Title: Reply from authors: A new shared vision on survival analysis: Good news from Baltimore
Abstract: The authors reported no conflicts of interest.The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. We read with interest the letter from Van den Eynde and colleagues.1Van den Eynde J. Danford D.A. Kutty S. Rethinking traditional survival analysis: modulated renewal analysis with competing risks regression.J Thorac Cardiovasc Surg Open. 2021; 8: 578-579Scopus (3) Google Scholar We must admit that it is quite difficult to reply to such a beautiful explanation of the main concept of our article. Recently, an increasing number of groups have used competing risk regression analysis to determine the influence of competing events such as mortality. As mentioned in our study, the new model combines this approach with modulated renewal analysis. This combination allows control of competing events and estimates the cause-specific probability of the event of interest at a particular time while allowing for repeated events during follow-up.2Guariento A. Doulamis I.P. Staffa S.J. Gellis L. Oh N.A. Kido T. et al.Long-term outcomes of truncus arteriosus repair: a modulated renewal competing risks analysis.J Thorac Cardiovasc Surg. February 12, 2021; ([Epub ahead of print])https://doi.org/10.1016/j.jtcvs.2021.01.136Abstract Full Text Full Text PDF Scopus (5) Google Scholar Van den Eynde and colleagues1Van den Eynde J. Danford D.A. Kutty S. Rethinking traditional survival analysis: modulated renewal analysis with competing risks regression.J Thorac Cardiovasc Surg Open. 2021; 8: 578-579Scopus (3) Google Scholar have clearly pointed out the most important advantages of this modeling technique when compared with classic Kaplan-Meier survival estimates and Cox regression analysis. Limiting the analysis to the first occurring event at follow-up results in failure to account for subsequent events and for the interactions of these with competing variables, particularly important when several events happen during the follow-up period.3Columbia Public HealthCompeting risk analysis.https://www.publichealth.columbia.edu/research/population-health-methods/competing-risk-analysisDate: 2019Google Scholar Kaplan-Meier and Cox regression models assume independence when there can be multiple causes for the event (so informative censoring is needed to avoid biased estimated of risk). As noted by some of the reviewers of our article during the peer-review process, modulated renewal is a statistical method that was brilliantly described by Kalbfleisch and Prentice.4Kalbfleisch J.D. Prentice R.L. The Statistical Analysis of Failure Time Data. Wiley, 2011https://doi.org/10.1002/9781118032985Crossref Scopus (3531) Google Scholar The terminology derives from industrial analyses (with modulated renewal characterized by the terms good as new, better than new, and worse than new). Although some groups (such as the group from the University of Alabama) have been pioneers in its use, modulated renewal analysis has not been widely applied in the context of cardiac surgery research. Therefore, the combination of modulated renewal and competing risk regression analysis can be considered a novelty in our field. It is with great enthusiasm that we welcome the words of Van den Eynde and colleagues.1Van den Eynde J. Danford D.A. Kutty S. Rethinking traditional survival analysis: modulated renewal analysis with competing risks regression.J Thorac Cardiovasc Surg Open. 2021; 8: 578-579Scopus (3) Google Scholar A great deal of effort will be needed in the coming years to promote the evolution of statistical analysis to keep pace with increasing use of big data and the growth of medical technology.5Kalfa D. Commentary: let's push on medical device innovation.J Thorac Cardiovasc Surg. February 26, 2021; ([Epub ahead of print])https://doi.org/10.1016/j.jtcvs.2021.02.074Abstract Full Text Full Text PDF Scopus (1) Google Scholar Good news from Baltimore! A new shared vision on survival analysis is coming (Figure 1). Rethinking traditional survival analysis: Modulated renewal analysis with competing risks regressionJTCVS OpenVol. 8PreviewWe read with interest the article by Guariento and colleagues1 regarding long-term outcomes of truncus arteriosus repair. In their study, the authors applied an innovative statistical methodology that they call "modulated renewal analysis with competing risks regression." In contrast to traditional survival analysis, this methodology allows one to perform time-to-event analysis of repeated events within the same patient while accounting for mortality as a competing outcome via informative censoring. Full-Text PDF Open Access