Article Figures & Data
Figures
- Figure 1.
Net benefits obtained from different selection approaches (A) and the cumulative distribution of 5-year absolute risk estimates (B).
Tables
- Table 1.
Eligibility criteria used in lung cancer screening trials
Eligibility criteria Trial Age, y Smoking history NELSON 50–74 ≥15 cigarettes/d for 25 y; or ≥10 cigarettes/d for at least 30 y; if former smokers, quitting time ≤10 y. LUSI 50–69 ≥15 cigarettes/d for at least 25 y; or ≥10 cigarettes/d for at least 30 y; if former smokers, quitting time ≤10 y. DLCST 50–69 Pack-years ≥20; if former smokers, age at quitting >50 y and quitting time <10 y ITALUNG 55–69 Pack-years ≥20 since the last 10 years; if former smokers, quitting time <10 y. DANTE 60–74 Pack-years ≥20. NLST 55–74 Pack-years ≥30; if former smokers, quitting time ≤15 y. - Table 2.
Predictors included in the Bach, Spitz, LLP, and PLCOM2012 model and the availability in the EPIC-Germany cohort
Predictors Bach Spitz LLP PLCOM2012 Availability in EPIC-Germany Age X Xa Xa X X Sex X Xa Xa X Smoking status X X Cigarettes smoked/d X X X Smoking duration X X X X Duration of cessation X X X Age at cessation X X Pack-years X X Asbestos exposure X X X X Dust exposure X Pneumonia X COPD X Emphysema X Hay fever X X Prior diagnosis of malignant tumor X X Xb Family history of cancer X X Family history of lung cancer X X BMI X X Education X X ↵aAge and sex were not included the model as predictors. However, the effects of age and sex were incorporated into the risk prediction by using the age- and sex-specific lung cancer incidence rates to estimate the baseline hazards.
↵bThis information was available but subjects with prior diagnosis of malignant tumor were excluded from the analysis.
- Table 3.
Baseline characteristics of the study population by sex among the ever smokers in the EPIC-Germany cohort (N = 20,700)
Men (n = 12,565) Women (n = 8,135) Age (range) 53.2 (40.0–69.4) 49.6 (40.0–69.0) LC in the first 5-years of follow-up 76 16 Age at diagnosis of lung cancer 63.5 (42.8–76.6) 62.0 (44.7–75.6) Current smokers (%) 4,648 (37.0) 3,649 (44.8) Duration of smoking (y) 24.0 (0.5–53.5) 23.0 (0.5–52.0) No. of cigarettes/d 15.0 (0.04–85.0) 8.8 (0.02–72.6) Pack-years 12.0 (0.05–127.5) 5.6 (0.05–66.0) Quitting time (former smokers) 16.0 (0.1–43.8) 14.1 (0.1–43.2) Asbestos exposure 151 (1.2) 8 (0.1) Hay fever 1,253 (10.0) 1,253 (15.4) BMI (kg/m2) 26.9 (14.5–55.2) 25.0 (15.1–58.7) Family history of cancer 3,882 (30.9) 3,129 (38.5) College education 4,609 (36.7) 2,051 (25.2) Abbreviation: LC, lung cancer.
- Table 4.
Validation performance of the lung cancer risk models applied to the ever smokers in the EPIC-Germany cohort (N = 20,700)
Discrimination (C-index, 95% CI) Calibrationa(E/O, 95% CI) Bach model 0.81 (0.76–0.86) 0.88 (0.72–1.08) Spitz model 0.78 (0.73–0.83) 3.75 (3.06–4.60) LLP model 0.79 (0.73–0.83) 1.12 (0.92–1.37) PLCOM2012 0.81 (0.76–0.86) 1.03 (0.87–1.23) ↵aThe expected and observed numbers of lung cancer are 81/92 (Bach), 345/92 (Spitz), 103/92 (LLP), and 130/126 (6-year risk, PLCOM2012).
- Table 5.
Comparison of the lung cancer risk prediction models and the eligibility criteria among ever smokers in the EPIC-Germany cohort (N = 20,700)
Criteria/model Threshold (%) Cases includeda Sensitivity (%) Specificity (%) PPV (%) cNPV (%) npositive = 3,409 NELSON/LUSI — 58 63.04 83.74 1.70 0.20 Bach 0.764932 57 61.96 83.73 1.67 0.20 Spitz 3.511813 49 53.26 83.69 1.44 0.25 LLP 0.852661 54 58.70 83.72 1.58 0.20 PLCOM2010 1.006991 61 66.30 83.75 1.79 0.18 npositive = 2,931 DLCST — 59 64.13 86.06 2.01 0.18 Bach 0.898835 57 61.96 86.05 1.94 0.20 Spitz 3.742099 45 48.91 86.0 1.54 0.26 LLP 0.940001 51 55.43 86.02 1.74 0.23 PLCOM2010 1.127746 59 64.13 86.06 2.01 0.18 npositive = 2,170 ITALUNG — 51 55.43 89.72 2.35 0.22 Bach 1.178258 51 55.43 89.72 2.35 0.22 Spitz 4.180923 41 44.56 89.67 1.89 0.28 LLP 1.179983 46 50.0 89.69 2.12 0.25 PLCOM2010 1.726509 55 59.80 89.74 2.53 0.20 npositive = 1,500 DANTE — 36 39.13 92.90 2.40 0.29 npositive = 1,458 NLST — 42 45.65 93.13 2.88 0.26 Bach 1.553146 44 47.83 93.14 3.02 0.25 Spitz 4.723909 34 36.96 93.09 2.33 0.30 LLP 1.528621 40 43.48 93.12 2.74 0.27 PLCOM2010 2.110365 46 50.0 93.15 3.16 0.24 ↵aCases that were diagnosed the first 5 years of follow-up.
Supplementary Data
- Supplementary Table 1, Figures 1-4 - Supplementary Table 1, Figures 1-4. Supplementary Table 1. Pairwise kappa before and after overlapping age range was applied (the lower triangle) and the net reclassification index (NRI, %, the upper triangle). Supplementary Figure 1. Participants selected for LDCT screening using different eligibility criteria among ever smokers in the EPIC-Germany cohort (N = 20,700). Supplementary Figure 2. ROC curves of the lung cancer risk prediction models applied to ever smokers in the EPIC-Germany cohort (N = 20,700). Supplementary Figure 3. The cumulative distribution of 5-year absolute risk estimates in the EPIC-Germany cohort (N = 20,700) and the LUSI study (N = 33,621). Supplementary Figure 4. The cumulative distribution of 5-year absolute risk estimates before and after missing risk factors were simulated (ever smokers in EPIC-Germany, N = 20,700).
Volume 8, Issue 9
