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Article ; Online: Informative presence bias in analyses of electronic health records-derived data: a cautionary note.

Harton, Joanna / Mitra, Nandita / Hubbard, Rebecca A

Journal of the American Medical Informatics Association : JAMIA

2022 Volume 29, Issue 7, Page(s) 1191–1199

Abstract: Objective: Electronic health record (EHR)-derived data are extensively used in health research. However, the pattern of patient interaction with the healthcare system can result in informative presence bias if those who have poorer health have more data ...

Abstract	Objective: Electronic health record (EHR)-derived data are extensively used in health research. However, the pattern of patient interaction with the healthcare system can result in informative presence bias if those who have poorer health have more data recorded than healthier patients. We aimed to determine how informative presence affects bias across multiple scenarios informed by real-world healthcare utilization patterns. Materials and methods: We conducted an analysis of EHR data from a pediatric healthcare system as well as simulation studies to characterize conditions under which informative presence bias is likely to occur. This analysis extends prior work by examining a variety of scenarios for the relationship between a biomarker and a health event of interest and the healthcare visit process. Results: Using biomarker values gathered at both informative and noninformative visits when estimating the effect of the biomarker on the event of interest resulted in minimal bias when the biomarker was relatively stable over time but produced substantial bias when the biomarker was more volatile. Adjusting analyses for the number of prior visits within a fixed look-back window was able to reduce but not eliminate this bias. Discussion: These results suggest that bias may arise frequently in commonly encountered scenarios and may not be eliminated by adjusting for prior visit intensity. Conclusion: Depending on the context, the estimated effect from analyses using data from all visits available may diverge from the true effect. Sensitivity analyses using only visits likely to be informative or noninformative based on visit type may aid in the assessment of the magnitude of potential bias.
MeSH term(s)	Bias ; Child ; Computer Simulation ; Electronic Health Records ; Humans
Language	English
Publishing date	2022-04-19
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1205156-1
ISSN	1527-974X ; 1067-5027
ISSN (online)	1527-974X
ISSN	1067-5027
DOI	10.1093/jamia/ocac050
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Zs.A 4128: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Bias Reduction Methods for Propensity Scores Estimated from Error-Prone EHR-Derived Covariates.

Harton, Joanna / Mamtani, Ronac / Mitra, Nandita / Hubbard, Rebecca A

Health services & outcomes research methodology

2020 Volume 21, Page(s) 169–187

Abstract: As the use of electronic health records (EHR) to estimate treatment effects has become widespread, concern about bias introduced by error in EHR-derived covariates has also grown. While methods exist to address measurement error in individual covariates, ...

Abstract	As the use of electronic health records (EHR) to estimate treatment effects has become widespread, concern about bias introduced by error in EHR-derived covariates has also grown. While methods exist to address measurement error in individual covariates, little prior research has investigated the implications of using propensity scores for confounder control when the propensity scores are constructed from a combination of accurate and error-prone covariates. We reviewed approaches to account for error in propensity scores and used simulation studies to compare their performance. These comparisons were conducted across a range of scenarios featuring variation in outcome type, validation sample size, main sample size, strength of confounding, and structure of the error in the mismeasured covariate. We then applied these approaches to a real-world EHR-based comparative effectiveness study of alternative treatments for metastatic bladder cancer. This head-to-head comparison of measurement error correction methods in the context of a propensity score-adjusted analysis demonstrated that multiple imputation for propensity scores performs best when the outcome is continuous and regression calibration-based methods perform best when the outcome is binary.
Language	English
Publishing date	2020-09-10
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1454630-9
ISSN	1387-3741
ISSN	1387-3741
DOI	10.1007/s10742-020-00219-3
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Zs.A 6488: Show issues

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Book ; Online: Combining Real-World and Randomized Control Trial Data Using Data-Adaptive Weighting via the On-Trial Score

Harton, Joanna / Segal, Brian / Mamtani, Ronac / Mitra, Nandita / Hubbard, Rebecca

2021

Abstract: Clinical trials with a hybrid control arm (a control arm constructed from a combination of randomized patients and real-world data on patients receiving usual care in standard clinical practice) have the potential to decrease the cost of randomized ... ...

