Risk stratification of screened populations could help improve colorectal cancer (CRC) screening. Use of the modified Asia-Pacific Colorectal Screening (APCS) score has been proposed in the Asia-Pacific region. This study was performed to build a new useful scoring model for CRC screening.
Data were reviewed from 5218 asymptomatic Japanese individuals who underwent their first screening colonoscopy. Multivariate logistic regression was used to investigate risk factors for advanced colorectal neoplasia (ACN), and a new scoring model for the prediction of ACN was developed based on the results. The discriminatory capability of the new model and the modified APCS score were assessed and compared. Internal validation was also performed.
ACN was detected in 225 participants. An 8-point scoring model for the prediction of ACN was developed using five independent risk factors for ACN (male sex, higher age, presence of two or more first-degree relatives with CRC, body mass index of > 22.5 kg/m2, and smoking history of > 18.5 pack-years). The prevalence of ACN was 1.6% (34/2172), 5.3% (127/2419), and 10.2% (64/627) in participants with scores of < 3, ≥ 3 to < 5, and ≥ 5, respectively. The c-statistic of the scoring model was 0.70 (95% confidence interval, 0.67–0.73) in both the development and internal validation sets, and this value was higher than that of the modified APCS score [0.68 (95% confidence interval, 0.65–0.71), P = 0.03].
We built a new simple scoring model for prediction of ACN in a Japanese population that could stratify the screened population into low-, moderate-, and high-risk groups.
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GLOBOCAN. Estimated cancer incidence, mortality and prevalence worldwide in 2012. 2012. http://globocan.iarc.fr/Default.aspx.
Schreuders EH, Ruco A, Rabeneck L, et al. Colorectal cancer screening: a global overview of existing programmes. Gut. 2015;64:1637–49.
Saito H. Colorectal cancer screening using immunochemical faecal occult blood testing in Japan. J Med Screen. 2006;13:S6–7.
Hori M, Matsuda T, Shibata A, et al. Cancer incidence and incidence rates in Japan in 2009: a study of 32 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) project. Jpn J Clin Oncol. 2015;45:884–91.
Betés M, Muñoz-Navas MA, Duque JM, et al. Use of colonoscopy as a primary screening test for colorectal cancer in average risk people. Am J Gastroenterol. 2003;98:2648–54.
Lin OS, Kozarek RA, Schembre DB, et al. Risk stratification for colon neoplasia: screening strategies using colonoscopy and computerized tomographic colonography. Gastroenterology. 2006;131:1011–9.
Driver JA, Gaziano JM, Gelber RP, et al. Development of a risk score for colorectal cancer in men. Am J Med. 2007;120:257–63.
Park Y, Freedman AN, Gail MH, et al. Validation of a colorectal cancer risk prediction model among white patients age 50 years and older. J Clin Oncol. 2009;27:694–8.
Freedman AN, Slattery ML, Ballard-Barbash R, et al. Colorectal cancer risk prediction tool for white men and women without known susceptibility. J Clin Oncol. 2009;27:686–93.
Wei EK, Colditz GA, Giovannucci EL, et al. Cumulative risk of colon cancer up to age 70 years by risk factor status using data from the Nurses’ Health Study. Am J Epidemiol. 2009;170:863–72.
Kastrinos F, Allen JI, Stockwell DH, et al. Development and validation of a colon cancer risk assessment tool for patients undergoing colonoscopy. Am J Gastroenterol. 2009;104:1508–18.
Ma E, Sasazuki S, Iwasaki M, Japan Public Health Center-based Prospective Study Group, et al. 10-year risk of colorectal cancer: development and validation of a prediction model in middle-aged Japanese men. Cancer Epidemiol. 2010;34:534–41.
Yeoh KG, Ho KY, Chiu HM, Asia-Pacific Working Group on Colorectal Cancer, et al. The Asia-Pacific colorectal screening score: a validated tool that stratifies risk for colorectal advanced neoplasia in asymptomatic Asian subjects. Gut. 2011;60:1236–41.
Cai QC, Yu ED, Xiao Y, et al. Derivation and validation of a prediction rule for estimating advanced colorectal neoplasm risk in average-risk Chinese. Am J Epidemiol. 2012;175:584–93.
Kaminski MF, Polkowski M, Kraszewska E, et al. A score to estimate the likelihood of detecting advanced colorectal neoplasia at colonoscopy. Gut. 2014;63:1112–9.
Tao S, Hoffmeister M, Brenner H. Development and validation of a scoring system to identify individuals at high risk for advanced colorectal neoplasms who should undergo colonoscopy screening. Clin Gastrointest Hepatol. 2014;12:478–85.
Kim DH, Cha JM, Shin HP, et al. Development and validation of a risk stratification-based screening model for predicting colorectal advanced neoplasia in Korea. J Clin Gastroenterol. 2015;49:41–9.
Sung JJY, Wong MC, Tsoi KK. Modified Asia-Pacific Colorectal Screening (APCS) score to stratify risk for colorectal advanced neoplasia in asymptomatic population in Asian subjects. Gastroenterology. 2014;146:S-730.
Wong MC, Ching JY, Ng S, et al. The discriminatory capability of existing scores to predict advanced colorectal neoplasia: a prospective colonoscopy study of 5,899 screening participants. Sci Rep. 2016;6:20080.
Sung JJY, Wong M, Lam TYT, et al. A modified colorectal screening score for prediction of advanced neoplasia: a prospective study of 5744 subjects. J Gastroenterol Hepatol. 2017;33:187–94.
