Risk Stratification for Second Primary Lung Cancer
Risk Stratification for Second Primary Lung Cancer
复制标题
第二原发性肺癌的风险分层
DOI：
10.1200/jco.2017.72.4203
复制
发表时间：
2017-09-01
影响因子：
45.3
通讯作者：
Wakelee, Heather A.
中科院分区：
文献类型：
--
作者：
Han, Summer S.;Rivera, Gabriel A.;Wakelee, Heather A.
目的：本研究评估原发性肺癌（IPLC）幸存者10年发生第二原发性肺癌（SPLC）的风险，并评估风险预测模型在筛选筛查标准方面的临床应用价值。方法采用seer数据，对1988年至2003年间诊断为IPLC的20,032名患者进行人群队列研究，这些患者在初次诊断后存活了bb0 = 5年。我们使用比例亚分布风险模型来估计在存在竞争风险的肺癌LC幸存者中发生SPLC的10年风险。考虑的预测因素包括年龄、性别、种族、治疗、组织学、分期和疾病程度。我们检查了预测模型的风险分层能力，并进行决策曲线分析，通过计算其在不同风险阈值筛查中的净收益来评估模型的临床效用。结果：虽然LC幸存者10年发生SPLC的中位风险为8.36%，但在最终预测模型中，根据年龄、组织学和IPLC的程度分层，估计的风险差异很大（范围为0.56%至14.3%）。对估计风险的十分位数进行分层显示，观察到的SPLC发病率在第10十分位数组（12.5%）明显高于第1十分位数组（2.9%,P < 10(-10)）。决策曲线分析产生了一系列风险阈值（1%至11.5%），在此范围内，风险模型的临床净收益大于假设的全筛查或不筛查情景。结论SPLC的风险分层方法可用于识别LC的幸存者，并可通过计算机断层扫描进行筛查。更全面的环境和遗传数据可能有助于提高SPLC风险模型的可预测性和分层能力。(C) 2017年由美国临床肿瘤学会出版
PurposeThis study estimated the 10-year risk of developing second primary lung cancer (SPLC) among survivors of initial primary lung cancer (IPLC) and evaluated the clinical utility of the risk prediction model for selecting eligibility criteria for screening.MethodsSEER data were used to identify a population-based cohort of 20,032 participants diagnosed with IPLC between 1988 and 2003 and who survived >= 5 years after the initial diagnosis. We used a proportional subdistribution hazards model to estimate the 10-year risk of developing SPLC among survivors of lung cancer LC in the presence of competing risks. Considered predictors included age, sex, race, treatment, histology, stage, and extent of disease. We examined the risk-stratification ability of the prediction model and performed decision curve analysis to evaluate the clinical utility of the model by calculating its net benefit in varied risk thresholds for screening.ResultsAlthough the median 10-year risk of SPLC among survivors of LC was 8.36%, the estimated risk varied substantially (range, 0.56% to 14.3%) when stratified by age, histology, and extent of IPLC in the final prediction model. The stratification by deciles of estimated risk showed that the observed incidence of SPLC was significantly higher in the tenth-decile group (12.5%) versus the first-decile group (2.9%; P < 10(-10)). The decision curve analysis yielded a range of risk thresholds (1% to 11.5%) at which the clinical net benefit of the risk model was larger than those in hypothetical all-screening or no-screening scenarios.ConclusionThe risk stratification approach in SPLC can be potentially useful for identifying survivors of LC to be screened by computed tomography. More comprehensive environmental and genetic data may help enhance the predictability and stratification ability of the risk model for SPLC. (C) 2017 by American Society of Clinical Oncology