In Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
BACKGROUND : This study used machine learning to develop a 3-year lung cancer risk prediction model with large real-world data in a mostly younger population.
METHODS : Over 4.7 million individuals, aged 45-65 years with no history of any cancer or lung cancer screening, diagnostic, or treatment procedures, with an outpatient visit in 2013 were identified in the Optum® De-identified Electronic Health Record (EHR) Dataset. A Least Absolute Shrinkage and Selection Operator model was fit using all available data in the 365 days prior. Temporal validation was assessed with recent data. External validation was assessed with data from Mercy Health Systems EHR and Optum® De-Identified Clinformatics Data Mart. Racial inequities in model discrimination were assessed with xAUCs.
RESULTS : The model AUC was 0.76. Top predictors included age, smoking, race, ethnicity, and diagnosis of chronic obstructive pulmonary disease. The model identified a high-risk group with lung cancer incidence 9 times the average cohort incidence, representing 10% of lung cancer patients. Model performed well temporally and externally, while performance was reduced for Asians and Hispanics.
CONCLUSIONS : A high-dimensional model trained using big data identified a subset of patients with high lung cancer risk. The model demonstrated transportability to EHR and claims data, while underscoring the need to assess racial disparities when using machine learning methods.
IMPACT : This internally and externally validated real-world data-based lung cancer prediction model is available on an open-source platform for broad sharing and application. Model integration into an EHR system could minimize physician burden by automating identification of high-risk patients.
Chandran Urmila, Reps Jenna, Yang Robert, Vachani Anil, Maldonado Fabien, Kalsekar Iftekhar
2022-Dec-28
