• Title/Summary/Keyword: Proportional hazards

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Comparison between Parametric and Semi-parametric Cox Models in Modeling Transition Rates of a Multi-state Model: Application in Patients with Gastric Cancer Undergoing Surgery at the Iran Cancer Institute

  • Zare, Ali;Mahmoodi, Mahmood;Mohammad, Kazem;Zeraati, Hojjat;Hosseini, Mostafa;Naieni, Kourosh Holakouie
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.11
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    • pp.6751-6755
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    • 2013
  • Background: Research on cancers with a high rate of mortality such as those occurring in the stomach requires using models which can provide a closer examination of disease processes and provide researchers with more accurate data. Various models have been designed based on this issue and the present study aimed at evaluating such models. Materials and Methods: Data from 330 patients with gastric cancer undergoing surgery at Iran Cancer Institute from 1995 to 1999 were analyzed. Cox-Snell Residuals and Akaike Information Criterion were used to compare parametric and semi-parametric Cox models in modeling transition rates among different states of a multi-state model. R 2.15.1 software was used for all data analyses. Results: Analysis of Cox-Snell Residuals and Akaike Information Criterion for all probable transitions among different states revealed that parametric models represented a better fitness. Log-logistic, Gompertz and Log-normal models were good choices for modeling transition rate for relapse hazard (state $1{\rightarrow}state$ 2), death hazard without a relapse (state $1{\rightarrow}state$ 3) and death hazard with a relapse (state $2{\rightarrow}state$ 3), respectively. Conclusions: Although the semi-parametric Cox model is often used by most cancer researchers in modeling transition rates of multistate models, parametric models in similar situations- as they do not need proportional hazards assumption and consider a specific statistical distribution for time to occurrence of next state in case this assumption is not made - are more credible alternatives.

Determinants of Reemployment after the Economic Crisis in 1997 : An Empirical Approach Using the Cox Proportional Hazards Regression Model (IMF 이후 발생한 실업자의 실업탈피 가능성 결정요인에 관한 연구 : 콕스 비례위험 회귀분석 모형을 이용한 실증분석)

  • Yoo, Tae-Kyun
    • Korean Journal of Social Welfare
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    • v.39
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    • pp.210-237
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    • 1999
  • The primary purpose of this study is to empirically examine the determinants of reemployment of the unemployed after the crash of Korea's economy in 1997. This study also investigates the effects of the government unemployment programs on reemployment of the program beneficiaries. Using the data from the 1998 Survey on Unemployment Condition and Welfare Needs, co-directed by the Korea Institute of Health and Welfare and the Korea Institute of Labor Policy, a Cox regression analysis was conducted. The study results suggested that, in general, the government unemployment programs did not have noticeable effects on reemployment of the beneficiaries. The study, however, found that the effect of the government programs varied, depending on the mode of unemployment-exit, that is, full-time versus part-time reemployment. In addition, the effects of such factors on reemployment as socio-economic characteristics of the unemployed, characteristics of households with unemployed family members, and previous job characteristics are also examined. Based on the study findings, some policy implications are discussed, and suggestions are made for improving the current unemployment programs.

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Aberrant Expression of CCAT1 Regulated by c-Myc Predicts the Prognosis of Hepatocellular Carcinoma