Abstract	Clinical trials with a hybrid control arm (a control arm constructed from a combination of randomized patients and real-world data on patients receiving usual care in standard clinical practice) have the potential to decrease the cost of randomized trials while increasing the proportion of trial patients given access to novel therapeutics. However, due to stringent trial inclusion criteria and differences in care and data quality between trials and community practice, trial patients may have systematically different outcomes compared to their real-world counterparts. We propose a new method for analyses of trials with a hybrid control arm that efficiently controls bias and type I error. Under our proposed approach, selected real-world patients are weighted by a function of the "on-trial score," which reflects their similarity to trial patients. In contrast to previously developed hybrid control designs that assign the same weight to all real-world patients, our approach upweights of real-world patients who more closely resemble randomized control patients while dissimilar patients are discounted. Estimates of the treatment effect are obtained via Cox proportional hazards models. We compare our approach to existing approaches via simulations and apply these methods to a study using electronic health record data. Our proposed method is able to control type I error, minimize bias, and decrease variance when compared to using only trial data in nearly all scenarios examined. Therefore, our new approach can be used when conducting clinical trials by augmenting the standard-of-care arm with weighted patients from the EHR to increase power without inducing bias. Comment: Presented at JSM 2020, ASA Biopharmaceutical Section Regulatory-Industry Statistics Workshop 2020, submitted to Pharmaceutical Statistics on 8/17/21
Keywords	Statistics - Methodology
Subject code	310 ; 610
Publishing date	2021-08-19
Publishing country	us
Document type	Book ; Online
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Article ; Online: Radiation dose is associated with improved local control for large, but not small, hepatocellular carcinomas.

Amit, Uri / Mohiuddin, Jahan J / Wojcieszynski, Andrzej P / Harton, Joanna / Williams, Graeme / Manjunath, Shwetha / Grandhi, Nikhil / Doucette, Abigail / Plastaras, John P / Metz, James M / Ben-Josef, Edgar

Radiation oncology (London, England)

2023 Volume 18, Issue 1, Page(s) 133

Abstract: Background: With advances in understanding liver tolerance, conformal techniques, image guidance, and motion management, dose-escalated radiotherapy has become a potential treatment for inoperable hepatocellular carcinoma (HCC). We aimed to evaluate the ...

Abstract	Background: With advances in understanding liver tolerance, conformal techniques, image guidance, and motion management, dose-escalated radiotherapy has become a potential treatment for inoperable hepatocellular carcinoma (HCC). We aimed to evaluate the possible impact of biologically effective dose (BED) on local control and toxicity among patients with HCC. Methods and materials: Patients treated at our institution from 2009 to 2018 were included in this retrospective analysis if they received definitive-intent radiotherapy with a nominal BED of at least 60 Gy. Patients were stratified into small and large tumors using a cutoff of 5 cm, based on our clinical practice. Toxicity was assessed using ALBI scores and rates of clinical liver function deterioration. Results: One hundred and twenty-eight patients were included, with a mean follow-up of 16 months. The majority of patients (90.5%) had a good performance status (ECOG 0-1), with Child-Pugh A (66.4%) and ALBI Grade 2 liver function at baseline (55.4%). Twenty (15.6%) patients had a local recurrence in the irradiated field during the follow-up period. Univariate and multivariate Cox proportional hazard analyses showed that only BED significantly predicted local tumor recurrence. Higher BED was associated with improved local control in tumors with equivalent diameters over 5 cm but not in smaller tumors. There was no difference in liver toxicity between the low and high-dose groups. Conclusions: Higher radiotherapy dose is associated with improved local control in large tumors but not in tumors smaller than 5 cm in diameter. High-dose radiotherapy was not associated with increased liver toxicity.
MeSH term(s)	Humans ; Carcinoma, Hepatocellular/radiotherapy ; Carcinoma, Hepatocellular/pathology ; Liver Neoplasms/radiotherapy ; Liver Neoplasms/pathology ; Retrospective Studies ; Radiation Dosage
Language	English
Publishing date	2023-08-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2224965-5
ISSN	1748-717X ; 1748-717X
ISSN (online)	1748-717X
ISSN	1748-717X
DOI	10.1186/s13014-023-02318-0
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Article: Immunological Functions of the Membrane Proximal Region of MHC Class II Molecules.

