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通过经过验证的风险预测模型,在肺癌幸存者中对第二次原发性肺癌进行基于风险模型的管理
Eunji Choi1,2,3, Sophia J Luo1, Victoria Y Ding1
1Stanford University School of Medicine, Stanford, California, USA.
Cancer
|October 25, 2023
概括
肺癌幸存者面临着第二次原发性肺癌 (SPLC) 的高风险. 一个经过验证的风险模型,SPLC-RAT,准确地识别高风险个体,并提高SPLC检测效率超过当前的指导方针.
科学领域:
- 在瘤学瘤学.
- 流行病学 流行病学
- 医疗信息学 医疗信息学
背景情况:
- 肺癌幸存者患第二原发性肺癌 (SPLC) 的风险较高.
- 现有的SPLC临床监测指南缺乏强有力的基于证据的支持.
- 一个经过验证的风险预测模型,SPLC-RAT,已经显示出希望,但缺乏现实世界的临床验证.
研究的目的:
- 验证SPLC风险评估工具 (SPLC-RAT) 在现实世界医院的肺癌幸存者队列中的预测性能.
- 与当前的指南相比,评估SPLC-RAT在通过基于风险的监测改善SPLC检测方面的潜力.
- 评估SPLC-RAT在识别患有SPLC高风险的肺癌幸存者的准确性.
主要方法:
- 从1997年至2006年期间,对8448名被诊断患有初始原发性肺癌 (IPLC) 的持续吸烟患者的数据进行分析.
- 通过2018年对患者的随访,以确定SPLC病例.
- 评估SPLC-RAT预测性能,并与国家综合癌症网络 (NCCN) 基于风险的监测指南进行比较.
主要成果:
- 在8448名IPLC患者中,5.7%的患者在26,470人年内发展出SPLC.
- SPLC-RAT表现出高预测准确度,接收器运行特征曲线下的面积为0.81.
- 使用SPLC-RAT (≥5.6%值) 的基于风险的监测显示出比NCCN指南更高的灵敏度 (86.4%) 和特异性 (38.9%),需要20%的CT后续检查.
结论:
- 该SPLC-RAT模型在现实环境中得到验证,用于准确识别SPLC高风险的肺癌幸存者.
- 使用SPLC-RAT进行基于风险的监测表明,与现有的临床指南相比,SPLC检测的效率和准确性更高.
- 这些发现支持将SPLC-RAT整合到临床实践中,以加强SPLC监测策略,为肺癌幸存者提供支持.
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