Background There is no validated, discriminating, and easy-to-apply tool for estimating risk of colorectal neoplasia. We studied whether the National Cancer Institute's (NCI's) Colorectal Cancer (CRC) Risk Assessment Tool, which estimates future CRC risk, could estimate current risk for advanced colorectal neoplasia among average-risk persons. Methods This cross-sectional study involved individuals age 50 to 80 years undergoing first-time screening colonoscopy. We measured medical and family history, lifestyle information, and physical measures and calculated each person's future CRC risk using the NCI tool's logistic regression equation. We related quintiles of future CRC risk to the current risk of advanced neoplasia (sessile serrated polyp or tubular adenoma ≥ 1 cm, a polyp with villous histology or high-grade dysplasia, or CRC). All statistical tests were two-sided. Results For 4457 (98.5%) with complete data (mean age = 57.2 years, SD = 6.6 years, 51.7% women), advanced neoplasia prevalence was 8.26%. Based on quintiles of five-year estimated absolute CRC risk, current risks of advanced neoplasia were 2.1% (95% confidence interval [CI] = 1.3% to 3.3%), 4.8% (95% CI = 3.5% to 6.4%), 6.4% (95% CI = 4.9% to 8.2%), 10.0% (95% CI = 8.1% to 12.1%), and 17.6% (95% CI = 15.5% to 20.6%; P < .001). For quintiles of estimated 10-year CRC risk, corresponding current risks for advanced neoplasia were 2.2% (95% CI = 1.4% to 3.5%), 4.8% (95% CI = 3.5% to 6.4%), 6.5% (95% CI = 5.0% to 8.3%), 9.3% (95% CI = 7.5% to 11.4%), and 18.4% (95% CI = 15.9% to 21.1%; P < .001). Among persons with an estimated five-year CRC risk above the median, current risk for advanced neoplasia was 12.8%, compared with 3.7% among those below the median (relative risk = 3.4, 95 CI = 2.7 to 4.4). Conclusions The NCI's Risk Assessment Tool, which estimates future CRC risk, may be used to estimate current risk for advanced neoplasia, making it potentially useful for tailoring and improving CRC screening efficiency among average-risk persons.

中文翻译：

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使用美国国家癌症研究所的大肠癌风险评估工具，可以评估晚期肿瘤的风险。

背景技术目前尚无经过验证，可识别且易于使用的工具来估计结直肠瘤形成的风险。我们研究了估计未来CRC风险的美国国家癌症研究所（NCI）的大肠癌（CRC）风险评估工具是否可以估计平均风险人群中目前发生晚期大肠癌的风险。方法这项横断面研究涉及年龄为50至80岁的首次接受结肠镜检查的个体。我们测量了患者的病史和家族史，生活方式信息以及身体状况，并使用NCI工具的逻辑回归方程计算了每个人未来的CRC风险。我们将五分之一的未来CRC风险与目前的晚期肿瘤形成风险（无固定锯齿状息肉或管状腺瘤≥1 cm，具有绒毛组织学或高度不典型增生的息肉，或CRC）。所有统计检验都是双面的。结果对于4457名（98.5％）具有完整数据（平均年龄= 57.2岁，SD = 6.6岁，女性为51.7％）的患者，晚期肿瘤形成率为8.26％。根据五年估计的绝对CRC风险的五分位数，目前晚期肿瘤的风险为2.1％（95％置信区间[CI] = 1.3％至3.3％），4.8％（95％CI = 3.5％至6.4％）， 6.4％（95％CI = 4.9％至8.2％），10.0％（95％CI = 8.1％至12.1％）和17.6％（95％CI = 15.5％至20.6％; P <.001）。对于估计的10年CRC风险的五分位数，相应的当前晚期肿瘤形成的风险为2.2％（95％CI = 1.4％至3.5％），4.8％（95％CI = 3.5％至6.4％），6.5％（95％） CI = 5.0％至8.3％），9.3％（95％CI = 7.5％至11.4％）和18.4％（95％CI = 15.9％至21.1％; P <.001）。在估计的五年CRC风险高于中位数的人群中，目前，晚期肿瘤的风险为12.8％，低于中位值的风险为3.7％（相对风险= 3.4，95 CI = 2.7至4.4）。结论NCI的风险评估工具可估计未来的CRC风险，可用于估计当前晚期肿瘤的风险，使其有可能用于调整和提高普通风险人群的CRC筛查效率。