Comparative performance of lung cancer risk models to define lung screening eligibility in the United Kingdom
Crosbie, Philip A
AffiliationInternational Agency for Research on Cancer, Lyon/FR,
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AbstractIntroduction: 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.
CitationRobbins 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.
JournalJournal of Thoracic Oncology
TypeMeetings and Proceedings