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Keywords:

  • Covariate adjustment;
  • Cox regression;
  • Cumulative hazard ratio;
  • Empirical likelihood;
  • Nonparametric estimator;
  • Nonproportionality;
  • Simultaneous confidence bands;
  • Survival analysis;
  • Time-to-event data

Summary In medical studies, it is often of scientific interest to evaluate the treatment effect via the ratio of cumulative hazards, especially when those hazards may be nonproportional. To deal with nonproportionality in the Cox regression model, investigators usually assume that the treatment effect has some functional form. However, to do so may create a model misspecification problem because it is generally difficult to justify the specific parametric form chosen for the treatment effect. In this article, we employ empirical likelihood (EL) to develop a nonparametric estimator of the cumulative hazard ratio with covariate adjustment under two nonproportional hazard models, one that is stratified, as well as a less restrictive framework involving group-specific treatment adjustment. The asymptotic properties of the EL ratio statistic are derived in each situation and the finite-sample properties of EL-based estimators are assessed via simulation studies. Simultaneous confidence bands for all values of the adjusted cumulative hazard ratio in a fixed interval of interest are also developed. The proposed methods are illustrated using two different datasets concerning the survival experience of patients with non-Hodgkin’s lymphoma or ovarian cancer.