Abstract
BackgroundThe Asia-Pacific Colorectal Screening (APCS) score is effective to screen high-risk groups of advanced colorectal neoplasia (ACN) patients but needs revising and can be combined with the fecal immunochemical test (FIT). This paper aimed to improve the APCS score and evaluate its use with the FIT in stratifying the risk of ACN.MethodsThis prospective and multicenter study enrolled 955 and 1201 asymptomatic Chinese participants to form the derivation and validation set, respectively. Participants received the risk factor questionnaire, colonoscopy and FIT. Multiple logistic regression was applied, and C-statistic, sensitivity and negative predictive values (NPVs) were used to compare the screening efficiency.ResultsA modified model was developed incorporating age, body mass index (BMI), family history, diabetes, smoking and drinking as risk factors, stratifying subjects into average risk (AR) or high risk (HR). In the validation set, the HR tier group had a 3.4-fold (95% CI 1.8–6.4) increased risk for ACN. The C-statistic for the modified score was 0.69 ± 0.04, and 0.67 ± 0.04 for the original score. The sensitivity of the modified APCS score combined with FIT for screening ACN high-risk cohorts was 76.7% compared with 36.7% of FIT alone and 70.0% of the modified APCS score alone. The NPVs of the modified score combined with FIT for ACN were 98.0% compared with 97.0% of FIT alone and 97.9% of the modified APCS score alone.ConclusionsThe modified score and its use with the FIT are efficient in selecting the HR group from a Chinese asymptomatic population.
Highlights
The Asia-Pacific Colorectal Screening (APCS) score is effective to screen high-risk groups of advanced colorectal neoplasia (ACN) patients but needs revising and can be combined with the fecal immunochemical test (FIT)
Based on a list of Colorectal cancer (CRC)-related risk factors, including sex, age, smoking status, alcohol consumption, diabetes, family history, obesity, diet and exercise, this study aimed to improve the existing APCS score and validate the modified model to confirm its effectiveness in screening high-risk groups of CRC among a Chinese asymptomatic population and further test the validity of the score combined with FIT
The distribution of all these factors in the two cohorts is shown in Table 1, and Fig. 1 is a flowchart demonstrating the process of the validation set
Summary
The Asia-Pacific Colorectal Screening (APCS) score is effective to screen high-risk groups of advanced colorectal neoplasia (ACN) patients but needs revising and can be combined with the fecal immunochemical test (FIT). Colorectal cancer (CRC) is the fourth leading malignant tumor for incidence and the second most common for mortality in both sexes across the world based on the 2018 GLOBOCAN estimates [1], and the morbidity of CRC in the Chinese population has continued to rise in He et al BMC Gastroenterology (2019) 19:226 is important to develop a simple predictive model that can be used to screen high-risk (HR) groups of CRCs to make subsequent screening methods, mainly colonoscopy, more effective and targeted. The original APCS model is relatively simple and is based merely on elementary clinical data, including sex, age, family history and smoking status Other risk factors, such as diabetes mellitus [10], alcohol consumption [11] and obesity [12], were overlooked, they have been reported to be closely related to CRC in previous studies.
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