  • Zhu, Hua-Qiang;Zhou, Xu;Chang, Hong;Li, Hong-Guang;Liu, Fang-Feng;Ma, Chao-Qun;Lu, Jun
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.13
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    • pp.5181-5185
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    • 2015
  • Background: CCAT1 has been reported to be linked with pathogenesis of malignancies including colon cancer and gastric cancer. However, the regulatory effect of CCAT1 in hepatocellular carcinoma (HCC) remains unclear. The purpose of this research was to identify any role of CCAT1 in the progression of HCC. Materials and Methods: Real time-PCR was performed to test the relative expression of CCAT1 in HCC tissues. A computation screen of CCAT1 promoter was conducted to search for transcription-factor-binding sites. The association of c-Myc with CCAT1 promoter in vivo was tested by Pearson correlation analysis and chromatin immunoprecipitation assay. Additionally, Kaplan-Meier analysis and Cox proportional hazards analyses were performed. Results: c-Myc directly binds to the E-box element in the promoter region of CCAT, and when ectopically expressed increases promoter activity and expression of CCAT1. Moreover, Kaplan-Meier analysis demonstrated that the patients with low expression of CCAT1 demonstrated better overall and relapse-free survival compared with the high expression group. Cox proportional hazards analyses showed that CCAT1 expression was an independent prognostic factor for HCC patients. Conclusions: The findings demonstrated CCAT1, acting as a potential biomarker in predicting the prognosis of HCC, is regulated by c-Myc.

Survival of Patients with Stomach Cancer and its Determinants in Kurdistan

  • Moradi, Ghobad;Karimi, Kohsar;Esmailnasab, Nader;Roshani, Daem
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.7
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    • pp.3243-3248
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    • 2016
  • Background: Stomach cancer is the fourth most common cancer and the second leading cause of death from cancer in the world. In Iran, this type of cancer has high rates of incidence and mortality. This study aimed to assess the survival rate of patients with stomach cancer and its determinants in Kurdistan, a province with one of the highest incidence rates of stomach cancer in the country. Materials and Methods: We studied a total of 202 patients with stomach cancer who were admitted to Tohid Hospital in Sanandaj from 2009 to 2013. Using Kaplan-Meier nonparametric methods the survival rate of patients was calculated in terms of different levels of age at diagnosis, gender, education, residential area, occupation, underweight, and clinical variables including tumor histology, site of tumor, disease stage, and type of treatment. In addition, we compared the survival rates using the log-rank test. Finally, Cox proportional hazards regression was applied using Stata 12 and R 3.1.0 software. The significance level was set at 0.05. Results: The mean age at diagnosis was $64.7{\pm}12.0$ years. The survival rate of patients with stomach cancer was 43.9% and 7% at the first and the fifth year after diagnosis, respectively. The results of log-rank test showed significant relationships between survival and age at diagnosis, education, disease stage, type of treatment, and degree of being underweight (P<0.05). Moreover, according to the results of Cox proportional hazards regression model, the variables of education, disease stage, and type of treatment were associated with patient survival (P<0.05). Conclusions: The survival rate of patients with stomach cancer is low and the prognosis is very poor. Given the poor prognosis of the patients, it is critical to find ways for early diagnosis and facilitating timely access to effective treatment methods.

Survival analysis for contract maintenance period using life insurance data (생명보험자료를 이용한 계약유지기간에 대한 생존분석)

  • Yang, Dae Geon;Ha, Il Do;Cho, Geon Ho
    • The Korean Journal of Applied Statistics
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    • v.31 no.6
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    • pp.771-783
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    • 2018
  • The life insurance industry is interested in various factors that influence the long-term extensions of insurance contracts such as the necessity for the advisors' long-term management of consumers, product consulting, and improvement of the investment aspects. This paper investigates important factors leading to a long-term contract that forms an important part of the life insurance industry in Korea. For this purpose we used the data of contents (i.e., data from Jan 1, 2011 to Dec 31, 2016) of the contracts of xxx insurance company. In this paper, we present how to select important variables to influence the duration of the contract maintenance via a penalized Cox's proportional hazards (PH) modelling approach using insurance life data. As the result of analysis, we found that the selected important factors were the advisor's status, the reward type 2 (annuity insurance) and tendency 4 (safety-pursuing type).

