This newsletter presents the activities of the project under the Prevention & Early Detection (Screening) cluster: DIOPTRA, LUCIA, MammoScreen, ONCOSCREEN, PANCAID and SANGUINE.
Background
While different lung cancer risk prediction models have been established as essential tools to identify high-risk participants for lung cancer screening programs, evaluations of their risk discriminatory performances have reported heterogenous findings in different research cohorts. We therefore aimed to summarise results of head-to-head comparisons of the predictive performance of various lung cancer risk models performed within the same study population.
Methods
In this systematic review and meta-analysis, we performed a systematic search of PubMed and Web of Science databases for primary studies published from inception to Oct 16, 2024. Articles comparing the performance of questionnaire-based lung cancer risk models in an independent, external validation cohort of participants with previous or current smoking exposure were included. The main reasons for exclusion of studies were if only one model was assessed in the external population or risk discrimination was not evaluated. Random-effects meta-analyses were conducted to synthesize differences in the area under the curve (AUC) of two models compared in multiple populations. To assess the risk of bias, PROBAST (the Prediction model Risk of Bias Assessment Tool) was used. The study was registered with PROSPERO, CRD42023427911.
Findings
The systematic search yielded 5568 records. In total, 15 eligible studies were included in the meta-analysis, comprising 4,134,648 individuals with previous or current smoking exposure, of whom 45,448 (1.10%) developed LC within 5–7 years. Among the nine models that were compared, AUC differences reached up to 0.050 between two models. The Lung Cancer Risk Assessment Tool (LCRAT), Bach model and PLCOm2012 model consistently had a higher AUC when compared to any other model, with AUC differences ranging between 0.018 (95% CI 0.011, 0.026) and 0.044 (95% CI 0.038, 0.049). The risk of bias and applicability concerns were deemed low in eight, and high in seven of the included studies. Results excluding studies with high risk of bias were mostly consistent. Among eight of the 24 model pairs that were compared, there was notable between-study heterogeneity (I2 ≥50%).
Interpretation
Our systematic review and meta-analyses of head-to-head comparisons disclose major differences in predictive performance of widely used lung cancer risk models. Although our review is limited to the availability of head-to-head comparisons, evidence from current cohort-based model comparisons indicates that the LCRAT, Bach and PLCOm2012 consistently outperformed alternative questionnaire-based risk prediction tools.
Lung cancer screening by low-dose computed tomography reduces lung cancer mortality, but reliable risk-based selection of participants is crucial to maximize benefits and minimize harms. Multiple risk models have been developed for this purpose, and their discrimination and calibration performance is commonly evaluated based on large-scale cohort studies. Using a recent comparative evaluation of 10 risk models as an example, we illustrate the merits, limitations and pitfalls of such evaluations.
This report provides a summary of the conclusions from the second annual meeting of the “Understanding (risk factors & determinants)” cluster within the EU Cancer Mission. The morning sessions featured scientific updates from each project, while the afternoon focused on “Cancer Mission Data Initiatives”, presented by a European Commission policy officer, and discussions on topics outlined in the common work plan deliverable. Key points included the importance of data management, AI in cancer research, risk stratification tools, and best practices in healthcare policy implementation. The meeting underscored the importance of collaborative efforts in addressing cancer research challenges and highlighted future plans for enhancing data sharing, citizen engagement, and addressing inequalities in cancer care.
This report summarizes the Policy brief formulating recommendations based on the research and innovation strand of the “Understanding” annual cluster meeting -Y2. The goal of this deliverable is to provide an annual policy brief with recommendations on Research & Innovation (R&I) on the macro scale, i.e., from the perspective of the “Understanding (risk factors & determinants)” cluster. This policy brief formulates recommendations to foster collaboration, focusing on data/material management, technological advancmeents, risk factor analysis, and policy implementation, based on the research and innovation strand of the “Understanding” annual cluster meeting in the second year. This deliverable raises common barriers and potential recommendations as well as practical recommendations for the near future.
This newsletter provides an update about the project activities.
This newsletter presents the activities of the project under the Prevention & Early Detection (Screening) cluster: DIOPTRA, LUCIA, MammoScreen, ONCOSCREEN, PANCAID and SANGUINE.
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