title: The Asia-Pacific Colorectal Screening score: a validated tool that stratifies risk for colorectal advanced neoplasia in asymptomatic Asian subjects.
abstract: OBJECTIVE
  To develop and validate a clinical risk score predictive of risk for colorectal advanced neoplasia for Asia.
  
  
  METHODS
  A prospective, cross-sectional and multicentre study was carried out in tertiary hospitals in 11 Asian cities. The subjects comprise 2752 asymptomatic patients undergoing screening colonoscopy. From a development set of 860 asymptomatic subjects undergoing screening colonoscopy, multiple logistic regression was applied to identify significant risk factors for advanced colorectal neoplasia defined as invasive carcinoma or advanced adenoma. The ORs for significant risk factors were utilised to develop a risk score ranging from 0 to 7 (Asia-Pacific Colorectal Screening (APCS) score). Three tiers of risk were arbitrarily defined: 0-1 'average risk' (AR); 2-3 'moderate risk' (MR); and 4-7 'high risk' (HR). Subjects undergoing screening colonoscopy between July 2006 and December 2007 were prospectively enrolled to form an independent validation group. Each subject had a personal APCS score calculated by summing the points attributed from the presence of risk factors in the individuals. The performance of the APCS score in predicting risk of advanced neoplasia was evaluated.
  
  
  RESULTS
  There were 860 subjects in the derivation set and 1892 subjects in the validation set, with a baseline prevalence of advanced neoplasia of 4.5% and 3%, respectively. Applying the APCS stratification in the validation set, 559 subjects (29.5%) were in the AR tier, 966 subjects (51.1%) in the MR tier and 367 (19.4%) subjects in the HR tier. The prevalence of advanced neoplasia in the AR, MR and HR groups was 1.3, 3.2 and 5.2%, respectively. The subjects in the MR and HR tiers had 2.6-fold (95% CI 1.1 to 6.0) and 4.3-fold (95% CI 1.8 to 10.3) increased prevalence of advanced neoplasia, respectively, than those in the AR tier.
  
  
  CONCLUSIONS
  The APCS score based on age, gender, family history and smoking is useful in selecting asymptomatic Asian subjects for priority of colorectal screening.
authors.affiliation: Department of Medicine, National University of Singapore. mdcykg@nus.edu.sg
authors.forename: Khay-Guan
authors.initials: KG
authors.lastname: Yeoh
authors.forename: Khek-Yu
authors.initials: KY
authors.lastname: Ho
authors.forename: Han-Mo
authors.initials: HM
authors.lastname: Chiu
authors.forename: Feng
authors.initials: F
authors.lastname: Zhu
authors.forename: Jessica Y L
authors.initials: JY
authors.lastname: Ching
authors.forename: Deng-Chyang
authors.initials: DC
authors.lastname: Wu
authors.forename: Takahisa
authors.initials: T
authors.lastname: Matsuda
authors.forename: Jeong-Sik
authors.initials: JS
authors.lastname: Byeon
authors.forename: Sang-Kil
authors.initials: SK
authors.lastname: Lee
authors.forename: Khean-Lee
authors.initials: KL
authors.lastname: Goh
authors.forename: Jose
authors.initials: J
authors.lastname: Sollano
authors.forename: Rungsun
authors.initials: R
authors.lastname: Rerknimitr
authors.forename: Rupert
authors.initials: R
authors.lastname: Leong
authors.forename: Kelvin
authors.initials: K
authors.lastname: Tsoi
authors.forename: Jaw-Town
authors.initials: JT
authors.lastname: Lin
authors.forename: Joseph J Y
authors.initials: JJ
authors.lastname: Sung
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001208:Asia / Q000453:epidemiology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D055088:Early Detection of Cancer / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D018570:Risk Assessment; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology