Wei Yinghui, Royston Patrick, Tierney Jayne F, Parmar Mahesh K B
MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, U.K.
Centre for Mathematical Sciences, School of Computing and Mathematics, University of Plymouth, U.K.
Stat Med. 2015 Sep 20;34(21):2881-98. doi: 10.1002/sim.6556. Epub 2015 Jun 23.
Meta-analysis of time-to-event outcomes using the hazard ratio as a treatment effect measure has an underlying assumption that hazards are proportional. The between-arm difference in the restricted mean survival time is a measure that avoids this assumption and allows the treatment effect to vary with time. We describe and evaluate meta-analysis based on the restricted mean survival time for dealing with non-proportional hazards and present a diagnostic method for the overall proportional hazards assumption. The methods are illustrated with the application to two individual participant meta-analyses in cancer. The examples were chosen because they differ in disease severity and the patterns of follow-up, in order to understand the potential impacts on the hazards and the overall effect estimates. We further investigate the estimation methods for restricted mean survival time by a simulation study.
使用风险比作为治疗效果度量对事件发生时间结局进行的荟萃分析有一个潜在假设，即风险是成比例的。受限平均生存时间的组间差异是一种避免此假设并允许治疗效果随时间变化的度量。我们描述并评估基于受限平均生存时间的荟萃分析，以处理不成比例的风险，并提出一种用于整体比例风险假设的诊断方法。通过在两项癌症个体参与者荟萃分析中的应用来说明这些方法。选择这些例子是因为它们在疾病严重程度和随访模式上有所不同，以便了解对风险和总体效果估计的潜在影响。我们通过模拟研究进一步研究受限平均生存时间的估计方法。