Harton, Jonathan / Jin, Lei / Hahn, Amy / Drake, Jim

F1000Research

2016 Volume 5

Abstract: Major histocompatibility complex (MHC) class II molecules present exogenously derived antigen peptides to CD4 T cells, driving activation of naïve T cells and supporting CD4-driven immune functions. However, MHC class II molecules are not inert protein ... ...

Abstract	Major histocompatibility complex (MHC) class II molecules present exogenously derived antigen peptides to CD4 T cells, driving activation of naïve T cells and supporting CD4-driven immune functions. However, MHC class II molecules are not inert protein pedestals that simply bind and present peptides. These molecules also serve as multi-functional signaling molecules delivering activation, differentiation, or death signals (or a combination of these) to B cells, macrophages, as well as MHC class II-expressing T cells and tumor cells. Although multiple proteins are known to associate with MHC class II, interaction with STING (stimulator of interferon genes) and CD79 is essential for signaling. In addition, alternative transmembrane domain pairing between class II α and β chains influences association with membrane lipid sub-domains, impacting both signaling and antigen presentation. In contrast to the membrane-distal region of the class II molecule responsible for peptide binding and T-cell receptor engagement, the membrane-proximal region (composed of the connecting peptide, transmembrane domain, and cytoplasmic tail) mediates these "non-traditional" class II functions. Here, we review the literature on the function of the membrane-proximal region of the MHC class II molecule and discuss the impact of this aspect of class II immunobiology on immune regulation and human disease.
Language	English
Publishing date	2016-03-17
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2699932-8
ISSN	2046-1402
ISSN	2046-1402
DOI	10.12688/f1000research.7610.1
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Article ; Online: A mixed methods study examining teamwork shared mental models of interprofessional teams during hospital discharge.

Manges, Kirstin / Groves, Patricia S / Farag, Amany / Peterson, Ryan / Harton, Joanna / Greysen, S Ryan

BMJ quality & safety

2019 Volume 29, Issue 6, Page(s) 499–508

Abstract: Background: Little is known about how team processes impact providers' abilities to prepare patients for a safe hospital discharge. Teamwork Shared Mental Models (teamwork-SMMs) are the teams' organised understanding of individual member's roles, ... ...

Abstract	Background: Little is known about how team processes impact providers' abilities to prepare patients for a safe hospital discharge. Teamwork Shared Mental Models (teamwork-SMMs) are the teams' organised understanding of individual member's roles, interactions and behaviours needed to perform a task like hospital discharge. Teamwork-SMMs are linked to team effectiveness in other fields, but have not been readily investigated in healthcare. This study examines teamwork-SMMs to understand how interprofessional teams coordinate care when discharging patients. Methods: This mixed methods study examined teamwork-SMMs of inpatient interprofessional discharge teams at a single hospital. For each discharge event, we collected data from the patient and their discharge team (nurse, physician and coordinator) using interviews and questionnaires. We quantitatively determined the discharge teams' teamwork-SMM components of quality and convergence using the Shared Mental Model Scale, and then explored their relationships to patient-reported preparation for posthospital care. We used qualitative thematic analysis of narrative cases to examine the contextual differences of discharge teams with higher versus lower teamwork-SMMs. Results: The sample included a total of 106 structured patient interviews, 192 provider day-of-discharge questionnaires and 430 observation hours to examine 64 discharge events. We found that inpatient teams with better teamwork-SMMs (ie, higher perceptions of teamwork quality or greater convergence) were more effective at preparing patients for post-hospital care. Additionally, teams with high and low teamwork-SMMs had different experiences with team cohesion, communication openness and alignment on the patient situation. Conclusions: Examining the quality and agreement of teamwork-SMMs among teams provides a better understanding of how teams coordinate care and may facilitate the development of specific team-based interventions to improve patient care at hospital discharge.
MeSH term(s)	Attitude of Health Personnel ; Clinical Competence ; Health Personnel/psychology ; Hospitals, Community ; Humans ; Interdisciplinary Communication ; Interviews as Topic ; Models, Psychological ; Patient Care Team ; Patient Discharge ; Quality of Health Care ; United States
Language	English
Publishing date	2019-11-27
Publishing country	England
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2592909-4
ISSN	2044-5423 ; 2044-5415
ISSN (online)	2044-5423
ISSN	2044-5415
DOI	10.1136/bmjqs-2019-009716
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Zs.A 3754: Show issues

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Article ; Online: Acute toxicity in patients treated with concurrent chemoradiotherapy with proton versus intensity-modulated radiation therapy for nonmetastatic head and neck cancers.

