Multistate Models for the Analysis of Oncology Data

Abstract

Survival analysis plays a major role in the research of clinical oncology. Standard survival analysis, where only one event is analyzed, is still used in the majority of studies. By using competing risks and multistate models, which are the extensions of standard survival analysis, more useful information can be derived from the data and more clinical questions can be tackled. In this article, we provide an introductory explanation for the theory and application of multistate models for clinicians and biostatisticians. We explain how to use R in multistate models with the dataset ‘mgus2’ from the survival package. Key points for the application of multistate models are presented using the data from a previously published multicenter prospective observational study on palliative radiotherapy for gastric cancer. We would emphasize that standard survival analysis, competing risks analysis, and multistate models are analyzed in the same framework.