Abstract
Assessment of Temporal Selection Bias in Genomic Testing in a Cohort of Patients With Cancer
Highlights
Molecular tumor profiling is routinely performed in cancer care and research
The overall Tc was –0.18, indicating that patients undergoing genomic testing later in their disease trajectories had survival shorter than would be expected if time to testing were independent of clinical risk
This association was observed for patients initially diagnosed with stage I (Tc, −0.18; 95% CI, −0.32 to −0.05), stage II (Tc, −0.16; 95% CI, −0.27 to −0.06), and stage III (Tc, −0.24; 95% CI, −0.32 to −0.15) disease but not stage IV disease (Tc, 0.01; 95% CI, −0.03 to 0.06) (Figure, A), consistent with a pattern of genomic testing after relapse
Summary
Molecular tumor profiling is routinely performed in cancer care and research. At scale, linked tumor profiles and clinical outcomes could enable researchers to develop rich predictors of treatment effectiveness. Profiling may be ordered in clinical practice to inform treatment for worsening cancer, introducing selection bias[1] into secondary analysis of genomic data. This would manifest as systematic differences between patients who entered a cohort and those who did not, and as differences by timing of cohort entry. This analysis was conducted to evaluate such temporal selection bias in a large clinicogenomic data set.
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