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Designing a Predictive Model for Colorectal Neoplasia Diagnosis Based on Clinical and Laboratory Findings in Colonoscopy Candidate Patients

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Abstract

Background

Health authorities have expanded two strategies to diminish CRC-related influence: CR screening and improve diagnostic process in symptomatic patients. The aim of the current study is to design a predictive model to identify the most important risk factors that can efficiently predict patients who have high risk of colorectal neoplasia.

Method

A cross-sectional study was constructed to include all patients who had positive test for FIT or had one or more risk factors for colorectal cancer based on the guidelines of detecting high-risk groups for colorectal cancer in Iran. Multivariable binary logistic regression model was constructed for prediction of colorectal neoplasia. We used sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio to check the accuracy. The Hosmer–Lemeshow test, chi-square test, and p value were used to determine the precision of model.

Result

Following an AIC stepwise selection model, only nine potential variables, namely gender, watery diarrhea, IBD, abdominal pain, melena, body mass index, depression drug, anti-inflammatory drug, and age, were found to be a predictor of colorectal neoplasia. The best cut-point probability in the final model was 0.27 and results of sensitivity and specificity, based on maximizing these two criteria, were 66% and 62%, respectively.

Conclusion

Overall, our model prediction was comparable with other risk prediction models for colorectal cancer. It had a modest discriminatory power to distinguish an individual’s neoplasia colorectal risk.

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References

  1. Alatise OI, Ayandipo OO, Adeyeye A, Seier K, Komolafe AO, Bojuwoye MO, et al. A symptom-based model to predict colorectal cancer in low-resource countries: results from a prospective study of patients at high risk for colorectal cancer. Cancer. 2018;124(13):2766–73.

    Article  PubMed  Google Scholar 

  2. Imperiale TF, Yu M, Monahan PO, Stump TE, Tabbey R, Glowinski E, et al. Risk of advanced neoplasia using the National Cancer Institute’s colorectal cancer risk assessment tool. J Natl Cancer Inst. 2017;109(1):djw181.

  3. Liao C-S, Lin Y-M, Chang H-C, Chen Y-H, Chong L-W, Chen C-H, et al. Application of quantitative estimates of fecal hemoglobin concentration for risk prediction of colorectal neoplasia. World J Gastroenterol: WJG. 2013;19(45):8366.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Scholefield J, Moss S, Mangham C, Whynes D, Hardcastle J. Nottingham trial of faecal occult blood testing for colorectal cancer: a 20-year follow-up. Gut. 2012;61(7):1036–40.

    Article  CAS  PubMed  Google Scholar 

  5. Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Harford WV, et al. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. N Engl J Med. 2000;343(3):162–8.

    Article  CAS  PubMed  Google Scholar 

  6. Nguyen SP, Bent S, Chen Y-H, Terdiman JP. Gender as a risk factor for advanced neoplasia and colorectal cancer: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2009;7(6):676–81. e3.

  7. Taylor DP, Burt RW, Williams MS, Haug PJ, Cannon-Albright LA. Population-based family history–specific risks for colorectal cancer: a constellation approach. Gastroenterology. 2010;138(3):877–85.

    Article  PubMed  Google Scholar 

  8. Botteri E, Iodice S, Raimondi S, Maisonneuve P, Lowenfels AB. Cigarette smoking and adenomatous polyps: a meta-analysis. Gastroenterology. 2008;134(2):388–95. e3.

  9. Terry MB, Neugut AI, Bostick RM, Sandler RS, Haile RW, Jacobson JS, et al. Risk factors for advanced colorectal adenomas: a pooled analysis. Cancer Epidemiology and Prevention Biomarkers. 2002;11(7):622–9.

    Google Scholar 

  10. Larsson SC, Orsini N, Wolk A. Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst. 2005;97(22):1679–87.

    Article  PubMed  Google Scholar 

  11. Cole BF, Logan RF, Halabi S, Benamouzig R, Sandler RS, Grainge MJ, et al. Aspirin for the chemoprevention of colorectal adenomas: meta-analysis of the randomized trials. JNCI: J Natl Cancer Inst. 2009;101(4):256–66.

  12. Cubiella J, Vega P, Salve M, Díaz-Ondina M, Alves MT, Quintero E, et al. Development and external validation of a faecal immunochemical test-based prediction model for colorectal cancer detection in symptomatic patients. BMC Med. 2016;14(1):128.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Winawer SJ, Zauber AG, Fletcher RH, Stillman JS, O’brien MJ, Levin B, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006;130(6):1872–85.

  14. Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Bond J, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134(5):1570–95.

    Article  CAS  PubMed  Google Scholar 

  15. Lee Y-h, Bang H, Kim DJ. How to establish clinical prediction models. Endocrinology and Metabolism. 2016;31(1):38–44.

  16. Yeoh K-G, Ho K-Y, Chiu H-M, Zhu F, Ching JY, Wu D-C, 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(9):1236–41.

    Article  PubMed  Google Scholar 

  17. Kim DH, Cha JM, Shin HP, Joo KR, Lee JI, Park DI. Development and validation of a risk stratification-based screening model for predicting colorectal advanced neoplasia in Korea. J Clin Gastroenterol. 2015;49(1):41–9.

    Article  CAS  PubMed  Google Scholar 

  18. Kaminski MF, Polkowski M, Kraszewska E, Rupinski M, Butruk E, Regula J. A score to estimate the likelihood of detecting advanced colorectal neoplasia at colonoscopy. Gut. 2014;63(7):1112–9.

