Piantadosi S, Byar D P, Gail M H
J Natl Cancer Inst. 1985 Aug;75(2):269-75.
An approach was devised for the problem of detecting geographic areas with poor survival for cancer patients. Methods were proposed to deal with the two major sources of variability in summary survival measures for geographic areas: the distribution of prognostic factors for individuals within an area and random variation. In addition, small geographic areas often had to be combined so that a sufficient number of cases could be obtained in each area for calculation of survival statistics, and a procedure for doing so was developed. Then stage-specific and overall 5-year survival estimates for each geographic area were converted to standardized normal deviates so that outlying observations could be detected using the theory of normal-order statistics. A similar approach was used to determine which geographic areas had unusually high proportions of advanced disease at diagnosis. Our outlier detection procedure was designed for screening available data for geographic areas possibly deserving further study rather than for concluding that survival or staging was substandard in those areas. Methods were applied to data from the Surveillance, Epidemiology, and End Results (SEER) Program for breast and colon cancer. For each cancer site, some geographic areas were identified with unusual survival or stage distributions.
针对检测癌症患者生存情况较差的地理区域这一问题，设计了一种方法。提出了一些方法来处理地理区域总体生存指标中两个主要的变异性来源：区域内个体预后因素的分布以及随机变异。此外，小地理区域常常需要合并，以便在每个区域获得足够数量的病例来计算生存统计数据，并开发了一种这样做的程序。然后，将每个地理区域特定阶段和总体的5年生存估计值转换为标准化正态偏差，以便使用正态顺序统计理论检测异常观测值。采用类似方法确定哪些地理区域在诊断时晚期疾病比例异常高。我们的异常值检测程序旨在筛选可能值得进一步研究的地理区域的现有数据，而非得出这些区域生存或分期不达标的结论。这些方法应用于监测、流行病学和最终结果（SEER）计划中乳腺癌和结肠癌的数据。对于每个癌症部位，识别出了一些生存或阶段分布异常的地理区域。
