title: Signal stratification of autoantibody levels in serum samples and its application to the early detection of lung cancer.
abstract: BACKGROUND
  Further signal stratification for the EarlyCDT®-Lung test should facilitate interpretation of the test, leading to more precise interventions for particular patients.
  
  
  METHODS
  Samples were measured for the presence of autoantibodies to seven tumor-associated antigens (TAAs) (p53, NY-ESO-1, CAGE, GBU4-5, SOX2, MAGE A4, and HuD). In addition to the current test cut-offs (determined using a previously reported Validation case-control sample set, set A; n=501), new high and low cut-offs were set in order to maximize the test's positive and negative predictive values (PPV and NPV, respectively). All three sets of cut-offs were applied to two confirmatory datasets: (I) the case-control set B (n=751), and (II) Population-derived set C (n=883), and all three datasets combined (n=2,135).
  
  
  RESULTS
  For the Validation dataset, cancer/non-cancer positivity for current cut-offs was 41%/9% (PPV =0.109, 1 in 9). The high positive stratum improved this to 25%/2% (PPV =0.274, 1 in 4). The low negative stratum improved this to 8%/23% (NPV =0.990, 1 in 105). This provides a 25-fold difference in lung cancer probability between the highest and lowest groups. The test performs equally well in subjects who fulfilled the entry risk criteria for the National Lung Screening Trial (NLST) and subjects who did not meet the NLST criteria.
  
  
  CONCLUSIONS
  The EarlyCDT®-Lung test has been converted to a four-stratum test by the addition of high and low sets of cut-offs: patients are thus stratified into four risk categories. This stratification will enable personalization of subsequent screening and treatment programs for high risk individuals or patients with lung nodules.
authors.affiliation: Oncimmune Ltd, Nottingham City Hospital, Nottingham, UK;
authors.forename: Graham F
authors.initials: GF
authors.lastname: Healey
authors.forename: Stephen
authors.initials: S
authors.lastname: Lam
authors.forename: Peter
authors.initials: P
authors.lastname: Boyle
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Hamilton-Fairley
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Peek
authors.forename: John F R
authors.initials: JF
authors.lastname: Robertson
keywords: Lung cancer; autoantibody (AAb); risk stratification; tumor-associated antigen