    Article  PubMed  Google Scholar 

  19. Schroy PC III, Wong JB, O’Brien MJ, Chen CA, Griffith JL. A risk prediction index for advanced colorectal neoplasia at screening colonoscopy. Am J Gastroenterol. 2015;110(7):1062.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Rawla P, Sunkara T, Barsouk A. Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Przegla̜d Gastroenterologiczny. 2019;14(2):89.

  21. Cubiella J, Vega P, Salve M, Díaz-Ondina M, Alves MT, Quintero E, et al. Development and external validation of a faecal immunochemical test-based prediction model for colorectal cancer detection in symptomatic patients. BMC Med. 2016;14(1):1–13.

    Article  Google Scholar 

  22. Botteri E, Crosta C, Bagnardi V, Tamayo D, Sonzogni AM, De Roberto G, et al. Predictors of advanced colorectal neoplasia at initial and surveillance colonoscopy after positive screening immunochemical faecal occult blood test. Dig Liver Dis. 2016;48(3):321–6.

    Article  PubMed  Google Scholar 

  23. Usher-Smith JA, Walter FM, Emery JD, Win AK, Griffin SJ. Risk prediction models for colorectal cancer: a systematic review. Cancer Prev Res. 2016;9(1):13–26.

    Article  CAS  Google Scholar 

  24. Stegeman I, de Wijkerslooth TR, Stoop EM, van Leerdam ME, Dekker E, van Ballegooijen M, et al. Colorectal cancer risk factors in the detection of advanced adenoma and colorectal cancer. Cancer Epidemiol. 2013;37(3):278–83.

    Article  PubMed  Google Scholar 

  25. Park Y, Freedman AN, Gail MH, Pee D, Hollenbeck A, Schatzkin A, et al. Validation of a colorectal cancer risk prediction model among white patients age 50 years and older. J Clin Oncol. 2009;27(5):694.

    Article  PubMed  Google Scholar 

  26. 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 Gastroenterol Hepatol. 2014;12(3):478–85.

    Article  PubMed  Google Scholar 

  27. Betés M, Munoz-Navas MA, Duque JM, Angós R, Macías E, Súbtil JC, et al. Use of colonoscopy as a primary screening test for colorectal cancer in average risk people. Am J Gastroenterol. 2003;98(12):2648–54.

    PubMed  Google Scholar 

  28. Hu Y, Chen H-Y, Yu C-Y, Xu J, Wang J-L, Qian J, et al. A long non-coding RNA signature to improve prognosis prediction of colorectal cancer. Oncotarget. 2014;5(8):2230.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Regula J, Rupinski M, Kraszewska E, Polkowski M, Pachlewski J, Orlowska J, et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med. 2006;355(18):1863–72.

    Article  CAS  PubMed  Google Scholar 

  30. Thompson M, Perera R, Senapati A, Dodds S. Predictive value of common symptom combinations in diagnosing colorectal cancer. Br J Surg. 2007;94(10):1260–5.

    Article  CAS  PubMed  Google Scholar 

  31. Hong SN, Son HJ, Choi SK, Chang DK, Kim Y-H, Jung S-H, et al. A prediction model for advanced colorectal neoplasia in an asymptomatic screening population. PloS one. 2017;12(8):e0181040.

  32. Birks J, Bankhead C, Holt TA, Fuller A, Patnick J. Evaluation of a prediction model for colorectal cancer: retrospective analysis of 2.5 million patient records. Cancer medicine. 2017;6(10):2453–60.

  33. Cueto-López N, García-Ordás MT, Dávila-Batista V, Moreno V, Aragonés N, Alaiz-Rodríguez R. A comparative study on feature selection for a risk prediction model for colorectal cancer. Comput Methods Programs Biomed. 2019;177:219–29.

    Article  PubMed  Google Scholar 

  34. Hsieh M-H, Sun L-M, Lin C-L, Hsieh M-J, Sun K, Hsu C-Y, et al. Development of a prediction model for colorectal cancer among patients with type 2 diabetes mellitus using a deep neural network. J Clin Med. 2018;7(9):277.

    Article  PubMed Central  Google Scholar 

  35. Hornbrook MC, Goshen R, Choman E, O’Keeffe-Rosetti M, Kinar Y, Liles EG, et al. Early colorectal cancer detected by machine learning model using gender, age, and complete blood count data. Dig Dis Sci. 2017;62(10):2719–27.

    Article  PubMed  Google Scholar 

  36. Zheng Y, Hua X, Win AK, MacInnis RJ, Gallinger S, Le Marchand L, et al. A new comprehensive colorectal cancer risk prediction model incorporating family history, personal characteristics, and environmental factors. Cancer Epidemiol Biomarkers Prev. 2020;29(3):549–57.

    Article  Google Scholar 

  37. Whiting P, Rutjes AW, Reitsma JB, Glas AS, Bossuyt PM, Kleijnen J. Sources of variation and bias in studies of diagnostic accuracy: a systematic review. Ann Intern Med. 2004;140(3):189–202.

    Article  PubMed  Google Scholar 

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Funding

Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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IR.SBMU.PHNS.REC.1399.11

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The authors declare no competing interests.

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Ghajari, H., Sadeghi, A., Khodakarim, S. et al. Designing a Predictive Model for Colorectal Neoplasia Diagnosis Based on Clinical and Laboratory Findings in Colonoscopy Candidate Patients. J Gastrointest Canc 53, 880–887 (2022). https://doi.org/10.1007/s12029-021-00737-4

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  • DOI: https://doi.org/10.1007/s12029-021-00737-4

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