Derivation and validation of a predictive model for advanced colorectal neoplasia in asymptomatic adults
Derivation and validation of a predictive model for advanced colorectal neoplasia in asymptomatic adults
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DOI：
10.1136/gutjnl-2020-321698
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发表时间：
2021-06-01
期刊：
影响因子：
24.5
通讯作者：
Ransohoff, David F.
中科院分区：
文献类型：
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作者：
Imperiale, Thomas F.;Monahan, Patrick O.;Ransohoff, David F.
目的了解晚期结直肠肿瘤（AN）的风险，有助于患者和提供者选择筛查试验，提高筛查效率和利用率。我们创建了一个风险预测模型AN，以帮助决定哪些测试可能是首选的，使用不考虑现有models.Design平均风险50至80岁的奥尔兹进行首次筛查结肠镜检查，从内窥镜单位招募印第安纳州。我们测量了社会人口统计学和身体特征，病史和家族史以及生活方式因素，并将这些与最先进的发现联系起来。我们用三分之二的样本推导出了一个风险方程，并为每个变量打分，以创建一个风险评分。具有可比风险的评分被归入风险类别。结果在3025名受试者的衍生集（平均年龄57.3（6.5）岁，52%的女性），AN患病率为9.4%。13变量模型（c-统计量=0.77）产生三个风险组，低风险、中风险和高风险组的AN风险分别为1.5%（95%CI 0.72%至2.74%）、7.06%（CI 5.89%至8.38%）和27.26%（CI 23.47%至31.30%）（p值
Objective Knowing risk for advanced colorectal neoplasia (AN) could help patients and providers choose among screening tests, improving screening efficiency and uptake. We created a risk prediction model for AN to help decide which test might be preferred, a use not considered for existing models.Design Average-risk 50-to-80-year olds undergoing first-time screening colonoscopy were recruited from endoscopy units in Indiana. We measured sociodemographic and physical features, medical and family history and lifestyle factors and linked these to the most advanced finding. We derived a risk equation on two-thirds of the sample and assigned points to each variable to create a risk score. Scores with comparable risks were collapsed into risk categories. The model and score were tested on the remaining sample.Results Among 3025 subjects in the derivation set (mean age 57.3 (6.5) years; 52% women), AN prevalence was 9.4%. The 13-variable model (c-statistic=0.77) produced three risk groups with AN risks of 1.5% (95% CI 0.72% to 2.74%), 7.06% (CI 5.89% to 8.38%) and 27.26% (CI 23.47% to 31.30%) in low-risk, intermediate-risk and high-risk groups (p value