期刊
PHARMACEUTICAL STATISTICS
卷 21, 期 1, 页码 163-175出版社
WILEY
DOI: 10.1002/pst.2159
关键词
analysis; mediation analysis; progression-free survival; randomized controlled trials as topic; surrogate endpoint; survival
资金
- National Institute of Allergy and Infectious Diseases [UM1-AI068634]
- National Institute of General Medical Sciences [T32 GM074905]
The study introduces a counterfactual-based mediation analysis method for causal assessment of surrogate endpoints in cancer randomized controlled trials. Using a multistate model for risk prediction, it considers both direct and indirect transitions, defining natural direct and indirect effects. The approach is illustrated through a case study on the use of metastasis as a surrogate outcome for prostate cancer-specific mortality in a randomized trial of radical prostatectomy.
In cancer randomized controlled trials, surrogate endpoints are frequently time-to-event endpoints, subject to the competing risk from the time-to-event clinical outcome. In this context, we introduce a counterfactual-based mediation analysis for a causal assessment of surrogacy. We use a multistate model for risk prediction to account for both direct transitions towards the clinical outcome and indirect transitions through the surrogate outcome. Within the counterfactual framework, we define natural direct and indirect effects with a causal interpretation. Based on these measures, we define the proportion of the treatment effect on the clinical outcome mediated by the surrogate outcome. We estimate the proportion for both the cumulative risk and restricted mean time lost. We illustrate our approach by using 18-year follow-up data from the SPCG-4 randomized trial of radical prostatectomy for prostate cancer. We assess time to metastasis as a surrogate outcome for prostate cancer-specific mortality.
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