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Comparative performance of lung cancer risk models to define lung screening eligibility in the United Kingdom
Robbins, H. Alcala, K. Swerdlow, A. Schoemaker, M. Wareham, N. Key, T. Travis, R. Brennan, P. Crosbie, Philip A J Callister, M.
Robbins, H.
Alcala, K.
Swerdlow, A.
Schoemaker, M.
Wareham, N.
Key, T.
Travis, R.
Brennan, P.
Crosbie, Philip A J
Callister, M.
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Abstract
Introduction: The National Health Service England (NHS) classifies
individuals as eligible for lung cancer screening using two prediction
models, PLCOm2012 and Liverpool Lung Project-v2 (LLPv2).
However, no study has compared the performance of lung cancer
risk models in the United Kingdom. Methods: We analysed current
and former smokers aged 40-80 in the UK Biobank (N¼217,199),
EPIC-UK (N¼30,982), and Generations Study (N¼25,849). We
quantified model calibration (ratio of expected to observed cases, E/
O) and discrimination (AUC). Results: Risk discrimination in UK
Biobank was best for the Lung Cancer Death Risk Assessment Tool
(LCDRAT, AUC¼0.82, 95%CI¼0.81-0.84), followed by the LCRAT
(AUC¼0.81, 95%CI¼0.79-0.82) and the Bach model (AUC¼0.80,
95%CI¼0.79-0.81) (Figure). Results were similar in EPIC-UK and
the Generations Study. All models overestimated risk in all cohorts,
with E/O in UK Biobank ranging from 1.30 for PLCOm2012 (95%
CI¼1.23-1.36) to 2.16 for LLPv2 (95%CI¼2.05-2.28). Overestimation
increased with area-level socioeconomic status. In the combined cohorts, USPSTF criteria classified 50.6% of future cases as
screening-eligible. The LCDRAT and LCRAT identified 60.9%, followed
by PLCOm2012 (58.3%), Bach (58.1%), and LLPv2 (53.6%).
Conclusion: Discrimination of lung cancer risk models in UK cohorts
was highest for LCDRAT and LCRAT, and lowest for LLPv2. Our results
highlight the importance of context-specific validation for prediction
tools.
Description
Date
2021
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Robbins H, Alcala K, Swerdlow A, Schoemaker M, Wareham N, Key T, et al. P42.07 Comparative Performance of Lung Cancer Risk Models to Define Lung Screening Eligibility in the United Kingdom. Journal of Thoracic Oncology. 2021 Mar;16(3):S480.