Development and validation of a novel risk prediction algorithm to estimate 10-year risk of oesophageal cancer in primary care: prospective cohort study and evaluation of performance against two other risk prediction models.

Background

Methods to identify patients at increased risk of oesophageal cancer are needed to better identify those for targeted screening. We aimed to derive and validate novel risk prediction algorithms (CanPredict) to estimate the 10-year risk of oesophageal cancer and evaluate performance against two other risk prediction models.

Methods

Prospective open cohort study using routinely collected data from 1804 QResearch® general practices. We used 1354 practices (12.9 M patients) to develop the algorithm. We validated the algorithm in 450 separate practices from QResearch (4.12 M patients) and 355 Clinical Practice Research Datalink (CPRD) practices (2.53 M patients). The primary outcome was an incident diagnosis of oesophageal cancer found in GP, mortality, hospital, or cancer registry data. Patients were aged 25-84 years and free of oesophageal cancer at baseline. Cox proportional hazards models were used with prediction selection to derive risk equations. Risk factors included age, ethnicity, Townsend deprivation score, body mass index (BMI), smoking, alcohol, family history, relevant co-morbidities and medications. Measures of calibration, discrimination, sensitivity, and specificity were calculated in the validation cohorts.

Finding

There were 16,384 incident cases of oesophageal cancer in the derivation cohort (0.13% of 12.9 M). The predictors in the final algorithms were: age, BMI, Townsend deprivation score, smoking, alcohol, ethnicity, Barrett's oesophagus, hiatus hernia,

Interpretation

We have developed and validated a novel prediction algorithm to quantify the absolute risk of oesophageal cancer. The CanPredict algorithms could be used to identify high risk patients for targeted screening.

Funding

Innovate UK and CRUK (grant 105857).

Informations de copyright

© 2023 The Author(s).

Déclaration de conflit d'intérêts

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: JHC is an NIHR senior investigator and reports grants from National Institute for Health Research (NIHR) Biomedical Research Centre, Oxford, grants from John Fell Oxford University Press Research Fund, grants from Cancer Research UK (CR-UK) grant number C5255/A18085, through the Cancer Research UK Oxford Centre, grants from the Oxford Wellcome Institutional Strategic Support Fund (204826/Z/16/Z) and other research councils, during the conduct of the study. JHC is an unpaid director of QResearch, a not-for-profit organisation which is a partnership between the University of Oxford and EMIS Health who supply the QResearch database used for this work. JHC has a 50% shareholding in ClinRisk Ltd, co-owning it with her husband, who is a director. As a shareholder and spouse of a director she has a financial and family interest in the ongoing and future success of the company. The company licences software both to the private sector and to NHS bodies or bodies that provide services to the NHS (through GP electronic health record providers, pharmacies, hospital providers and other NHS providers). This software implements algorithms (including similar cancer risk algorithms) developed from access to the QResearch database during her time at the University of Nottingham. CC reports grants from INNOVATE UK (to fund this work), grants from NIHR and research councils to fund other research projects outside the scope of this work and previous consultancy with ClinRisk outside the scope of the current work. RCF holds patents related to the Cytosponge and related assays licensed by the Medical Research Council to Covidien (now Medtronic). RCF reports grants from INNOVATE UK (to fund this work). RCF is named on patents related to Cytosponge and related assays which have been licensed by the Medical Research Council to Covidien GI Solutions (now Medtronic); payments to institution for webinars for Medtronic (2021), Olympus (2021) and Riche (2020); patents for Cytosponge and related assays, payment to institution for participation in Medtronic Cytosponge Advisory Board (2021) and is a co-founder and shareholder for Cyted Ltd. XWM has no interests to declare.