Comparative performance of lung cancer risk models to define lung screening eligibility in the United Kingdom

Abstract: Background: The National Health Service England (NHS) classifies individuals as eligible for lung cancer screening using two risk prediction models, PLCOm2012 and Liverpool Lung Project-v2 (LLPv2). However, no study has compared the performance of lung cancer risk models in the UK. Methods: We analysed current and former smokers aged 40–80 years in the UK Biobank (N = 217,199), EPIC-UK (N = 30,813), and Generations Study (N = 25,777). 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, AUC = 0.82, 95% CI = 0.81–0.84), followed by the LCRAT (AUC = 0.81, 95% CI = 0.79–0.82) and the Bach model (AUC = 0.80, 95% CI = 0.79–0.81). 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 1.20 for LLPv3 (95% CI = 1.14–1.27) to 2.16 for LLPv2 (95% CI = 2.05–2.28). Overestimation increased with area-level socioeconomic status. In the combined cohorts, USPSTF 2013 criteria classified 50.7% of future cases as screening eligible. The LCDRAT and LCRAT identified 60.9%, followed by PLCOm2012 (58.3%), Bach (58.0%), LLPv3 (56.6%), and LLPv2 (53.7%). Conclusion: In UK cohorts, the ability of risk prediction models to classify future lung cancer cases as eligible for screening was best for LCDRAT/LCRAT, very good for PLCOm2012, and lowest for LLPv2. Our results highlight the importance of validating prediction tools in specific countries

Establishing a survival probability prediction model for different lung cancer therapies

[[abstract]]Cancer is the leading cause of death in Taiwan, according to the Ministry of Health and Welfare (2017), with cancers of the trachea, bronchus, and lung being the most prevalent. Thus, it is critically important to study this disease. By using Taiwan’s National Health Insurance Research Database (NHIRDB), which covers 99.9% of residents, we are capable of analyzing comorbidities and predicting the outcomes of the clinical therapy. This study focuses on non-small cell lung cancer. We first obtain cancer registration indexes from two million individual patient records in NHIRDB by screening patients of having a clinical diagnosis of ICD C33-34 (trachea, bronchus and lung cancer). Then, we used these cancer registration indexes to find all the therapies and comorbidity of the patients and used them as input parameters to establish a predictive model of survival probability for lung cancer. Linear and nonlinear data mining methods were employed to build prediction models to study the effects of different therapies on the 3-year survival probability of lung cancer patients. We found that the artificial neural network (ANN) model performs better than the logistic regression (LR) model. It comes out that the best point of the ANN model on the ROC curve is at sensitivity = 77.6%, specificity = 76.8% and AUROC = 83%.[[notice]]補正完