Kim, Kristine N / Harton, Joanna / Mitra, Nandita / Lukens, John N / Lin, Alexander / Amaniera, Isabella / Doucette, Abigail / Gabriel, Peter / Baumann, Brian / Metz, James / Wojcieszynski, Andrzej

Head & neck

2022 Volume 44, Issue 11, Page(s) 2386–2394

Abstract: Background: We evaluated if proton therapy is associated with decreased acute toxicities compared to intensity-modulated radiation therapy (IMRT) in patients receiving concurrent chemoradiotherapy for head and neck cancers.: Methods: We analyzed 580 ... ...

Abstract	Background: We evaluated if proton therapy is associated with decreased acute toxicities compared to intensity-modulated radiation therapy (IMRT) in patients receiving concurrent chemoradiotherapy for head and neck cancers. Methods: We analyzed 580 patients with nonmetastatic head and neck cancers. Primary endpoint was any 90-day grade ≥3 toxicity, prospectively collected and graded per CTCAEv4. Modified Poisson regression models were used. Results: Ninety-five patients received proton and 485 IMRT. The proton group had more HPV-positive tumors (65.6 vs. 58.0%, p = 0.049), postoperative treatment (76.8 vs. 62.1%, p = 0.008), unilateral neck treatment (18.9 vs. 6.6%, p < 0.001) and significantly lower doses to organs-at-risk compared to IMRT group. Adjusted for patient and treatment characteristics, the proton group had decreased grade 2 dysgeusia (RR0.67, 95%CI 0.53-0.84, p = 0.004) and a trend toward lower grade ≥3 toxicities (RR0.60, 95%CI 0.41-0.88, p = 0.06). Conclusions: Proton therapy was associated with significantly reduced grade 2 dysgeusia and nonstatistically significant decrease in acute grade ≥3 toxicities compared to IMRT.
MeSH term(s)	Chemoradiotherapy/adverse effects ; Dysgeusia/etiology ; Head and Neck Neoplasms/etiology ; Head and Neck Neoplasms/therapy ; Humans ; Proton Therapy/adverse effects ; Protons ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated/adverse effects
Chemical Substances	Protons
Language	English
Publishing date	2022-07-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	645165-2
ISSN	1097-0347 ; 0148-6403 ; 1043-3074
ISSN (online)	1097-0347
ISSN	0148-6403 ; 1043-3074
DOI	10.1002/hed.27146
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Zs.A 1493: Show issues

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Article ; Online: A Bayesian latent class approach for EHR-based phenotyping.

Hubbard, Rebecca A / Huang, Jing / Harton, Joanna / Oganisian, Arman / Choi, Grace / Utidjian, Levon / Eneli, Ihuoma / Bailey, L Charles / Chen, Yong

Statistics in medicine

2018 Volume 38, Issue 1, Page(s) 74–87

Abstract: Phenotyping, ie, identification of patients possessing a characteristic of interest, is a fundamental task for research conducted using electronic health records. However, challenges to this task include imperfect sensitivity and specificity of clinical ... ...

Abstract	Phenotyping, ie, identification of patients possessing a characteristic of interest, is a fundamental task for research conducted using electronic health records. However, challenges to this task include imperfect sensitivity and specificity of clinical codes and inconsistent availability of more detailed data such as laboratory test results. Despite these challenges, most existing electronic health records-derived phenotypes are rule-based, consisting of a series of Boolean arguments informed by expert knowledge of the disease of interest and its coding. The objective of this paper is to introduce a Bayesian latent phenotyping approach that accounts for imperfect data elements and missing not at random missingness patterns that can be used when no gold-standard data are available. We conducted simulation studies to compare alternative phenotyping methods under different patterns of missingness and applied these approaches to a cohort of 68 265 children at elevated risk for type 2 diabetes mellitus (T2DM). In simulation studies, the latent class approach had similar sensitivity to a rule-based approach (95.9% vs 91.9%) while substantially improving specificity (99.7% vs 90.8%). In the PEDSnet cohort, we found that biomarkers and clinical codes were strongly associated with latent T2DM status. The latent T2DM class was also strongly predictive of missingness in biomarkers. Glucose was missing in 83.4% of patients (odds ratio for latent T2DM status = 0.52) while hemoglobin A1c was missing in 91.2% (odds ratio for latent T2DM status = 0.03 ), suggesting missing not at random missingness. The latent phenotype approach may substantially improve on rule-based phenotyping.
MeSH term(s)	Adolescent ; Bayes Theorem ; Child ; Clinical Coding/statistics & numerical data ; Diabetes Mellitus, Type 2/etiology ; Electronic Health Records/statistics & numerical data ; Female ; Humans ; Latent Class Analysis ; Male ; Phenotype ; Risk Factors ; Sensitivity and Specificity
Language	English
Publishing date	2018-09-03
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	843037-8
ISSN	1097-0258 ; 0277-6715
ISSN (online)	1097-0258
ISSN	0277-6715
DOI	10.1002/sim.7953
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Zs.A 1756: Show issues

