Cronin Kathleen A, Gail Mitchell H, Zou Zhaohui, Bach Peter B, Virtamo Jarmo, Albanes Demetrius
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
J Natl Cancer Inst. 2006 May 3;98(9):637-40. doi: 10.1093/jnci/djj163.
The Bach model was developed to predict the absolute 10-year risk of developing lung cancer among smokers by use of participants in the Carotene and Retinol Efficacy Trial of lung cancer prevention. We assessed the validity of the Bach model among 6239 smokers from the placebo arm of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study. The expected numbers of lung cancer cases and deaths without lung cancer were calculated from the Bach model and compared with the observed numbers of corresponding events over 10 years. We found that the risk model slightly underestimated the observed lung cancer risk (number of lung cancers expected/number observed = 0.89, 95% confidence interval [CI] = 0.80 to 0.99) over 10 years. The competing risk portion of the model substantially underestimated risk of non-lung cancer mortality (number of non-lung cancer deaths expected/number observed = 0.61, 95% CI = 0.57 to 0.64) over 10 years. The age-specific concordance indices for 10-year predictions were 0.77 (95% CI = 0.70 to 0.84), 0.59 (95% CI = 0.53 to 0.65), 0.62 (95% CI = 0.57 to 0.67), and 0.57 (95% CI = 0.49 to 0.67) for the age groups 50-54, 55-59, 60-64, and 65-69 years, respectively. Periodic radiographic screening in the ATBC Study may explain why slightly more cancers were observed than expected from the Bach model.
巴赫模型的开发目的是通过肺癌预防胡萝卜素和视黄醇功效试验的参与者，预测吸烟者患肺癌的绝对10年风险。我们在α-生育酚、β-胡萝卜素癌症预防（ATBC）研究安慰剂组的6239名吸烟者中评估了巴赫模型的有效性。根据巴赫模型计算出肺癌病例和无肺癌死亡的预期数量，并与10年期间相应事件的观察数量进行比较。我们发现，该风险模型在10年期间略微低估了观察到的肺癌风险（预期肺癌数量/观察到的数量 = 0.89，95%置信区间[CI] = 0.80至0.99）。该模型的竞争风险部分在10年期间大幅低估了非肺癌死亡率（预期非肺癌死亡数量/观察到的数量 = 0.61，95%CI = 0.57至0.64）。50 - 54岁、55 - 59岁、60 - 64岁和65 - 69岁年龄组10年预测的年龄特异性一致性指数分别为0.77（95%CI = 0.70至0.84）、0.59（95%CI = 0.53至0.65）、0.62（95%CI = 0.57至0.67）和0.57（95%CI = 0.49至0.67）。ATBC研究中的定期影像学筛查可能解释了为什么观察到的癌症比巴赫模型预期的略多。