Impact of beta blockers on survival outcomes in ovarian cancer: a nationwide population-based cohort study

  • Baek, Min-Hyun;Kim, Dae-Yeon;Kim, Seon Ok;Kim, Ye-Jee;Park, Young-Han
    • Journal of Gynecologic Oncology
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    • v.29 no.6
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    • pp.82.1-82.13
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    • 2018
  • Objective: The impact of beta blockers (BBs) on survival outcomes in ovarian cancer was investigated. Methods: By using Korean National Health Insurance Service Data, Cox proportional hazards regression was performed to analyze hazard ratios (HRs) with 95% confidence intervals (CIs) adjusting for confounding factors. Results: Among 866 eligible patients, 206 (23.8%) were BB users and 660 (76.2%) were non-users. Among the 206 BB users, 151 (73.3%) were non-selective beta blocker (NSBB) users and 105 (51.0%) were selective beta blocker (SBB) users. BB use in patients aged ${\geq}60$ years, longer duration use (${\geq}1$ year), in patients with Charlson Comorbidity Index (CCI) ${\geq}3$, and in cardiovascular disease including hypertension was associated with better survival outcome. These findings were observed in both NSBB and SBB. When duration of medication was analyzed based on number of days, NSBB (${\geq}180$ days) was associated with improved overall survival (OS) with a relatively shorter period of use compared to SBB (${\geq}720$ days). In multivariate Cox proportional hazards model, longer duration of BB medication (${\geq}1$ year) was an independent favorable prognostic factor for both OS and disease-specific survival in ovarian cancer patients. Conclusion: In our nationwide population-based cohort study, BB use was associated with better survival outcomes in ovarian cancer in cases of long term duration of use, in older patients, and in cardiovascular and/or other underlying disease (CCI ${\geq}3$).

Analysis of stage III stomach cancer using the restricted mean survival time (제한된 평균 생존시간을 이용한 위암 3기 자료 분석에 관한 연구)

  • Kim, Bitna;Lee, Minjung
    • The Korean Journal of Applied Statistics
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    • v.34 no.2
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    • pp.255-266
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    • 2021
  • The purpose of this study is to compare the effects of treatment on stage III stomach cancer data obtained from the SEER program of the National Cancer Institute and to identify the significant risk factors for the survival rates of stage III stomach cancer. Since the proportional hazards assumption was violated for treatment, we used the restricted mean survival time as an alternative to the proportional hazards model. The restricted mean survival time was estimated using pseudo-observations, and the effects of treatment were compared using a test statistic based on the estimated restricted mean survival times. We conducted the regression analysis using a generalized linear model to investigate the significant predictors for the restricted mean survival time of patients with stage III stomach cancer. We found that there was a significant difference between the restricted mean survival times of treatment groups. Age at diagnosis, race, substage, grade, tumor size, surgery, and treatment were significant predictors for the restricted mean survival time of patients with stage III stomach cancer. Surgery was the most significant predictor for increasing the restricted mean survival time of patients with stage III stomach cancer.

Hepatocellular Carcinoma: Texture Analysis of Preoperative Computed Tomography Images Can Provide Markers of Tumor Grade and Disease-Free Survival

  • Jiseon Oh;Jeong Min Lee;Junghoan Park;Ijin Joo;Jeong Hee Yoon;Dong Ho Lee;Balaji Ganeshan;Joon Koo Han
    • Korean Journal of Radiology
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    • v.20 no.4
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    • pp.569-579
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    • 2019
  • Objective: To investigate the usefulness of computed tomography (CT) texture analysis (CTTA) in estimating histologic tumor grade and in predicting disease-free survival (DFS) after surgical resection in patients with hepatocellular carcinoma (HCC). Materials and Methods: Eighty-one patients with a single HCC who had undergone quadriphasic liver CT followed by surgical resection were enrolled. Texture analysis of tumors on preoperative CT images was performed using commercially available software. The mean, mean of positive pixels (MPP), entropy, kurtosis, skewness, and standard deviation (SD) of the pixel distribution histogram were derived with and without filtration. The texture features were then compared between groups classified according to histologic grade. Kaplan-Meier and Cox proportional hazards analyses were performed to determine the relationship between texture features and DFS. Results: SD and MPP quantified from fine to coarse textures on arterial-phase CT images showed significant positive associations with the histologic grade of HCC (p < 0.05). Kaplan-Meier analysis identified most CT texture features across the different filters from fine to coarse texture scales as significant univariate markers of DFS. Cox proportional hazards analysis identified skewness on arterial-phase images (fine texture scale, spatial scaling factor [SSF] 2.0, p < 0.001; medium texture scale, SSF 3.0, p < 0.001), tumor size (p = 0.001), microscopic vascular invasion (p = 0.034), rim arterial enhancement (p = 0.024), and peritumoral parenchymal enhancement (p = 0.010) as independent predictors of DFS. Conclusion: CTTA was demonstrated to provide texture features significantly correlated with higher tumor grade as well as predictive markers of DFS after surgical resection of HCCs in addition to other valuable imaging and clinico-pathologic parameters.

