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基于风险模型的肺癌查以及美国的种族和民族差异

Eunji Choi^1,2, Victoria Y Ding¹, Sophia J Luo¹

¹Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California.

|October 26, 2023

概括

基于风险的肺癌查显著减少了种族差异,并与当前的USPSTF 2021指南相比提高了查性能. 这种方法提高了跨不同种族群体的肺癌检测.

科学领域:

在瘤学瘤学.
公共卫生公共卫生
流行病学流行病学

背景情况:

2021年美国预防服务工作组 (USPSTF) 对肺癌查的指导方针减少了非洲裔美国人和白人之间的差异,但没有解决其他群体的问题.
基于风险模型的查可能会减轻差异并改善肺癌查的性能,但在不同人群中缺乏验证.

研究的目的:

为了验证和重新校准2012年前列腺,肺部,结肠直肠和卵巢癌查试验 (PLCOm2012) 模型,跨越美国的种族和民族群体.
通过基于风险的查与PLCOm2012模型对比USPSTF2021标准来评估差异和查绩效.

主要方法:

使用了多民族队列研究 (105,261名参与者) 与1993-2018年的数据.
使用重新校准的PLCOm2012模型 (PLCOm2012-Update) 计算了6年肺癌风险,并评估了查资格 (风险≥1.3%).
基于风险的查和USPSTF 2021标准之间的查性能 (资格与发病率,敏感性,特异性,需要查的数量) 在种族/民族群体之间进行比较.

主要成果:

在PLCOm2012-Update中,跨种族和民族的预测准确度很好 (AUC,0.72-0.82).
2021年USPSTF标准显示出显著的差异,非洲裔美国人与白人相比,他们的资格发生率较低53%.
基于风险的查大大减少了这种差异 (E-I比率:15.9比18.4),并在其他少数群体中显示出最小的差异.
基于风险的查提高了整体敏感性 (67.2%对57.7%),并减少了与USPSTF 2021标准相比 (26对30) 查所需的数量,具有相似的特异性 (76.6%).

结论:

基于风险的肺癌查有效减少了种族和民族差异.
与USPSTF 2021标准相比,这种方法可以提高不同人群的肺癌查性能.

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