Cancer Prevention office, Xuzhou Cancer Hospital, Huancheng Road 131, Gulou District, Xuzhou, 221000, Jiangsu, China.
Endocrinology and metabolism, Tianjin Medical University General Hospital, Tianjin, 300000, China.
BMC Cancer. 2022 Sep 7;22(1):961. doi: 10.1186/s12885-022-10047-y.
Colorectal cancer is one of the most common cancers in the world. Several studies suggest using the Asia-Pacific colorectal screening (APCS) score and its modified versions to select high-risk populations for early colonoscopy, but external validation remains rare, and which score should be selected for CRC screening in China is unclear. Validation of multiple scores in the same population might help to choose the best performing score.
We conducted a cross-sectional study under the framework of Cancer Screening Program in Urban China, data from asymptomatic colorectal cancer screening in Xuzhou was used to validate the APCS score, the colorectal neoplasia predict (CNP) score, the Korean colorectal screening (KCS) score, the Modified APCS score and the 8-point risk score in predicting colorectal advanced neoplasia (CAN).
1804 subjects were included in the analysis and 112 CAN (6.21%) was detected. In each score, the detection rate of CAN was higher in the high-risk group than in the non-high-risk group (P < 0.05), and the RR (95%C.I.) ranged 2.20 (1.50-3.22) [8-point risk] to 4.00 (2.41-6.65) [Modified APCS]. The c-statistics (95%C.I.) of the scoring systems ranged from 0.58 (0.53-0.62) [8-point risk] to 0.65 (0.61-0.69) [KCS]. The sensitivity (95%C.I.) of these systems ranged from 31.25 (22.83-40.70) [8-point risk] to 84.82 (76.81-90.90) [Modified APCS], while the specificity (95%C.I.) ranged from 43.50 (41.12-45.90) [Modified APCS] to 83.81 (81.96-85.53) [8-point risk]. Using the APCS scoring system as a comparator, the net reclassification improvement (NRI) of each modified version ranged from - 10.34% (95%C.I.: - 22.63 to 1.95%) [8-point risk] to 4.79% (95%C.I.: - 1.50% to 11.08) [KCS]. The colonoscopy resource load (95%C.I.) ranged from 9 [1-3] [8-point risk] to 11 [3-5] [APCS and Modified APCS].
The APCS score and its modified versions have certain ability to predict the risk of advanced neoplasia and reduce the resource load. The modified APCS score and the KCS score seemed the preferable systems to classify high risk subjects based on its high RR, sensitivity and predictive ability in the selected population. Future research could focus on adding risk factors or combining with laboratory test results to improve the predictive power of the scoring system.
结直肠癌是世界上最常见的癌症之一。几项研究表明，使用亚太结直肠筛查（APCS）评分及其改良版本来选择高危人群进行早期结肠镜检查，但外部验证仍然很少，并且不清楚在中国应该选择哪种评分进行 CRC 筛查。在同一人群中验证多个评分可能有助于选择表现最佳的评分。
我们在中国城市癌症筛查计划的框架下进行了一项横断面研究，使用徐州无症状结直肠筛查的数据来验证 APCS 评分、结直肠肿瘤预测（CNP）评分、韩国结直肠筛查（KCS）评分、改良 APCS 评分和 8 分风险评分在预测结直肠晚期肿瘤（CAN）方面的性能。
纳入 1804 例受试者进行分析，共检出 112 例 CAN（6.21%）。在每个评分系统中，高危组的 CAN 检出率均高于非高危组（P<0.05），RR（95%CI）范围为 2.20（1.50-3.22）[8 分风险]至 4.00（2.41-6.65）[改良 APCS]。评分系统的 C 统计量（95%CI）范围为 0.58（0.53-0.62）[8 分风险]至 0.65（0.61-0.69）[KCS]。这些系统的灵敏度（95%CI）范围为 31.25（22.83-40.70）[8 分风险]至 84.82（76.81-90.90）[改良 APCS]，而特异性（95%CI）范围为 43.50（41.12-45.90）[改良 APCS]至 83.81（81.96-85.53）[8 分风险]。以 APCS 评分系统为对照，每个改良版本的净重新分类改善（NRI）范围为-10.34%（95%CI：-22.63 至 1.95%）[8 分风险]至 4.79%（95%CI：-1.50%至 11.08%）[KCS]。结肠镜检查资源负荷（95%CI）范围为 9[1-3][8 分风险]至 11[3-5][APCS 和改良 APCS]。
APCS 评分及其改良版本具有一定的预测高级别肿瘤风险和降低资源负荷的能力。改良 APCS 评分和 KCS 评分在选择人群中具有较高的 RR、灵敏度和预测能力，似乎是将高危人群分类的较好系统。未来的研究可以集中在添加风险因素或与实验室检测结果相结合，以提高评分系统的预测能力。
