Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany.
Clin Gastroenterol Hepatol. 2014 Mar;12(3):478-85. doi: 10.1016/j.cgh.2013.08.042. Epub 2013 Sep 8.
BACKGROUND & AIMS: Screening the population for colorectal cancer (CRC) by colonoscopy could reduce the disease burden. However, targeted screening of individuals at high risk could increase its cost effectiveness.
We developed a scoring system to identify individuals with at least 1 advanced adenoma, based on easy-to-collect risk factors among 7891 participants of the German screening colonoscopy program. The system was validated in an independent sample of 3519 participants. Multiple logistic regression was used to develop the algorithm, and the regression coefficient-based scores were used to determine individual risks. Relative risk and numbers of colonoscopies needed for detecting one or more advanced neoplasm(s) were calculated for quintiles of the risk score. The predictive ability of the scoring system was quantified by the area under the curve.
We identified 9 risk factors (sex, age, first-degree relatives with a history of CRC, cigarette smoking, alcohol consumption, red meat consumption, ever regular use [at least 2 times/wk for at least 1 y] of nonsteroidal anti-inflammatory drugs, previous colonoscopy, and previous detection of polyps) that were associated significantly with risk of advanced neoplasms. The developed score was associated strongly with the presence of advanced neoplasms. In the validation sample, individuals in the highest quintile of scores had a relative risk for advanced neoplasm of 3.86 (95% confidence interval, 2.71-5.49), compared with individuals in the lowest quintile. The number needed to screen to detect 1 or more advanced neoplasm(s) varied from 20 to 5 between quintiles of the risk score. In the validation sample, the scoring system identified patients with CRC or any advanced neoplasm with area under the curve values of 0.68 and 0.66, respectively.
We developed a scoring system, based on easy-to-collect risk factors, to identify individuals most likely to have advanced neoplasms. This system might be used to stratify individuals for CRC screening.
通过结肠镜检查对结直肠癌（CRC）进行人群筛查可以减轻疾病负担。然而，对高危人群进行靶向筛查可能会增加其成本效益。
我们基于德国筛查结肠镜检查计划中 7891 名参与者中易于收集的危险因素，开发了一种评分系统，用于识别至少有 1 个高级腺瘤的个体。该系统在 3519 名独立参与者的样本中得到了验证。我们使用多元逻辑回归来开发算法，并使用基于回归系数的评分来确定个体风险。为风险评分的五分位数计算了检测一个或多个高级肿瘤所需的相对风险和结肠镜检查数量。通过曲线下面积量化评分系统的预测能力。
我们确定了 9 个与高级肿瘤风险相关的危险因素（性别、年龄、一级亲属有 CRC 病史、吸烟、饮酒、摄入红肉类、曾定期（至少每周 2 次，至少 1 年）使用非甾体抗炎药、既往结肠镜检查和以前发现息肉）。开发的评分与高级肿瘤的存在密切相关。在验证样本中，评分最高五分位数的个体发生高级肿瘤的相对风险为 3.86（95%置信区间，2.71-5.49），而评分最低五分位数的个体为 1。为检测 1 个或多个高级肿瘤而需要筛查的数量在风险评分五分位数之间从 20 到 5 不等。在验证样本中，评分系统对 CRC 或任何高级肿瘤的识别曲线下面积值分别为 0.68 和 0.66。
我们基于易于收集的危险因素开发了一种评分系统，用于识别最有可能患有高级肿瘤的个体。该系统可用于对 CRC 筛查进行分层。
