Law Chee-Wei, Rampal Sanjay, Roslani April C, Mahadeva Sanjiv
Division of Colorectal Surgery, Department of Surgery, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
J Gastroenterol Hepatol. 2014 Nov;29(11):1890-6. doi: 10.1111/jgh.12638.
With an increasing burden on overstretched colonoscopy services, a simple risk score for significant pathology in symptomatic patients may aid in the prioritization of patients.
A derivative study of a risk score model for colonic neoplasia (colorectal carcinoma [CRC] and advanced adenoma) and CRC alone was conducted in symptomatic adults referred for an index colonoscopy. The accuracy of the final model was assessed by the area under the curve (AUC) of the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit statistic.
A total of 1013 subjects (mean age 59.9 ± 13.7 years, 52.3% females) from a multi-ethnic Asian background (Chinese 56%, Malay 20.4%, Indian 21.5%) were recruited. Colonic neoplasia and CRC were identified in 175 (17.3%) and 114 (11.3%) cases, respectively. Risk scores were assigned to individual factors identified in a logistic regression model of both demographic (age, gender, ethnicity, education level, smoking history, Aspirin use) and clinical symptoms (change in bowel habit, bloody stool, weight loss, appetite loss, lethargy). The risk score for each patient was the sum of their individual risk factors. The AUC of the risk score for colonic neoplasia and CRC was 0.76 (Hosmer-Lemeshow goodness-of-fit statistic of P = 0.745) and 0.83 (Hosmer-Lemeshow goodness-of-fit statistic of P = 0.982), respectively.
A simple risk score for colonic neoplasia and CRC may be able to prioritize colonoscopy referrals in symptomatic subjects from a multi-ethnic background. A further study to validate this scoring system is required.
随着结肠镜检查服务负担日益加重，针对有症状患者显著病变的简单风险评分可能有助于确定患者的优先次序。
对因首次结肠镜检查而转诊的有症状成年人进行了一项关于结肠肿瘤（结直肠癌[CRC]和高级别腺瘤）及单独CRC风险评分模型的衍生研究。通过受试者工作特征曲线的曲线下面积（AUC）和Hosmer-Lemeshow拟合优度统计量评估最终模型的准确性。
共招募了1013名来自多民族亚洲背景（华人56%，马来人20.4%，印度人21.5%）的受试者（平均年龄59.9±13.7岁，女性占52.3%）。分别在175例（17.3%）和114例（11.3%）病例中发现了结肠肿瘤和CRC。对在人口统计学（年龄、性别、种族、教育水平、吸烟史、阿司匹林使用情况）和临床症状（排便习惯改变、便血、体重减轻、食欲减退、乏力）的逻辑回归模型中确定的各个因素赋予风险评分。每位患者的风险评分是其各个风险因素的总和。结肠肿瘤和CRC风险评分的AUC分别为0.76（Hosmer-Lemeshow拟合优度统计量P = 0.745）和0.83（Hosmer-Lemeshow拟合优度统计量P = 0.982）。
针对结肠肿瘤和CRC的简单风险评分或许能够对来自多民族背景的有症状受试者的结肠镜检查转诊进行优先排序。需要进一步开展研究以验证该评分系统。
