Derivation and validation of a risk scoring model to predict advanced colorectal neoplasm in adults of all ages

• Published in: Journal of gastroenterology and hepatology Vol. 32; no. 7; pp. 1328 - 1335
• Main Authors: Yang, Hyo‐Joon, Choi, Sungkyoung, Park, Soo‐Kyung, Jung, Yoon Suk, Choi, Kyu Yong, Park, Taesung, Kim, Ji Yeon, Park, Dong Il
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01-07-2017
• Subjects: Adult; Aged; Aged, 80 and over; Asian Continental Ancestry Group; Body mass; Body mass index; Carcinoembryonic antigen; Cholesterol; Cohort Studies; Colon; Colonoscopy; Colorectal carcinoma; colorectal neoplasms; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - prevention & control; Cross-Sectional Studies; Female; Forecasting; Humans; Laboratories; Logistic Models; Low density lipoprotein; Male; Mass Screening; Middle Aged; Models, Statistical; Prevalence; Risk Assessment; Risk Factors; Risk groups; Serum levels; Smoking; Young Adult; risk assessment; young adult; mass screening; colonoscopy; colorectal neoplasms
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/jgh.13711

Background and Aims
Little is known about how to include adults < 50 years in colonoscopy screening. This study aimed to derive a risk‐scoring model incorporating laboratory indicators for metabolic risks to predict advanced colorectal neoplasia (ACN) in asymptomatic Korean adults both younger and older than 50 years.
Methods
In this cross‐sectional study, 70 812 consecutive adult recipients of a screening colonoscopy in a single health check‐up center in Korea between 2003 and 2012 were enrolled. A risk score model was developed using multiple logistic regression model and internally validated.
Results
Overall prevalence of ACN was 1.4% (956/70 812). A 15‐point score model was developed to comprise age, sex, family history of colorectal cancer, smoking, body mass index, serum levels of fasting glucose, low‐density lipoprotein cholesterol, and carcinoembryonic antigen. Based on the score, the validation cohort could be categorized into five risk groups (low, borderline, moderate, high, and very high) with an ACN prevalence of 0.7%, 1.3%, 2.7%, 6.6%, and 13.2%, respectively. Compared with the borderline risk group, the low‐risk group showed a 50.3% reduced risk of ACN. Meanwhile, the moderate, high, and very high risk groups showed 2, 5, and 10‐fold increased risk of ACN. The score showed significantly superior discriminative power than the Asian‐Pacific colorectal screening score (P = 0.003).
Conclusions
Our scoring model based on both clinical and laboratory risk factors is useful for the prediction of ACN. This score may be used to include adults < 50 years in colonoscopy screening.