治愈时间的统计推断

Yueh Wang, Hung Hung
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引用次数: 0

摘要

在以人群为基础的癌症生存分析中,净生存是政府评估医疗保健计划的重要指标。几十年来,观察到净生存率在长期随访后达到平台期,这就是所谓的“统计治愈”。提出了几种方法来解决统计治愈问题。此外,治愈时间还可以用来评价某一特定患者群体的医疗保健计划的时间,也可以帮助临床医生解释患者的预后,因此治愈时间是一项重要的医疗保健指标。然而,这些方法都假定固化时间为无穷大,不便于对固化时间进行推断。在本文中,我们通过条件生存定义了一个更一般的统计治愈概念。基于新定义的统计治愈,治愈时间得到了很好的定义。我们开发了固化时间模型方法,并通过仿真显示了各种特性。在数据分析中,我们估计了台湾22种主要癌症的治愈时间,我们进一步以结直肠癌数据为例,通过带有协变量性别、年龄组和分期的治愈时间模型进行统计推断。本文提供了一种估算治愈时间的方法,可为公共卫生政策的制定提供参考。
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Statistical Inference on the Cure Time
In population-based cancer survival analysis, the net survival is important for government to assess health care programs. For decades, it is observed that the net survival reaches a plateau after long-term follow-up, this is so called ``statistical cure''. Several methods were proposed to address the statistical cure. Besides, the cure time can be used to evaluate the time period of a health care program for a specific patient population, and it also can be helpful for a clinician to explain the prognosis for patients, therefore the cure time is an important health care index. However, those proposed methods assume the cure time to be infinity, thus it is inconvenient to make inference on the cure time. In this dissertation, we define a more general concept of statistical cure via conditional survival. Based on the newly defined statistical cure, the cure time is well defined. We develop cure time model methodologies and show a variety of properties through simulation. In data analysis, cure times are estimated for 22 major cancers in Taiwan, we further use colorectal cancer data as an example to conduct statistical inference via cure time model with covariate sex, age group, and stage. This dissertation provides a methodology to obtain cure time estimate, which can contribute to public health policy making.
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