Restricted Mean Survival Time for Survival Analysis: A Quick Guide for Clinical Researchers

Han, Kyunghwa; Jung, Inkyung

doi:10.3348/kjr.2022.0061

Cited by 46 publications

(17 citation statements)

References 22 publications

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“…We analyzed event-free time of CV events and all-cause mortality using multivariate analysis of restricted mean survival time (RMST) which is a novel alternative to Cox proportional hazards model that can be applied also when the proportional hazards assumption is not fulfilled (33). The average length of event-free time until CVE or death occurred was calculated using RMST from baseline to a particular time point during 10 years of follow up.…”

Section: Statistical Analysesmentioning

confidence: 99%

Central obesity as assessed by conicity index and a-body shape index associates with cardiovascular risk factors and mortality in kidney failure patients

Ryu

Suliman²,

Qureshi³

et al. 2023

Front. Nutr.

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BackgroundAnthropometric indices of central obesity, waist circumference (WC), conicity index (CI), and a-body shape index (ABSI), are prognostic indicators of cardiovascular (CV) risk. The association of CI and ABSI with other CV risk indices, markers of nutritional status and inflammation, and clinical outcomes in chronic kidney disease (CKD) stage 5 (CKD5) patients was investigated.MethodsIn a cross-sectional study with longitudinal follow up of 203 clinically stable patients with CKD5 (median age 56 years; 68% males, 17% diabetics, 22% with CV disease, and 39% malnourished), we investigated CI and ABSI and their associations with atherogenic index of plasma (AIP), Framingham CV risk score (FRS), Agatston scoring of coronary artery calcium (CAC) and aortic valve calcium (AVC), handgrip strength (HGS), high sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6). CV events (CVE) and all-cause mortality during up to 10-years follow up were analyzed by multivariate survival analysis of restricted mean survival time (RMST).ResultsChronic kidney disease patients with middle and highest CI and ABSI tertiles (indicating greater abdominal fat deposition), compared to those with the lowest CI and ABSI tertiles, tended to be older, more often men and diabetic, had significantly higher levels of hsCRP, IL-6, AIP, FRS, CAC and AVC scores. CI and ABSI were positively correlated with CAC, FRS, AIP, hsCRP and IL-6. Both CI and ABSI were negatively correlated with HGS. In age-weighted survival analysis, higher CI and ABSI were associated with higher risk of CVE (Wald test = 4.92, p = 0.027; Wald test = 4.95, p = 0.026, respectively) and all-cause mortality (Wald test = 5.24, p = 0.022; Wald test = 5.19, p = 0.023, respectively). In RMST analysis, low vs. high and middle tertiles of CI and ABSI associated with prolonged CVE-free time and death-free time, and these differences between groups increased over time.ConclusionAbdominal fat deposit indices, CI and ABSI, predicted CV outcomes and all-cause mortality, and were significantly associated with the inflammatory status in CKD patients.

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Section: Statistical Analysesmentioning

confidence: 99%

Central obesity as assessed by conicity index and a-body shape index associates with cardiovascular risk factors and mortality in kidney failure patients

Ryu

Suliman²,

Qureshi³

et al. 2023

Front. Nutr.

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show abstract

“…We aimed to use age-adjusted restricted mean survival time (RMST) as a method to compare survival between the sexes. RMST is defined as the area under the survival curve up to a specific time point and can overcome some of the limitations of proportional hazard modelling [ 42 ].…”

Section: Methodsmentioning

confidence: 99%

Sex Differences in Survival from Neuroendocrine Neoplasia in England 2012–2018: A Retrospective, Population-Based Study

