Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Am J Epidemiol. 2012 Mar 15;175(6):584-93. doi: 10.1093/aje/kwr337. Epub 2012 Feb 10.
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.
目前尚无针对中国一般风险人群的结直肠高级别瘤变（定义为浸润性癌、10mm 及以上的腺瘤、绒毛状腺瘤或伴高级别异型增生的腺瘤）的预测模型。在这项于 2006 年至 2008 年间进行的研究中，共纳入了 7541 名年龄在 40 岁及以上、接受过全结肠镜检查且无结直肠疾病史的一般风险中国人群。推导队列和验证队列分别包括 5229 名和 2312 名患者。通过逻辑回归模型开发预测模型，并进行内部和外部验证。预测模型由 8 个变量（年龄、性别、吸烟、糖尿病、绿色蔬菜、腌制食品、油炸食品和白色肉类）组成，得分范围为 0 至 14 分。在验证队列中，低危（≤3 分）和高危（>3 分）评分人群中，高级别瘤变的风险分别为 2.6%和 10.0%（P<0.001）。如果仅对高危人群进行结肠镜检查，则可以检测到 80.3%的高级别瘤变患者，同时减少 49.2%的结肠镜检查数量。该预测模型具有良好的判别能力（受试者工作特征曲线下面积为 0.74，95%置信区间：0.70，0.78）和校准度（P=0.77），因此可以为中国一般风险人群的结直肠高级别瘤变提供准确的风险分层。