Clinicopathologic Features and Prognostic Factors for Patients with Large Gastric Tumors (대형 위암의 임상병리학적 분석 및 예후)

  • Jang, You-Jin;Park, Jung-Min;Kim, Jong-Han;Park, Sung-Soo;Kim, Chong-Suk;Mok, Young-Jae
    • Journal of Gastric Cancer
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    • v.6 no.4
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    • pp.244-249
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    • 2006
  • Purpose: Tumor size has been reported to be one of the prognostic factors in the preoperative setting and 8 cm has been confirmed as a cut-off value for large gastric tumors with respect to postoperative complications. The aim of this study was to investigate the clinicopathologic features and the prognosis in patients with tumors larger than 8 cm in diameter. Materials and Methods: We retrospectively studied 2,260 patients with gastric cancer who underwent a gastrectomy from 1983 to 2001 at the Department of Surgery, Korea University College of Medicine. For a comparative analysis we divided the cases into the large and the small groups according to tumor size. The clinicopathological factors associated with large gastric tumors were analyzed by using univariate and multivariate analyses. To determine which variables were independent prognostic factors for overall survival, we applied the Cox proportional hazards model and we used P<0.05 as the cutoff value for statistical significance. Results: Univariate and multivariate analyses disclosed that tumor location (P<0.001), resection type (P<0.001), curability (P<0.001), depth of invasion (P<0.001), number of metastatic lymph nodes (P<0.001), differentiation (P<0.001) and combined resection (P<0.001) were significantly different between the two groups. The independent factors for survival identified by using the Cox proportional hazards model for large gastric tumors were nodal status (P<0.001), curative resection (P<0.001), depth of invasion (P=0.010), type of resection (P=0.018) and age (P=0.033). Conclusion: Large gastric tumors showed more aggressive local findings than their smaller counterparts. In patients with large gastric tumors, a curative resection was the most important factor for the prognosis. Therefore, we suggest that every effort should be made to do a curative gastrectomy and an accurate preoperative examination. (J Korean Gastric Cancer Assoc 2006;6:244-249)

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Did Anti-dumping Duties Really Restrict Import?: Empirical Evidence from the US, the EU, China, and India

  • Choi, Nakgyoon
    • East Asian Economic Review
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    • v.21 no.1
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    • pp.3-27
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    • 2017
  • This paper studied the effects of anti-dumping measures on the imports to investigate whether the trade restriction effect of an anti-dumping duty is dominant. Our results indicate that a 1% increase in the anti-dumping duties decreases the import of the targeted product by about 0.43~0.51%. The actual statistics, however, show that the total import of the targeted products increased by about 30 percent while an anti-dumping duty was in force. That indicates that an anti-dumping duty is just a temporary import relief. This paper also investigated whether an anti-dumping duty is terminated in the case that the injury would not be likely to continue or recur if the duty were removed. The hazards model estimates show that increase in market share, MFN tariff rate, and dumping margin decrease the hazard of termination of an anti-dumping duty, but the increase in value added increases the hazard of termination. Generally speaking, this result indicates that the WTO member countries have regulated the overuse of an anti-dumping measure. The findings of this paper show that there is a country- and industry-wise heterogeneous characteristic in the effect as well as termination of an anti-dumping duty.