Personalized Risk Assessment in Never, Light, and Heavy Smokers in a prospective cohort in Taiwan.
The objective of this study was to develop markedly improved risk prediction models for lung cancer using a prospective cohort of 395,875 participants in Taiwan. Discriminatory accuracy was measured by generation of receiver operator curves and estimation of area under the curve (AUC). In multivariate Cox regression analysis, age, gender, smoking pack-years, family history of lung cancer, personal cancer history, BMI, lung function test, and serum biomarkers such as carcinoembryonic antigen (CEA), bilirubin, alpha fetoprotein (AFP), and c-reactive protein (CRP) were identified and included in an integrative risk prediction model. The AUC in overall population was 0.851 (95% CI = 0.840-0.862), with never smokers 0.806 (95% CI = 0.790-0.819), light smokers 0.847 (95% CI = 0.824-0.871), and heavy smokers 0.732 (95% CI = 0.708-0.752). By integrating risk factors such as family history of lung cancer, CEA and AFP for light smokers, and lung function test (Maximum Mid-Expiratory Flow, MMEF25-75%), AFP and CEA for never smokers, light and never smokers with cancer risks as high as those within heavy smokers could be identified. The risk model for heavy smokers can allow us to stratify heavy smokers into subgroups with distinct risks, which, if applied to low-dose computed tomography (LDCT) screening, may greatly reduce false positives.
Department of Epidemiology, and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Xifeng
X
Wu
Institute of Population Health Science, National Health Research Institutes, Zhunan, Taiwan.|China Medical University Hospital, Taichung, Taiwan.
Chi Pang
CP
Wen
Department of Epidemiology, and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Yuanqing
Y
Ye
Institute of Population Health Science, National Health Research Institutes, Zhunan, Taiwan.|China Medical University Hospital, Taichung, Taiwan.
MinKwang
M
Tsai
Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Christopher
C
Wen
Department of Radiological Sciences, University of California at Irvine, Irvine, CA, USA.
Jack A
JA
Roth
Department of Epidemiology, and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Xia
X
Pu
Department of Epidemiology, and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Wong-Ho
WH
Chow
Department of Epidemiology, and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Chad
C
Huff
Department of Epidemiology, and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Sonia
S
Cunningham
Department of Epidemiology, and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Maosheng
M
Huang
Institute of Population Health Science, National Health Research Institutes, Zhunan, Taiwan.|China Medical University Hospital, Taichung, Taiwan.
Shuanbei
S
Wu
MJ Health Management Institution, Taipei, Taiwan.
Chwen Keng
CK
Tsao
Department of Epidemiology, and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Jian
J
Gu
UC San Diego Moores Cancer Center, San Diego, California, USA.
Scott M
SM
Lippman
D000368:Aged; D019540:Area Under Curve; D001663:Bilirubin / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002272:Carcinoembryonic Antigen / Q000097:blood; D015331:Cohort Studies; D016002:Discriminant Analysis; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009313:National Health Programs; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012307:Risk Factors; D000074285:Smokers / Q000706:statistics & numerical data*; D013624:Taiwan / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D000509:alpha-Fetoproteins / Q000032:analysis
D002272:Carcinoembryonic Antigen; D000509:alpha-Fetoproteins; D002097:C-Reactive Protein; D001663:Bilirubin