KAPLAN MEIER CURVE

RAJALAKSHMI.R
14.07.2022
INTRODUCTION :

 In 1958, Edward L Kaplan and Paul Meier published paper pn

how to deal with incomplete observations.

 Analysis of time to event data is of paramount importance in

clinical, epidemiological research

 Survival data analysis : does not imply actual survival of

patient, it relates with an event (event can be anything of
researchers interest)

 Time to event : time from beginning of date of enrolment in a

study to the endpoint when event of interest is reached or
subject is sensored from study
PREPARING KAPLAN MEIER SURVIVAL ANALYSIS:

Each subject is characterized by three variables :

1. Serial time = interval ( total survival time of an individual)

2. status at end of serial time (event occurred or censored)

3. which study group they belong to.

PREPARING KAPLAN MEIER SURVIVAL ANALYSIS

Step 1 : construction of table using excel spreadsheet or word

document containing 3 key elements required for input. They are
 serial time
 status of serial time
 study group

Step 2 : table is sorted by ascending serial lines, beginning with

shortest times for each group

Step 3 : Once table is constructed, KM analysis is done using

statistical program such as SPSS, Sigmaplot, Originpro software.
CENSORING IN KAPLAN MEIER CURVE :
 3 TYPES :

1. Right censoring – event of interest did not happen till end of

study date

2. Interval censoring – event of interest happens within interval

between two dates, but we do not know exact date

3. Left censoring – event of interest happens before a specific

date but time interval between event, specific date is not
known.
CENSORING IN KAPLAN MEIER CURVE :
3 ASSUMPTIONS BEFORE CONSTRUCTING KAPLAN MEIER CURVE :

In real life cases , we do not have an idea of true survival rate function. In KM
estimator, we estimate and approximate the true survival fraction from the study
data.

1. Survival probabilities are same for all samples who joined late in
study and those who joined early.

2. Censored observations should have same probability of event as

those remaining under observation

3. Occurrence of event are done at a specified time. (day, month,

year of occurrence of specific event of interest should be
available to provide accurate survival estimates)
DIFFERENT KAPLAN-MEIER CURVES USED IN CANCER LITERATURE

 Overall survival the event of interest is death from any cause.

 Disease free survival the event of interest is relapse of a disease rather than
death. Because patients may have relapsed but not yet died, disease free survival
curves are lower than overall survival curves.

 Progression free survival uses progression of a disease as an end-point (i.e.

tumor growth or spread). This is useful in isolating and assessing the effects of a
particular treatment on a disease.

 Disease specific survival curves (also known as cause specific survival) utilize
death from the disease of interest as the endpoint. This curve can be misleading in
that it will always be higher than overall survival and disease free survival curves
because events are limited only to death from a specific disease, i.e. patients that
have disease relapse or die from nonrelated causes are not included as events.
EXAMPLE :

 5 year trial
 2 groups ( group A, group B)
 n= 6 in each group
 event of interest – death from any cause
Suggested Software.

There are several statistical software that allow to perform time to

event analysis by the KaplanMeir method.

The best known are:

 SPSS 23.0 (https://www.ibm.com/support/knowledgecenter/
SSLVMB_23.0.0/spss/advanced/idh_kmei.html)

 Stata 16 (https://www.stata.com/support/faqs/graphics/
gph/graphdocs/kaplan-meier-survival-function/index.html)

 SAS (https://support.sas.com/documentation/onlinedoc/
stat/142/kaplan.pdf)

 MEDCALC (https://www.medcalc.org/manual/kaplanmeier.php)
THANK YOU