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Article ; Online: The CLRX.1/NOD24 (NLRP2P) pseudogene codes a functional negative regulator of NF-κB, pyrin-only protein 4.

Porter, K A / Duffy, E B / Nyland, P / Atianand, M K / Sharifi, H / Harton, J A

Genes and immunity

2014 Volume 15, Issue 6, Page(s) 392–403

Abstract: Pseudogenes are duplicated yet defunct copies of functional parent genes. However, some pseudogenes have gained or retained function. In this study, we consider a functional role for the NLRP2-related, higher primate-specific, processed pseudogene NLRP2P, ...

Abstract	Pseudogenes are duplicated yet defunct copies of functional parent genes. However, some pseudogenes have gained or retained function. In this study, we consider a functional role for the NLRP2-related, higher primate-specific, processed pseudogene NLRP2P, which is closely related to Pyrin-only protein 2 (POP2/PYDC2), a regulator of nuclear factor-κB (NF-κB) and the inflammasome. The NLRP2P open-reading frame on chromosome X has features consistent with a processed pseudogene (retrotransposon), yet encodes a 45-amino-acid, Pyrin-domain-related protein. The open-reading frame of NLRP2P shares 80% identity with POP2 and is under purifying selection across Old World primates. Although widely expressed, NLRP2P messenger RNA is upregulated by lipopolysaccharide in human monocytic cells. Functionally, NLRP2P impairs NF-κB p65 transactivation by reducing activating phosphorylation of RelA/p65. Reminiscent of POP2, NLRP2P reduces production of the NF-κB-dependent cytokines tumor necrosis factor alpha and interleukin (IL)-6 following toll-like receptor stimulation. In contrast to POP2, NLRP2P fails to inhibit the ASC-dependent NLRP3 inflammasome. In addition, beyond regulating cytokine production, NLRP2P has a potential role in cell cycle regulation and cell death. Collectively, our findings suggest that NLRP2P is a resurrected processed pseudogene that regulates NF-κB RelA/p65 activity and thus represents the newest member of the POP family, POP4.
MeSH term(s)	Adaptor Proteins, Signal Transducing/genetics ; Adaptor Proteins, Signal Transducing/metabolism ; Animals ; Apoptosis/genetics ; Apoptosis Regulatory Proteins ; Base Sequence ; Blotting, Western ; Cell Cycle/genetics ; Cell Line ; Cell Line, Tumor ; Cell Nucleus/metabolism ; Gene Expression Regulation/drug effects ; HEK293 Cells ; HeLa Cells ; Humans ; Lipopolysaccharides/pharmacology ; Microscopy, Fluorescence ; Molecular Sequence Data ; Phosphorylation ; Pseudogenes/genetics ; RNA Interference ; Repressor Proteins/metabolism ; Retroelements/genetics ; Reverse Transcriptase Polymerase Chain Reaction ; Serine/metabolism ; Transcription Factor RelA/genetics ; Transcription Factor RelA/metabolism ; Tumor Necrosis Factor-alpha/pharmacology
Chemical Substances	Adaptor Proteins, Signal Transducing ; Apoptosis Regulatory Proteins ; Lipopolysaccharides ; NLRP2 protein, human ; NLRP4 protein, human ; RELA protein, human ; Repressor Proteins ; Retroelements ; Transcription Factor RelA ; Tumor Necrosis Factor-alpha ; Serine (452VLY9402)
Language	English
Publishing date	2014-05-29
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2060566-3
ISSN	1476-5470 ; 1466-4879
ISSN (online)	1476-5470
ISSN	1466-4879
DOI	10.1038/gene.2014.30
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Zs.A 5592: Show issues

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Article ; Online: Effectiveness of First-line Immune Checkpoint Blockade Versus Carboplatin-based Chemotherapy for Metastatic Urothelial Cancer.

