TY - JOUR
T1 - A Validated Clinical Risk Prediction Model for Lung Cancer in Smokers of All Ages and Exposure Types
T2 - A HUNT Study
AU - Markaki, Maria
AU - Tsamardinos, Ioannis
AU - Langhammer, Arnulf
AU - Lagani, Vincenzo
AU - Hveem, Kristian
AU - Røe, Oluf Dimitri
N1 - Correction posted here: 10.1016/j.ebiom.2022.104187
PY - 2018
Y1 - 2018
N2 - Lung cancer causes >1·6 million deaths annually, with early diagnosis being paramount to effective treatment. Here we present a validated risk assessment model for lung cancer screening. The prospective HUNT2 population study in Norway examined 65,237 people aged >20years in 1995-97. After a median of 15·2years, 583 lung cancer cases had been diagnosed; 552 (94·7%) ever-smokers and 31 (5·3%) never-smokers. We performed multivariable analyses of 36 candidate risk predictors, using multiple imputation of missing data and backwards feature selection with Cox regression. The resulting model was validated in an independent Norwegian prospective dataset of 45,341 ever-smokers, in which 675 lung cancers had been diagnosed after a median follow-up of 11·6years. Our final HUNT Lung Cancer Model included age, pack-years, smoking intensity, years since smoking cessation, body mass index, daily cough, and hours of daily indoors exposure to smoke. External validation showed a 0·879 concordance index (95% CI [0·866-0·891]) with an area under the curve of 0·87 (95% CI [0·85-0·89]) within 6years. Only 22% of ever-smokers would need screening to identify 81·85% of all lung cancers within 6years. Our model of seven variables is simple, accurate, and useful for screening selection.
AB - Lung cancer causes >1·6 million deaths annually, with early diagnosis being paramount to effective treatment. Here we present a validated risk assessment model for lung cancer screening. The prospective HUNT2 population study in Norway examined 65,237 people aged >20years in 1995-97. After a median of 15·2years, 583 lung cancer cases had been diagnosed; 552 (94·7%) ever-smokers and 31 (5·3%) never-smokers. We performed multivariable analyses of 36 candidate risk predictors, using multiple imputation of missing data and backwards feature selection with Cox regression. The resulting model was validated in an independent Norwegian prospective dataset of 45,341 ever-smokers, in which 675 lung cancers had been diagnosed after a median follow-up of 11·6years. Our final HUNT Lung Cancer Model included age, pack-years, smoking intensity, years since smoking cessation, body mass index, daily cough, and hours of daily indoors exposure to smoke. External validation showed a 0·879 concordance index (95% CI [0·866-0·891]) with an area under the curve of 0·87 (95% CI [0·85-0·89]) within 6years. Only 22% of ever-smokers would need screening to identify 81·85% of all lung cancers within 6years. Our model of seven variables is simple, accurate, and useful for screening selection.
KW - All ages
KW - All smokers
KW - Data-driven
KW - Early diagnosis
KW - Ever-smokers
KW - External validation
KW - Feature selection
KW - Lung cancer prediction
UR - http://www.scopus.com/inward/record.url?scp=85045553780&partnerID=8YFLogxK
U2 - 10.1016/j.ebiom.2018.03.027
DO - 10.1016/j.ebiom.2018.03.027
M3 - Journal article
C2 - 29678673
SN - 2352-3964
VL - 31
SP - 36
EP - 46
JO - EBioMedicine
JF - EBioMedicine
ER -