U.S. Department of Veterans Affairs Million Veteran Program Coordinating Center, Boston, Massachusetts.
Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina.
Cancer Epidemiol Biomarkers Prev. 2024 Nov 1;33(11):1456-1464. doi: 10.1158/1055-9965.EPI-24-0791.
Risk for colorectal cancer may accumulate through multiple environmental factors. Understanding their effects, along with genetics, age, and family history, could allow improvements in clinical decisions for screening protocols. We aimed to extend the previous work by recalibrating an environmental risk score (e-Score) for colorectal cancer among a sample of US veteran participants of the Million Veteran Program.
Demographic, lifestyle, and colorectal cancer data from 2011 to 2022 were abstracted from survey responses and health records of 227,504 male Million Veteran Program participants. Weighting for each environmental factor's effect size was recalculated using Veterans Affairs training data to create a recalibrated e-Score. This recalibrated score was compared with the original weighted e-Score in a validation sample of 113,752 (n cases = 590). Nested multiple logistic regression models tested associations between quintiles for recalibrated and original e-Scores. Likelihood ratio tests were used to compare model performance.
Age (P < 0.0001), education (P < 0.0001), diabetes (P < 0.0001), physical activity (P < 0.0001), smoking (P < 0.0001), NSAID use (P < 0.0001), calcium (P = 0.015), folate (P = 0.020), and fruit consumption (P = 0.019) were significantly different between colorectal cancer case and control groups. In the validation sample, the recalibrated e-Score model significantly improved the base model performance (P < 0.001), but the original e-Score model did not (P = 0.07). The recalibrated e-Score model quintile 5 was associated with significantly higher odds for colorectal cancer compared with quintile 1 (Q5 vs. Q1: 1.79; 95% CI, 1.38-2.33).
Multiple environmental factors and the recalibrated e-Score quintiles were significantly associated with colorectal cancer cases.
A recalibrated, veteran-specific e-Score could be used to help personalize colorectal cancer screening and prevention strategies.
结直肠癌风险可能通过多种环境因素累积。了解这些因素以及遗传、年龄和家族史的影响，可能有助于改进筛查方案的临床决策。我们旨在通过对百万退伍军人计划（Million Veteran Program）中美国退伍军人参与者的样本进行重新校准，扩展之前关于环境风险评分（e-Score）的工作。
从 2011 年至 2022 年，从 227504 名百万退伍军人计划男性参与者的调查回复和健康记录中提取人口统计学、生活方式和结直肠癌数据。使用退伍军人事务部培训数据重新计算每个环境因素影响大小的权重，以创建重新校准的 e-Score。在 113752 名（n 例=590）验证样本中比较重新校准的 e-Score 与原始加权 e-Score。嵌套多逻辑回归模型测试了重新校准和原始 e-Score 五分位数之间的关联。似然比检验用于比较模型性能。
年龄（P < 0.0001）、教育程度（P < 0.0001）、糖尿病（P < 0.0001）、体力活动（P < 0.0001）、吸烟（P < 0.0001）、非甾体抗炎药使用（P < 0.0001）、钙（P = 0.015）、叶酸（P = 0.020）和水果摄入（P = 0.019）在结直肠癌病例和对照组之间存在显著差异。在验证样本中，重新校准的 e-Score 模型显著提高了基础模型的性能（P < 0.001），但原始 e-Score 模型没有（P = 0.07）。与五分位数 1 相比，重新校准的 e-Score 模型五分位数 5 与结直肠癌的发生显著相关（Q5 与 Q1：1.79；95%CI，1.38-2.33）。
多种环境因素和重新校准的 e-Score 五分位数与结直肠癌病例显著相关。
一个重新校准的、针对退伍军人的 e-Score 可以用于帮助个性化结直肠癌筛查和预防策略。
