Department of Gastroenterology/Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University/Naval Medical University, National Clinical Research Center for Digestive Diseases (Shanghai), National Quality Control Center of Digestive Endoscopy, Shanghai, 200433, China.
Department of Gastroenterology, Yantai Zhifu Hospital, Yantai, 264000, China.
J Hematol Oncol. 2022 Nov 4;15(1):162. doi: 10.1186/s13045-022-01378-1.
No fully validated risk-stratification strategies have been established in China where colonoscopies resources are limited. We aimed to develop and validate a fecal immunochemical test (FIT)-based risk-stratification model for colorectal neoplasia (CN); 10,164 individuals were recruited from 175 centers nationwide and were randomly allocated to the derivation (n = 6776) or validation cohort (n = 3388). Multivariate logistic analyses were performed to develop the National Colorectal Polyp Care (NCPC) score, which formed the risk-stratification model along with FIT. The NCPC score was developed from eight independent predicting factors and divided into three levels: low risk (LR 0-14), intermediate risk (IR 15-17), and high risk (HR 18-28). Individuals with IR or HR of NCPC score or FIT+ were classified as increased-risk individuals in the risk-stratification model and were recommended for colonoscopy. The IR/HR of NCPC score showed a higher prevalence of CNs (21.8%/32.8% vs. 11.0%, P < 0.001) and ACNs (4.3%/9.2% vs. 2.0%, P < 0.001) than LR, which was also confirmed in the validation cohort. Similar relative risks and predictive performances were demonstrated between non-specific gastrointestinal symptoms (NSGS) and asymptomatic cohort. The risk-stratification model identified 73.5% CN, 82.6% ACN, and 93.6% CRC when guiding 52.7% individuals to receive colonoscopy and identified 55.8% early-onset ACNs and 72.7% early-onset CRCs with only 25.6% young individuals receiving colonoscopy. The risk-stratification model showed a good risk-stratification ability for CN and early-onset CRCs in Chinese population, including individuals with NSGS and young age.
在中国，结肠镜检查资源有限，尚未建立完全验证的风险分层策略。我们旨在开发和验证一种基于粪便免疫化学测试（FIT）的结直肠肿瘤（CN）风险分层模型；来自全国 175 个中心的 10164 人被随机分配到推导队列（n=6776）或验证队列（n=3388）。多变量逻辑分析用于开发国家结直肠息肉管理（NCPC）评分，该评分与 FIT 一起构成风险分层模型。NCPC 评分由 8 个独立的预测因素组成，分为三个等级：低风险（LR 0-14）、中风险（IR 15-17）和高风险（HR 18-28）。NCPC 评分的 IR/HR 或 FIT+个体被归类为风险分层模型中的高危个体，并建议进行结肠镜检查。NCPC 评分的 IR/HR 显示出更高的 CNs（21.8%/32.8% vs. 11.0%，P<0.001）和 ACNs（4.3%/9.2% vs. 2.0%，P<0.001）患病率，这在验证队列中也得到了证实。非特异性胃肠道症状（NSGS）和无症状队列的相似相对风险和预测性能也得到了证实。当指导 52.7%的个体接受结肠镜检查时，该风险分层模型可识别 73.5%的 CN、82.6%的 ACN 和 93.6%的 CRC，并可识别 55.8%的早发 ACN 和 72.7%的早发 CRC，仅需对 25.6%的年轻个体进行结肠镜检查。该风险分层模型在中国人群中对 CN 和早发 CRC 具有良好的风险分层能力，包括具有 NSGS 和年轻年龄的个体。
