Analysis of Prognostic Factors of Low-Grade Gliomas in Adults Using Time-Dependent Competing Risk Models: A Population Study Based on the Surveillance, Epidemiology, and End Results Database

Abstract

Background Because of multiple competing death outcomes and time-varying coefficients, using a Cox regression model to analyze the prognostic factors of low-grade gliomas (LGG) may lead to a possible bias. Therefore, we adopted time-dependent competing risk models to obtain accurate prognostic factors for LGG. Methods In this retrospective cohort study, data were extracted from patients enrolled in the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2018. Univariate analysis was performed using the cumulative incidence function (CIF) and Kaplan-Meier (KM) function. Time-dependent competing risk and Cox regression models were used in the multivariable analysis. Results A total of 2581 patients were diagnosed with low-grade glioma, among whom 889 died from low-grade glioma, 114 died from other causes, and the rest were alive. The time-dependent competing risk models indicated that age, sex, marital status, primary tumor site, histological type, tumor diameter, surgery, and year of diagnosis were significantly associated with low-grade glioma-specific death, and the relative effect of age, tumor diameter, surgery, oligodendroglioma, and mixed glioma on low-grade glioma-specific death changed over time. Compared with the competing risk models, the Cox regression model misestimated the hazard ratio (HR) of covariates on the outcome and even produced false-negative results. Conclusions The time-dependent competing risk models were better than the Cox regression model for evaluating the impact of covariates on low-grade glioma-specific mortality in the presence of competing risks and time-varying coefficients. The models identified the prognostic factors of LGG more accurately than the Cox regression model.