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Flexible modeling of hazard ratio curves in multi-state models

In this presentation we propose a flexible approach using P-splines to allow for non-linear relationships between continuous predictors and survival in the multi-state framework. To obtain immediately interpretable results we construct smooth hazard ratio curves with confidence intervals to describe the relation between the continuous predictor and risk when a specific value is taken as the reference. These methods are illustrated on a database on breast cancer using a progressive three-state semi-Markov model.
 
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