Robust Inference for Zero-Inflated Models with Outliers Applied to the Number of Involved Lymph Nodes in Patients with Breast Cancer

Author:

Shahsavari Saeed1,Yaseri Mehdi1,Hosseini Mostafa1,Moghimbeigi Abbas2

Affiliation:

1. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran

2. Department of Biostatistics and Epidemiology, School of Health, Research Center for Health, Safety and Environment, Alborz University of Medical Sciences, Karaj

Abstract

Abstract Objective: The aim of this study is to investigate the factors that influencing the number of axillary lymph nodes in women diagnosed with early breast cancer by choosing a strong model to evaluate the excess of zeros and outliers usually present in these data. Methods: The study based on a retrospective analysis of hospital records of 669 breast cancer patients in Iran. Zero-inflated, robust zero-inflated and Bayesian modelling techniques were used to assess the association between factors studied and the number of involved lymph nodes in breast cancer patients. Count data models, including zero-inflated models (zero-inflated Poisson and zero-inflated negative binomial), robust zero-inflated models (robust zero-inflated Poisson and robust zero-inflated negative binomial) and Bayesian models (Bayesian zero-inflated Poisson and Bayesian zero-inflated negative binomial) were applied. Performance evaluation of models was compared using AIC and BIC. Results: According to the AIC and BIC, the robust zero-inflated negative binomial model is the best model. Findings indicate that women who had a larger tumor had a greater number of axillary lymph nodes, hormone receptor status was associated with the number of lymph nodes, tumor grades II and III also contributed to a higher number of lymph nodes. Women who were older had a higher risk of having lymph nodes. Conclusions: Our analysis showed that the robust zero-inflated negative binomial is the best model for predicting and describing the number of nodes involved in primary breast cancer when overdispersion and outliers occurs.

Publisher

Research Square Platform LLC

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