Comparison of prognostic models to predict the occurrence of colorectal cancer in asymptomatic individuals: a systematic literature review and external validation in the EPIC and UK Biobank prospective cohort studies

Smith, Todd; Muller, David C.; Moons, Karel G.M.; Cross, Amanda J.; Ferrari, Pietro; Fagherazzi, Guy; Peeters, Petra H.M.; Severi, Gianluca; Hüsing, Anika; Kaaks, Rudolf; Tjønneland, Anne; Olsen, Anja; Overvad, Kim; Bonet, Catalina; Rodríguez‐Barranco, Miguel; Huerta, José María; Gurrea, Aurelio Barricarte; Bradbury, Kathryn E.; Trichopoulou, Antonia; Bamia, Christina; Orfanos, Philippos; Palli, Domenico; Pala, Valeria; Víneis, Paolo; Bueno‐de‐Mesquita, Bas; Ohlsson, Bodil; Harlid, Sophia; Guelpen, Bethany Van; Skeie, Guri; Weiderpass, Elisabete; Jenab, Mazda; Murphy, Neil; Riboli, Elio; Gunter, Marc J.; Aleksandrova, Krasimira; Tzoulaki, Ioanna

doi:10.1136/gutjnl-2017-315730

Cited by 36 publications

(47 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, C-statistics are nearly identical to those reported in other external validations of the NCI tool for both baseline AN on screening colonoscopy [8, 9] and invasive CRC in population-based prospective cohorts with a time horizon of 5 (UK Biobank, AUC = 0.60), 8 (NIH-AARP, AUC = 0.60) and 10 years (EPIC, AUC = 0.61) [6, 15]. A retrospective study by Tariq et al included 749 ethnically and gender diverse participants (91% African American and Asian, 58% female) and revealed an AUC of 0.62.…”

Section: Discussionsupporting

confidence: 59%

“…In 2019, Smith and colleagues systematically identified published CRC risk prediction models and externally validated them using two large population-based cohorts. Overall, models required between 3 and 13 variables, and moderate-to good AUCs up to 0.70 were reported, thereby broadening the pool of available risk prediction models to choose from in clinical settings [15], based on the available clinical variables.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Advanced neoplasia in Veterans at screening colonoscopy using the National Cancer Institute Risk Assessment Tool

et al. 2019

View full text Add to dashboard Cite

BackgroundAdapting screening strategy to colorectal cancer (CRC) risk may improve efficiency for all stakeholders however limited tools for such risk stratification exist. Colorectal cancers usually evolve from advanced neoplasms that are present for years. We applied the National Cancer Institute (NCI) CRC Risk Assessment Tool, which calculates future risk of CRC, to determine whether it could be used to predict current advanced neoplasia (AN) in a veteran cohort undergoing a baseline screening colonoscopy.MethodsThis was a prospective assessment of the relationship between future CRC risk predicted by the NCI tool, and the presence of AN at screening colonoscopy. Family, medical, dietary and physical activity histories were collected at the time of screening colonoscopy and used to calculate absolute CRC risk at 5, 10 and 20 years. Discriminatory accuracy was assessed.ResultsOf 3121 veterans undergoing screening colonoscopy, 94% had complete data available to calculate risk (N = 2934, median age 63 years, 100% men, and 15% minorities). Prevalence of AN at baseline screening colonoscopy was 11 % (N = 313). For tertiles of estimated absolute CRC risk at 5 years, AN prevalences were 6.54% (95% CI, 4.99, 8.09), 11.26% (95% CI, 9.28-13.24), and 14.21% (95% CI, 12.02-16.40). For tertiles of estimated risk at 10 years, the prevalences were 6.34% (95% CI, 4.81-7.87), 11.25% (95% CI, 9.27-13.23), and 14.42% (95% CI, 12.22-16.62). For tertiles of estimated absolute CRC risk at 20 years, current AN prevalences were 7.54% (95% CI, 5.75-9.33), 10.53% (95% CI, 8.45-12.61), and 12.44% (95% CI, 10.2-14.68). The area under the curve for predicting current AN was 0.60 (95% CI; 0.57-0.63, p < 0.0001) at 5 years, 0.60 (95% CI, 0.57-0.63, p < 0.0001) at 10 years and 0.58 (95% CI, 0.54-0.61, p < 0.0001) at 20 years.ConclusionThe NCI tool had modest discriminatory function for estimating the presence of current advanced neoplasia in veterans undergoing a first screening colonoscopy. These findings are comparable to other clinically utilized cancer risk prediction models and may be used to inform the benefit-risk assessment of screening, particularly for patients with competing comorbidities and lower risk, for whom a non-invasive screening approach is preferred.

