Survival Analysis & KM Estimates

Know-How
Saidulu Aithagoni
Date: 01Jun2016
Agenda
 Introduction
 Survival data
 Censoring
 Left
 Right
 Interval
 Why use KM ?
 Calculating the KM
 KM Plot (1) & Interpretation
 KM estimates - tool
 References
 Q&A
Introduction
• Survival data models provide interpretation of data representing the
time until an event occurs.
• In many situations, the event is death,
• It can also represent the time to other bad events such as cancer relapse or
failure of a medical device.
• It can also be used to denote time to positive events such as pregnancy.
• Often patients are lost to follow-up prior to death/event, but you can still
use the information to better estimate the survival probability over time.
• Survival Analysis typically focuses on time to event data.
• In the most general sense, it consists of techniques for +ve valued
random variables, such as
• Time to death
• Time to onset (or relapse) of a disease
• Survival analysis is done using the Kaplan-Meier curve, an approach
developed by Edward Kaplan and Paul Meier in 1958.
Survival data

• survival data are not fully observed, but rather are censored.
Survival data (cont. 1)
• For survival analysis we required
1) Time origin
Ex: Randomization to EOT
2) Time Scale
Ex: Days/ Weeks/ Years
3) Event
Ex: Death, occurrence of a AE
Censoring
Right censoring:
Un observed event is to the right of our censoring time., i.e., event has not
happened at the end of the trial/follow-up.
Ex: Lost to follow-up, Withdrawn
This is usually used in most of the clinical trials.
Left censoring:
It is very rare to use.
• Event of interest already occurred at the observation time, but it is not
known exactly when.
• Ex: Infected with cancer
Interval censoring:
With in a specified time period, how the data is going to change.
• Ex: Time to undetectable viral load in AIDS studies, based on
measurements of viral load taken at each clinic visit
Censoring (Conti. 1)
• Independent vs informative censoring
• Right truncation, Left truncation
• Right censoring is categorized into 3 types
- Type I, II and III censorings
• Type I & Type II are called singly censored
• Type III is called randomly censored.
Why use KM ?
• The goal is to estimate a population survival curve from a sample.
• If every patient is followed until death, the curve may be estimated
simply by computing the fraction surviving at each time.
• However, in most studies patients tend to drop out, become lost to
follow-up, move away, etc.
• A Kaplan-Meier analysis allows estimation of survival over time, even
when pts drop out or are studied for different lengths of time.
Calculating the KM

• T : Time
• D: Death/event
• C: Censored
• R: Still at risk
Calculating the KM (Conti. 1)
Calculating the KM (Conti. 2)
• Survival estimation at time point 6:
• SF=(21-3)/21=18/21=0.8571

• Survival estimation at time point 7: still at risk is becoming 21-(3+1)=17

• SF=(17-1)/17*SF of at time point 6=16/17*0.8571=0.80666

• Survival estimation at time point 13: still at risk is becoming 13-(0+1)=12

• SF=(12-1)/12*SF of at time point 12=11/12*0.7529=0.69015

• Survival estimation at time point 20: still at risk is becoming 9-(0+1)=8

• SF=(8-0)/8*SF of at time point 19=8/8*0.6275=0.6275
KM Plot (1) & Interpretation
KM Plot (2) & Interpretation
KM estimates – tool
KM estimates – tool (conti. 1)
References

• http://
www.amstat.org/chapters/northeasternillinois/pastevents/presentations/
summer05_Ibrahim_J.pdf
• http://www.hutchon.net/kaplan-meier.htm
Q&A