A new long-term survival model with dispersion induced by discrete frailty.

Frailty models are generally used to model heterogeneity between the individuals. The distribution of the frailty variable is often assumed to be continuous. However, there are situations where a discretely-distributed frailty may be appropriate. In this paper, we propose extending the proportional hazards frailty models to allow a discrete distribution for the frailty variable. Having zero frailty can be interpreted as being immune or cured (long-term survivors). Thus, we develop a new survival model induced by discrete frailty with zero-inflated power series distribution, which can account for overdispersion. A numerical study is carried out under the scenario that the baseline distribution follows an exponential distribution, however this assumption can be easily relaxed and some other distributions can be considered. Moreover, this proposal allows for a more realistic description of the non-risk individuals, since individuals cured due to intrinsic factors (immune) are modeled by a deterministic fraction of zero-risk while those cured due to an intervention are modeled by a random fraction. Inference is developed by the maximum likelihood method for the estimation of the model parameters. A simulation study is performed in order to evaluate the performance of the proposed inferential method. Finally, the proposed model is applied to a data set on malignant cutaneous melanoma to illustrate the methodology.

Relaxed Poisson cure rate models.

The purpose of this article is to make the standard promotion cure rate model (Yakovlev and Tsodikov, ) more flexible by assuming that the number of lesions or altered cells after a treatment follows a fractional Poisson distribution (Laskin, ). It is proved that the well-known Mittag-Leffler relaxation function (Berberan-Santos, ) is a simple way to obtain a new cure rate model that is a compromise between the promotion and geometric cure rate models allowing for superdispersion. So, the relaxed cure rate model developed here can be considered as a natural and less restrictive extension of the popular Poisson cure rate model at the cost of an additional parameter, but a competitor to negative-binomial cure rate models (Rodrigues et al., ). Some mathematical properties of a proper relaxed Poisson density are explored. A simulation study and an illustration of the proposed cure rate model from the Bayesian point of view are finally presented.

A power series beta Weibull regression model for predicting breast carcinoma.

The postmastectomy survival rates are often based on previous outcomes of large numbers of women who had a disease, but they do not accurately predict what will happen in any particular patient's case. Pathologic explanatory variables such as disease multifocality, tumor size, tumor grade, lymphovascular invasion, and enhanced lymph node staining are prognostically significant to predict these survival rates. We propose a new cure rate survival regression model for predicting breast carcinoma survival in women who underwent mastectomy. We assume that the unknown number of competing causes that can influence the survival time is given by a power series distribution and that the time of the tumor cells left active after the mastectomy for metastasizing follows the beta Weibull distribution. The new compounding regression model includes as special cases several well-known cure rate models discussed in the literature. The model parameters are estimated by maximum likelihood. Further, for different parameter settings, sample sizes, and censoring percentages, some simulations are performed. We derive the appropriate matrices for assessing local influences on the parameter estimates under different perturbation schemes and present some ways to assess local influences. The potentiality of the new regression model to predict accurately breast carcinoma mortality is illustrated by means of real data.

The exponential-Poisson model for recurrent event data: an application to a set of data on malaria in Brazil.

In this paper, we introduce a new model for recurrent event data characterized by a baseline rate function fully parametric, which is based on the exponential-Poisson distribution. The model arises from a latent competing risk scenario, in the sense that there is no information about which cause was responsible for the event occurrence. Then, the time of each recurrence is given by the minimum lifetime value among all latent causes. The new model has a particular case, which is the classical homogeneous Poisson process. The properties of the proposed model are discussed, including its hazard rate function, survival function, and ordinary moments. The inferential procedure is based on the maximum likelihood approach. We consider an important issue of model selection between the proposed model and its particular case by the likelihood ratio test and score test. Goodness of fit of the recurrent event models is assessed using Cox-Snell residuals. A simulation study evaluates the performance of the estimation procedure in the presence of a small and moderate sample sizes. Applications on two real data sets are provided to illustrate the proposed methodology. One of them, first analyzed by our team of researchers, considers the data concerning the recurrence of malaria, which is an infectious disease caused by a protozoan parasite that infects red blood cells.

