Department of Medicine, National University of Singapore.
Gut. 2011 Sep;60(9):1236-41. doi: 10.1136/gut.2010.221168. Epub 2011 Mar 14.
To develop and validate a clinical risk score predictive of risk for colorectal advanced neoplasia for Asia.
A prospective, cross-sectional and multicentre study was carried out in tertiary hospitals in 11 Asian cities. The subjects comprise 2752 asymptomatic patients undergoing screening colonoscopy. From a development set of 860 asymptomatic subjects undergoing screening colonoscopy, multiple logistic regression was applied to identify significant risk factors for advanced colorectal neoplasia defined as invasive carcinoma or advanced adenoma. The ORs for significant risk factors were utilised to develop a risk score ranging from 0 to 7 (Asia-Pacific Colorectal Screening (APCS) score). Three tiers of risk were arbitrarily defined: 0-1 'average risk' (AR); 2-3 'moderate risk' (MR); and 4-7 'high risk' (HR). Subjects undergoing screening colonoscopy between July 2006 and December 2007 were prospectively enrolled to form an independent validation group. Each subject had a personal APCS score calculated by summing the points attributed from the presence of risk factors in the individuals. The performance of the APCS score in predicting risk of advanced neoplasia was evaluated.
There were 860 subjects in the derivation set and 1892 subjects in the validation set, with a baseline prevalence of advanced neoplasia of 4.5% and 3%, respectively. Applying the APCS stratification in the validation set, 559 subjects (29.5%) were in the AR tier, 966 subjects (51.1%) in the MR tier and 367 (19.4%) subjects in the HR tier. The prevalence of advanced neoplasia in the AR, MR and HR groups was 1.3, 3.2 and 5.2%, respectively. The subjects in the MR and HR tiers had 2.6-fold (95% CI 1.1 to 6.0) and 4.3-fold (95% CI 1.8 to 10.3) increased prevalence of advanced neoplasia, respectively, than those in the AR tier.
The APCS score based on age, gender, family history and smoking is useful in selecting asymptomatic Asian subjects for priority of colorectal screening.
为亚洲人群开发并验证一种预测结直肠进展性肿瘤风险的临床风险评分。
在 11 个亚洲城市的三级医院进行了一项前瞻性、横断面和多中心研究。研究对象包括 2752 名无症状接受筛查性结肠镜检查的患者。从 860 名无症状接受筛查性结肠镜检查的患者中建立了一个开发队列，采用多元逻辑回归来确定侵袭性癌或高级腺瘤定义的结直肠高级别肿瘤的显著危险因素。利用显著危险因素的比值比来开发风险评分，范围从 0 到 7（亚太结直肠筛查评分（APCS））。任意定义了三个风险等级：0-1“平均风险”（AR）；2-3“中度风险”（MR）；4-7“高风险”（HR）。2006 年 7 月至 2007 年 12 月期间接受筛查性结肠镜检查的患者被前瞻性纳入验证队列。通过将个体中存在的危险因素的分数相加，为每个个体计算个人的 APCS 评分。评估 APCS 评分在预测高级别肿瘤风险方面的性能。
在推导队列中纳入 860 名患者，在验证队列中纳入 1892 名患者，基线高级别肿瘤的患病率分别为 4.5%和 3%。在验证队列中应用 APCS 分层，559 名患者（29.5%）处于 AR 等级，966 名患者（51.1%）处于 MR 等级，367 名患者（19.4%）处于 HR 等级。AR、MR 和 HR 组中高级别肿瘤的患病率分别为 1.3%、3.2%和 5.2%。MR 和 HR 等级的患者高级别肿瘤的患病率分别比 AR 等级的患者高 2.6 倍（95%CI 1.1 至 6.0）和 4.3 倍（95%CI 1.8 至 10.3）。
基于年龄、性别、家族史和吸烟的 APCS 评分可用于选择亚洲无症状患者进行结直肠筛查的优先级。
