Survival Analysis with Discrete Biomarkers Under a Semiparametric Bayesian Conditional Poisson Model

Discrete biomarkers derived as cell densities or counts from tissue microarrays and immunostaining are widely used to study immune signatures in relation to survival outcomes in cancer. Although routinely collected, these signatures are not measured with exact precision because the sampling mechanism involves examination of small tissue cores from a larger section of interest. We model these error-prone biomarkers as Poisson processes with latent rates, inducing heteroscedasticity in their conditional variance. While critical for tumor histology, such measurement error frameworks remain understudied for conditionally Poisson-distributed covariates. To address this, we propose a Bayesian joint model that incorporates a Dirichlet process (DP) mixture to flexibly characterize the latent covariate distribution. The proposed approach is evaluated using simulation studies which demonstrate a superior bias reduction and robustness to the underlying model in realistic settings when compared to existing methods. We further incorporate Bayes factors for hypothesis testing in the Bayesian semiparametric joint model. The methodology is applied to a survival study of high-grade serous carcinoma where comparisons are made between the proposed and existing approaches. Accompanying R software is available at the GitHub repository listed in the Web Appendices.