Variations in lung cancer risk among smokers
Variations in lung cancer risk among smokers
复制标题
DOI：
10.1093/jnci/95.6.470
复制
发表时间：
2003-03-19
影响因子：
10.3
通讯作者：
Begg, CB
中科院分区：
文献类型：
--
作者：
Bach, PB;Kattan, MW;Begg, CB
背景：虽然没有证据表明筛查肺癌有益，但筛查项目吸引了许多认为自己因吸烟而处于高风险的人。我们试图确定吸烟者患肺癌的风险是否有可预测的变化。方法：我们使用了18172名受试者的数据，这些受试者参加了胡萝卜素和视黄醇疗效试验（CARET）——一项大型的肺癌预防随机试验——来推导肺癌风险预测模型。模型输入包括受试者的年龄、性别、石棉接触史和吸烟史。我们通过比较预测和观察到的肺癌风险十分位数来评估模型的校准，并通过评估模型对来自五个CARET研究地点的数据的估计程度来验证它可以预测第六个研究地点的事件。然后，我们将该模型应用于一项用计算机断层扫描（CT）筛查肺癌的研究中，以评估吸烟者患肺癌的风险。结果：该模型内部有效，标定良好。CT研究的参与者10年患肺癌的风险差异很大，从每天吸两包烟50年并继续吸烟的68岁男性的15%到每天吸一包烟28年直到9年前戒烟的51岁女性的0.8%。即使在有资格参加癌症预防临床试验的CT研究参与者中，风险也有很大差异。结论：吸烟者患肺癌的风险差异很大。准确的风险预测可以帮助考虑自愿筛查的个人平衡潜在的利益和风险。风险预测对研究人员设计肺癌预防的临床试验也很有用。
Background: Although there is no proven benefit associated with screening for lung cancer, screening programs are attracting many individuals who perceive themselves to be at high risk due to smoking. We sought to determine whether the risk of lung cancer varies predictably among smokers. Methods: We used data on 18172 subjects enrolled in the Carotene and Retinol Efficacy Trial (CARET)-a large, randomized trial of lung cancer prevention-to derive a lung cancer risk prediction model. Model inputs included the subject's age, sex, asbestos exposure history, and smoking history. We assessed the model's calibration by comparing predicted and observed rates of lung cancer across risk deciles and validated it by assessing the extent to which a model estimated on data from five CARET study sites could predict events in the sixth study site. We then applied the model to evaluate the risk of lung cancer among smokers enrolled in a study of lung cancer screening with computed tomography (CT). Results: The model was internally valid and well calibrated. Ten-year lung cancer risk varied greatly among participants in the CT study, from 15% for a 68-year-old man who has smoked two packs per day for 50 years and continues to smoke, to 0.8% for a 51-year-old woman who smoked one pack per day for 28 years before quitting 9 years earlier. Even among the subset of CT study participants who would be eligible for a clinical trial of cancer prevention, risk varied greatly. Conclusions: The risk of lung cancer varies widely among smokers. Accurate risk prediction may help individuals who are contemplating voluntary screening to balance the potential benefits and risks. Risk prediction may also be useful for researchers designing clinical trials of lung cancer prevention.