External validation of the parsimonious EuroLung risk models: analysis of the Brazilian Lung Cancer Registry
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Updated: Jun 11, 2025
An R-Based Landscape Validation of a Competing Risk Model
Published on: September 16, 2022
Paula Duarte D'Ambrosio1, Ricardo Mingarini Terra1, Alessandro Brunelli2
1. Instituto do Câncer do Estado de São Paulo - ICESP - Hospital das Clínicas de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.
Objective:
The purpose of this study was to assess performance in the Brazilian Lung Cancer Registry Database by using the parsimonious EuroLung risk models for morbidity and mortality.
Methods:
The EuroLung1 and EuroLung2 models were tested and evaluated through calibration (calibration plot, Brier score, and the Hosmer-Lemeshow test) and discrimination (ROC AUCs), in a national multicenter registry of 1,031 patients undergoing anatomic lung resection.
Results:
The evaluation of performance in Brazilian health care facilities utilizing risk-adjustment models, specifically EuroLung1 and EuroLung2, revealed substantial miscalibration, as evidenced by calibration plots and Hosmer-Lemeshow tests in both models. In terms of calibration, EuroLung1 exhibited a calibration plot with overlapping points, characterized by a slope of 1.11 and a Brier score of 0.15; the Hosmer-Lemeshow test yielded a statistically significant p-value of 0.015; and the corresponding ROC AUC was 0.678 (95% CI: 0.636-0.721). The EuroLung2 model displayed better calibration, featuring fewer overlapping points in the calibration plot, with a slope of 1.22, with acceptable discrimination, as indicated by a ROC AUC of 0.756 (95% CI: 0.670-0.842). Both models failed to accurately predict morbidity and mortality outcomes in this specific health care context.
Conclusions:
Discrepancies between the EuroLung model predictions and outcomes in Brazil underscore the need for model refinement and for a probe into inefficiencies in the Brazilian health care system.
