Risk Scores for Predicting Advanced Colorectal Neoplasia in the Average-risk Population: A Systematic Review and Meta-analysis

Abstract

OBJECTIVES:A systematic review and meta‐analysis was performed to summarize the available evidence on risk scores for predicting advanced colorectal neoplasia (advanced adenomas and cancer) in average‐risk and asymptomatic populations undergoing screening colonoscopy.METHODS:PubMed, EMBASE, and Web of Science databases were searched up to 28 March 2018. Studies that developed or validated a risk score to predict the risk of advanced colorectal neoplasia were included. Two reviewers independently extracted study characteristics including diagnostic performance indicators and assessed risk of bias and applicability in the included studies. Metaanalyses were conducted to determine the overall discrimination of risk scores evaluated by more than 1 study.RESULTS:A total of 22 studies including 17 original risk scores were identified. Risk scores included a median number of 5 risk factors. Factors most commonly included were age, sex, family history in first‐degree relatives, body mass index and smoking. The area under the receiver operating characteristic curve of risk scores ranged from 0.62 to 0.77 in the individual studies and from 0.61 to 0.70 in the meta‐analyses.CONCLUSIONS:Although the majority of available risk scores had relatively weak discriminatory power, they may be of some use for risk stratification in CRC screening. Rather than developing more risk scores based on environmental risk factors, future research should focus on exploring possibilities of enhancing predictive power by combining risk factor data with novel laboratory matters, such as polygenetic risk scores.

Prevalence of serrated lesions, risk factors, and their association with synchronous advanced colorectal neoplasia in asymptomatic screened individuals

“…Right‐sided and left‐sided SLs were defined as those located in the proximal colon (the cecum and ascending and transverse colon) and distal colon (the descending and sigmoid colon and rectum), respectively. Relationships were also evaluated after adjusting for the effect of the following potentially related factors: age, sex, BMI, family history of CRC, DM, smoking, alcohol consumption, regular intake of NSAIDs, and presence of synchronous non‐advanced adenoma 29 …”

Precision Treatment and Prevention of Colorectal Cancer—Hope or Hype?

“…To date, more than 50 loci associated with CRC are currently estimated to explain about 12% of the genetic contribution to CRC risk. 33 However, the discriminatory performance of polygenic risk scores for CRC thus far has been modest, 34 especially when compared to scores developed for breast cancer. 35 Models combining polygenic risk scores and environmental risk factors have the potential to increase performance compared to either model alone.…”

“…39 Indeed, external validation studies have demonstrated worse model performance when applied to diverse populations. 34 Even with identification of more CRC risk variants and optimization of performance characteristics, application of risk models to real-world clinical practice does not appear to be on the immediate horizon and will require additional variant discovery and validation.…”

Opportunities and Challenges in Moving From Current Guidelines to Personalized Colorectal Cancer Screening

“…Of models reporting it, approximately half of the models had an AUROC >0.7 in The most recent systematic review identified 17 original risk scores, with median number of 5 risk factors, and AUROCs ranging from 0.62 to 0.77. 84 The authors suggested that rather than developing yet more risk scores based on environmental risk factors, future research should aim to enhance predictive power by incorporating novel laboratory markers.…”