Cited by 138Statistical Methods in EpidemiologyMeta-analysis and systematic reviewsImbalanced Data Classification Techniques

ROC curves for clinical prediction models part 1. ROC plots showed no added value above the AUC when evaluating the performance of clinical prediction models

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Verbakel, Jan Y., Steyerberg, Ewout W., Uno, Hajime, De Cock, Bavo, Wynants, Laure, Collins, Gary S., Van Calster, Ben·2020·Journal of Clinical Epidemiology

Abstract

OBJECTIVES: Receiver operating characteristic (ROC) curves show how well a risk prediction model discriminates between patients with and without a condition. We aim to investigate how ROC curves are presented in the literature and discuss and illustrate their potential limitations. STUDY DESIGN AND SETTING: We conducted a pragmatic literature review of contemporary publications that externally validated clinical prediction models. We illustrated limitations of ROC curves using a testicular cancer case study and simulated data. RESULTS: Of 86 identified prediction modeling studies, 52 (60%) presented ROC curves without thresholds and one (1%) presented an ROC curve with only a few thresholds. We illustrate that ROC curves in their standard form withhold threshold information have an unstable shape even for the same area under the curve (AUC) and are problematic for comparing model performance conditional on threshold. We compare ROC curves with classification plots, which show sensitivity and specificity conditional on risk thresholds. CONCLUSION: ROC curves do not offer more information than the AUC to indicate discriminative ability. To assess the model's performance for decision-making, results should be provided conditional on risk thresholds. Therefore, if discriminatory ability must be visualized, classification plots are attractive.

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  1. Van Calster B, Steyerberg EW, Harrell FH. Risk prediction for indi- viduals. JAMA 2015;314:1875.

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Authors
Verbakel, J. Y., Steyerberg, E. W., Uno, H., De Cock, B., Wynants, L., Collins, G. S., & Van Calster, B.
Affiliations
  • University of Oxford (GB)
  • Leiden University Medical Center (NL)
  • Dana-Farber Cancer Institute (US)
  • KU Leuven (BE)
Venue
Journal of Clinical Epidemiology
Publisher
Elsevier BV
Published
2020-10
Volume
126
Pages
207-216
ISSN
0895-4356 (ISSN-L)
OpenAlex
W3045258609
Cited by
138
References
48
Citations by year
2026: 26 · 2025: 34 · 2024: 29 · 2023: 21 · 2022: 15 · 2021: 9 · 2020: 3 · 2013: 1
FWCI
8.46
Type
journal article
Language
en
Update notices
erratum (2021-02-01)
Open access
Locations
  • Journal of Clinical Epidemiology (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Leiden Repository (Leiden University) (submittedVersion, cc-by-nc-nd)
  • Lirias (KU Leuven) (submittedVersion, cc-by-nc-nd)
  • Data Archiving and Networked Services (DANS) (submittedVersion, cc-by-nc-nd)
Funders
  • Cancer Research UK
  • Patient-Centered Outcomes Research Institute
  • Fonds Wetenschappelijk Onderzoek
  • NIHR Oxford Biomedical Research Centre
  • Seventh Framework Programme
Topics
  • Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
  • Physical Sciences › Computer Science › Artificial Intelligence › Imbalanced Data Classification Techniques
Keywords
ROC curve, area under the curve, clinical prediction model, risk prediction model, sensitivity and specificity, risk thresholds, model discrimination, external validation, testicular cancer
MeSH terms
Clinical Decision Rules, Computer Simulation, Decision Making, Humans, Lymph Nodes, Male, Models, Theoretical, Predictive Value of Tests, Retroperitoneal Neoplasms, ROC Curve, Sensitivity and Specificity, Testicular Neoplasms, Models, Statistical, Risk Assessment, Area Under Curve

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