Background & Aims

Patients found to be at high risk of advanced proximal neoplasia (APN) after flexible sigmoidoscopy screening should be considered for colonoscopy examination. We developed and validated a scoring system to identify persons at risk for APN.

Methods

We collected data from 7954 asymptomatic subjects (age, 50–75 y) who received screening colonoscopy examinations at 14 sites in Asia. We randomly assigned 5303 subjects to the derivation cohort and the remaining 2651 to the validation cohort. We collected data from the derivation cohort on age, sex, family history of colorectal cancer, smoking, drinking, body mass index, medical conditions, and use of nonsteroidal anti-inflammatory drugs or aspirin. Associations between the colonoscopic findings of APN and each risk factor were examined using the Pearson χ² test, and we assigned each participant a risk score (0–15), with scores of 0 to 3 as average risk and scores of 4 or higher as high risk. The scoring system was tested in the validation cohort. We used the Cochran–Armitage test of trend to compare the prevalence of APN among subjects in each group.

Results

In the validation cohort, 79.5% of patients were classified as average risk and 20.5% were classified as high risk. The prevalence of APN in the average-risk group was 1.9% and in the high-risk group was 9.4% (adjusted relative risk, 5.08; 95% CI, 3.38–7.62; P < .001). The score included age (61–70 y, 3; ≥70 y, 4), smoking habits (current/past, 2), family history of colorectal cancer (present in a first-degree relative, 2), and the presence of neoplasia in the distal colorectum (nonadvanced adenoma 5–9 mm, 2; advanced neoplasia, 7). The c-statistic of the score was 0.74 (95% CI, 0.68–0.79), and for distal findings alone was 0.67 (95% CI, 0.60–0.74). The Hosmer–Lemeshow goodness-of-fit test statistic was greater than 0.05, indicating the reliability of the validation set. The number needed to refer was 11 (95% CI, 10–13), and the number needed to screen was 15 (95% CI, 12–17).

Conclusions

We developed and validated a scoring system to identify persons at risk for APN. Screening participants who undergo flexible sigmoidoscopy screening with a score of 4 points or higher should undergo colonoscopy evaluation.

中文翻译：

---

亚太地区近端结肠肿瘤风险评分的开发和验证。

背景与目标

经软式乙状结肠镜检查发现存在晚期近端瘤形成 (APN) 高风险的患者应考虑进行结肠镜检查。我们开发并验证了一个评分系统来识别有 APN 风险的人。

方法

我们收集了来自亚洲 14 个地点的 7954 名无症状受试者（年龄 50-75 岁）的数据，这些受试者接受了结肠镜检查。我们将 5303 名受试者随机分配到推导队列，将剩余的 2651 名受试者随机分配到验证队列。我们从推导队列中收集了关于年龄、性别、结直肠癌家族史、吸烟、饮酒、体重指数、医疗状况以及使用非甾体抗炎药或阿司匹林的数据。^{使用 Pearson χ 2}检查 APN 的结肠镜检查结果与每个危险因素之间的关联测试，我们为每个参与者分配了一个风险评分（0-15），评分为 0 到 3 为平均风险，评分为 4 或更高为高风险。评分系统在验证队列中进行了测试。我们使用 Cochran-Armitage 趋势检验来比较每组受试者中 APN 的患病率。

结果

在验证队列中，79.5% 的患者被归类为平均风险，20.5% 的患者被归类为高风险。平均风险组的 APN 患病率为 1.9%，高风险组为 9.4%（调整后的相对风险，5.08；95% CI，3.38-7.62；P< .001)。评分包括年龄（61-70 岁，3 分；≥70 岁，4 分）、吸烟习惯（现在/过去，2 分）、结直肠癌家族史（存在于一级亲属，2 分）以及远端结直肠肿瘤（非晚期腺瘤 5-9 mm，2；晚期肿瘤，7）。评分的 c 统计量为 0.74（95% CI，0.68-0.79），仅远端检查结果为 0.67（95% CI，0.60-0.74）。Hosmer-Lemeshow 拟合优度检验统计量大于 0.05，表明验证集的可靠性。需要参考的数字是 11 (95% CI, 10-13)，需要筛选的数字是 15 (95% CI, 12-17)。

结论

我们开发并验证了一个评分系统来识别有 APN 风险的人。接受柔性乙状结肠镜筛查且得分为 4 分或更高的筛查参与者应接受结肠镜检查评估。