生存资料的Decision Curve Analysis-DCA分析

作者：白介素2

本文内容包括:

1. 基于生存资料的DCA分析（目前为止尚无成熟的软件包可用）
2. MSKCC提供的源函数（搬运工,应用这个函数，并翻译该函数的参数）
3. 示例展示多因素cox模型的DCA分析，以lung数据集为例
4. 示例展示单因素cox模型的DCA分析，分别以melanoma, lung两个数据集展示
5. 绘制net reduction in interventions随阈概率变化的关系

决策曲线分析

• 决策曲线分析是评估预测模型，诊断测试和分子标记的简单方法。

• 该方法首次在2006年由MSKCC的 Vickers AJ博士发表在 Medical Decision Making杂志上，Vickers AJ, Elkin EB. Decision curve analysis: a novel method for evaluating prediction models. Medical Decision Making. 2006 Nov-Dec;26(6):565-74.，相对于ROC曲线还是比较年轻的一种方法.

• 2008年又进一步在该杂志上详细描述了该方法: Steyerberg EW, Vickers AJ. Decision curve analysis: a discussion. Medical Decision Making. 2008 Jan-Feb;28(1):146-9.

• 2008年11月，Vickers AJ又进一步扩展了 DCA的应用范围，推广到了生存资料的分析，用于评估诊断试验，分子标志，预测模型：Vickers AJ, Cronin AM, Elkin EB, Gonen M. BMC Medical Informatics and Decision Making. 2008 Nov 26;8(1):53. Extensions to decision curve analysis, a novel method for evaluating diagnostic tests, prediction models and molecular markers.

• 更多关于 DCA的理论知识可以参考以下文献资源：

  • Vickers AJ. Decision analysis for the evaluation of diagnostic tests, - prediction models and molecular markers. Am Stat. 2008;62(4):314-320.

  • Baker SG, Cook NR, Vickers A, Kramer BS. Using relative utility curves to evaluate risk prediction. J R Stat Soc Ser A Stat Soc. 2009 Oct 1;172(4):729-748.

  • Steyerberg EW, Vickers AJ, Cook NR, Gerds T, Gonen M, Obuchowski N, Pencina MJ, Kattan MW. Assessing the performance of prediction models: a framework for traditional and novel measures. Epidemiology. 2010 Jan;21(1):128-38.

  • Vickers AJ, Cronin AM. Traditional statistical methods for evaluating prediction models are uninformative as to clinical value: towards a decision analytic framework. Semin Oncol. 2010 Feb;37(1):31-8.

• 两篇关于治疗反应的扩展DCA分析论文

  • Vickers AJ, Kattan MW, Daniel S. Method for evaluating prediction models that apply the results of randomized trials to individual patients. Trials. 2007;8:14

  • Vickers AJ, Kramer BS, Baker SG. Selecting patients for randomized trials: a systematic approach based on risk group. Trials. 2006;7:30.

多个主流期刊推荐DCA方法的文章

• 主流杂志包括：JCO,BMJ,Ann Intern Med, JAMA等大名鼎鼎的杂志

• Kerr KF, Brown MD, Zhu K, Janes H. Assessing the Clinical Impact of Risk Prediction Models With Decision Curves: Guidance for Correct Interpretation and Appropriate Use. J Clin Oncol. 2016 Jul 20;34(21):2534-40. doi: 10.1200/JCO.2015.65.5654.

• Vickers AJ, Van Calster B, Steyerberg EW. Net benefit approaches to the evaluation of prediction models, molecular markers, and diagnostic tests. BMJ. 2016 Jan 25;352:i6. doi: 10.1136/bmj.i6.

• Fitzgerald M, Saville BR, Lewis RJ. Decision curve analysis. JAMA. 2015 Jan 27;313(4):409-10. doi: 10.1001/jama.2015.37.

• Localio AR, Goodman S. Beyond the usual prediction accuracy metrics: reporting results for clinical decision making. Ann Intern Med. 2012 Aug 21;157(4):294-5. doi: 10.7326/0003-4819-157-4-201208210-00014.