Development and Validation of the Asia-Pacific Proximal Colon Neoplasia Risk Score

Wong, Martin C.S. and Rerknimitr, Rungsun and Goh, Khean Lee and Matsuda, Takahisa and Kim, Hyun Soo and Wu, Deng Chyang and Wu, Kai Chun and Yeoh, Khay Guan and Chong, Vui Heng and Ahmed, Furqaan and Sollano, Jose D. and Menon, Jayaram and Chiu, Han Mo and Li, Jingnan and Ching, Jessica Y.L. and Sung, Joseph J.Y. (2021) Development and Validation of the Asia-Pacific Proximal Colon Neoplasia Risk Score. Clinical Gastroenterology and Hepatology, 19 (1). 119-127.e1. ISSN 1542-3565, DOI

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Background & Aims: Patients found to be at high risk of advanced proximal neoplasia (APN) after flexible sigmoidoscopy screening should be considered for colonoscopy examination. We developed and validated a scoring system to identify persons at risk for APN. Methods: We collected data from 7954 asymptomatic subjects (age, 50–75 y) who received screening colonoscopy examinations at 14 sites in Asia. We randomly assigned 5303 subjects to the derivation cohort and the remaining 2651 to the validation cohort. We collected data from the derivation cohort on age, sex, family history of colorectal cancer, smoking, drinking, body mass index, medical conditions, and use of nonsteroidal anti-inflammatory drugs or aspirin. Associations between the colonoscopic findings of APN and each risk factor were examined using the Pearson χ2 test, and we assigned each participant a risk score (0–15), with scores of 0 to 3 as average risk and scores of 4 or higher as high risk. The scoring system was tested in the validation cohort. We used the Cochran–Armitage test of trend to compare the prevalence of APN among subjects in each group. Results: In the validation cohort, 79.5% of patients were classified as average risk and 20.5% were classified as high risk. The prevalence of APN in the average-risk group was 1.9% and in the high-risk group was 9.4% (adjusted relative risk, 5.08; 95% CI, 3.38–7.62; P <.001). The score included age (61–70 y, 3; ≥70 y, 4), smoking habits (current/past, 2), family history of colorectal cancer (present in a first-degree relative, 2), and the presence of neoplasia in the distal colorectum (nonadvanced adenoma 5–9 mm, 2; advanced neoplasia, 7). The c-statistic of the score was 0.74 (95% CI, 0.68–0.79), and for distal findings alone was 0.67 (95% CI, 0.60–0.74). The Hosmer–Lemeshow goodness-of-fit test statistic was greater than 0.05, indicating the reliability of the validation set. The number needed to refer was 11 (95% CI, 10–13), and the number needed to screen was 15 (95% CI, 12–17). Conclusions: We developed and validated a scoring system to identify persons at risk for APN. Screening participants who undergo flexible sigmoidoscopy screening with a score of 4 points or higher should undergo colonoscopy evaluation. © 2021 AGA Institute

Item Type: Article
Funders: General Research Fund (grant 14134916 ) of the Research Grants Council of Hong Kong, China
Uncontrolled Keywords: CRC; Diagnostic; Early Detection; Prognostic
Subjects: R Medicine
Divisions: Faculty of Medicine
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 03 May 2021 07:33
Last Modified: 03 May 2021 07:33

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