Improvement of Risk Prediction by Genomic Profiling: Reclassification Measures Versus the Area Under the Receiver Operating Characteristic Curve
Improvement of Risk Prediction by Genomic Profiling: Reclassification Measures Versus the Area Under the Receiver Operating Characteristic Curve
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DOI：
10.1093/aje/kwq122
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发表时间：
2010-08-01
影响因子：
5
通讯作者：
Janssens, A. Cecile J. W.
中科院分区：
文献类型：
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作者：
Mihaescu, Raluca;van Zitteren, Moniek;Janssens, A. Cecile J. W.
即使在受试者工作特征曲线下面积（AUC）没有改善或改善极小时，也观察到重新分类，目前尚不清楚这是否表明临床效用改善。作者使用经验和模拟数据研究了不同Δ AUC的总重新分类、净重新分类改进和综合鉴别改进。实证分析比较了基于年龄，性别和体重指数的2型糖尿病风险预测与18个已建立的遗传风险因素更新的预测。模拟数据用于研究针对0.005、0.05和0.10的Δ AUC的重新分类的测量。计算所有可能的临界值的总重新分类和净重新分类改善。当增加18个多态性时，2型糖尿病风险预测的AUC从0.63提高到0.66，而根据所选择的截止值，总的重新分类范围从0%到22.5%。在模拟研究中，总重新分类、净重新分类改善和综合辨别改善随着Δ AUC的增加而增加。当Δ AUC较低（0.005）时，净重新分类改善值接近于零，综合辨别改善为0.08%（P > 0.05），但总重新分类范围为0 - 6.7%。重新分类随AUC增加而增加，但主要随所选截止值而变化。在没有AUC增加的情况下观察到的重新分类不太可能改善临床效用。
Reclassification is observed even when there is no or minimal improvement in the area under the receiver operating characteristic curve (AUC), and it is unclear whether it indicates improved clinical utility. The authors investigated total reclassification, net reclassification improvement, and integrated discrimination improvement for different delta AUC using empirical and simulated data. Empirical analyses compared prediction of type 2 diabetes risk based on age, sex, and body mass index with prediction updated with 18 established genetic risk factors. Simulated data were used to investigate measures of reclassification against delta AUCs of 0.005, 0.05, and 0.10. Total reclassification and net reclassification improvement were calculated for all possible cutoff values. The AUC of type 2 diabetes risk prediction improved from 0.63 to 0.66 when 18 polymorphisms were added, whereas total reclassification ranged from 0% to 22.5% depending on the cutoff value chosen. In the simulation study, total reclassification, net reclassification improvement, and integrated discrimination improvement increased with higher delta AUC. When delta AUC was low (0.005), net reclassification improvement values were close to zero, integrated discrimination improvement was 0.08% (P > 0.05), but total reclassification ranged from 0 to 6.7%. Reclassification increases with increasing AUC but predominantly varies with the cutoff values chosen. Reclassification observed in the absence of AUC increase is unlikely to improve clinical utility.