A modified colorectal screening score for prediction of advanced neoplasia: A prospective study of 5744 subjects

作者：Joseph J.�Y. Sung, Martin C. S. Wong, Thomas Yuen Tung Lam, Kelvin K.F. Tsoi, Victor C. W. Chan, Wilson W. L. Cheung, Jessica Y. L. Ching · 发表于：Journal of Gastroenterology and Hepatology · 年份：2017 · DOI：10.1111/jgh.13835 · 被引用次数：91 · 研究领域：Colorectal Cancer Screening and Detection、Gastric Cancer Management and Outcomes、Genetic factors in colorectal cancer

Abstract Background and Aim We validated a modified risk algorithm based on the Asia‐Pacific Colorectal Screening (APCS) score that included body mass index (BMI) for prediction of advanced neoplasia. Methods Among 5744 Chinese asymptomatic screening participants undergoing a colonoscopy in Hong Kong from 2008 to 2012, a random sample of 3829 participants acted as the derivation cohort. The odds ratios for significant risk factors identified by binary logistic regression analysis were used to build a scoring system ranging from 0 to 6, divided into “average risk” (AR): 0; “moderate risk” (MR): 1–2; and “high risk” (HR): 3–6. The other 1915 subjects formed a validation cohort, and the performance of the score was assessed. Results The prevalence of advanced neoplasia in the derivation and validation cohorts was 5.4% and 6.0%, respectively ( P = 0.395). Old age, male gender, family history of colorectal cancer, smoking, and BMI were significant predictors in multivariate regression analysis. A BMI cut‐off at > 23 kg/m 2 had better predictive capability and lower number needed to screen than that of > 25 kg/m 2 . Utilizing the score developed, 8.4%, 57.4%, and 34.2% in the validation cohort were categorized as AR, MR, and HR, respectively. The corresponding prevalence of advanced neoplasia was 3.8%, 4.3%, and 9.3%. Subjects in the HR group had 2.48‐fold increased prevalence of advanced neoplasia than the AR group. The c‐statistics of the modified score had better discriminatory ...