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

Martin C S Wong; Rungsun Rerknimitr; Khean Lee Goh; Takahisa Matsuda; Hyun-Soo Kim; Deng-Chyang Wu; Kai Chun Wu; Khay Guan Yeoh; Vui Heng Chong; Furqaan Ahmed; Jose D Sollano; Jayaram Menon; Han-Mo Chiu; Jingnan Li; Jessica Y L Ching; Joseph J Y Sung

doi:10.1016/j.cgh.2019.12.031

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

Clin Gastroenterol Hepatol. 2021 Jan;19(1):119-127.e1. doi: 10.1016/j.cgh.2019.12.031. Epub 2020 Jan 7.

Authors

Martin C S Wong¹, Rungsun Rerknimitr², Khean Lee Goh³, Takahisa Matsuda⁴, Hyun-Soo Kim⁵, Deng-Chyang Wu⁶, Kai Chun Wu⁷, Khay Guan Yeoh⁸, Vui Heng Chong⁹, Furqaan Ahmed¹⁰, Jose D Sollano¹¹, Jayaram Menon¹², Han-Mo Chiu¹³, Jingnan Li¹⁴, Jessica Y L Ching¹⁵, Joseph J Y Sung¹⁶

Affiliations

¹ Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong.
² Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
³ Department of Gastroenterology and Hepatology, University of Malaya, Kuala Lumpur, Malaysia.
⁴ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
⁵ Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
⁶ Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁷ Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
⁸ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁹ Division of Gastroenterology, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, Brunei Darussalam.
¹⁰ Division of Gastroenterology, Aga Khan University, Karachi, Pakistan.
¹¹ Section of Gastroenterology, University of Santo Tomas Hospital, Manila, Philippines.
¹² Department of Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.
¹³ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
¹⁴ Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
¹⁵ Department of Medicine and Therapeutics, The Chinese University of Hong Kong; The Institute of Digestive Disease, The Chinese University of Hong Kong.
¹⁶ Department of Medicine and Therapeutics, The Chinese University of Hong Kong; The Institute of Digestive Disease, The Chinese University of Hong Kong; The State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China. Electronic address: jjysung@cuhk.edu.hk.

PMID: 31923642
DOI: 10.1016/j.cgh.2019.12.031

Abstract

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.

Keywords: CRC; Diagnostic; Early Detection; Prognostic.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Colonoscopy
Colorectal Neoplasms* / diagnosis
Colorectal Neoplasms* / epidemiology
Early Detection of Cancer*
Humans
Middle Aged
Reproducibility of Results
Risk Assessment
Risk Factors