White

Russell

Remmers

et al. 2023

Cancers

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Pre-clinical studies have suggested sex hormone signalling pathways may influence tumorigenesis in neuroendocrine neoplasia (NEN). We conducted a retrospective, population-based study to compare overall survival (OS) between males and females with NEN. A total of 14,834 cases of NEN diagnosed between 2012 and 2018, recorded in England’s National Cancer Registry and Analysis Service (NCRAS), were analysed. The primary outcome was OS with 5 years maximum follow-up. Multivariable analysis, restricted mean survival time and mediation analysis were performed. Appendiceal, pulmonary and early-stage NEN were most commonly diagnosed in females; stomach, pancreatic, small intestinal, colonic, rectal and later-stage NEN were more often diagnosed in males. Females displayed increased survival irrespective of the stage, morphology or level of deprivation. On average, they survived 3.62 (95% CI 1.73–5.90) to 10.26 (6.6–14.45) months longer than males; this was statistically significant in NEN of the lung, pancreas, rectum and stomach (p < 0.001). The stage mediated improved survival in stomach, lung, and pancreatic NEN but not in rectal NEN. The reasons underlying these differences are not yet understood. Overall, females diagnosed with NEN tend to survive longer than males, and the stage at presentation only partially explains this. Future research, as well as prognostication and treatment, should consider sex as an important factor.

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“…RMST can be interpreted as the “life expectancy” between diagnosis and our chosen time horizon of 5 years, with the change in RMST (ΔRMST) representing the difference in “life expectancy” between two groups of interest. 21 Multivariable Cox proportional regression models were used to calculate hazard ratios (HRs) for OS, adjusting for race, SES, age, subsite, stage, and treatment. Multivariable Fine and Gray regression models were used to calculate HRs for CSS with competing risks, adjusting for race, SES, age, subsite, stage, and treatment.…”

Section: Methodsmentioning

confidence: 99%

“…Restricted mean survival time (RMST) was estimated as an alternative measure of survival. RMST can be interpreted as the “life expectancy” between diagnosis and our chosen time horizon of 5 years, with the change in RMST (ΔRMST) representing the difference in “life expectancy” between two groups of interest 21 . Multivariable Cox proportional regression models were used to calculate hazard ratios (HRs) for OS, adjusting for race, SES, age, subsite, stage, and treatment.…”

Section: Methodsmentioning

confidence: 99%

Race and socioeconomic status interact with HPV to influence survival disparities in oropharyngeal squamous cell carcinoma

et al. 2023

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Background HPV‐related oropharyngeal squamous cell carcinoma (OPSCC) is associated with a favorable prognosis, yet patients of color and low socioeconomic status (SES) continue to experience inferior outcomes. We aim to understand how the emergence of HPV has impacted race and SES survival disparities in OPSCC. Methods A retrospective cohort of 18,362 OPSCC cases from 2010 to 2017 was assembled using the SEER (Surveillance, Epidemiology, and End Results) database. Cox proportional regression and Fine and Gray regression models were used to calculate hazard ratios (HRs) adjusting for race, SES, age, subsite, stage, and treatment. Results Black patients had lower overall survival than patients of other races in HPV‐positive and HPV‐negative OPSCC (HR 1.31, 95% CI 1.13–1.53 and HR 1.23, 95% CI 1.09–1.39, respectively). Higher SES was associated with improved survival in all patients. Race had a diminished association with survival among high SES patients. Low SES Black patients had considerably worse survival than low SES patients of other races. Conclusion Race and SES interact variably across cohorts. High SES was protective of the negative effects of race, although there remains a disparity in outcomes among Black and non‐Black patients, even in high SES populations. The persistence of survival disparities suggests that the HPV epidemic has not improved outcomes equally across all demographic groups.

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Restricted Mean Survival Time for Survival Analysis: A Quick Guide for Clinical Researchers

Cited by 46 publications

References 22 publications

Central obesity as assessed by conicity index and a-body shape index associates with cardiovascular risk factors and mortality in kidney failure patients

Central obesity as assessed by conicity index and a-body shape index associates with cardiovascular risk factors and mortality in kidney failure patients

Sex Differences in Survival from Neuroendocrine Neoplasia in England 2012–2018: A Retrospective, Population-Based Study

Race and socioeconomic status interact with HPV to influence survival disparities in oropharyngeal squamous cell carcinoma

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