Sung JJ, Ng SC, Chan FK, An updated Asia Pacific Consensus Recommendations on colorectal cancer screening, et al. An updated Asia Pacific consensus recommendations on colorectal cancer screening. Gut. 2015;64:121–32.
Hamashima C, Sobue T, Muramatsu Y, et al. Comparison of observed and expected numbers of detected cancers in the research center for cancer prevention and screening program. Jpn J Clin Oncol. 2006;36:301–8.
Sekiguchi M, Kakugawa Y, Terauchi T, et al. Sensitivity of 2-[18F]fluoro-2-deoxyglucose positron emission tomography for advanced colorectal neoplasms: a large-scale analysis of 7505 asymptomatic screening individuals. J Gastroenterol. 2016;51:1122–32.
Budhathoki S, Iwasaki M, Sawada N, et al. Soy food and isoflavone intake and endometrial cancer risk: the Japan Public Health Center-based prospective study. BJOG. 2015;122:304–11.
Participants in the Paris Workshop. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003;58(Suppl):S3–43.
Edge SB, Byrd DR, Compton CC, et al., editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.
Hamiliton SR, Bosman FT, Boffetta P, et al. Carcinoma of the colon and rectum. In: Bosman FT, Carneiro F, Hruban RH, et al., editors. WHO classification of tumors of the digestive system. 4th ed. Lyon: IARC; 2010. p. 134–46.
Winawer SJ, Zauber AG. The advanced adenoma as the primary target of screening. Gastrointest Endosc Clin N Am. 2002;12:1–9.
Schlemper RJ, Itabashi M, Kato Y, et al. Differences in the diagnostic criteria used by Japanese and Western pathologists to diagnose colorectal carcinoma. Cancer. 1998;82:60–9.
Moons KG, Kengne AP, Woodward M, et al. Risk prediction models: I. Development, internal validation, and assessing the incremental value of a new (bio)marker. Heart. 2012;98:683–90.
Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36.
Regula J, Rupinski M, Kraszewska E, et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med. 2006;355:1863–72.
Strul H, Kariv R, Leshno M, et al. The prevalence rate and anatomic location of colorectal adenoma and cancer detected by colonoscopy in average-risk individuals aged 40–80 years. Am J Gastroenterol. 2006;101:255–62.
Pendergrass CJ, Edelstein DL, Hylind LM, et al. Occurrence of colorectal adenomas in younger adults: an epidemiologic necropsy study. Clin Gastroenterol Hepatol. 2008;6:1011–5.
Boursi B, Halak A, Umansky M, et al. Colonoscopic screening of an average-risk population for colorectal neoplasia. Endoscopy. 2009;41:516–21.
Heitman SJ, Ronksley PE, Hilsden RJ, et al. Prevalence of adenomas and colorectal cancer in average risk individuals: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2009;7:1272–8.
Byeon JS, Yang SK, Kim TI, Asia Pacific Working Group for Colorectal Cancer, et al. Colorectal neoplasm in asymptomatic Asians: a prospective multinational multicenter colonoscopy survey. Gastrointest Endosc. 2007;65:1015–22.
Hassan C, Pickhardt PJ, Kim DH, et al. Systematic review: distribution of advanced neoplasia according to polyp size at screening colonoscopy. Aliment Pharmacol Ther. 2010;31:210–7.
Corley DA, Jensen CD, Marks AR, et al. Variation of adenoma prevalence by age, sex, race, and colon location in a large population: implications for screening and quality programs. Clin Gastroenterol Hepatol. 2013;11:172–80.
Rex DK, Helbig CC. High yields of small and flat adenomas with high-definition colonoscopes using either white light or narrow band imaging. Gastroenterology. 2007;133:42–7.
Chiu HM, Ching JY, Wu KC, et al. A risk-scoring system combined with a fecal immunochemical test is effective in screening high-risk subjects for early colonoscopy to detect advanced colorectal neoplasms. Gastroenterology. 2016;150:617–25.
Butterworth AS, Higgins JP, Pharoah P. Relative and absolute risk of colorectal cancer for individuals with a family history: a meta-analysis. Eur J Cancer. 2006;42:216–27.
Schoen RE, Razzak A, Yu KJ, et al. Incidence and mortality of colorectal cancer in individuals with a family history of colorectal cancer. Gastroenterology. 2015;149:1438–45.
Quintero E, Carrillo M, Leoz ML, Oncology Group of the Asociación Española de Gastroenterología, et al. Risk of advanced neoplasia in first-degree relatives with colorectal cancer: a Large Multicenter Cross-Sectional Study. PLoS Med. 2016;13:e1002008.
Rex DK, Schoenfeld PS, Cohen J, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015;81:31–53.
Moons KG, Kengne AP, Grobbee DE, et al. Risk prediction models: II. External validation, model updating, and impact assessment. Heart. 2012;98:691–8.
This study was supported by JSPS KAKENHI, grant number 17K15978 and the National Cancer Center Research and Development Fund (27-A-5). The authors thank Angela Morben, DVM, ELS, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.
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Sekiguchi, M., Kakugawa, Y., Matsumoto, M. et al. A scoring model for predicting advanced colorectal neoplasia in a screened population of asymptomatic Japanese individuals. J Gastroenterol 53, 1109–1119 (2018). https://doi.org/10.1007/s00535-018-1433-7