Comparison of prognostic markers for censored outcomes: application in the NSABP B-14 study
    Status: Unpublished
    Abstract: Prognostic markers for risk of recurrence or mortality are becoming very popular and important in the decision making process of cancer patients and their physicians. Those with good prognostics can avoid unnecessary chemotherapies and the resulted agony. The receiver operating characteristic (ROC) curves are often used to assess and compare prognostic markers for binary outcomes. However, they cannot be directly used in assessing prognostic markers for time-to-event outcomes, which are usually subject to censoring. Recently several statistical methods such as the C¨Cindex, time-dependent ROC curve and the predictiveness curve have been developed for this purpose. In early stage estrogen receptor-positive (ER+) breast cancer, the 21-gene panel Oncotype DX assay and the Adjuvant!, based on age, tumor size and grade and other clinical variables, are widely used tools for patient prognosis and provide guidance in decision making. The recurrence score (RS) from the Oncotype DX assay and a risk index (RI) summarized from Adjuvant! both provide quantitative evaluation of recurrence risk. Here we applied those recently developed statistical methods to compare the prognostic utility of RS and RI in ER+, node-negative (N0), and tamoxifen-treated breast cancer patients enrolled on the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14 trial. We showed that the RS was a stronger prognostic marker than RI, and combining RS with clinical variables also improved the prognostic utility in the NSABP B-14 trial. The results will help to improve treatment decision for breast cancer patients in public health practice.
    Date: 23 September 2011
    Date Type: Completion
    Defense Date: 20 July 2011
    Approval Date: 23 September 2011
    Submission Date: 25 July 2011
    Access Restriction: No restriction; The work is available for access worldwide immediately.
    Patent pending: No
    Institution: University of Pittsburgh
    Thesis Type: Master's Thesis
    Refereed: Yes
    Degree: MS - Master of Science
    URN: etd-07252011-195444
    Uncontrolled Keywords: concordant; sensitivity; specificity
    Schools and Programs: Graduate School of Public Health > Biostatistics
    Date Deposited: 10 Nov 2011 14:53
    Last Modified: 20 Jan 2012 12:45
    Other ID: http://etd.library.pitt.edu/ETD/available/etd-07252011-195444/, etd-07252011-195444

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