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Comment & Response |

Competing Risk of Death in Kaplan-Meier Curves When Analyzing Subsequent Keratinocyte Cancer—Reply

Mackenzie R. Wehner, MD, MPhil1; Eleni Linos, MD, DrPH2; W. John Boscardin, PhD3; Mary-Margaret Chren, MD2,4
[+] Author Affiliations
1Department of Dermatology, University of Pennsylvania, Philadelphia
2Department of Dermatology, University of California, San Francisco
3Department of Epidemiology and Biostatistics, University of California, San Francisco
4Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
JAMA Dermatol. 2016;152(4):494-495. doi:10.1001/jamadermatol.2015.5153.
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In Reply We appreciate the letter by Verkouteren et al, which challenges our specialty to think about rigorous methodological issues. We agree that death is a competing risk, as it is in every survival analysis, and that overestimation is a possibility when using standard Kaplan-Meier analyses. Competing risks analysis using a cumulative incidence curve (CIC) may give a lower estimate than Kaplan-Meier, especially when death is a frequent outcome.

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Figure.
Illustrated Are 1 − Kaplan-Meier Curves and Cumulative Incidence Curves (CIC) of the Probability of Developing a Subsequent Keratinocyte Carcinoma (KC)

In red are the results from Kaplan-Meier analysis, with upper and lower 95% CIs in dotted red lines. In blue are the results of the CIC analysis, with upper and lower 95% CIs in dotted blue lines.

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April 1, 2016
Joris A. C. Verkouteren, MD; Tamar Nijsten, MD, PhD; Loes M. Hollestein, PhD
1Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
1Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands2Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
JAMA Dermatol. 2016;152(4):493-494. doi:10.1001/jamadermatol.2015.5152.
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