Molecular and Clinical Cancer Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
Thorax. 2021 Feb;76(2):161-168. doi: 10.1136/thoraxjnl-2020-215158. Epub 2020 Oct 20.
Early detection of lung cancer saves lives, as demonstrated by the two largest published low-dose CT screening trials. Optimal implementation depends on our ability to identify those most at risk.
Version 2 of the Liverpool Lung Project risk score (LLPv2) was developed from case-control data in Liverpool and further adapted when applied for selection of subjects for the UK Lung Screening Trial. The objective was to produce version 3 (LLPv3) of the model, by calibration to national figures for 2017. We validated both LLPv2 and LLPv3 using questionnaire data from 75 958 individuals, followed up for lung cancer over 5 years. We validated both discrimination, using receiver operating characteristic (ROC) analysis, and absolute incidence, by comparing deciles of predicted incidence with observed incidence. We calculated proportionate difference as the percentage excess or deficit of observed cancers compared with those predicted. We also carried out Hosmer-Lemeshow tests.
There were 599 lung cancers diagnosed over 5 years. The discrimination of both LLPv2 and LLPv3 was significant with an area under the ROC curve of 0.81 (95% CI 0.79 to 0.82). However, LLPv2 overestimated absolute risk in the population. The proportionate difference was -58.3% (95% CI -61.6% to -54.8%), that is, the actual number of cancers was only 42% of the number predicted.In LLPv3, calibrated to national 2017 figures, the proportionate difference was -22.0% (95% CI -28.1% to -15.5%).
While LLPv2 and LLPv3 have the same discriminatory power, LLPv3 improves the absolute lung cancer risk prediction and should be considered for use in further UK implementation studies.
两项已发表的最大规模低剂量 CT 筛查试验证明，早期发现肺癌可挽救生命。最佳实施取决于我们识别高危人群的能力。
利物浦肺癌计划风险评分（LLPv2）的版本 2 源自利物浦的病例对照数据，并在应用于英国肺癌筛查试验的受试者选择时进一步进行了调整。目标是通过校准 2017 年的全国数据，生成该模型的第 3 版（LLPv3）。我们使用来自 75958 名个体的问卷调查数据对 LLPv2 和 LLPv3 进行验证，这些个体在 5 年内进行了肺癌随访。我们通过接收者操作特征（ROC）分析评估了两者的区分能力，并通过比较预测发病率的十分位数与观察到的发病率来评估绝对发病率。我们将比例差异计算为与预测相比观察到的癌症的超额或不足百分比。我们还进行了 Hosmer-Lemeshow 检验。
5 年内诊断出 599 例肺癌。 LLPv2 和 LLPv3 的区分度均具有统计学意义，ROC 曲线下面积分别为 0.81（95%CI 0.79 至 0.82）。然而，LLPv2 高估了人群中的绝对风险。比例差异为-58.3%（95%CI -61.6%至-54.8%），即实际癌症数量仅为预测数量的 42%。在 LLPv3 中，根据全国 2017 年的数据进行校准，比例差异为-22.0%（95%CI -28.1%至-15.5%）。
虽然 LLPv2 和 LLPv3 具有相同的区分能力，但 LLPv3 提高了绝对肺癌风险预测的准确性，应考虑用于进一步的英国实施研究。
