Multistate Markov Modelling for Disease Progression of Breast Cancer Patients Based on CA15-3 Marker

  • Gurprit Grover Department of Statistics, University of Delhi, Delhi, India.
  • Prafulla Kumar Swain Department of Statistics, Utkal University, Bhubaneswar, India.
  • Komal Goel Department of Statistics, University of Delhi, Delhi, India.
  • Vikas Singh Department of General Surgery, Institute of Postgraduate Medical Education & Research, Kolkata, India.
Keywords: Multistate model, breast cancer, CA15-3 marker, prognostic factors, Cox PH model


Multi-state models are a flexible tool for analyzing complex time-to-event problems with multiple endpoints, especially in chronic diseases where the patients move through different states. It provides a more detailed insight into the disease process as compared to other statistical models. The primary objective of this paper is to study the significance of CA15-3 as a disease marker in monitoring and evaluating the diseases progression of breast cancer patients using a multistate Markov model. Based on ranges of CA15-3 marker (< 25 U/ml and ≥ 25 U/ml ) states have been defined and transition intensities, transition probabilities and expected state specific survival time have been estimated. Also, the effect of prognostic factors viz. age, tumor size, tumor grade, involve lymph nodes, ER status, PR status etc., on transition intensities have been explored.


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