Multi-Objective Composite Longitudinal Biomarker Scores for Improved Cancer Risk Assessment
Abstract
Repeated blood-based biomarker measurements can improve cancer risk assessment by capturing longitudinal changes missed by single-time-point analyses. Parametric Empirical Bayes (PEB) incorporates prior measurements to estimate individualized reference values, but existing implementations do not account for the time between measurements and rely on predefined panels with fixed combination rules. We developed improved Parametric Empirical Bayes (iPEB), which accounts for the intervals between serial measurements, adjusts for covariates, and performs feature selection and optimized biomarker combination. iPEB optimizes biomarker weights for specific clinical objectives, such as maximizing sensitivity at a prespecified specificity or diagnostic lead time. We evaluated iPEB through simulations and a real-world application using six protein biomarkers (pro-SFTPB, CEA, CA125, CYFRA 21-1, osteopontin, and HE4) from a case-control study nested within the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. The analysis included 324 lung cancer cases and 1,674 controls with at least two serial measurements; six centers were used for model development and four for independent validation. Optimized for sensitivity at 99% specificity, iPEB achieved 24.2% sensitivity in the independent test set, compared with 18.2% for conventional PEB applied to the same four-marker panel. Optimized instead for lead time, iPEB added approximately 50 days of lead time at that stringent operating point. iPEB improved lung cancer risk assessment in independent PLCO data, supporting objective-driven optimization of longitudinal biomarkers for early detection.
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BibTeX
@misc{sarkar2026multiobjective,
title = {{Multi-Objective Composite Longitudinal Biomarker Scores for Improved Cancer Risk Assessment}},
author = {Bitan Sarkar and Ana Maria Kenney and James P. Long and Johannes F. Fahrmann and Samir Hanash and Kim-Anh Do and Ehsan Irajizad},
howpublished = {arXiv},
year = {2026},
month = sep,
doi = {10.48550/arxiv.2609.08225},
eprint = {2609.08225},
archivePrefix = {arXiv},
url = {https://arxiv.org/abs/2609.08225},
}
RIS
TY - UNPB
TI - Multi-Objective Composite Longitudinal Biomarker Scores for Improved Cancer Risk Assessment
AU - Bitan Sarkar
AU - Ana Maria Kenney
AU - James P. Long
AU - Johannes F. Fahrmann
AU - Samir Hanash
AU - Kim-Anh Do
AU - Ehsan Irajizad
PY - 2026
DA - 2026/09/08
PB - arXiv
DO - 10.48550/arxiv.2609.08225
UR - https://arxiv.org/abs/2609.08225
AB - Repeated blood-based biomarker measurements can improve cancer risk assessment by capturing longitudinal changes missed by single-time-point analyses. Parametric Empirical Bayes (PEB) incorporates prior measurements to estimate individualized reference values, but existing implementations do not account for the time between measurements and rely on predefined panels with fixed combination rules. We developed improved Parametric Empirical Bayes (iPEB), which accounts for the intervals between serial measurements, adjusts for covariates, and performs feature selection and optimized biomarker combination. iPEB optimizes biomarker weights for specific clinical objectives, such as maximizing sensitivity at a prespecified specificity or diagnostic lead time. We evaluated iPEB through simulations and a real-world application using six protein biomarkers (pro-SFTPB, CEA, CA125, CYFRA 21-1, osteopontin, and HE4) from a case-control study nested within the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. The analysis included 324 lung cancer cases and 1,674 controls with at least two serial measurements; six centers were used for model development and four for independent validation. Optimized for sensitivity at 99% specificity, iPEB achieved 24.2% sensitivity in the independent test set, compared with 18.2% for conventional PEB applied to the same four-marker panel. Optimized instead for lead time, iPEB added approximately 50 days of lead time at that stringent operating point. iPEB improved lung cancer risk assessment in independent PLCO data, supporting objective-driven optimization of longitudinal biomarkers for early detection.
ER -