Derivation and validation of a prediction rule for estimating advanced colorectal neoplasm risk in average-risk Chinese.
No prediction rule is currently available for advanced colorectal neoplasms, defined as invasive cancer, an adenoma of 10 mm or more, a villous adenoma, or an adenoma with high-grade dysplasia, in average-risk Chinese. In this study between 2006 and 2008, a total of 7,541 average-risk Chinese persons aged 40 years or older who had complete colonoscopy were included. The derivation and validation cohorts consisted of 5,229 and 2,312 persons, respectively. A prediction rule was developed from a logistic regression model and then internally and externally validated. The prediction rule comprised 8 variables (age, sex, smoking, diabetes mellitus, green vegetables, pickled food, fried food, and white meat), with scores ranging from 0 to 14. Among the participants with low-risk (≤3) or high-risk (>3) scores in the validation cohort, the risks of advanced neoplasms were 2.6% and 10.0% (P < 0.001), respectively. If colonoscopy was used only for persons with high risk, 80.3% of persons with advanced neoplasms would be detected while the number of colonoscopies would be reduced by 49.2%. The prediction rule had good discrimination (area under the receiver operating characteristic curve = 0.74, 95% confidence interval: 0.70, 0.78) and calibration (P = 0.77) and, thus, provides accurate risk stratification for advanced neoplasms in average-risk Chinese.
Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Quan-Cai
QC
Cai
En-Da
ED
Yu
Yi
Y
Xiao
Wen-Yuan
WY
Bai
Xing
X
Chen
Li-Ping
LP
He
Yu-Xiu
YX
Yang
Ping-Hong
PH
Zhou
Xue-Liang
XL
Jiang
Hui-Min
HM
Xu
Hong
H
Fan
Zhi-Zheng
ZZ
Ge
Nong-Hua
NH
Lv
Zhi-Gang
ZG
Huang
You-Ming
YM
Li
Shu-Ren
SR
Ma
Jie
J
Chen
Yan-Qing
YQ
Li
Jian-Ming
JM
Xu
Ping
P
Xiang
Li
L
Yang
Fu-Lin
FL
Lin
Zhao-Shen
ZS
Li
D000236:Adenoma / Q000175:diagnosis / Q000209:etiology; D000328:Adult; D000367:Age Factors; D000368:Aged; D002681:China; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000209:etiology; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012372:ROC Curve; D018570:Risk Assessment; D012737:Sex Factors; D011795:Surveys and Questionnaires