Development and validation of a risk prediction model for post-polypectomy colorectal cancer in the USA: a prospective cohort study.
Development and validation of a risk prediction model for post-polypectomy colorectal cancer in the USA: a prospective cohort study.
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DOI：
10.1016/j.eclinm.2023.102139
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发表时间：
2023-08
影响因子：
15.1
通讯作者：
Song, Mingyang
中科院分区：
文献类型：
--
作者：
Knudsen, Markus Dines;Wang, Kai;Wang, Liang;Polychronidis, Georgios;Berstad, Paula;Wu, Kana;He, Xiaosheng;Hang, Dong;Fang, Zhe;Ogino, Shuji;Chan, Andrew T.;Giovannucci, Edward;Wang, Molin;Song, Mingyang
对于息肉切除术后结直肠癌（PPCRC），目前缺乏有效的风险分层工具。我们的目标是开发一种有效的风险分层工具，用于在三个基于人群的大型队列中预测PPCRC，并在临床队列中验证该工具。利用美国三个以人群为基础的卫生专业人员队列（护士健康研究（NHS） I、II和卫生专业人员随访研究（HPFS））的综合内窥镜、组织病理学和流行病学数据，我们开发了一个风险评分来预测1986年至2017年间26,741例息肉切除术患者的PPCRC发生率。我们在2007年至2018年期间进行息肉切除术的76,603例麻省总医院（MGB）结肠镜检查队列（波士顿，马萨诸塞州，美国）中验证了PPCRC评分。在所有四个队列中，我们收集了患者人口统计学、内镜病史、息肉特征和息肉切除术时生活方式因素的详细数据。结果是PPCRC的发病率，通过NHS/HPFS队列的两年随访问卷评估，并通过与MGB队列的马萨诸塞州癌症登记处的联系评估。在所有四个队列中，在基线前或基线后6个月内被诊断患有CRC或死亡的个体被排除在外。我们使用Cox回归计算风险比（HR）和95%置信区间（CI），并使用c统计量评估歧视，使用净再分类改进（NRI）评估再分类。在NHS/HPFS和MGB队列中，中位随访12.8年（四分位数间距（IQR）： 9.3, 16.7）和5.1年（IQR: 2.7, 7.8），我们分别记录了220例和241例PPCRC病例。我们确定了基于11个预测因子的PPCRC风险评分。在验证队列中，PPCRC风险评分显示与PPCRC风险有很强的相关性（HR高vs低，3.55,95% CI, 2.59-4.88）， c统计值（95% CI）为0.75(0.70-0.79)，即使在目前结肠镜监测建议定义的低和高风险息肉组（c统计值分别为0.73和0.71）中也存在歧视性，导致PPCRC患者的NRI为45% （95% CI, 36-54%）。我们开发并验证了PPCRC的风险分层模型，该模型可能有助于指导量身定制的结肠镜检查。需要进一步的工作来确定最佳监测间隔，并测试PPCRC的其他预测因子的附加价值，除了当前研究中包括的预测因子，以及实施研究。， the, the, the。
Effective risk stratification tools for post-polypectomy colorectal cancer (PPCRC) are lacking. We aimed to develop an effective risk stratification tool for the prediction of PPCRC in three large population-based cohorts and to validate the tool in a clinical cohort. Leveraging the integrated endoscopic, histopathologic and epidemiologic data in three U.S population-based cohorts of health professional (the Nurses' Health Study (NHS) I, II and Health Professionals Follow-up Study (HPFS)), we developed a risk score to predict incident PPCRC among 26,741 patients with a polypectomy between 1986 and 2017. We validated the PPCRC score in the Mass General Brigham (MGB) Colonoscopy Cohort (Boston, Massachusetts, U.S) of 76,603 patients with a polypectomy between 2007 and 2018. In all four cohorts, we collected detailed data on patients’ demographics, endoscopic history, polyp features, and lifestyle factors at polypectomy. The outcome, incidence of PPCRC, was assessed by biennial follow-up questionnaires in the NHS/HPFS cohorts, and through linkage to the Massachusetts Cancer Registry in the MGB cohort. In all four cohorts, individuals who were diagnosed with CRC or died before baseline or within six months after baseline were excluded. We used Cox regression to calculate the hazard ratio (HR), 95% confidence interval (CI) and assessed the discrimination using C-statistics and reclassification using the Net Reclassification Improvement (NRI). During a median follow-up of 12.8 years (interquartile range (IQR): 9.3, 16.7) and 5.1 years (IQR: 2.7, 7.8) in the NHS/HPFS and MGB cohorts, we documented 220 and 241 PPCRC cases, respectively. We identified a PPCRC risk score based on 11 predictors. In the validation cohort, the PPCRC risk score showed a strong association with PPCRC risk (HR for high vs. low, 3.55, 95% CI, 2.59–4.88) and demonstrated a C-statistic (95% CI) of 0.75 (0.70–0.79), and was discriminatory even within the low- and high-risk polyp groups (C-statistic, 0.73 and 0.71, respectively) defined by the current colonoscopy surveillance recommendations, leading to a NRI of 45% (95% CI, 36–54%) for patients with PPCRC. We developed and validated a risk stratification model for PPCRC that may be useful to guide tailored colonoscopy surveillance. Further work is needed to determine the optimal surveillance interval and test the added value of other predictors of PPCRC beyond those included in the current study, along with implementation studies. , the , the , the .
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通讯作者：
Song, Mingyang