A risk scoring system for advanced colorectal neoplasia in high-risk participants to improve current colorectal cancer screening in Tianjin, China

Abstract

Background Given the limited effectiveness of the current Chinese colorectal cancer (CRC) screening procedure, adherence to colonoscopy remains low. We aim to develop and validate a scoring system based on individuals who were identified as having a high risk in initial CRC screening to achieve more efficient risk stratification and improve adherence to colonoscopy. Methods A total of 29,504 screening participants with positive High-Risk Factor Questionnaire (HRFQ) or faecal immunochemical test (FIT) who underwent colonoscopy in Tianjin from 2012–2020 were enrolled in this study. Binary regression analysis was used to evaluate the association between risk factors and advanced colorectal neoplasia. Internal validation was also used to assess the performance of the scoring system. Results Male sex, older age (age ≥ 50 years), high body mass index (BMI ≥ 28 kg/m2), current or past smoking and weekly alcohol intake were identified as risk factors for advanced colorectal neoplasm. The odds ratios (ORs) for significant variables were applied to construct the risk score ranging from 0–11: LR, low risk (score 0–3); MR, moderate risk (score 4–6); and HR, high risk (score 7–11). Compared with subjects with LR, those with MR and HR had ORs of 2.47 (95% confidence interval, 2.09–2.93) and 4.59 (95% confidence interval, 3.86–5.44), respectively. The scoring model showed an outstanding discriminatory capacity with a c-statistic of 0.64 (95% confidence interval, 0.63–0.65). Conclusions Our results showed that the established scoring system could identify very high-risk populations with colorectal neoplasia. Combining this risk score with current Chinese screening methods may improve the effectiveness of CRC screening and adherence to colonoscopy.

Colorectal Cancer: Epidemiology, Risk Factors, and Prevention

“…Different risk factors, including age, gender, smoking, and family history, may be considered for the calculation of risk scores [229][230][231][232]. Combining the risk score with the FIT test was suggested as an effective strategy for more accurate detection of colorectal neoplasia in asymptomatic individuals [233][234][235].…”

Liver cancer screening: risk stratification indication from other main digestive cancer in Chinese populations

“…Among the 13 eligible studies included, 5 are about colorectal cancer [9][10][11][12][13], 5 are about esophageal cancer [14][15][16][17][18], and 3 are about gastric cancer [19][20][21]. Furthermore, the gastric cancer risk stratification method was more systematic and mature than other cancers.…”