Validation of prediction models in the presence of competing risks: a guide through modern methods
Open accessAbstract
Thorough validation is pivotal for any prediction model before it can be advocated for use in medical practice. For time-to-event outcomes such as breast cancer recurrence, death from other causes is a competing risk. Model performance measures must account for such competing events. In this article, we present a comprehensive yet accessible overview of performance measures for this competing event setting, including the calculation and interpretation of statistical measures for calibration, discrimination, overall prediction error, and clinical usefulness by decision curve analysis. All methods are illustrated for patients with breast cancer, with publicly available data and R code.
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- Authors
- van Geloven, N., Giardiello, D., Bonneville, E. F., Teece, L., Ramspek, C. L., van Smeden, M., Snell, K. I. E., van Calster, B., Pohar-Perme, M., Riley, R. D., Putter, H., & Steyerberg, E.
- Affiliations
- Leiden University Medical Center (NL)
- Keele University (GB)
- Corresponding author
- Steyerberg, Ewout
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2022-05-24
- Volume
- 377
- Pages
- e069249
- ISSN
- 1756-1833 (ISSN-L)
- OpenAlex
- W4281398289
- Cited by
- 106
- References
- 50
- Citations by year
- 2026: 21 · 2025: 32 · 2024: 26 · 2023: 24 · 2022: 3
- FWCI
- 15.67
- Type
- journal article
- Language
- en
- Open access
- green
- pure.eur.nl
- Licence
- Locations
- BMJ (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- Leiden Repository (Leiden University) (submittedVersion, other-oa)
- Leiden Repository (Leiden University) (submittedVersion, cc-by-nc)
- dCOBISS.SI Digital Repository (submittedVersion, other-oa)
- Keele Research Repository (Keele University) (submittedVersion, cc-by)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by-nc)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Lirias (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Funders
- Javna Agencija za Raziskovalno Dejavnost RS (P3-0154)
- Topics
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods and Inference
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Keywords
- prediction model validation, competing risks, time-to-event outcomes, breast cancer recurrence, model calibration, discrimination (statistics), clinical utility, decision curve analysis, competing events
- MeSH terms
- Humans, Risk Factors, Models, Statistical, Proportional Hazards Models, Risk Assessment
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