Development and validation of a clinical score for predicting risk of adenoma at screening colonoscopy
Menée à l'aide de questionnaires et à partir de données portant sur 541 puis 1 334 personnes incluses dans un essai national américain évaluant le dépistage du cancer colorectal par coloscopie, cette étude évalue la performance d'un système de score, basé sur l'âge, le sexe, l'indice de masse corporelle et l'existence d'au moins un parent au premier degré atteint d'un cancer colorectal, pour estimer la probabilité de détecter des adénomes colorectaux au cours d'une coloscopie de dépistage
Background : Currently no clinical tools use demographic and risk factor information to predict the risk of finding an adenoma in individuals undergoing colon cancer screening. Such a tool would be valuable for identifying those who would most benefit from screening colonoscopy.
Methods : We used baseline data from men and women who underwent screening colonoscopy the randomized, multicenter National Colonoscopy Study (NCS) to develop and validate an adenoma risk model. The study, conducted at three sites in the U.S. (Minneapolis, MN; Seattle, WA; and Shreveport, LA) asked all participants to complete baseline questionnaires on clinical risk factors and family history. Model parameters estimated from logistic regression yielded an area under the receiver operating characteristic curve (AUROCC) used to assess prediction.
Results : 541 subjects were included in the development model, and 1334 in the validation of the risk score. Variables in the prediction of adenoma risk for colonoscopy screening were age (likelihood ratio test for overall contribution to model, p<0.001), male sex (p<0.001), body mass index (BMI) (p<0.001), family history of at least one first-degree relative with colorectal cancer (p = 0.036), and smoking history (p<0.001). The adjusted AUROCC of 0.67 (95% CI 0.61, 0.74) for the derivation cohort was not statistically significant different from that in the validation cohort. The adjusted AUROCC for the entire cohort was 0.64 (95% CI: 0.60, 0.67).
Conclusion : We developed and validated a simple well calibrated risk score.
Impact : This tool may be useful for estimating risk of adenomas in screening eligible men and women.
Cancer Epidemiology Biomarkers & Prevention , résumé, 2015