Existing general population models inaccurately predict lung cancer risk in patients referred for surgical evaluation.
Existing general population models inaccurately predict lung cancer risk in patients referred for surgical evaluation.
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DOI：
10.1016/j.athoracsur.2010.08.054
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发表时间：
2011-01
期刊：
影响因子：
--
通讯作者：
Grogan EL
中科院分区：
文献类型：
--
作者：
Isbell JM;Deppen S;Putnam JB Jr;Nesbitt JC;Lambright ES;Dawes A;Massion PP;Speroff T;Jones DR;Grogan EL
因可疑肺部病变而接受手术的患者良性率为9-55%。已有经过验证的预测模型可以估计普通人群中发生恶性肿瘤的概率，目前的实践指南建议使用这些模型。我们在外科人群中评估了这些模型，以确定现有模型预测良性或恶性疾病的准确性。我们对我们的胸科手术质量改进数据库(2005-2008)进行了回顾性回顾，以确定接受肺病变切除的患者。根据年龄、吸烟状况和氟脱氧葡萄糖正电子发射断层扫描(PET)结果将患者分成不同的亚组。使用Mayo和SPN预测模型计算每个患者的恶性肿瘤概率。使用接收器工作特性(ROC)和校准曲线来衡量模型的性能。89名患者符合入选标准，其中73%为恶性肿瘤。根据年龄、吸烟史和PET结节亲和力，将术前行PET扫描的患者分为4个亚组。患有PET嗜好病变的老年吸烟者有90%的恶性率。有PET非嗜好病变的患者，或年龄为50岁或从不吸烟者的PET嗜好病变的患者，恶性肿瘤发生率为62%。梅奥和SPN模型的ROC曲线下面积分别为0.79和0.80；然而，这两个模型的校正很差(p<；0.001)。尽管诊断和成像技术有所改进，但目前的普通人群模型并不能准确地预测手术评估错误的患者中的肺癌。需要更准确的预测模型来识别良性疾病患者，以减少非治疗性切除。
atients undergoing resections for suspicious pulmonary lesions have a 9-55% benign rate. Validated prediction models exist to estimate the probability of malignancy in a general population and current practice guidelines recommend their use. We evaluated these models in a surgical population to determine the accuracy of existing models to predict benign or malignant disease. We conducted a retrospective review of our thoracic surgery quality improvement database (2005-2008) to identify patients who underwent resection of a pulmonary lesion. Patients were stratified into subgroups based on age, smoking status and fluorodeoxyglucose positron emission tomography (PET) results. The probability of malignancy was calculated for each patient using the Mayo and SPN prediction models. Receiver operating characteristic (ROC) and calibration curves were used to measure model performance. 89 patients met selection criteria; 73% were malignant. Patients with preoperative PET scans were divided into 4 subgroups based on age, smoking history and nodule PET avidity. Older smokers with PET-avid lesions had a 90% malignancy rate. Patients with PET- non-avid lesions, or PET-avid lesions with age<50 years or never smokers of any age had a 62% malignancy rate. The area under the ROC curve for the Mayo and SPN models was 0.79 and 0.80, respectively; however, the models were poorly calibrated (p<0.001). Despite improvements in diagnostic and imaging techniques, current general population models do not accurately predict lung cancer among patients ref erred for surgical evaluation. Prediction models with greater accuracy are needed to identify patients with benign disease to reduce non-therapeutic resections.
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影响因子：
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作者：
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