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Validation and public health modelling of risk prediction models for kidney cancer using the UK Biobank.

Accepted version
Peer-reviewed

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Authors

Pennells, Lisa 
Wood, Angela 
Rossi, Sabrina H 

Abstract

OBJECTIVES: To externally validate risk models for the detection of kidney cancer, as early detection of kidney cancer improves survival and stratifying the population using risk models could enable an individually tailored screening programme. METHODS: We validated the performance of 30 existing phenotypic models predicting the risk of kidney cancer in the UK Biobank cohort (n = 450 687). We compared the discrimination and calibration of models for men, women, and a mixed-sex cohort. Population level data were used to estimate model performance in a screening scenario for a range of risk thresholds (6-year risk: 0.1-1.0%). RESULTS: In all, 10 models had reasonable discrimination (area under the receiver-operating characteristic curve >0.60), although some had poor calibration. Modelling demonstrated similar performance of the best models over a range of thresholds. The models showed an improvement in ability to identify cases compared to age- and sex-based screening. All the models performed less well in women than men. CONCLUSIONS: The present study is the first comprehensive external validation of risk models for kidney cancer. The best-performing models are better at identifying individuals at high risk of kidney cancer than age and sex alone; however, the benefits are relatively small. Feasibility studies are required to determine applicability to a screening programme.

Description

Keywords

#KidneyCancer, #kcsm, #uroonc, kidney cancer, public health modelling, risk models, risk stratification, screening, validation, Biological Specimen Banks, Female, Humans, Kidney Neoplasms, Male, Mass Screening, Public Health, Risk Assessment, Risk Factors, United Kingdom

Journal Title

BJU Int

Conference Name

Journal ISSN

1464-4096
1464-410X

Volume Title

Publisher

Wiley

Rights

All rights reserved
Sponsorship
Department of Health (via National Institute for Health Research (NIHR)) (21823/NIHR301182)
Cancer Research UK (C96/A25177)
Cancer Research UK (21464)
MRC (MC_UU_00006/6)
Medical Research Council (G0701619)
Medical Research Council (MR/K014811/1)
British Heart Foundation (SP/18/3/33801)
EPSRC (EP/T017961/1)
HH was supported by a National Institute of Health Research Methods Fellowship (RM-SR-2017-09-009) and is now supported by a National Institute of Health Research Development and Skills Enhancement Award (NIHR301182). SHR is supported by The Urology Foundation and a Cancer Research UK Clinical Research Fellowship. GDS’s work on this topic is funded by Kidney Cancer UK, The Urology Foundation, The Rosetrees Trust, Yorkshire Cancer Research and Cancer Research UK and supported by The Mark Foundation for Cancer Research, the Cancer Research UK Cambridge Centre [C9685/A25177] and NIHR Cambridge BRC. The University of Cambridge has received salary support in respect of SJG from the NHS in the East of England through the Clinical Academic Reserve. JUS was funded by a Cancer Research UK Prevention Fellowship (C55650/A21464) and is now supported by a National Institute of Health Research Advanced Fellowship (NIHR300861). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.