Development and validation of a risk score for advanced colorectal adenoma recurrence after endoscopic resection
Development and validation of a risk score for advanced colorectal adenoma recurrence after endoscopic resection
复制标题
DOI：
10.3748/wjg.v22.i26.6049
复制
发表时间：
2016-07-14
影响因子：
4.3
通讯作者：
Muscatiello, Nicola
中科院分区：
文献类型：
--
作者：
Facciorusso, Antonio;Di Maso, Marianna;Muscatiello, Nicola
目的：为了开发和验证内镜息肉切除术后晚期结直肠腺瘤（ACA）复发的风险评分，方法：在2004年至2008年期间在福贾大学接受结肠息肉切除术的3360例患者中，回顾性分析了843例患者的1155例ACA。根据指南，监测间隔为3年，主要终点为3年ACA复发。将基线临床参数和ACA的主要特征输入到考克斯回归分析中，然后将单变量分析中P < 0.05的变量作为候选变量检验到逐步考克斯回归模型中（条件向后选择）。将考克斯回归模型的回归系数乘以2并四舍五入，以获得易于使用的点数，便于计算评分。为了避免过于乐观的结果，由于模型拟合和评估在同一数据集，我们进行了内部10倍交叉验证的bootstrap sampling.RESULTS：中位数病变大小为16 mm（1 - 2 -23），而腺瘤的中位数为2.5（1-3），其中ACA的数量为1.5（1-2）。息肉切除术后3年，229例ACA（19.8%）复发，其中157例（13.5%）为异时性肿瘤，72例（6.2%）为局部复发。多变量分析，排除变量“切除类型”后，由于其与其他预测因素的共线性，证实病变大小，ACA数量和异型增生的等级与主要结局显着相关。然后通过将回归系数乘以2来建立评分，并通过受试者操作特征曲线分析选择截止点5。特别是，248例患者（365例ACA）属于高风险组（评分>= 5），其中174例ACA（47.6%）检测到3年复发，而其余595例患者（690例ACA）被纳入低风险组（评分< 5），其中3年复发率为7.9%（55/690例ACA）。模型的曲线下面积为0.81（0.72-0.86），总体分类错误率为0.09。该模型最终通过10倍交叉validation.CONCLUSION验证：我们的研究提供了支持使用一种新的风险评分作为临床预测ACA复发结肠息肉切除术后。
AIM: To develop and validate a risk score for advanced colorectal adenoma (ACA) recurrence after endoscopic polypectomy.METHODS: Out of 3360 patients who underwent colon polypectomy at University of Foggia between 2004 and 2008, data of 843 patients with 1155 ACAs was retrospectively reviewed. Surveillance intervals were scheduled by guidelines at 3 years and primary endpoint was considered 3-year ACA recurrence. Baseline clinical parameters and the main features of ACAs were entered into a Cox regression analysis and variables with P < 0.05 in the univariate analysis were then tested as candidate variables into a stepwise Cox regression model (conditional backward selection). The regression coefficients of the Cox regression model were multiplied by 2 and rounded in order to obtain easy to use point numbers facilitating the calculation of the score. To avoid overoptimistic results due to model fitting and evaluation in the same dataset, we performed an internal 10-fold cross-validation by means of bootstrap sampling.RESULTS: Median lesion size was 16 mm (12-23) while median number of adenomas was 2.5 (1-3), whereof the number of ACAs was 1.5 (1-2). At 3 years after polypectomy, recurrence was observed in 229 ACAs (19.8%), of which 157 (13.5%) were metachronous neoplasms and 72 (6.2%) local recurrences. Multivariate analysis, after exclusion of the variable "type of resection" due to its collinearity with other predictive factors, confirmed lesion size, number of ACAs and grade of dysplasia as significantly associated to the primary outcome. The score was then built by multiplying the regression coefficients times 2 and the cut-off point 5 was selected by means of a Receiver Operating Characteristic curve analysis. In particular, 248 patients with 365 ACAs fell in the higher-risk group (score >= 5) where 3-year recurrence was detected in 174 ACAs (47.6%) whereas the remaining 595 patients with 690 ACAs were included in the low-risk group (score < 5) where 3-year recurrence rate was 7.9% (55/690 ACAs). Area under the curve of the model was 0.81 (0.72-0.86) with an overall classification error rate of 0.09. The model was finally validated by means of 10-fold cross validation.CONCLUSION: Our study provides support for the use of a novel risk score as a clinical predictor of ACA recurrence after colon polypectomy.