Department of Epidemiology, UT MD Anderson Cancer Center, 1155 Pressler Street - Unit 1340, Houston, Texas 77030-4009, USA.
Br J Cancer. 2010 Jul 27;103(3):423-9. doi: 10.1038/sj.bjc.6605759. Epub 2010 Jun 29.
Three lung cancer (LC) models have recently been constructed to predict an individual's absolute risk of LC within a defined period. Given their potential application in prevention strategies, a comparison of their accuracy in an independent population is important.
We used data for 3197 patients with LC and 1703 cancer-free controls recruited to an ongoing case-control study at the Harvard School of Public Health and Massachusetts General Hospital. We estimated the 5-year LC risk for each risk model and compared the discriminatory power, accuracy, and clinical utility of these models.
Overall, the Liverpool Lung Project (LLP) and Spitz models had comparable discriminatory power (0.69), whereas the Bach model had significantly lower power (0.66; P=0.02). Positive predictive values were highest with the Spitz models, whereas negative predictive values were highest with the LLP model. The Spitz and Bach models had lower sensitivity but better specificity than did the LLP model.
We observed modest differences in discriminatory power among the three LC risk models, but discriminatory powers were moderate at best, highlighting the difficulty in developing effective risk models.
最近构建了三种肺癌 (LC) 模型，以预测个体在特定时间段内的 LC 绝对风险。鉴于它们在预防策略中的潜在应用，在独立人群中比较它们的准确性非常重要。
我们使用了哈佛公共卫生学院和马萨诸塞州综合医院正在进行的病例对照研究中招募的 3197 名 LC 患者和 1703 名无癌症对照的数据。我们为每个风险模型估计了 5 年的 LC 风险，并比较了这些模型的判别能力、准确性和临床实用性。
总体而言，利物浦肺项目 (LLP) 和 Spitz 模型具有相当的判别能力 (0.69)，而 Bach 模型的能力明显较低 (0.66；P=0.02)。Spitz 模型的阳性预测值最高，而 LLP 模型的阴性预测值最高。Spitz 和 Bach 模型的敏感性低于 LLP 模型，但特异性更高。
我们观察到三种 LC 风险模型之间的判别能力存在适度差异，但判别能力充其量只是中等，这突显了开发有效风险模型的困难。
