Recommendations for the analysis of competing risks in the context of randomized clinical trials are well established. Meta-analysis of individual patient data (IPD) is the gold standard for synthesizing evidence for clinical interpretation based on multiple studies. Surprisingly, no formal guidelines have been yet proposed to conduct an IPD meta-analysis with competing risk endpoints. To fill this gap, this work details (i) how to handle the heterogeneity between trials via a stratified regression model for competing risks and (ii) that the usual metrics of inconsistency to assess heterogeneity can readily be employed. Our proposal is illustrated by the re-analysis of a recently published meta-analysis in nasopharyngeal carcinoma, aiming at quantifying the benefit of the addition of chemotherapy to radiotherapy on each competing endpoint.

中文翻译：

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具有竞争性事件发生时间终点的临床试验的荟萃分析

在随机临床试验的背景下分析竞争风险的建议已经确立。个体患者数据 (IPD) 的 Meta 分析是基于多项研究为临床解释合成证据的金标准。令人惊讶的是，尚未提出正式指南来进行具有竞争风险终点的 IPD 荟萃分析。为了填补这一空白，这项工作详细说明了 (i) 如何通过竞争风险的分层回归模型处理试验之间的异质性，以及 (ii) 可以很容易地使用通常的不一致指标来评估异质性。我们的提议通过对最近发表的鼻咽癌荟萃分析的重新分析得到说明，该荟萃分析旨在量化在每个竞争终点上将化疗加入放疗的益处。