Comparison of prognostic models to predict the occurrence of colorectal cancer in asymptomatic individuals: a systematic literature review and external validation in the EPIC and UK Biobank prospective cohort studies
Smith, Todd; Muller, David C; Moons, Karel G M; Cross, Amanda J; Johansson, Mattias; Ferrari, Pietro; Fagherazzi, Guy; Peeters, Petra H M; Severi, Gianluca; Hüsing, Anika; Kaaks, Rudolf; Tjonneland, Anne; Olsen, Anja; Overvad, Kim; Bonet, Catalina; Rodriguez-Barranco, Miguel; Huerta, Jose Maria; Barricarte Gurrea, Aurelio; Bradbury, Kathryn E; Trichopoulou, Antonia; Bamia, Christina; Orfanos, Philippos; Palli, Domenico; Pala, Valeria; Vineis, Paolo; Bueno-de-Mesquita, Bas; Ohlsson, Bodil; Harlid, Sophia; Van Guelpen, Bethany; Skeie, Guri; Weiderpass, Elisabete; Jenab, Mazda; Murphy, Neil; Riboli, Elio; Gunter, Marc J; Aleksandrova, Krasimira Jekova; Tzoulaki, Ioanna
(2019) Gut, volume 68, issue 4, pp. 672 - 683
(Article)
Abstract
OBJECTIVE: To systematically identify and validate published colorectal cancer risk prediction models that do not require invasive testing in two large population-based prospective cohorts. DESIGN: Models were identified through an update of a published systematic review and validated in the European Prospective Investigation into Cancer and Nutrition (EPIC) and the
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UK Biobank. The performance of the models to predict the occurrence of colorectal cancer within 5 or 10 years after study enrolment was assessed by discrimination (C-statistic) and calibration (plots of observed vs predicted probability). RESULTS: The systematic review and its update identified 16 models from 8 publications (8 colorectal, 5 colon and 3 rectal). The number of participants included in each model validation ranged from 41 587 to 396 515, and the number of cases ranged from 115 to 1781. Eligible and ineligible participants across the models were largely comparable. Calibration of the models, where assessable, was very good and further improved by recalibration. The C-statistics of the models were largely similar between validation cohorts with the highest values achieved being 0.70 (95% CI 0.68 to 0.72) in the UK Biobank and 0.71 (95% CI 0.67 to 0.74) in EPIC. CONCLUSION: Several of these non-invasive models exhibited good calibration and discrimination within both external validation populations and are therefore potentially suitable candidates for the facilitation of risk stratification in population-based colorectal screening programmes. Future work should both evaluate this potential, through modelling and impact studies, and ascertain if further enhancement in their performance can be obtained.
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Keywords: epidemiology, colorectal cancer, cancer prevention, medical statistics, colorectal cancer screening, Colorectal Neoplasms/epidemiology, Predictive Value of Tests, Prognosis, Risk Assessment, Early Detection of Cancer, Humans, Risk Factors, Asymptomatic Diseases, United Kingdom/epidemiology, Europe/epidemiology, Biological Specimen Banks, Gastroenterology, Research Support, Non-U.S. Gov't, Journal Article, Validation Studies, Comparative Study
ISSN: 0017-5749
Publisher: BMJ Publishing Group
Note: Funding Information: Competing interests tS received a studentship from the Medical research council (Mr/M501712/1). DcM is supported by a cancer research UK Population research Fellowship (c57955/a24390). KJa received a research grant from the german research Foundation (DFg) (al 1784/3-1), KeB received research grants from cancer research UK (c570/a16491) and the Medical research council (Mr/ M012190/1); no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; KgMM is director of research of a large (around 500 employees) research and teaching institute within his University Medical center. they perform both investigator-driven and industry-driven research projects with a number of pharmaceutical and diagnostic companies. in addition, some of the members of staff receive unrestricted grants for research projects from a number of companies. it is their explicit policy to work with several companies and not to focus on one or two industrial partners. He receives no personal payment from any industrial partner. Funding Information: Funding tS is supported by a Medical research council studentship (Mr/ M501712/1). DcM is supported by a cancer research UK Population research Fellowship (c57955/a24390). this work was partly supported by the german research Foundation (DFg) grant al 1784/3-1, which has funded the research position of Ka for the time of study conduct and analysis. KeB received research grants from cancer research UK (c570/a16491) and the Medical research council (Mr/M012190/1). the coordination of ePic is financially supported by the european commission (Dg-SancO) and the international agency for research on cancer. the national cohorts are supported by Danish cancer Society (Denmark); ligue contre le cancer, institut gustave roussy, Mutuelle générale de l’education nationale and institut national de la Santé et de la recherche Médicale (inSerM) (France); german cancer aid, german cancer research center (DKFZ), Federal Ministry of education and research (BMBF), Deutsche Krebshilfe, Deutsches Krebsforschungszentrum and Federal Ministry of education and research (germany); the Hellenic Health Foundation (greece); associazione italiana per la ricerca sul cancro-airc-italy and national research council (italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), netherlands cancer registry (nKr), lK research Funds, Dutch Prevention Funds, Dutch ZOn (Zorg Onderzoek nederland), World cancer research Fund (WcrF), Statistics netherlands (the netherlands); erc-2009-adg 232997 and nordforsk, nordic centre of excellence programme on Food, nutrition and Health (norway); Health research Fund (FiS), Pi13/00061 to granada, Pi13/01162 to ePic-Murcia, regional governments of andalucía, asturias, Basque country, Murcia and navarra, iSciii retic (rD06/0020) (Spain); Swedish cancer Society, Swedish research council and county councils of Skåne and Västerbotten (Sweden); and cancer research UK (14136 to ePic-norfolk; c570/a16491 and c8221/a19170 to ePic-Oxford), Medical research council (1000143 to ePic-norfolk, Mr/M012190/1 to ePic-Oxford) (UK). Publisher Copyright: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019.
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