Feld, Emily / Harton, Joanna / Meropol, Neal J / Adamson, Blythe J S / Cohen, Aaron / Parikh, Ravi B / Galsky, Matthew D / Narayan, Vivek / Christodouleas, John / Vaughn, David J / Hubbard, Rebecca A / Mamtani, Ronac

European urology

2019 Volume 76, Issue 4, Page(s) 524–532

Abstract: Background: Limited data compare first-line carboplatin-based chemotherapy and immune checkpoint blockade in cisplatin-ineligible metastatic urothelial carcinoma (mUC) patients. The primary evidence guiding treatment decisions was a recent Food and Drug ...

Abstract	Background: Limited data compare first-line carboplatin-based chemotherapy and immune checkpoint blockade in cisplatin-ineligible metastatic urothelial carcinoma (mUC) patients. The primary evidence guiding treatment decisions was a recent Food and Drug Administration/European Medicines Agency safety alert based on emerging data from two ongoing phase III trials, reporting shorter survival in programmed death-ligand 1 (PD-L1)-negative patients receiving immunotherapy. Final results from these trials are unknown. Objective: To compare survival in cisplatin-ineligible mUC patients receiving first-line immunotherapy versus those receiving carboplatin-based chemotherapy. Design, setting, and participants: We conducted a retrospective cohort study of 2017 mUC patients receiving first-line carboplatin-based chemotherapy (n = 1530) or immunotherapy (n = 487) from January 1, 2011 to May 18, 2018 using the Flatiron Health electronic health record-derived database. Outcome measurements and statistical analysis: The primary outcomes were overall survival (OS), comparing 12- and 36-mo OS, and hazard ratios before and after 12 mo. Propensity score-based inverse probability of treatment weighting (IPTW) was used to address confounding in Kaplan-Meier and Cox regression model estimates of comparative effectiveness. Results and limitations: IPTW-adjusted OS rates in the immunotherapy group were lower at 12 mo (39.6% [95% confidence interval {CI} 34.0-45.3%] vs 46.1% [95% CI 43.4-48.8%]) but higher at 36 mo (28.3% [95% CI 21.8-34.7%] vs 13.3% [95% CI 11.1-15.5%]) relative to the chemotherapy group. Immunotherapy treatment demonstrated inferior OS during the first 12 mo relative to carboplatin-based chemotherapy (IPTW-adjusted hazard ratio [HR] 1.37, 95% CI 1.15-1.62), but superior OS beyond 12 mo (IPTW-adjusted HR 0.50, 95% CI 0.30-0.85). Limitations include retrospective design and potential unmeasured confounding. Conclusions: In the setting of mUC, clinicians and patients should carefully consider how to balance the short-term benefit of chemotherapy against the long-term benefit of immunotherapy. Patient summary: To determine the optimal first-line therapy for metastatic bladder cancer patients who are unfit for cisplatin, we compared carboplatin-based chemotherapy versus immunotherapy using real-world data. Survival in the 1st year of treatment was lower with immunotherapy relative to chemotherapy, but for patients surviving beyond the 1st year, immunotherapy was superior.
MeSH term(s)	Aged ; Antineoplastic Agents/therapeutic use ; Carboplatin/therapeutic use ; Carcinoma, Transitional Cell/drug therapy ; Carcinoma, Transitional Cell/secondary ; Cohort Studies ; Female ; Humans ; Immune Checkpoint Inhibitors/therapeutic use ; Male ; Retrospective Studies ; Urologic Neoplasms/drug therapy ; Urologic Neoplasms/pathology
Chemical Substances	Antineoplastic Agents ; Immune Checkpoint Inhibitors ; Carboplatin (BG3F62OND5)
Language	English
Publishing date	2019-07-28
Publishing country	Switzerland
Document type	Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	193790-x
ISSN	1873-7560 ; 1421-993X ; 0302-2838
ISSN (online)	1873-7560 ; 1421-993X
ISSN	0302-2838
DOI	10.1016/j.eururo.2019.07.032
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