Position: Stop Chasing the C-index when Evaluating Survival Analysis Models
Bibliographic record
Abstract
The current state of evaluation in survival analysis is plagued by the persistent use of evaluation metrics in ways that are misaligned with the stated modeling objective. In addition, many such evaluations are based on censoring assumptions that are left implicit or unjustified. This means that the reported performance can be misleading and may fail to answer the scientific or modeling question the evaluation was intended to address. In this position paper, we critically examine evaluation practices in survival analysis and highlight how censoring makes evaluation fundamentally different from standard regression or classification. We place particular focus on concordance-based measures, such as the C-index, which we show are heavily overused in the literature. To help identify appropriate metrics, we propose a set of key desiderata and introduce a double-helix ladder, in which valid evaluation requires alignment between metric and modeling assumptions. Through controlled experiments, we show that violations of this alignment can lead to misleading model comparisons. We conclude by providing practical guidance on how to evaluate a survival model.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.000 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".