Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada.
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada; O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada.
J Clin Epidemiol. 2018 Jan;93:25-35. doi: 10.1016/j.jclinepi.2017.10.006. Epub 2017 Oct 16.
Kaplan-Meier survival analysis overestimates cumulative incidence in competing risks (CRs) settings. The extent of overestimation (or its clinical significance) has been questioned, and CRs methods are infrequently used. This meta-analysis compares the Kaplan-Meier method to the cumulative incidence function (CIF), a CRs method.
We searched MEDLINE, EMBASE, BIOSIS Previews, Web of Science (1992-2016), and article bibliographies for studies estimating cumulative incidence using the Kaplan-Meier method and CIF. For studies with sufficient data, we calculated pooled risk ratios (RRs) comparing Kaplan-Meier and CIF estimates using DerSimonian and Laird random effects models. We performed stratified meta-analyses by clinical area, rate of CRs (CRs/events of interest), and follow-up time.
Of 2,192 identified abstracts, we included 77 studies in the systematic review and meta-analyzed 55. The pooled RR demonstrated the Kaplan-Meier estimate was 1.41 [95% confidence interval (CI): 1.36, 1.47] times higher than the CIF. Overestimation was highest among studies with high rates of CRs [RR = 2.36 (95% CI: 1.79, 3.12)], studies related to hepatology [RR = 2.60 (95% CI: 2.12, 3.19)], and obstetrics and gynecology [RR = 1.84 (95% CI: 1.52, 2.23)].
The Kaplan-Meier method overestimated the cumulative incidence across 10 clinical areas. Using CRs methods will ensure accurate results inform clinical and policy decisions.
在竞争风险（CRs）环境下，Kaplan-Meier 生存分析会高估累积发生率。这种高估的程度（或其临床意义）存在争议，并且很少使用 CRs 方法。本荟萃分析比较了 Kaplan-Meier 方法与累积发生率函数（CIF）这一 CRs 方法。
我们检索了 MEDLINE、EMBASE、BIOSIS Previews、Web of Science（1992-2016）和文献的参考文献，以寻找使用 Kaplan-Meier 方法和 CIF 估算累积发生率的研究。对于有足够数据的研究，我们使用 DerSimonian 和 Laird 随机效应模型计算了比较 Kaplan-Meier 和 CIF 估计值的汇总风险比（RR）。我们按临床领域、CRs 发生率（感兴趣的 CRs/事件）和随访时间进行了分层荟萃分析。
在 2192 篇摘要中，我们系统综述纳入了 77 项研究，对其中 55 项进行了荟萃分析。汇总 RR 表明 Kaplan-Meier 估计值比 CIF 高 1.41 倍（95%置信区间[CI]：1.36，1.47）。在 CRs 发生率较高的研究中高估程度最高[RR=2.36（95%CI：1.79，3.12）]、与肝脏病学相关的研究[RR=2.60（95%CI：2.12，3.19）]和妇产科研究[RR=1.84（95%CI：1.52，2.23）]。
Kaplan-Meier 方法在 10 个临床领域高估了累积发生率。使用 CRs 方法将确保准确的结果，为临床和政策决策提供信息。
