Kim Ji Yeon, Choi Sungkyoung, Park Taesung, Kim Seul Ki, Jung Yoon Suk, Park Jung Ho, Kim Hong Joo, Cho Yong Kyun, Sohn Chong Il, Jeon Woo Kyu, Kim Byung Ik, Choi Kyu Yong, Park Dong Il
Division of Gastroenterology, Department of Internal Medicine, Mediplex Sejong Hospital, Incheon, Korea.
The Research Institute of Basic Sciences, Seoul National University, Korea.
Intest Res. 2019 Apr;17(2):253-264. doi: 10.5217/ir.2018.00062. Epub 2018 Nov 20.
BACKGROUND/AIM: Colorectal cancer incidence among patients aged ≤50 years is increasing. This study aimed to develop and validate an advanced colorectal neoplasm (ACRN) screening model for young adults aged <50 years in Korea.
This retrospective cross-sectional study included 59,575 consecutive asymptomatic Koreans who underwent screening colonoscopy between 2003 and 2012 at a single comprehensive health care center. Young Adult Colorectal Screening (YCS) score was developed as an optimized risk stratification model for ACRN using multivariate analysis and was internally validated. The predictive power and diagnostic performance of YCS score was compared with those of Asia-Pacific Colorectal Screening (APCS) and Korean Colorectal Screening (KCS) scores.
41,702 and 17,873 subjects were randomly allocated into the derivation and validation cohorts, respectively, by examination year. ACRN prevalence was 0.9% in both cohorts. YCS score comprised sex, age, alcohol, smoking, obesity, glucose metabolism abnormality, and family history of CRC, with score ranges of 0 to 10. In the validation cohort, ACRN prevalence was 0.6% in the low-risk tier (score, 0-4), 1.5% in the moderate-risk tier (score, 5-7), and 3.4% in the high-risk tier (score, 8-10). ACRN risk increased 2.5-fold (95%CI, 1.8-3.4) in the moderate-risk tier and 5.8-fold (95%CI, 3.4-9.8) in the high-risk tier compared with the low-risk tier. YCS score identified better balanced accuracy (53.9%) than APCS (51.5%) and KCS (50.7%) scores and had relatively good discriminative power (area under the curve=0.660).
YCS score based on clinical and laboratory risk factors was clinically effective and beneficial for predicting ACRN risk and targeting screening colonoscopy in adults aged <50 years.
背景/目的：50岁及以下患者的结直肠癌发病率正在上升。本研究旨在开发并验证一种针对韩国50岁以下年轻人的晚期结直肠肿瘤（ACRN）筛查模型。
这项回顾性横断面研究纳入了2003年至2012年间在单一综合医疗中心接受筛查结肠镜检查的59575名连续无症状韩国人。通过多变量分析开发了青年成人结直肠筛查（YCS）评分，作为ACRN的优化风险分层模型，并进行了内部验证。将YCS评分的预测能力和诊断性能与亚太结直肠筛查（APCS）和韩国结直肠筛查（KCS）评分进行比较。
根据检查年份，分别将41702名和17873名受试者随机分配到推导队列和验证队列。两个队列中的ACRN患病率均为0.9%。YCS评分包括性别、年龄、饮酒、吸烟、肥胖、糖代谢异常和结直肠癌家族史，评分范围为0至10分。在验证队列中，低风险组（评分0 - 4分）的ACRN患病率为0.6%，中风险组（评分5 - 7分）为1.5%，高风险组（评分8 - 10分）为3.4%。与低风险组相比，中风险组的ACRN风险增加了2.5倍（95%CI，1.8 - 3.4），高风险组增加了5.8倍（95%CI，3.4 - 9.8）。YCS评分的平衡准确率（53.9%）优于APCS（51.5%）和KCS（50.7%）评分，且具有相对较好的鉴别能力（曲线下面积 = 0.660）。
基于临床和实验室风险因素的YCS评分在预测50岁以下成年人的ACRN风险和靶向筛查结肠镜检查方面具有临床有效性和益处。
