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Prediction and clinical utility of a liver cancer risk model in Chinese adults: A prospective cohort study of 0.5 million people
Author(s) -
Yu Chengxiao,
Song Ci,
Lv Jun,
Zhu Meng,
Yu Canqing,
Guo Yu,
Yang Ling,
Chen Yiping,
Chen Zhengming,
Jiang Tao,
Ma Hongxia,
Jin Guangfu,
Shen Hongbing,
Hu Zhibin,
Li Liming
Publication year - 2021
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.33487
Subject(s) - medicine , liver cancer , guideline , cancer , biobank , population , prospective cohort study , cohort , demography , risk assessment , environmental health , pathology , bioinformatics , computer security , sociology , computer science , biology
China has made rapid progress in reducing the incidence of HBV infection in the past three decades, along with a rapidly changing lifestyle and aging population. We aimed to develop and validate an up‐to‐date liver cancer risk prediction model with routinely available predictors and evaluate its applicability for screening guidance. Using data from the China Kadoorie Biobank, we included 486 285 participants in this analysis. Fifteen risk factors were included in the model. Flexible parametric survival models were used to estimate the 10‐year absolute risk of liver cancer. Decision curve analysis was performed to evaluate the net benefit of the model to quantify clinical utility. A total of 2706 participants occurred liver cancer over the 4 814 320 person‐years of follow‐up. Excellent discrimination of the model was observed in both development and validation datasets, with c‐statistics (95% CI) of 0.80 (0.79‐0.81) and 0.80 (0.78‐0.82) respectively, as well as excellent calibration of observed and predicted risks. Decision curve analysis revealed that use of the model in selecting participants for screening improved benefit at a threshold of 2% 10‐year risk, compared to current guideline of screening all HBsAg carriers. Our model was more sensitive than current guideline for cancer screening (28.17% vs 25.96%). We developed and validated a CKB‐PLR (Prediction for Liver cancer Risk Based on the China Kadoorie Biobank Study) model to predict the absolute risk of liver cancer for both HBsAg seropositive and seronegative populations. Application of the model is beneficial for precisely identifying the high‐risk groups among the general population.