The Asia-Pacific Colorectal Screening score: a validated tool that stratifies risk for colorectal advanced neoplasia in asymptomatic Asian subjects

• Published in: Gut Vol. 60; no. 9; pp. 1236 - 1241
• Main Authors: Yeoh, Khay-Guan, Ho, Khek-Yu, Chiu, Han-Mo, Zhu, Feng, Ching, Jessica Y L, Wu, Deng-Chyang, Matsuda, Takahisa, Byeon, Jeong-Sik, Lee, Sang-Kil, Goh, Khean-Lee, Sollano, Jose, Rerknimitr, Rungsun, Leong, Rupert, Tsoi, Kelvin, Lin, Jaw-Town, Sung, Joseph J Y
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.09.2011; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: adenoma; Adult; advanced adenoma; Age; Age Factors; Aged; Asia - epidemiology; Biological and medical sciences; Clinical medicine; Colon; Colonoscopy; Colorectal cancer; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - etiology; Cost analysis; Early Detection of Cancer - methods; Endoscopy; Epidemiologic Methods; Family medical history; Female; Gastroenterology. Liver. Pancreas. Abdomen; Gender; Genetic Predisposition to Disease; Humans; Male; Medical sciences; Medical screening; Middle Aged; Patient Selection; Population; Risk Assessment; Risk factors; risk stratification; screening; Sex Factors; Smoking; Smoking - adverse effects; Smoking - epidemiology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors; Asia; Human; Rectal disease; Colorectal cancer; Asymptomatic; Malignant tumor; Medical screening; Colonic disease; Risk factor; Gastroenterology; Rectum; Digestive diseases; Intestinal disease; Colon; Cancer
• ISSN: 0017-5749; 1468-3288; 1468-3288
• DOI: 10.1136/gut.2010.221168

ObjectiveTo develop and validate a clinical risk score predictive of risk for colorectal advanced neoplasia for Asia.MethodsA prospective, cross-sectional and multicentre study was carried out in tertiary hospitals in 11 Asian cities. The subjects comprise 2752 asymptomatic patients undergoing screening colonoscopy. From a development set of 860 asymptomatic subjects undergoing screening colonoscopy, multiple logistic regression was applied to identify significant risk factors for advanced colorectal neoplasia defined as invasive carcinoma or advanced adenoma. The ORs for significant risk factors were utilised to develop a risk score ranging from 0 to 7 (Asia-Pacific Colorectal Screening (APCS) score). Three tiers of risk were arbitrarily defined: 0–1 ‘average risk’ (AR); 2–3 ‘moderate risk’ (MR); and 4–7 ‘high risk’ (HR). Subjects undergoing screening colonoscopy between July 2006 and December 2007 were prospectively enrolled to form an independent validation group. Each subject had a personal APCS score calculated by summing the points attributed from the presence of risk factors in the individuals. The performance of the APCS score in predicting risk of advanced neoplasia was evaluated.ResultsThere were 860 subjects in the derivation set and 1892 subjects in the validation set, with a baseline prevalence of advanced neoplasia of 4.5% and 3%, respectively. Applying the APCS stratification in the validation set, 559 subjects (29.5%) were in the AR tier, 966 subjects (51.1%) in the MR tier and 367 (19.4%) subjects in the HR tier. The prevalence of advanced neoplasia in the AR, MR and HR groups was 1.3, 3.2 and 5.2%, respectively. The subjects in the MR and HR tiers had 2.6-fold (95% CI 1.1 to 6.0) and 4.3-fold (95% CI 1.8 to 10.3) increased prevalence of advanced neoplasia, respectively, than those in the AR tier.ConclusionsThe APCS score based on age, gender, family history and smoking is useful in selecting asymptomatic Asian subjects for priority of colorectal screening.