Risk prediction models for endometrial cancer: development and validation in an international consortium

Autor: Joy Shi, Peter Kraft, Bernard A Rosner, Yolanda Benavente, Amanda Black, Louise A Brinton, Chu Chen, Megan A Clarke, Linda S Cook, Laura Costas, Luigino Dal Maso, Jo L Freudenheim, Jon Frias-Gomez, Christine M Friedenreich, Montserrat Garcia-Closas, Marc T Goodman, Lisa Johnson, Carlo La Vecchia, Fabio Levi, Jolanta Lissowska, Lingeng Lu, Susan E McCann, Kirsten B Moysich, Eva Negri, Kelli O'Connell, Fabio Parazzini, Stacey Petruzella, Jerry Polesel, Jeanette Ponte, Timothy R Rebbeck, Peggy Reynolds, Fulvio Ricceri, Harvey A Risch, Carlotta Sacerdote, Veronica W Setiawan, Xiao-Ou Shu, Amanda B Spurdle, Britton Trabert, Penelope M Webb, Nicolas Wentzensen, Lynne R Wilkens, Wang Hong Xu, Hannah P Yang, Herbert Yu, Mengmeng Du, Immaculata De Vivo
Rok vydání: 2023
Předmět:
Zdroj: JNCI: Journal of the National Cancer Institute. 115:552-559
ISSN: 1460-2105
0027-8874
DOI: 10.1093/jnci/djad014
Popis: Background Endometrial cancer risk stratification may help target interventions, screening, or prophylactic hysterectomy to mitigate the rising burden of this cancer. However, existing prediction models have been developed in select cohorts and have not considered genetic factors. Methods We developed endometrial cancer risk prediction models using data on postmenopausal White women aged 45-85 years from 19 case-control studies in the Epidemiology of Endometrial Cancer Consortium (E2C2). Relative risk estimates for predictors were combined with age-specific endometrial cancer incidence rates and estimates for the underlying risk factor distribution. We externally validated the models in 3 cohorts: Nurses’ Health Study (NHS), NHS II, and the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Results Area under the receiver operating characteristic curves for the epidemiologic model ranged from 0.64 (95% confidence interval [CI] = 0.62 to 0.67) to 0.69 (95% CI = 0.66 to 0.72). Improvements in discrimination from the addition of genetic factors were modest (no change in area under the receiver operating characteristic curves in NHS; PLCO = 0.64 to 0.66). The epidemiologic model was well calibrated in NHS II (overall expected-to-observed ratio [E/O] = 1.09, 95% CI = 0.98 to 1.22) and PLCO (overall E/O = 1.04, 95% CI = 0.95 to 1.13) but poorly calibrated in NHS (overall E/O = 0.55, 95% CI = 0.51 to 0.59). Conclusions Using data from the largest, most heterogeneous study population to date (to our knowledge), prediction models based on epidemiologic factors alone successfully identified women at high risk of endometrial cancer. Genetic factors offered limited improvements in discrimination. Further work is needed to refine this tool for clinical or public health practice and expand these models to multiethnic populations.
Databáze: OpenAIRE
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