title: A Risk Prediction Model for Sporadic CRC Based on Routine Lab Results.
abstract: Current risk scores for colorectal cancer (CRC) are based on demographic and behavioral factors and have limited predictive values.
  
  
  
  To develop a novel risk prediction model for sporadic CRC using clinical and laboratory data in electronic medical records.
  
  
  
  We conducted a nested case-control study in a UK primary care database. Cases included those with a diagnostic code of CRC, aged 50-85. Each case was matched with four controls using incidence density sampling. CRC predictors were examined using univariate conditional logistic regression. Variables with p value <0.25 in the univariate analysis were further evaluated in multivariate models using backward elimination. Discrimination was assessed using receiver operating curve. Calibration was evaluated using the McFadden's R2. Net reclassification index (NRI) associated with incorporation of laboratory results was calculated. Results were internally validated.
  
  
  
  A model similar to existing CRC prediction models which included age, sex, height, obesity, ever smoking, alcohol dependence, and previous screening colonoscopy had an AUC of 0.58 (0.57-0.59) with poor goodness of fit. A laboratory-based model including hematocrit, MCV, lymphocytes, and neutrophil-lymphocyte ratio (NLR) had an AUC of 0.76 (0.76-0.77) and a McFadden's R2 of 0.21 with a NRI of 47.6 %. A combined model including sex, hemoglobin, MCV, white blood cells, platelets, NLR, and oral hypoglycemic use had an AUC of 0.80 (0.79-0.81) with a McFadden's R2 of 0.27 and a NRI of 60.7 %. Similar results were shown in an internal validation set.
  
  
  
  A laboratory-based risk model had good predictive power for sporadic CRC risk.
authors.affiliation: Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, 733 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA. bben217@gmail.com.|Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA. bben217@gmail.com.|Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA. bben217@gmail.com.|Tel-Aviv University, 69978, Tel Aviv, Israel. bben217@gmail.com.
authors.forename: Ben
authors.identifier: 0000-0002-1304-8340
authors.initials: B
authors.lastname: Boursi
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.|Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.|Division of Hematology/Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.
authors.forename: Ronac
authors.initials: R
authors.lastname: Mamtani
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.|Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Hwang
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.|Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Haynes
authors.affiliation: Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, 733 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA.|Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.|Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.
authors.forename: Yu-Xiao
authors.initials: YX
authors.lastname: Yang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012307:Risk Factors
keywords: Cancer; Colon; Risk model; Screening