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Clin Cancer Res. 2015 Apr 1;21(7):1530-6. doi: 10.1158/1078-0432.CCR-14-2154.

Conditional Survival: A Useful Concept to Provide Information on How Prognosis Evolves over Time.

Author information

1
Institute for Medical Biometry and Statistics, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.
2
Department of Medicine I, Hematology, Oncology and Stem Cell Transplantation, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany. Clinic for Internal Medicine, University Hospital Basel, Basel, Switzerland.
3
Department of Medicine I, Hematology, Oncology and Stem Cell Transplantation, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.
4
Institute for Medical Biometry and Statistics, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany. ms@imbi.uni-freiburg.de.

Abstract

Conditional survival (CS) is defined as the probability of surviving further t years, given that a patient has already survived s years after the diagnosis of a chronic disease. It is the simplest form of a dynamic prediction in which other events in the course of the disease or biomarker values measured up to time s can be incorporated. CS has attracted attention in recent years either in an absolute or relative form where the latter is based on a comparison with an age-adjusted normal population being highly relevant from a public health perspective. In its absolute form, CS constitutes the quantity of major interest in a clinical context. Given a clinical cohort of patients with a particular type of cancer, absolute CS can be estimated by conditional Kaplan-Meier estimates in strata defined, for example, by age and disease stage or by a conditional version of the Cox and other regression models for time-to-event data. CS can be displayed as a function of the prediction time s in parametric as well as nonparametric fashion. We illustrate the use of absolute CS in a large clinical cohort of patients with multiple myeloma. For investigating CS, it is necessary to ensure almost complete long-term follow-up of the patients enrolled in the clinical cohort and to consider potential age-stage migration as well as changing treatment modalities over time. CS provides valuable and relevant information on how prognosis develops over time. It also serves as a starting point for identifying factors related to long-term survival.

PMID:
25833308
DOI:
10.1158/1078-0432.CCR-14-2154
[Indexed for MEDLINE]
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