Using median survival in meta-analysis of experimental time-to-event data
Abstract Background Time-to-event data is frequently reported in both clinical and preclinical research spheres. Systematic review and meta-analysis is a tool that can help to identify pitfalls in preclinical research conduct and reporting that can help to improve translational efficacy. However, po...
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| Format: | Article |
| Language: | English |
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BMC
2021-11-01
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| Series: | Systematic Reviews |
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| Online Access: | https://doi.org/10.1186/s13643-021-01824-0 |
| _version_ | 1819011104084328448 |
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| author | Theodore C. Hirst Emily S. Sena Malcolm R. Macleod |
| author_facet | Theodore C. Hirst Emily S. Sena Malcolm R. Macleod |
| author_sort | Theodore C. Hirst |
| collection | DOAJ |
| description | Abstract Background Time-to-event data is frequently reported in both clinical and preclinical research spheres. Systematic review and meta-analysis is a tool that can help to identify pitfalls in preclinical research conduct and reporting that can help to improve translational efficacy. However, pooling of studies using hazard ratios (HRs) is cumbersome especially in preclinical meta-analyses including large numbers of small studies. Median survival is a much simpler metric although because of some limitations, which may not apply to preclinical data, it is generally not used in survival meta-analysis. We aimed to appraise its performance when compared with hazard ratio-based meta-analysis when pooling large numbers of small, imprecise studies. Methods We simulated a survival dataset with features representative of a typical preclinical survival meta-analysis, including with influence of a treatment and a number of covariates. We calculated individual patient data-based hazard ratios and median survival ratios (MSRs), comparing the summary statistics directly and their performance at random-effects meta-analysis. Finally, we compared their sensitivity to detect associations between treatment and influential covariates at meta-regression. Results There was an imperfect correlation between MSR and HR, although the opposing direction of treatment effects between summary statistics appeared not to be a major issue. Precision was more conservative for HR than MSR, meaning that estimates of heterogeneity were lower. There was a slight sensitivity advantage for MSR at meta-analysis and meta-regression, although power was low in all circumstances. Conclusions We believe we have validated MSR as a summary statistic for use in a meta-analysis of small, imprecise experimental survival studies—helping to increase confidence and efficiency in future reviews in this area. While assessment of study precision and therefore weighting is less reliable, MSR appears to perform favourably during meta-analysis. Sensitivity of meta-regression was low for this set of parameters, so pooling of treatments to increase sample size may be required to ensure confidence in preclinical survival meta-regressions. |
| first_indexed | 2024-12-21T01:22:51Z |
| format | Article |
| id | doaj.art-490e1b6ce0e348c1b15b5742ec7e035a |
| institution | Directory Open Access Journal |
| issn | 2046-4053 |
| language | English |
| last_indexed | 2024-12-21T01:22:51Z |
| publishDate | 2021-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Systematic Reviews |
| spelling | doaj.art-490e1b6ce0e348c1b15b5742ec7e035a2022-12-21T19:20:35ZengBMCSystematic Reviews2046-40532021-11-0110111310.1186/s13643-021-01824-0Using median survival in meta-analysis of experimental time-to-event dataTheodore C. Hirst0Emily S. Sena1Malcolm R. Macleod2Centre for Clinical Brain Sciences, University of EdinburghCentre for Clinical Brain Sciences, University of EdinburghCentre for Clinical Brain Sciences, University of EdinburghAbstract Background Time-to-event data is frequently reported in both clinical and preclinical research spheres. Systematic review and meta-analysis is a tool that can help to identify pitfalls in preclinical research conduct and reporting that can help to improve translational efficacy. However, pooling of studies using hazard ratios (HRs) is cumbersome especially in preclinical meta-analyses including large numbers of small studies. Median survival is a much simpler metric although because of some limitations, which may not apply to preclinical data, it is generally not used in survival meta-analysis. We aimed to appraise its performance when compared with hazard ratio-based meta-analysis when pooling large numbers of small, imprecise studies. Methods We simulated a survival dataset with features representative of a typical preclinical survival meta-analysis, including with influence of a treatment and a number of covariates. We calculated individual patient data-based hazard ratios and median survival ratios (MSRs), comparing the summary statistics directly and their performance at random-effects meta-analysis. Finally, we compared their sensitivity to detect associations between treatment and influential covariates at meta-regression. Results There was an imperfect correlation between MSR and HR, although the opposing direction of treatment effects between summary statistics appeared not to be a major issue. Precision was more conservative for HR than MSR, meaning that estimates of heterogeneity were lower. There was a slight sensitivity advantage for MSR at meta-analysis and meta-regression, although power was low in all circumstances. Conclusions We believe we have validated MSR as a summary statistic for use in a meta-analysis of small, imprecise experimental survival studies—helping to increase confidence and efficiency in future reviews in this area. While assessment of study precision and therefore weighting is less reliable, MSR appears to perform favourably during meta-analysis. Sensitivity of meta-regression was low for this set of parameters, so pooling of treatments to increase sample size may be required to ensure confidence in preclinical survival meta-regressions.https://doi.org/10.1186/s13643-021-01824-0Systematic reviewMeta-analysisMedian survivalTime-to-eventExperimental studies |
| spellingShingle | Theodore C. Hirst Emily S. Sena Malcolm R. Macleod Using median survival in meta-analysis of experimental time-to-event data Systematic Reviews Systematic review Meta-analysis Median survival Time-to-event Experimental studies |
| title | Using median survival in meta-analysis of experimental time-to-event data |
| title_full | Using median survival in meta-analysis of experimental time-to-event data |
| title_fullStr | Using median survival in meta-analysis of experimental time-to-event data |
| title_full_unstemmed | Using median survival in meta-analysis of experimental time-to-event data |
| title_short | Using median survival in meta-analysis of experimental time-to-event data |
| title_sort | using median survival in meta analysis of experimental time to event data |
| topic | Systematic review Meta-analysis Median survival Time-to-event Experimental studies |
| url | https://doi.org/10.1186/s13643-021-01824-0 |
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