Individualized Risk Prediction Model for Lung Cancer in Korean Men

Sohee Park,Il Su Park,Ji An Lee,Hyunsun Lim,Byung-Ho Nam,Hai-Rim Shin,Jun Tae Han,Hye-Ryung Yang,Jin Soo Lee,Olga Y Gorlova

doi:10.1371/journal.pone.0054823

Abstract

PurposeLung cancer is the leading cause of cancer deaths in Korea. The objective of the present study was to develop an individualized risk prediction model for lung cancer in Korean men using population-based cohort data.MethodsFrom a population-based cohort study of 1,324,804 Korean men free of cancer at baseline, the individualized absolute risk of developing lung cancer was estimated using the Cox proportional hazards model. We checked the validity of the model using C statistics and the Hosmer–Lemeshow chi-square test on an external validation dataset.ResultsThe risk prediction model for lung cancer in Korean men included smoking exposure, age at smoking initiation, body mass index, physical activity, and fasting glucose levels. The model showed excellent performance (C statistic = 0.871, 95% CI = 0.867–0.876). Smoking was significantly associated with the risk of lung cancer in Korean men, with a four-fold increased risk in current smokers consuming more than one pack a day relative to non-smokers. Age at smoking initiation was also a significant predictor for developing lung cancer; a younger age at initiation was associated with a higher risk of developing lung cancer.ConclusionThis is the first study to provide an individualized risk prediction model for lung cancer in an Asian population with very good model performance. In addition to current smoking status, earlier exposure to smoking was a very important factor for developing lung cancer. Since most of the risk factors are modifiable, this model can be used to identify those who are at a higher risk and who can subsequently modify their lifestyle choices to lower their risk of lung cancer.

Highlights

Lung cancer is one of the most commonly occurring malignancies, with more than 1.3 million incident cases, and a major cause of cancer death worldwide [1]
We considered a composite variable for smoking that combined smoking status and the average amount smoked per day
Major Risk Factors Affecting the Lung Cancer Risk A total of 1,309,144 participants aged 30 to 80 years were included in this study, and 10,007 newly diagnosed lung cancer cases were observed during the 8-year follow-up

Summary

Introduction

Lung cancer is one of the most commonly occurring malignancies, with more than 1.3 million incident cases, and a major cause of cancer death worldwide [1]. In Korea, cancer has been the leading cause of death since the 1980s; in particular, lung cancer has ranked first among all cancer deaths. In 2010, a total of 15,623 lung cancer deaths occurred, and 73% (n = 11,411) of them were among men in Korea [2]. The age-standardized lung cancer incidence rates in 2009 were 46.8 in men and 13.9 in women per 100,000 person-years [3]. Compared with other types of cancer, lung cancer survival rates were much lower in Korea. The 5-year relative survival rates were 14.9% in men and 19.6% in women for cancer patients newly diagnosed between 2001 and 2005 in Korea [3]

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