Parker Corette B, DeLong Elizabeth R
RTI International, P.O. Box 12194, Research Triangle Park, NC 27709, USA.
Stat Med. 2003 Nov 30;22(22):3473-88. doi: 10.1002/sim.1580.
Receiver operating characteristic (ROC) methodology is widely used to evaluate and compare diagnostic tests. Generally, each diagnostic test is applied once to each subject in a population and the results, reported on a continuous scale, are used to construct the ROC curve. We extend the standard method to accommodate a framework in which the diagnostic test is repeated over time to monitor for occurrence of an event. Unlike the usual situation in which event status is static, the problem we address involves event status that is not constant over the monitoring period. Subjects generally are classified as non-events, or controls, until they experience events that convert them to cases. Viewing the data as incomplete discrete failure time data with time-varying covariates, potentially useful diagnostic markers can be related appropriately in time with the true condition and varying amounts of information per individual can be taken into account. The ROC curve provides an assessment of the performance of the test in combination with the schedule of testing. Within this framework, a computational simplification is introduced to calculate variances and covariances for the areas under the ROC curves. Periodic monitoring for reperfusion following thrombolytic treatment for acute myocardial infarction provides a detailed example, whereby the lengths of the testing interval combined with different diagnostic markers are compared.
接受者操作特征（ROC）方法被广泛用于评估和比较诊断测试。一般来说，对人群中的每个受试者都应用一次诊断测试，并将以连续尺度报告的结果用于构建ROC曲线。我们扩展了标准方法，以适应一种框架，即在该框架中，诊断测试会随着时间重复进行，以监测事件的发生。与事件状态是静态的通常情况不同，我们所处理的问题涉及在监测期内并非恒定不变的事件状态。在经历将其转变为病例的事件之前，受试者通常被归类为非事件或对照。将数据视为具有随时间变化的协变量的不完全离散失效时间数据，潜在有用的诊断标志物可以在时间上与真实状况适当地关联起来，并且可以考虑到每个个体不同数量的信息。ROC曲线结合测试时间表对测试性能进行评估。在此框架内，引入了一种计算简化方法来计算ROC曲线下面积的方差和协方差。对急性心肌梗死溶栓治疗后的再灌注进行定期监测提供了一个详细示例，据此比较了测试间隔长度与不同诊断标志物。
