Smooth transformation models for survival analysis: A tutorial using R

Over the last five decades, we have seen strong methodological advances in survival analysis, using parametric methods and, more prominently, methods based on non-/semi-parametric estimation. As the methodological landscape continues to evolve, the task of navigating through the multitude of methods and identifying available software resources is becoming increasingly challenging-especially in more complex scenarios, such as when dealing with interval-censored or clustered survival data, non-proportional hazards, or dependent censoring. This tutorial explores the potential of using the framework of smooth transformation models for survival analysis in the R system for statistical computing. This framework provides a unified maximum-likelihood approach that covers a wide range of survival models, including well-established ones such as the Weibull model and a fully parametric version of the famous Cox proportional hazards model, and various extensions for more complex scenarios. We explore models for non-proportional/crossing hazards, dependent censoring, clustered observations and extensions towards personalized medicine within this framework. Using survival data from a two-arm randomized controlled trial on rectal cancer therapy, we demonstrate how survival analysis tasks can be seamlessly navigated in R within this framework using the implementation provided by the tram package, and few related packages.