New scoring systems for predicting advanced proximal neoplasia in asymptomatic adults with or without knowing distal colorectal findings: a prospective, cross-sectional study
| Autor: | Thomas F Imperiale, Patrick O Monahan, Timothy E. Stump, David F. Ransohoff |
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| Rok vydání: | 2023 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Epidemiology Colorectal cancer Cross-sectional study Logistic regression Asymptomatic Article Descending colon Risk Factors Internal medicine Medicine Humans Medical history Prospective Studies Early Detection of Cancer business.industry Public Health Environmental and Occupational Health Colonoscopy Middle Aged medicine.disease medicine.anatomical_structure Cross-Sectional Studies Oncology Dysplasia Female medicine.symptom Metabolic syndrome business Colorectal Neoplasms |
| Zdroj: | Eur J Cancer Prev |
| ISSN: | 1473-5709 |
| Popis: | BACKGROUND Models estimating risk for advanced proximal colorectal neoplasia (APN) may be used to select colorectal cancer (CRC) screening test, either prior to knowing distal colorectal findings or afterward. Current models have only fair discrimination and nearly all require knowing distal findings. OBJECTIVE Derive and test risk prediction models for APN with and without distal findings. SETTING Selected endoscopy centers within central Indiana, USA. PARTICIPANTS Average-risk persons undergoing first-time screening colonoscopy. INTERVENTIONS Demographics, personal and family medical history, lifestyle factors and physical measures were linked to the most advanced finding in proximal and distal colorectal segments. For both models, logistic regression identified factors independently associated with APN on a derivation set. Based on equation coefficients, points were assigned to each factor, and risk for APN was examined for each score. Scores with comparable risks were collapsed into risk categories. Both models and their scoring systems were tested on the validation set. MAIN OUTCOME APN, defined as any adenoma or sessile serrated lesion ≥1 cm, one with villous histology or high-grade dysplasia, or CRC proximal to the descending colon. RESULTS Among 3025 subjects in the derivation set (mean age 57.3 ± 6.5 years; 52% women), APN prevalence was 4.5%; 2859 (94.5%) had complete data on risk factors. Independently associated with APN were age, sex, cigarette smoking, cohabitation status, metabolic syndrome, non-steroidal anti-inflammatory drug use and physical activity. This model (without distal findings) was well-calibrated (P = 0.62) and had good discrimination (c-statistic = 0.73). In low-, intermediate- and high-risk groups that comprised 21, 58 and 21% of the sample, respectively, APN risks were 1.47% (95% CI, 0.67-2.77%), 3.09% (CI, 2.31-4.04%) and 11.6% (CI, 9.10-14.4%), respectively (P |
| Databáze: | OpenAIRE |
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