PO.PR01.02 · 预防研究
在人群层面预测个体化的终生总体癌症风险概率
Projecting individualized probabilities of lifetime total cancer risk across a population
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
引言：技术进步和直接面向消费者的营销激发了患者对癌症筛查与预防的巨大内在需求。然而，在缺乏强有力数据或指南的情况下，医生在临床实践中如何对待此类患者所能获得的支持极为有限。
方法：我们在英国生物样本库（UK Biobank，UKB）中预测了人群层面个体化的10年及终生癌症风险概率，以及采取健康行为可能带来的改善。我们建立了针对特定癌种的模型，以同时筛选并量化文献中已识别的危险因素的影响。随后我们使用iCARE软件包来量化并预测个体参与者的绝对癌症风险。我们评估了：(1) 按年龄和性别划分的总体癌症风险分布；(2) 在人群层面实现健康危险因素状态的潜在影响。
结果：最终研究样本纳入446,795名患者。在38个针对特定癌种的模型中共纳入118个不同的变量。终生癌症风险的分布呈右偏且在男女两性中变异范围广泛。男性终生癌症风险中位数为29.5%（四分位距（IQR）8.4%），女性为21.0%（IQR 8.8%）。对于男性，第90百分位数的终生癌症风险（42.61%）较中位数高1.4倍，较第10百分位数（23.78%）高1.8倍。同样，对于女性，第90百分位数的终生癌症风险（35.46%）较中位数高1.7倍，较第10百分位数（15.28%）高2.3倍。若将所有可改变的危险因素设定为理想状态，则该风险在男性降至20.5%（IQR 3.9%），在女性降至16.5%（IQR 4.9%）。各年龄组之间存在相当大的重叠：处于第90百分位数的50-59岁男性风险（11.9%）高于处于第25百分位数的60-70岁男性（11.8%）；处于第90百分位数的40-49岁女性风险（7.4%）高于处于第60百分位数的50-59岁女性（6.8%）以及处于第20百分位数的60-70岁女性（7.3%）。
结论：在英国生物样本库队列中，终生癌症风险差异极大，但采取健康行为可使该风险显著下降。各年龄组之间的10年癌症风险存在相当大的重叠，提示随着未来更多证据的积累，未来的多癌种筛查指南应考虑年龄和性别以外的更多因素。我们的结果强调了精准预防方法的潜力，即根据全面、个体化的风险而非仅依据基于年龄的标准来分配预防资源和筛查强度。
查看英文原文 English abstract
Introduction : Technological advances and direct-to-consumer marketing have unearthed significant organic demand from patients for cancer screening and prevention. However, in the absence of strong data or guidelines, physicians have minimal support on how to approach patients in clinical practice.
Methods : We projected individualized probabilities of 10-year and lifetime cancer risk across a population as well as potential improvement with healthy behaviors in the UK Biobank (UKB). We developed cancer-specific models to simultaneously select and quantify the impact of risk factors identified in the literature. We then used iCARE package to quantify and project absolute cancer risks for individual participants. We evaluated (1) the distribution of total cancer risk by age and sex and (2) the potential impact of achieving healthy risk factor profiles at the population level.
Results : The final study sample included 446,795 patients. A total of 118 distinct variables were included across 38 cancer-specific models. The distribution of lifetime cancer risk had a rightward skew and wide variation for both men and women. The median lifetime cancer risk was 29.5% for men (interquartile range (IQR) 8.4%) and 21.0% for women (IQR 8.8%). The lifetime risk of cancer at the 90 th percentile (42.61%) was 1.4x higher compared to the median and 1.8x higher than the 10 th percentile (23.78%) for men. Similarly, the lifetime risk of cancer at the 90 th percentile (35.46%) was 1.7x higher compared to the median and 2.3x higher than the 10 th percentile (15.28%) for women. If all modifiable risk factors were set to the ideal state, this decreased to 20.5% for men (IQR 3.9%) and 16.5% for women (IQR 4.9%). There was considerable overlap between age groups, with men aged 50-59 at the 90 th percentile having greater risk (11.9%) than men aged 60-70 at the 25 th percentile (11.8%), and women aged 40-49 at the 90 th percentile having greater risk (7.4%) than women aged 50-59 at the 60 th percentile (6.8%) and women aged 60-70 at the 20 th percentile (7.3%).
Conclusions : Lifetime cancer risk varies widely across the UK Biobank cohort, but this risk decreases substantially with healthy behaviors. There was considerable overlap in 10-year cancer risk between age groups, suggesting that future multicancer screening guidelines should account for more than age and sex as more evidence becomes available in the future. Our results underscore the potential for precision prevention approaches that allocate preventive resources and screening intensity according to comprehensive, individualized risk rather than age-based criteria alone.
利益披露 Disclosure
N. Butala,
Shockwave Medical Independent Contractor.
Boston Scientific Independent Contractor.
Catch Bio Independent Contractor.
N. Al-Hammadi,
Catch Bio Independent Contractor.
A. Fullerton,
Catch Bio Employment.