External validation of the parsimonious EuroLung risk models: analysis of the Brazilian Lung Cancer Registry.

IF 2.9 4区医学 Q2 RESPIRATORY SYSTEM

Jornal Brasileiro De Pneumologia Pub Date : 2024-09-27 eCollection Date: 2024-01-01 DOI:10.36416/1806-3756/e20240226

Paula Duarte D'Ambrosio, Ricardo Mingarini Terra, Alessandro Brunelli, Leticia Leone Lauricella, Carolina Adan Cavadas, Jaqueline Schaparini Fonini, Jefferson Luiz Gross, Federico Enrique Garcia Cipriano, Fabio May da Silva, Paulo Manuel Pêgo-Fernandes

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引用次数: 0

Abstract

Objective: The purpose of this study was to assess performance in the Brazilian Lung Cancer Registry Database by using the parsimonious EuroLung risk models for morbidity and mortality.

Methods: The EuroLung1 and EuroLung2 models were tested and evaluated through calibration (calibration plot, Brier score, and the Hosmer-Lemeshow test) and discrimination (ROC AUCs), in a national multicenter registry of 1,031 patients undergoing anatomic lung resection.

Results: The evaluation of performance in Brazilian health care facilities utilizing risk-adjustment models, specifically EuroLung1 and EuroLung2, revealed substantial miscalibration, as evidenced by calibration plots and Hosmer-Lemeshow tests in both models. In terms of calibration, EuroLung1 exhibited a calibration plot with overlapping points, characterized by a slope of 1.11 and a Brier score of 0.15; the Hosmer-Lemeshow test yielded a statistically significant p-value of 0.015; and the corresponding ROC AUC was 0.678 (95% CI: 0.636-0.721). The EuroLung2 model displayed better calibration, featuring fewer overlapping points in the calibration plot, with a slope of 1.22, with acceptable discrimination, as indicated by a ROC AUC of 0.756 (95% CI: 0.670-0.842). Both models failed to accurately predict morbidity and mortality outcomes in this specific health care context.

Conclusions: Discrepancies between the EuroLung model predictions and outcomes in Brazil underscore the need for model refinement and for a probe into inefficiencies in the Brazilian health care system.

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欧洲肺癌风险模型的外部验证：对巴西肺癌登记处的分析。

研究目的本研究的目的是评估巴西肺癌登记数据库中使用简约的 EuroLung 发病率和死亡率风险模型的性能：在一个全国性多中心登记处，对1031名接受解剖肺切除术的患者进行了EuroLung1和EuroLung2模型的校准（校准图、Brier评分和Hosmer-Lemeshow检验）和判别（ROC AUCs）测试和评估：对巴西医疗机构使用风险调整模型（特别是 EuroLung1 和 EuroLung2）进行的绩效评估发现，两个模型的校准图和 Hosmer-Lemeshow 检验均显示存在严重的校准误差。在校准方面，EuroLung1 的校准图上有重叠点，斜率为 1.11，Brier 得分为 0.15；Hosmer-Lemeshow 检验得出的统计学显著 p 值为 0.015；相应的 ROC AUC 为 0.678（95% CI：0.636-0.721）。EuroLung2 模型的校准效果更好，校准图中的重叠点更少，斜率为 1.22，ROC AUC 为 0.756（95% CI：0.670-0.842），具有可接受的区分度。在这种特殊的医疗环境下，两种模型都无法准确预测发病率和死亡率：结论：EuroLung 模型的预测结果与巴西的结果之间存在差异，这突出表明有必要对模型进行改进，并对巴西医疗保健系统的低效率进行调查。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Jornal Brasileiro De Pneumologia RESPIRATORY SYSTEM-

CiteScore

3.50

自引率

14.80%

发文量

118

审稿时长

20 weeks

期刊介绍： The Brazilian Journal of Pulmonology publishes scientific articles that contribute to the improvement of knowledge in the field of the lung diseases and related areas.