van 't Klooster Cilie C, Ridker Paul M, Cook Nancy R, Aerts Joachim G J V, Westerink Jan, Asselbergs Folkert W, van der Graaf Yolanda, Visseren Frank L J
Department of Vascular Medicine, University Medical Center Utrecht (UMCU), Utrecht University, Utrecht, the Netherlands.
Divisions of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
JACC CardioOncol. 2020 Aug 28;2(3):400-410. doi: 10.1016/j.jaccao.2020.07.001. eCollection 2020 Sep.
Cardiovascular disease (CVD) and cancer share many common risk factors; patients with CVD also may be at risk of developing cancer.
The aim of this study was to derive and externally validate prediction models for the estimation of lifetime and 10-year risk for total, colorectal, and lung cancer in patients with established CVD.
Data from patients with established CVD from the UCC-SMART cohort (N = 7,280) were used for model development, and from the CANTOS trial (N = 9,322) for model validation. Predictors were selected based on previously published cancer risk scores, clinical availability, and presence in the derivation dataset. Fine and Gray competing risk-adjusted lifetime models were developed for the outcomes total, colorectal, and lung cancer.
Selected predictors were age, sex, smoking, weight, height, alcohol use, antiplatelet use, diabetes, and C-reactive protein. External calibration for the 4-year risk of lung, colorectal, and total cancer was reasonable in our models, as was discrimination with C-statistics of 0.74, 0.64, and 0.63, respectively. Median predicted lifetime and 10-year risks in CANTOS were 26% (range 1% to 52%) and 13% (range 1% to 31%) for total cancer; 4% (range 0% to 13%) and 2% (range 0% to 6%) for colorectal cancer; and 5% (range 0% to 37%) and 2% (range 0% to 24%) for lung cancer.
Lifetime and 10-year risk of total, colorectal, and lung cancer can be estimated reasonably well in patients with established CVD with readily available clinical predictors. With additional study, these tools could be used in clinical practice to further aid in the emphasis of healthy lifestyle changes and to guide thresholds for targeted diagnostics and screening.
心血管疾病（CVD）和癌症有许多共同的风险因素；患有CVD的患者也可能有患癌症的风险。
本研究的目的是推导并外部验证用于估计已确诊CVD患者患全部癌症、结直肠癌和肺癌的终生风险及10年风险的预测模型。
来自UCC-SMART队列（N = 7280）的已确诊CVD患者的数据用于模型开发，来自CANTOS试验（N = 9322）的数据用于模型验证。根据先前发表的癌症风险评分、临床可用性以及推导数据集中是否存在来选择预测因素。针对全部癌症、结直肠癌和肺癌的结局，开发了Fine和Gray竞争风险调整终生模型。
选定的预测因素为年龄、性别、吸烟、体重、身高、饮酒、使用抗血小板药物、糖尿病和C反应蛋白。在我们的模型中，肺癌、结直肠癌和全部癌症4年风险的外部校准是合理的，其C统计量的辨别力分别为0.74、0.64和0.63。CANTOS中预测的全部癌症终生风险和10年风险的中位数分别为26%（范围1%至52%）和13%（范围1%至31%）；结直肠癌为4%（范围0%至13%）和2%（范围0%至6%）；肺癌为5%（范围0%至37%）和