show abstract

Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Advanced neoplasia in Veterans at screening colonoscopy using the National Cancer Institute Risk Assessment Tool

et al. 2019

View full text Add to dashboard Cite

show abstract

“…At present, there have been a number of predictive studies for colorectal cancer. Smith et al [7] have evaluated 16 diagnostic models for colorectal cancer screening, and Kawai et al [8] have analyzed the clinical applicability of 28 prognostic models for colorectal cancer.…”

Section: Introductionmentioning

confidence: 99%

A competing-risk nomogram to predict cause-specific death in elderly patients with colorectal cancer after surgery (especially for colon cancer)

Wang¹,

Wang²,

Yang³

et al. 2020

World J Surg Onc

View full text Add to dashboard Cite

Background: Clinically, when the diagnosis of colorectal cancer is clear, patients are more concerned about their own prognosis survival. Special population with high risk of accidental death, such as elderly patients, is more likely to die due to causes other than tumors. The main purpose of this study is to construct a prediction model of cause-specific death (CSD) in elderly patients using competing-risk approach, so as to help clinicians to predict the probability of CSD in elderly patients with colorectal cancer. Methods: The data were extracted from Surveillance, Epidemiology, and End Results (SEER) database to include ≥ 65-year-old patients with colorectal cancer who had undergone surgical treatment from 2010 to 2016. Using competing-risk methodology, the cumulative incidence function (CIF) of CSD was calculated to select the predictors among 13 variables, and the selected variables were subsequently refined and used for the construction of the proportional subdistribution hazard model. The model was presented in the form of nomogram, and the performance of nomogram was bootstrap validated internally and externally using the concordance index (Cindex). Results: Dataset of 19,789 patients who met the inclusion criteria were eventually selected for analysis. The fiveyear cumulative incidence of CSD was 31.405% (95% confidence interval [CI] 31.402-31.408%). The identified clinically relevant variables in nomogram included marital status, pathological grade, AJCC TNM stage, CEA, perineural invasion, and chemotherapy. The nomogram was shown to have good discrimination after internal validation with a C-index of 0.801 (95% CI 0.795-0.807) as well as external validation with a C-index of 0.759 (95% CI 0.716-0.802). Both the internal and external validation calibration curve indicated good concordance between the predicted and actual outcomes. Conclusion: Using the large sample database and competing-risk analysis, a postoperative prediction model for elderly patients with colorectal cancer was established with satisfactory accuracy. The individualized estimates of CSD outcome for the elderly patients were realized.

show abstract

“…However, less than half of these (21 of 52 models) have been externally validated. Moreover, the discriminatory ability of models to identify individuals with colorectal neoplasia is variable 20 , 21 , 32 – 34 .…”

Section: Current Risk Stratificationmentioning

confidence: 99%

A risk-stratified approach to colorectal cancer prevention and diagnosis

Hull

Rees

Sharp

et al. 2020

Nat Rev Gastroenterol Hepatol

View full text Add to dashboard Cite

Population screening and endoscopic surveillance are used widely to prevent the development of and death from colorectal cancer (CRC). However, CRC remains a major cause of cancer mortality and the increasing burden of endoscopic investigations threatens to overwhelm some health services. This Perspective describes the rationale for and approach to improved risk stratification and decision-making for CRC prevention and diagnosis. Limitations of current approaches will be discussed using the UK as an example of the challenges faced by a particular health-care system, followed by discussion of novel risk biomarker utilization. We explore how risk stratification will be advantageous to current health-care providers and users, enabling more efficient use of limited colonoscopy resources. We discuss risk stratification in the setting of population screening as well as the surveillance of high-risk groups and investigation of symptomatic patients. We also address challenges in the development and validation of risk stratification tools and identify key research priorities.

show abstract

Comparison of prognostic models to predict the occurrence of colorectal cancer in asymptomatic individuals: a systematic literature review and external validation in the EPIC and UK Biobank prospective cohort studies

Cited by 36 publications

References 28 publications

Advanced neoplasia in Veterans at screening colonoscopy using the National Cancer Institute Risk Assessment Tool

Advanced neoplasia in Veterans at screening colonoscopy using the National Cancer Institute Risk Assessment Tool

A competing-risk nomogram to predict cause-specific death in elderly patients with colorectal cancer after surgery (especially for colon cancer)

A risk-stratified approach to colorectal cancer prevention and diagnosis

Contact Info

Product

Resources

About