Abstract
This study aims to develop and validate a new algorithm that incorporates distal colonoscopic findings to predict advanced proximal neoplasia (APN) in a Chinese asymptomatic population. We collected age, gender, and colonoscopic findings from a prospectively performed colonoscopy study between 2013 and 2015 in a large hospital-based endoscopy unit in Shanghai, China. Eligible subjects were allocated to a derivation group (n = 3,889) and validation group (n = 1,944) by random sampling. A new index for APN and its cut-off level were evaluated from the derivation cohort by binary logistic regression. The model performance was tested in the validation cohort using area under the curve (AUC). Age, gender, and distal finding were found to be independent predictors of APN in the derivation cohort (p < 0.001). Subjects were categorized into Average Risk (AR) and High Risk (HR) based on a cut-off score of 2. The AUC of the derivation and validation cohorts were 0.801 (0.754–0.847) and 0.722 (0.649–0.794), respectively. In the validation cohort, those in the HR group had a 3.57 fold higher risk of APN when compared with the AR group (P < 0.001), requiring 18 (95% CI = 12–28) follow-up colonoscopies to detect 1 APN. This new clinical index is useful to stratify APN risk in Chinese population.
Highlights
Worldwide, colorectal cancer (CRC) is the third most common cancer in males and ranks the second in females, with an estimated 1.4 million cases and 693,900 deaths reported in 20121
Levitzky et al has performed an external validation of the model devised by Imperiale et al, and the discriminatory capability was found to be lower in a different population, including black and Hispanic11. to the primary objective of this study is to develop and validate a new model tailored to predict advanced proximal neoplasia (APN) in a Chinese asymptomatic population
For the derivation cohort and validation cohort, the APN rates were 2.7% and 2.4%, respectively
Summary
Colorectal cancer (CRC) is the third most common cancer in males and ranks the second in females, with an estimated 1.4 million cases and 693,900 deaths reported in 20121. Colonoscopy might not be suited as a primary screening test in resource-limited countries with limited colonoscopy capacity[10] It may be more cost-effective and cost-saving to reserve colonoscopy for subjects with high risk for APN in population-based screening[11,12]. To address this need, Imperiale et al.[12] proposed a 7-point scoring system to predict APN by using age, gender, and distal findings at FS as predictors and a high discrimination value was reported in its internal validation group. We conducted this cross-sectional study in a large hospital-based endoscopy unit
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