Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
Epidemiol Health. 2021;43:e2021069. doi: 10.4178/epih.e2021069. Epub 2021 Sep 16.
This study aimed to validate a simple risk assessment tool for estimating the advanced colorectal neoplasia (ACN) risk at colonoscopy screenings and potential factors relevant for implementing this tool in the Korean population.
Our study analyzed data from the Cancer Screenee Cohort Study conducted by the National Cancer Center in Korea. The risk level was assessed using the Asia Pacific Colorectal Screening (APCS) score developed by the Asia-Pacific Working Group on Colorectal Cancer. Logistic regression models were used to examine the associations between colorectal-related outcomes and the risk level by APCS score. The discriminatory performance of the APCS score for various colorectal-related outcomes was assessed using C-statistics.
In 12,520 individuals, 317 ACN cases and 4,528 adenoma cases were found. The APCS tool successfully classified the study population into different risk groups, and significant differences in the ACN rate and other outcomes were observed. The APCS score demonstrated acceptable discrimination capability with area under the curve values ranging from 0.62 to 0.65 for various outcomes. The results of the multivariate logistic regression model revealed that the high-risk group had a 3.1-fold higher risk of ACN (95% confidence interval, 2.08 to 4.67) than the average-risk group. Body mass index (BMI) was identified as a significant predictor of ACN in both multivariate and subgroup analyses.
Our study highlighted significant differences in colorectal-related screening outcomes by colorectal risk level measured using the APCS score, and BMI could be used to improve the discriminatory capability of the APCS score.
本研究旨在验证一种简单的风险评估工具，用于评估结肠镜筛查时的高级结直肠腺瘤（ACN）风险，以及在韩国人群中实施该工具的相关潜在因素。
本研究分析了韩国国家癌症中心进行的癌症筛查队列研究的数据。风险水平使用亚太结直肠筛查（APCS）评分进行评估，该评分由亚太结直肠癌工作组开发。使用逻辑回归模型检验 APCS 评分与结直肠相关结局之间的关联。使用 C 统计量评估 APCS 评分对各种结直肠相关结局的判别性能。
在 12520 名个体中，发现 317 例 ACN 病例和 4528 例腺瘤病例。APCS 工具成功地将研究人群分为不同的风险组，并且观察到 ACN 发生率和其他结局的显著差异。APCS 评分对各种结局的曲线下面积值在 0.62 至 0.65 之间，显示出可接受的判别能力。多变量逻辑回归模型的结果表明，高危组的 ACN 风险是平均风险组的 3.1 倍（95%置信区间，2.08 至 4.67）。在多变量和亚组分析中，体重指数（BMI）被确定为 ACN 的显著预测因子。
本研究强调了使用 APCS 评分测量的结直肠风险水平对结直肠相关筛查结局的显著差异，并且 BMI 可用于提高 APCS 评分的判别能力。
