Jw. Chapman et al., ALTERNATIVE MULTIVARIATE MODELING FOR TIME TO LOCAL RECURRENCE FOR BREAST-CANCER PATIENTS RECEIVING A LUMPECTOMY ALONE, Surgical oncology, 5(5-6), 1996, pp. 265-271
Certain prognostic factors (patient and/or tumour characteristics) may
be associated with low (or high) risk for local recurrence. Patients
with these characteristics could be candidates for less (or more) adju
vant therapy or a less (or more) aggressive surgical approach. However
, the assessment of many factors can be problematic with the standard
multivariate technique-a Cox proportional hazards model and step-wise
regression. We compared the results obtained when using a Cox model wi
th those from four alternative models (exponential, Weibull, log logis
tic and log Normal) in step-wise and all subset regressions. Between 1
977 and 1986, 293 primary invasive breast cancer patients were treated
at the Henrietta Banting Breast Centre with a lumpectomy with or with
out an axillary dissection, and with no postoperative adjuvant therapy
. The variables considered were age, lymph node status, tumour size, e
strogen receptor (ER), progesterone receptor (PgR), histologic grade,
nuclear grade, carcinoma in situ (CIS), amount of CIS, and presence of
tumour emboli. With follow-up to 1991, nodal status was not found to
be included in the step-wise Cox model, although it was in the step-wi
se exponential, Weibull and log Normal models, and in the best all sub
set models for all model types. The variables tumour emboli, ER, age,
CIS and nodal status were consistently included in the best all subset
regressions, regardless of model type. In the 1993 follow-up, the var
iables in the stepwise Cox model were tumour emboli, ER, age, CIS and
nodal status. The multivariate consideration of all possible subsets o
f regression variables led to an earlier indication of the importance
of nodal status, while the data strongly supported accelerated failure
time models over the Cox model.