Prospective assessment of a nasopharyngeal carcinoma risk score in a population undergoing screening
Prospective assessment of a nasopharyngeal carcinoma risk score in a population undergoing screening
复制标题
接受筛查人群鼻咽癌风险评分的前瞻性评估
DOI：
10.1002/ijc.33424
复制
发表时间：
2020-12-24
影响因子：
6.4
通讯作者：
Cao，Su-Mei
中科院分区：
文献类型：
--
作者：
Chen，Geng-Hang;Liu，Zhiwei;Cao，Su-Mei
尽管有证据表明爱泼斯坦-巴尔病毒（EBV）标志物可用于对NPC高危地区的鼻咽癌（NPC）风险进行分层，但目前还没有经过验证的NPC风险预测模型。我们的目的是在接受NPC筛查的地方性人群中验证基于EBV的NPC风险评分。这项前瞻性研究是在2008年在中国南方启动的一项正在进行的NPC筛查试验中进行的，有51235名成年参与者。我们评估了评分的区分能力（受试者操作特征曲线下面积，AUC）。使用逻辑回归开发了一个新的模型，该模型结合了EBV评分、性别和家族史，并使用交叉验证进行了内部验证。比较AUC。我们还结合风险评分、人群发病率和竞争死亡率数据计算了NPC的绝对风险。2008年至2016年共发现151例NPC病例。基于EBV的评分具有高度区分性，AUC = 0.95（95% CI = 0.93 - 0.97）。对于90%的特异性，该评分的敏感性为87.4%（95%CI = 81.0 - 92.3%）。随着特异性从90%增加到99%，阳性预测值从2.4%（95% CI = 1.9 - 3.0%）增加到12.5%（9.9 - 15.5%）。相应地，每个检测到的NPC病例的阳性检测数量从272（95% CI = 255 - 290）减少到50（41 - 59）。将评分与其他风险因素（性别，NPC一级家族史）结合并不能改善AUC。年龄在55至59岁之间的男性风险最高，5年绝对NPC风险最高，为6.5%。我们外部验证了先前开发的EBV评分在高风险人群中的区分准确性。增加非病毒性危险因素并不能提高鼻咽癌的预测。
Despite evidence suggesting the utility of Epstein‐Barr virus (EBV) markers to stratify individuals with respect to nasopharyngeal carcinoma (NPC) risk in NPC high‐risk regions, no validated NPC risk prediction model exists. We aimed to validate an EBV‐based NPC risk score in an endemic population undergoing screening for NPC. This prospective study was embedded within an ongoing NPC screening trial in southern China initiated in 2008, with 51 235 adult participants. We assessed the score's discriminatory ability (area under the receiver‐operator‐characteristics curve, AUC). A new model incorporating the EBV score, sex and family history was developed using logistic regression and internally validated using cross‐validation. AUCs were compared. We also calculated absolute NPC risk combining the risk score with population incidence and competing mortality data. A total of 151 NPC cases were detected in 2008 to 2016. The EBV‐based score was highly discriminating, with AUC = 0.95 (95% CI = 0.93‐0.97). For 90% specificity, the score had 87.4% sensitivity (95% CI = 81.0‐92.3%). As specificity increased from 90% to 99%, the positive predictive value increased from 2.4% (95% CI = 1.9‐3.0%) to 12.5% (9.9‐15.5%). Correspondingly, the number of positive tests per detected NPC case decreased from 272 (95% CI = 255‐290) to 50 (41‐59). Combining the score with other risk factors (sex, first‐degree family history of NPC) did not improve AUC. Men aged 55 to 59 years with the highest risk profile had the highest 5‐year absolute NPC risk of 6.5%. We externally validated the discriminatory accuracy of a previously developed EBV score in a high‐risk population. Adding nonviral risk factors did not improve NPC prediction.