Early detection of renal cell carcinoma (RCC) has the potential to improve disease outcomes. No screening programme for sporadic RCC is in place. Given relatively low incidence, screening would need to focus on people at high risk of clinically meaningful disease so as to limit overdiagnosis and screen-detected false-positives.
Among 192,172 participants from the EPIC cohort (including 588 incident RCC cases), we evaluated a published RCC risk prediction model (including age, sex, BMI, and smoking status) in terms of discrimination (C-statistic) and calibration (observed probability as a function of predicted probability. We used a flexible parametric survival model to develop an expanded model including age, sex, BMI, and smoking status, with the addition of self-reported history of hypertension and measured blood pressure.
The previously published model yielded well-calibrated probabilities and good discrimination (C-statistic [95% CI]: 0.699 [0.679, 0.721]). Our model had slightly improved discrimination (0.714 [0.694, 0.735], bootstrap optimism-corrected C-statistic: 0.709). Despite this good performance, predicted risk was low for the vast majority of participants, with 70% of participants having 10 year risk less than 0.0025.
Although the models performed well for the prediction of incident RCC, they are currently insufficiently powerful to identify individuals at substantial risk of RCC in a general population.
Despite the promising performance of the EPIC RCC risk prediction model, further development of the model, possibly including biomarkers of risk, is required to enable risk-stratification of RCC.
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2020 Dec 17 [Epub ahead of print]
Rosie K Singleton, Alicia K Heath, Joanna L Clasen, Ghislaine Scelo, Mattias Johannson, Florence Le Calvez-Kelm, Elisabete Weiderpass, Fredrik Liedberg, Borje Ljungberg, Justin Harbs, Anja Olsen, Anne Tjonneland, Christina C Dahm, Rudolf Kaaks, Renée Turzanski Fortner, Salvatore Panico, Giovanna Tagliabue, Giovanna Masala, Rosario Tumino, Fulvio Ricceri, Inger T Gram, Carmen Santiuste, Catalina Bonet, Miguel Rodríguez-Barranco, Matthias B Schulze, Manuela M Bergmann, Ruth C Travis, Ioanna Tzoulaki, Elio Riboli, David C Muller
School of Public Health, Imperial College London., International Agency For Research On Cancer., Institution of Translational Medicine, Lund University., Department of Surgical and Perioperative Sciences, Umea University., Department of Radiation Sciences, Oncology, Umeå University., Diet, Genes and Environment, Danish Cancer Society Research Center., Research Unit for Epidemiology, Department of Public Health, Aarhus University., Division of Cancer Epidemiology, Deutsches Krebsforschungszentrum (DKFZ)., Department of Clinical Medicine and Surgery, Unit of Clinical Epidemiology and Predictive Medicine, Federico II University., Cancer Registry Unit, Fondazione IRCSS Istituto Nazionale dei Tumori., Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for cancer research, prevention and clinical network (ISPRO)., Cancer Registry and Histopathology Unit, Provincial Health Authority (ASP), Ragusa., Dept. of Clinical and Biological Sciences, University of Turin., Community Medicine, University of Tromsø, The Arctic University of Norway., Epidemiology, Murcia Regional Health Council., Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO)., Granada Cancer Registry, Andalusian School of Public Health; Biomedical Research Institute of Granada (ibs.Granada), University of Granada; CIBER of Epidemiology and Public Health (CIBERESP)., Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke., Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke., Nuffield Department of Population Health, University of Oxford., Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London., Department of Epidemiology and Biostatistics, Imperial College London., School of Public Health, Imperial College London .