Target Trial Emulation

The protocol is not a prospective clinical trial. Published TTE work has been criticized for weak reporting of emulation methods, unclear protocols, and insufficient handling of confounders. Randomization is emulated by cloning each patient into SABR and VATS strategy copies at baseline. TTE requires researchers to specify a hypothetical randomized trial protocol before applying it to available data. The target trial framework clarifies the causal question by describing the ideal randomized trial that would answer it. Target trial emulation applies randomized-trial design principles to observational data to reduce bias and clarify causal estimands. The grace period is intended to reduce immortal time bias from unequal waiting times between SABR and surgery. The protocol specifies an ideal hypothetical randomized trial and describes how it will be emulated with observational administrative data. The emulation aims to approximate random assignment to SES groups by assuming exchangeability conditional on measured baseline covariates. The real-world emulation used cohort entry as first-ever GLP-1RA or SGLT-2i prescription as first second-line glucose-lowering therapy from January 1, 2…