Landmark analysis to adjust for immortal time bias in oncology studies using claims data linked to death data

Farr, A.; Foley, Kathleen A.

doi:10.1016/j.jval.2013.03.284

Cited by 6 publications

(6 citation statements)

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“…Unlike traditional survival analysis approaches (e.g., Kaplan Meier), landmark analysis accounts for the time elapsed since the initial surgery, as well as for the occurrence of intervening events such as recurrence. 12 As expected, several traditional factors (e.g., tumor size, margin status, tumor grade 3 or 4, AJCC T and N categories) were associated with prognosis, and the impact of these variables on survival were noted to vary over time. Thus, we developed a tool predicting the probability of OS at various times after resection accounting for intervening events.…”

Section: Discussionsupporting

confidence: 69%

“…11 Landmark analysis splits the follow-up time at a common, prespecified time point, the so-called ''landmark.'' 12 In turn, landmark analysis allows for a more dynamic prediction of survival that accounts for the time elapsed since the initial surgery, as well as the occurrence of intervening events such as recurrence. The current study aimed to develop a dynamic prognostic model for patients undergoing curative-intent resection for ICC using landmark analysis.…”

Section: Discussionmentioning

confidence: 99%

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Dynamic Prediction of Survival After Curative Resection of Intrahepatic Cholangiocarcinoma: A Landmarking-Based Analysis

et al. 2022

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Background. The current study aimed to develop a dynamic prognostic model for patients undergoing curative-intent resection for intrahepatic cholangiocarcinoma (ICC) using landmark analysis. Methods. Patients who underwent curative-intent surgery for ICC from 1999 to 2017 were selected from a multiinstitutional international database. A landmark analysis to Gaya Spolverato and Giulia Capelli are co-first authors.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Dynamic Prediction of Survival After Curative Resection of Intrahepatic Cholangiocarcinoma: A Landmarking-Based Analysis

et al. 2022

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“…Before 2014, only 5% of patients had CLM resection, however after that the frequency increased sharply in 2015, peaking at 19.4% in 2017. To account for immortal time bias, landmark analysis was used to evaluate the impact of hepatic resection on survival 40 . Using a 12-month landmark, the 5-year survival rate for patients who had undergone hepatic metastasis resection was 58.3%, compared with 27.0% for patients without resection; median overall survival for these two groups was 74.3 months (95% CI, 58.5 to 90.0 months) and 32.6 months (95% CI, 30.1 to 35.2 months), respectively with HR of 0.33 (95% CI, 0.22 to 0.41, P < 0.0001, Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Comparison of different groups was performed using the log-rank test; p -value < 0.05 was considered significant. For analysis of the impact of hepatic resection on survival, the length of survival is known to impact the possibility that patients will undergo hepatic resection, thereby inducing a bias in favor of resection using traditional survival methods 40 . Hence, a landmark analysis was used to decrease bias induced by including various events that happens after the baseline hazard models 4 , 62 , 63 .…”

Section: Methodsmentioning

confidence: 99%

Survival improvement for patients with metastatic colorectal cancer over twenty years

Zeineddine

Yousef

et al. 2023

npj Precis. Onc.

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Over the past two decades of successive clinical trials in metastatic colorectal cancer (CRC), the median overall survival of both control and experimental arms has steadily improved. However, the incremental change in survival for metastatic CRC patients not treated on trial has not yet been quantified. We performed a retrospective review of 1420 patients with de novo metastatic CRC who received their primary treatment at the University of Texas M.D. Anderson Cancer Center (UTMDACC) from 2004 through 2019. Median OS was roughly stable for patients diagnosed between 2004 and 2012 (22.6 months) but since has steadily improved for those diagnosed in 2013 to 2015 (28.8 months), and 2016 to 2019 (32.4 months). Likewise, 5-year survival rate has increased from 15.7% for patients diagnosed from 2004 to 2006 to 26% for those diagnosed from 2013 to 2015. Notably, survival improved for patients with BRAFV600E mutant as well as microsatellite unstable (MSI-H) tumors. Multivariate regression analysis identified surgical resection of liver metastasis (HR = 0.26, 95% CI, 0.19–0.37), use of immunotherapy (HR = 0.44, 95% CI, 0.29–0.67) and use of third line chemotherapy (regorafenib or trifluridine/tipiracil, HR = 0.74, 95% CI, 0.58–0.95), but not year of diagnosis (HR = 0.99, 95% CI, 0.98–1), as associated with better survival, suggesting that increased use of these therapies are the drivers of the observed improvement in survival.

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“…In order to address the issue of immortal time bias, a landmark analysis was performed to evaluate the association between treatment delays and OS, with a designated landmark date of 150 days after HCC diagnosis. ( 27 ) In this analysis, patients who died before the designated landmark time and those who received HCC treatment after the landmark were excluded, thus eliminating immortal time bias in the treatment‐delay group. Sensitivity analysis was further conducted with landmark dates of 120 and 180 days after HCC diagnosis.…”

Section: Methodsmentioning

confidence: 99%

Therapeutic Underuse and Delay in Hepatocellular Carcinoma: Prevalence, Associated Factors, and Clinical Impact

et al. 2021

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Prognosis of hepatocellular carcinoma (HCC) could be affected by lack of or delayed therapy. We aimed to characterize the prevalence, correlates, and clinical impact of therapeutic underuse and delay in patients with HCC. Patients with HCC diagnosed between 2010 and 2017 were analyzed from the United States National Cancer Database. Logistic regression analysis identified factors associated with no and delayed (>90 days after diagnosis) HCC treatment. Cox proportional hazards regression with landmark analysis assessed the association between therapeutic delay and overall survival (OS), accounting for immortal time bias. Of 116,299 patients with HCC, 24.2% received no treatment and 18.4% of treated patients had delayed treatment. Older age, Black, Hispanic, lower socioeconomic status, earlier year of diagnosis, treatment at nonacademic centers, Northeast region, increased medical comorbidity, worse liver dysfunction, and higher tumor burden were associated with no treatment. Among treated patients, younger age, Hispanic, Black, treatment at academic centers, West region, earlier tumor stage, and receipt of noncurative treatment were associated with treatment delays. In multivariable Cox regression with a landmark of 150 days, patients with and without treatment delays had similar OS (adjusted hazard ratio [aHR], 1.01; 95% confidence interval [CI], 0.98-1.04) with a median survival of 33.7 vs. 32.1 months, respectively. However, therapeutic delay was associated with worse OS in patients who had tumor, nodes, and metastases (TNM) stage 1 (aHR, 1.06; 95% CI, 1.01-1.11) or received curative treatment (aHR, 1.12; 95% CI, 1.05-1.18). Conclusion: One-fourth of patients with HCC receive no therapy and one-fifth of treated patients experience treatment delays. Both were associated with demographic, socioeconomic, and clinical characteristics of patients as well as facility type and region. The association between therapeutic delay and survival was stage and treatment dependent. (Hepatology Communications 2021;0:1-14).

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Landmark analysis to adjust for immortal time bias in oncology studies using claims data linked to death data

Cited by 6 publications

References 0 publications

Dynamic Prediction of Survival After Curative Resection of Intrahepatic Cholangiocarcinoma: A Landmarking-Based Analysis

Dynamic Prediction of Survival After Curative Resection of Intrahepatic Cholangiocarcinoma: A Landmarking-Based Analysis

Survival improvement for patients with metastatic colorectal cancer over twenty years

Therapeutic Underuse and Delay in Hepatocellular Carcinoma: Prevalence, Associated Factors, and Clinical Impact

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