Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.
BMC Gastroenterol. 2011 Sep 8;11:97. doi: 10.1186/1471-230X-11-97.
Colonoscopy is an invasive and costly procedure with a risk of serious complications. It would therefore be useful to prioritise colonoscopies by identifying people at higher risk of either cancer or premalignant adenomas. The aim of this study is to assess a model that identifies people with colorectal cancer, advanced, large and small adenomas.
Patients seen by gastroenterologists and colorectal surgeons between April 2004 and December 2006 completed a validated, structured self-administered questionnaire prior to colonoscopy. Information was collected on symptoms, demographics and medical history. Multinomial logistic regression was used to simultaneously assess factors associated with findings on colonoscopy of cancer, advanced adenomas and adenomas sized 6 -9 mm, and ≤ 5 mm. The area under the curve of ROC curve was used to assess the incremental gain of adding demographic variables, medical history and symptoms (in that order) to a base model that included only age.
Sociodemographic variables, medical history and symptoms (from 8,204 patients) jointly provide good discrimination between colorectal cancer and no abnormality (AUC 0.83), but discriminate less well between adenomas and no abnormality (AUC advanced adenoma 0.70; other adenomas 0.67). Age is the dominant risk factor for cancer and adenomas of all sizes. Having a colonoscopy within the last 10 years confers protection for cancers and advanced adenomas.
Our models provide guidance about which factors can assist in identifying people at higher risk of disease using easily elicited information. This would allow colonoscopy to be prioritised for those for whom it would be of most benefit.
结肠镜检查是一种具有严重并发症风险的侵入性和昂贵的程序。因此，通过确定患有癌症或癌前腺瘤风险较高的人群，对结肠镜检查进行优先排序将是有用的。本研究旨在评估一种能够识别患有结直肠癌、晚期、大型和小型腺瘤的人的模型。
2004 年 4 月至 2006 年 12 月期间，胃肠病学家和结直肠外科医生诊治的患者在结肠镜检查前完成了一份经过验证的结构化自我管理问卷。收集了症状、人口统计学和病史信息。使用多项逻辑回归来同时评估与结肠镜检查中癌症、晚期腺瘤和 6-9mm 及≤5mm 大小腺瘤相关的因素。ROC 曲线下面积用于评估在仅包括年龄的基本模型中添加人口统计学变量、病史和症状（按此顺序）的增量增益。
社会人口统计学变量、病史和症状（来自 8204 名患者）共同提供了结直肠癌与无异常之间的良好区分（AUC 0.83），但在区分腺瘤与无异常方面效果较差（AUC 高级腺瘤 0.70；其他腺瘤 0.67）。年龄是癌症和所有大小腺瘤的主要危险因素。在过去 10 年内进行结肠镜检查可预防癌症和高级腺瘤。
我们的模型提供了指导，说明哪些因素可以使用易于引出的信息来帮助识别患有更高疾病风险的人群。这将允许对那些最受益的人进行结肠镜检查的优先排序。
