Abstract
Objectives
To evaluate the empirical concordance between the hazard ratio (HR) and the median
ratio (MR) in survival cancer studies.
Study Design and Setting
We selected all cancer survival articles from the New England Journal of Medicine published between 2000 and 2010. The qualitative concordance was estimated by the
proportion of measured pairs in which the treatment effects for the MR and HR are
in the same direction. The quantitative concordance was assessed through (1) the mean
difference between the logarithms of the measures, (2) the Lin coefficient, and (3)
the Bland–Altman plot.
Results
We retrieved 106 measured pairs (HR–MR) corresponding to 54 articles. Concordance
was high, at both the qualitative (99 of 106, 93.4%) and quantitative levels (mean
MR-to-HR ratio, 1.01; 95% confidence interval: 0.95, 1.06). However, the 95% Bland–Altman
discordance limits indicate that the MR can be up to 50% higher or 50% lower than
the HR.
Conclusion
The average concordance allows trialists to approximate HR from MR to determine sample
size. However, the discordance limits are too great to consider that both measures
are interchangeable. The actual policy to report HR only is not enough. Our results
emphasize the need to attach descriptive survival measures to the HR.
Keywords
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Article info
Publication history
Published online: July 22, 2014
Accepted:
May 12,
2014
Footnotes
Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest: The authors declare that there is no conflict of interest.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
