Derivation and Validation of a Predictive Model for Advanced Colorectal Neoplasia in Asymptomatic Adults
Year: 2019
Type: article
Study design: Observational Study
Abstract: Background: A system to estimate risk for advanced colorectal neoplasia (AN) could help direct patients and providers to choices among the various screening tests, improving screening efficiency and uptake. We aimed to create a comprehensive risk prediction model for AN.Methods: Average-risk 50-80 year-olds undergoing 1st-time screening colonoscopy were recruited from selected endoscopy units in central Indiana. We measured socio-demographic and physical features, medical and family history, and lifestyle factors, and linked these to the most advanced finding. We derived a risk equation on 2/3s of the sample, and assigned points to each variable to create a risk score. Scores with comparable risks were collapsed into risk categories. The model and score were tested on the remaining sample.Findings: Among 3,025 subjects in the derivation set (mean age 57·3 (6·5) years; 52% women), AN prevalence was 9·4% (including 26 CRCs). The 12-variable model (c-statistic=0.77) resulted in 3 risk groups with AN risks of 1.5% (95% CI, 0·72-2·74%), 7·06% (CI, 5·89-8·38%) and 27·26% (CI, 23·47- 31·30%) in the low-, intermediate-, and high-risk groups (P-value for trend < 0·001), with 23%, 59%, and 18% of subjects, respectively. In the validation set of 1,475 subjects with AN prevalence of 8·4%, model performance was comparable (c-statistic=0·78, with AN risks of 2·73% (CI, 1·25-5·11%), 5·57% (CI, 4·12-7·34%) and 25·79% (CI, 20·51-31·66%) in the low-, intermediate- and high-risk subgroups, respectively (P<0·001), with proportions of 23%, 59%, and 18%.Interpretation: This model identifies sizeable low-risk and high-risk subgroups for which non-invasive screening and colonoscopy, respectively, may be preferable.Funding Statement: This work was supported by the National Cancer Institute (R01-CA104459); the Walther Cancer Institute, Indianapolis, IN; The Indiana University Melvin and Bren Simon Cancer Center; and a project development team within the Indiana Clinical and Translational Sciences Institute (grant UL1TR001108) from the National Center for Research Resources, National Institutes of Health, Indianapolis, IN.Declaration of Interests: The authors stated: "None."Ethics Approval Statement: This study was conducted at the Indiana University Medical Center in Indianapolis, IN, and was approved by the Institutional Review Board of Indiana University (Indianapolis, IN). Methods and results are reported according to STROBE (strengthening the Reporting of Observational Studies in Epidemiology) and TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) guidelines.
Source: Gut
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3091188560