title: Lung cancer risk prediction: Prostate, Lung, Colorectal And Ovarian Cancer Screening Trial models and validation.
abstract: BACKGROUND
  Identification of individuals at high risk for lung cancer should be of value to individuals, patients, clinicians, and researchers. Existing prediction models have only modest capabilities to classify persons at risk accurately.
  
  
  METHODS
  Prospective data from 70 962 control subjects in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) were used in models for the general population (model 1) and for a subcohort of ever-smokers (N = 38 254) (model 2). Both models included age, socioeconomic status (education), body mass index, family history of lung cancer, chronic obstructive pulmonary disease, recent chest x-ray, smoking status (never, former, or current), pack-years smoked, and smoking duration. Model 2 also included smoking quit-time (time in years since ever-smokers permanently quit smoking). External validation was performed with 44 223 PLCO intervention arm participants who completed a supplemental questionnaire and were subsequently followed. Known available risk factors were included in logistic regression models. Bootstrap optimism-corrected estimates of predictive performance were calculated (internal validation). Nonlinear relationships for age, pack-years smoked, smoking duration, and quit-time were modeled using restricted cubic splines. All reported P values are two-sided.
  
  
  RESULTS
  During follow-up (median 9.2 years) of the control arm subjects, 1040 lung cancers occurred. During follow-up of the external validation sample (median 3.0 years), 213 lung cancers occurred. For models 1 and 2, bootstrap optimism-corrected receiver operator characteristic area under the curves were 0.857 and 0.805, and calibration slopes (model-predicted probabilities vs observed probabilities) were 0.987 and 0.979, respectively. In the external validation sample, models 1 and 2 had area under the curves of 0.841 and 0.784, respectively. These models had high discrimination in women, men, whites, and nonwhites.
  
  
  CONCLUSIONS
  The PLCO lung cancer risk models demonstrate high discrimination and calibration.
authors: Department of Community Health Sciences, Brock University, 500 Glenridge Ave, St Catharines, ON, Canada. martin.tammemagi@brocku.ca
authors: C Martin
authors: CM
authors: Tammemagi
authors: Paul F
authors: PF
authors: Pinsky
authors: Neil E
authors: NE
authors: Caporaso
authors: Paul A
authors: PA
authors: Kvale
authors: William G
authors: WG
authors: Hocking
authors: Timothy R
authors: TR
authors: Church
authors: Thomas L
authors: TL
authors: Riley
authors: John
authors: J
authors: Commins
authors: Martin M
authors: MM
authors: Oken
authors: Christine D
authors: CD
authors: Berg
authors: Philip C
authors: PC
authors: Prorok
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