The destructive negative binomial cure rate model with a latent activation scheme.

A new flexible cure rate survival model is developed where the initial number of competing causes of the event of interest (say lesions or altered cells) follow a compound negative binomial (NB) distribution. This model provides a realistic interpretation of the biological mechanism of the event of interest as it models a destructive process of the initial competing risk factors and records only the damaged portion of the original number of risk factors. Besides, it also accounts for the underlying mechanisms that leads to cure through various latent activation schemes. Our method of estimation exploits maximum likelihood (ML) tools. The methodology is illustrated on a real data set on malignant melanoma, and the finite sample behavior of parameter estimates are explored through simulation studies.

Destructive weighted Poisson cure rate models.

In this paper, we develop a flexible cure rate survival model by assuming the number of competing causes of the event of interest to follow a compound weighted Poisson distribution. This model is more flexible in terms of dispersion than the promotion time cure model. Moreover, it gives an interesting and realistic interpretation of the biological mechanism of the occurrence of event of interest as it includes a destructive process of the initial risk factors in a competitive scenario. In other words, what is recorded is only from the undamaged portion of the original number of risk factors.

A new class of regression model for a bounded response with application in the study of the incidence rate of colorectal cancer.

Response variables in medical sciences are often bounded, e.g. proportions, rates or fractions of incidence of some disease. In this work, we are interested to study if some characteristics of the population, e.g. sex and race which can explain the incidence rate of colorectal cancer cases. To accommodate such responses, we propose a new class of regression models for bounded response by considering a new distribution in the open unit interval which includes a new parameter to make a more flexible distribution. The proposal is to obtain compound power normal distribution as a base distribution with a quantile transformation of another family of distributions with the same support and then is to study some properties of the new family. In addition, the new family is extended to regression models as an alternative to the regression model with a unit interval response. We also present inferential procedures based on the Bayesian methodology, specifically a Metropolis-Hastings algorithm is used to obtain the Bayesian estimates of parameters. An application to real data to illustrate the use of the new family is considered.

A Bayesian long-term survival model parametrized in the cured fraction.

The main goal of this paper is to investigate a cure rate model that comprehends some well-known proposals found in the literature. In our work the number of competing causes of the event of interest follows the negative binomial distribution. The model is conveniently reparametrized through the cured fraction, which is then linked to covariates by means of the logistic link. We explore the use of Markov chain Monte Carlo methods to develop a Bayesian analysis in the proposed model. The procedure is illustrated with a numerical example.

A new survival model with surviving fraction: An application to colorectal cancer data.

We propose a new survival model for lifetime data in the presence of surviving fraction and obtain some of its properties. Its genesis is based on extensions of the promotion time cure model, where an extra parameter controls the heterogeneity or dependence of an unobserved number of lifetimes. We construct a regression model to evaluate the effects of covariates in the cured fraction. We discuss inference aspects for the proposed model in a classical approach, where some maximum likelihood tools are explored. Further, an expectation maximization algorithm is developed to calculate the maximum likelihood estimates of the model parameters. We also perform an empirical study of the likelihood ratio test in order to compare the promotion time cure and the proposed models. We illustrate the usefulness of the new model by means of a colorectal cancer data set.

A gap time model based on a multiplicative marginal rate function that accounts for zero-recurrence units.

In this article, we propose an alternative gap time model based on a multiplicative marginal rate function, which is formulated considering each gap time conditional on the previous recurrence times. In this formulation, the gap times are treated equally and the relation between successive events is no longer a problem. Furthermore, this article considers the inclusion of a proportion of zero-recurrence units (for which the event of interest will not occur) into the model to analyze recurrent event data. Inference aspects of the proposed model are discussed through maximum likelihood approach. A simulation study is carried out to examine the performance of the estimation procedure. The model is applied to hospital readmission data among colorectal cancer patients.

