Derivation and Validation of a Prediction Rule for Estimating Advanced Colorectal Neoplasm Risk in Average-Risk Chinese

• Published in: American journal of epidemiology Vol. 175; no. 6; pp. 584 - 593
• Main Authors: Cai, Quan-Cai, Yu, En-Da, Xiao, Yi, Bai, Wen-Yuan, Chen, Xing, He, Li-Ping, Yang, Yu-Xiu, Zhou, Ping-Hong, Jiang, Xue-Liang, Xu, Hui-Min, Fan, Hong, Ge, Zhi-Zheng, Lv, Nong-Hua, Huang, Zhi-Gang, Li, You-Ming, Ma, Shu-Ren, Chen, Jie, Li, Yan-Qing, Xu, Jian-Ming, Xiang, Ping, Yang, Li, Lin, Fu-Lin, Li, Zhao-Shen
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 15-03-2012; Oxford Publishing Limited (England)
• Subjects: Adenoma - diagnosis; Adenoma - etiology; Adult; Age Factors; Aged; Asian people; Biological and medical sciences; China; Colonoscopy; Colorectal cancer; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - etiology; Cross-Sectional Studies; Decision Support Techniques; Digestive system. Abdomen; Early Detection of Cancer; Endoscopy; Epidemiology; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Humans; Investigative techniques, diagnostic techniques (general aspects); Logistic Models; Male; Mass Screening; Medical sciences; Medical screening; Middle Aged; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Assessment; Risk factors; ROC Curve; Sex Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surveys and Questionnaires; Tumors; Asia; China; logistic models; risk factors; mass screening; colonoscopy; colorectal neoplasms; cross-sectional studies; Rectal disease; Asiatic; Colorectal cancer; Risk; Epidemiology; Prevention; Colonoscopy; Cross sectional study; Intestinal disease; Advanced stage; Endoscopy; Public health; Estimation; Prediction; Malignant tumor; Medical screening; Colonic disease; Test validation; Risk factor; Digestive diseases; Chinese; Models; Predictive factor; Cancer; Logistics
• ISSN: 0002-9262; 1476-6256
• DOI: 10.1093/aje/kwr337

No prediction rule is currently available for advanced colorectal neoplasms, defined as invasive cancer, an adenoma of 10 mm or more, a villous adenoma, or an adenoma with high-grade dysplasia, in average-risk Chinese. In this study between 2006 and 2008, a total of 7,541 average-risk Chinese persons aged 40 years or older who had complete colonoscopy were included. The derivation and validation cohorts consisted of 5,229 and 2,312 persons, respectively. A prediction rule was developed from a logistic regression model and then internally and externally validated. The prediction rule comprised 8 variables (age, sex, smoking, diabetes mellitus, green vegetables, pickled food, fried food, and white meat), with scores ranging from 0 to 14. Among the participants with low-risk (≤3) or high-risk (>3) scores in the validation cohort, the risks of advanced neoplasms were 2.6% and 10.0% (P < 0.001), respectively. If colonoscopy was used only for persons with high risk, 80.3% of persons with advanced neoplasms would be detected while the number of colonoscopies would be reduced by 49.2%. The prediction rule had good discrimination (area under the receiver operating characteristic curve = 0.74, 95% confidence interval: 0.70, 0.78) and calibration (P = 0.77) and, thus, provides accurate risk stratification for advanced neoplasms in average-risk Chinese.