Gamel J W, Vogel R L
Veterans Administration Medical Center, Louisville, KY.
Br J Cancer. 1993 Dec;68(6):1167-70. doi: 10.1038/bjc.1993.498.
Following adjuvant therapy for breast cancer, some patients will die of this tumour while the remainder will die of other causes. Deaths from breast cancer tend to follow a lognormal distribution, while deaths from other causes can be approximated by national demographic data. By combining these two survival models, we have generated an age-specific method for estimating the impact of treatment on overall long-term survival. Treatment was designed to operate by one of two mechanisms: an increase in cured fraction, or an increase in median tumour-related survival time among uncured patients. This analysis revealed that, for young and middle-aged patients, an increase in cured fraction has substantially greater long-term clinical impact than an increase in median survival time. Unfortunately, the non-parametric tests traditionally used in prospective clinical trials cannot distinguish between these two mechanisms of action.
在接受乳腺癌辅助治疗后，一些患者会死于该肿瘤，而其余患者会死于其他原因。乳腺癌导致的死亡往往呈对数正态分布，而其他原因导致的死亡可以用国家人口统计数据来近似估计。通过结合这两种生存模型，我们生成了一种按年龄划分的方法，用于估计治疗对总体长期生存的影响。治疗旨在通过两种机制之一发挥作用：提高治愈比例，或延长未治愈患者中与肿瘤相关的中位生存时间。该分析表明，对于中青年患者，提高治愈比例比延长中位生存时间具有更大的长期临床影响。不幸的是，前瞻性临床试验中传统使用的非参数检验无法区分这两种作用机制。
