Visualizing length of survival in time-to-event studies: a complement to Kaplan-Meier plots.

Abstract

Because of censoring, standard methods of plotting individual survival times are invalid. Therefore, graphic display of time-to-event data usually takes the form of a Kaplan-Meier survival plot. Kaplan-Meier plots, however, make differences between groups seem larger than they really are. To overcome these limitations, we developed a technique for producing scatter plots with survival data and applied it to data from a randomized trial of patients with renal cancer. As of June 21, 2001, 25 of the 347 patients with kidney cancer in the Medical Research Council RE01 randomized treatment trial for whom data were available had been censored, and the remainder had died. Values of the censored survival times were imputed by assuming a log-normal distribution in survival times and by drawing a random sample given that that each patient with censored data survived at least to the point of censoring. The combined original and imputed data were then examined by use of dot plots and scatter plots. In the RE01 trial, median survival of patients treated with interferon was 3.0 months (95% confidence interval = 0.3 to 5.5 months) longer than that in patients treated with medroxyprogesterone acetate. The Kaplan-Meier analysis showed clear separation between treatment groups and between prognostic groups. In contrast, comparisons of individual observed and imputed survival times between groups of patients showed considerable overlap and gave a more realistic idea of the modest between-group differences than Kaplan-Meier comparisons. These graphs of the distribution of survival times for individuals in each study group, which are simple to produce, may usefully complement Kaplan-Meier plots.