Yang Hyo-Joon, Choi Sungkyoung, Park Soo-Kyung, Jung Yoon Suk, Choi Kyu Yong, Park Taesung, Kim Ji Yeon, Park Dong Il
Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Interdisciplinary Program in Bioinformatics, Seoul National University, Seoul, Korea.
J Gastroenterol Hepatol. 2017 Jul;32(7):1328-1335. doi: 10.1111/jgh.13711.
Little is known about how to include adults < 50 years in colonoscopy screening. This study aimed to derive a risk-scoring model incorporating laboratory indicators for metabolic risks to predict advanced colorectal neoplasia (ACN) in asymptomatic Korean adults both younger and older than 50 years.
In this cross-sectional study, 70 812 consecutive adult recipients of a screening colonoscopy in a single health check-up center in Korea between 2003 and 2012 were enrolled. A risk score model was developed using multiple logistic regression model and internally validated.
Overall prevalence of ACN was 1.4% (956/70 812). A 15-point score model was developed to comprise age, sex, family history of colorectal cancer, smoking, body mass index, serum levels of fasting glucose, low-density lipoprotein cholesterol, and carcinoembryonic antigen. Based on the score, the validation cohort could be categorized into five risk groups (low, borderline, moderate, high, and very high) with an ACN prevalence of 0.7%, 1.3%, 2.7%, 6.6%, and 13.2%, respectively. Compared with the borderline risk group, the low-risk group showed a 50.3% reduced risk of ACN. Meanwhile, the moderate, high, and very high risk groups showed 2, 5, and 10-fold increased risk of ACN. The score showed significantly superior discriminative power than the Asian-Pacific colorectal screening score (P = 0.003).
Our scoring model based on both clinical and laboratory risk factors is useful for the prediction of ACN. This score may be used to include adults < 50 years in colonoscopy screening.
对于如何将50岁以下成年人纳入结肠镜筛查，我们知之甚少。本研究旨在建立一个纳入代谢风险实验室指标的风险评分模型，以预测50岁及以上无症状韩国成年人的晚期结直肠肿瘤（ACN）。
在这项横断面研究中，纳入了2003年至2012年间在韩国一家健康体检中心连续接受结肠镜筛查的70812名成年受检者。使用多元逻辑回归模型建立风险评分模型并进行内部验证。
ACN的总体患病率为1.4%（956/70812）。建立了一个15分的评分模型，包括年龄、性别、结直肠癌家族史、吸烟、体重指数、空腹血糖血清水平、低密度脂蛋白胆固醇和癌胚抗原。根据该评分，验证队列可分为五个风险组（低、临界、中、高和极高），ACN患病率分别为0.7%、1.3%、2.7%、6.6%和13.2%。与临界风险组相比，低风险组的ACN风险降低了50.3%。同时，中、高和极高风险组的ACN风险分别增加了2倍、5倍和10倍。该评分的判别能力显著优于亚太结直肠癌筛查评分（P = 0.003）。
我们基于临床和实验室风险因素的评分模型对ACN的预测很有用。该评分可用于将50岁以下成年人纳入结肠镜筛查。