Bayesian cure rate models induced by frailty in survival analysis.

Frailty models provide a convenient way of modeling unobserved dependence and heterogeneity in survival data which, if not accounted for duly, would result incorrect inference. Gamma frailty models are commonly used for this purpose, but alternative continuous distributions are possible as well. However, with cure rate being present in survival data, these continuous distributions may not be appropriate since individuals with long-term survival times encompass zero frailty. So, we propose here a flexible probability distribution induced by a discrete frailty, and then present some special discrete probability distributions. We specifically focus on a special hyper-Poisson distribution and then develop the corresponding Bayesian simulation, influence diagnostics and an application to real dataset by means of intensive Markov chain Monte Carlo algorithm. These illustrate the usefulness of the proposed model as well as the inferential results developed here.

A Bayesian destructive weighted Poisson cure rate model and an application to a cutaneous melanoma data.

In this article, we propose a new Bayesian flexible cure rate survival model, which generalises the stochastic model of Klebanov et al. [Klebanov LB, Rachev ST and Yakovlev AY. A stochastic-model of radiation carcinogenesis--latent time distributions and their properties. Math Biosci 1993; 113: 51-75], and has much in common with the destructive model formulated by Rodrigues et al. [Rodrigues J, de Castro M, Balakrishnan N and Cancho VG. Destructive weighted Poisson cure rate models. Technical Report, Universidade Federal de São Carlos, São Carlos-SP. Brazil, 2009 (accepted in Lifetime Data Analysis)]. In our approach, the accumulated number of lesions or altered cells follows a compound weighted Poisson distribution. This model is more flexible than the promotion time cure model in terms of dispersion. Moreover, it possesses an interesting and realistic interpretation of the biological mechanism of the occurrence of the event of interest as it includes a destructive process of tumour cells after an initial treatment or the capacity of an individual exposed to irradiation to repair altered cells that results in cancer induction. In other words, what is recorded is only the damaged portion of the original number of altered cells not eliminated by the treatment or repaired by the repair system of an individual. Markov Chain Monte Carlo (MCMC) methods are then used to develop Bayesian inference for the proposed model. Also, some discussions on the model selection and an illustration with a cutaneous melanoma data set analysed by Rodrigues et al. [Rodrigues J, de Castro M, Balakrishnan N and Cancho VG. Destructive weighted Poisson cure rate models. Technical Report, Universidade Federal de São Carlos, São Carlos-SP. Brazil, 2009 (accepted in Lifetime Data Analysis)] are presented.

A hands-on approach for fitting long-term survival models under the GAMLSS framework.

In many data sets from clinical studies there are patients insusceptible to the occurrence of the event of interest. Survival models which ignore this fact are generally inadequate. The main goal of this paper is to describe an application of the generalized additive models for location, scale, and shape (GAMLSS) framework to the fitting of long-term survival models. In this work the number of competing causes of the event of interest follows the negative binomial distribution. In this way, some well known models found in the literature are characterized as particular cases of our proposal. The model is conveniently parameterized in terms of the cured fraction, which is then linked to covariates. We explore the use of the gamlss package in R as a powerful tool for inference in long-term survival models. The procedure is illustrated with a numerical example.

Generalized log-gamma regression models with cure fraction.

In this paper, the generalized log-gamma regression model is modified to allow the possibility that long-term survivors may be present in the data. This modification leads to a generalized log-gamma regression model with a cure rate, encompassing, as special cases, the log-exponential, log-Weibull and log-normal regression models with a cure rate typically used to model such data. The models attempt to simultaneously estimate the effects of explanatory variables on the timing acceleration/deceleration of a given event and the surviving fraction, that is, the proportion of the population for which the event never occurs. The normal curvatures of local influence are derived under some usual perturbation schemes and two martingale-type residuals are proposed to assess departures from the generalized log-gamma error assumption as well as to detect outlying observations. Finally, a data set from the medical area is analyzed.