Novel statistical methodology for analyzing longitudinal biomarker data.

Longitudinal designs for biomarker traits are very appealing for a number of reasons. First, the collection of repeated biomarker measurements over time allows investigators to characterize both the overall and individual trajectories in these measurements. This helps investigators to understand overall effects as well as how individuals vary around these average effects. Distinguishing individual heterogeneity from average trend is impossible without longitudinal data. This distinction is important for understanding individual between-subject in its own right, as well as in developing predictors of disease outcome from longitudinal marker data. There are many statistical issues that are unique to longitudinal data analysis ranging from correctly specifying realistic models which characterize average changes over time and individual variation, accounting for observations that are taken at unequally spaced observation times which may differ between individuals, to accounting for missing data due to occasionally missed measurements or loss to follow-up. When the reason for missing data is not related to the underlying observation process, most longitudinal data analysis methods can be routinely applied. However, complex modelling is necessary when the reason for missing an observation or dropout is directly related to the underlying outcome process [1–2]. Statistical techniques that appropriately analyze continuous and discrete longitudinal data have been discussed by many authors. Diggle, et al. [3] provides a good summary of these techniques for the practitioner, while Fitzmaurice et al. [4] discusses recent advances from a more technical perspective. The three papers in this section present innovative approaches for solving important methodological problems in biomarker studies. Most standard longitudinal data analysis techniques assume that the measurement process is independent of the outcome process. However, when the outcome is related to the underlying observation process, failure to properly account for the observation process can result in bias [5]. Schildcrout et al.[6] proposed an approach for regression modelling for longitudinal binary data where the outcome is measured with probabilities determined by an auxiliary variable that is related, but not identical to the binary outcome. Modelling multivariate longitudinal biomarker data is an increasingly common issue with the advent of an increasing number of important biomarker techniques (e.g., multiple cytokines in a multiplex assay or multiple reproductive hormones that describe complex biological phenomenon). Although various authors have proposed techniques for analyzing multivariate longitudinal data [7–8 and others], little work has focused on estimating multivariate linear mixed models under known constraints in the relationship between the multivariate outcomes. Roy et al [9] proposes such an approach for analyzing multivariate reproductive hormones over the menstrual cycle, where established relationships have solid biological justification. Finally, the collection of longitudinal biomarker data as disease predictors is becoming an increasingly important design in diagnostic medicine. Pfeiffer et al. [10] proposes flexible non-parametric methodology for combining biomarkers that exploits the longitudinal structure in formulating a score that is used for predicting a binary outcome.