Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Risk prediction rule for advanced neoplasia on screening colonoscopy for average-risk individuals
Ala I Sharara, Ali El Mokahal, Ali H Harb, Natalia Khalaf, Fayez S Sarkis, Mustapha M El-Halabi, Nabil M Mansour, Ahmad Malli, Robert Habib
Ala I Sharara, Ali El Mokahal, Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
Ali H Harb, Digestive and Liver Diseases Division, University of Texas-Southwestern, Dallas, TX 75390, United States
Natalia Khalaf, Division of Gastroenterology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX 77030, United States
Fayez S Sarkis, Division of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, MO 66160, United States
Mustapha M El-Halabi, Division of Gastroenterology, St Elizabeth Healthcare, Crestview Hills, KY 41017, United States
Nabil M Mansour, Department of Internal Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX 77030, United States
Ahmad Malli, Gastroenterology, Hennepin Healthcare, Minneapolis, MN 55404, United States
Robert Habib, Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
Author contributions: Sharara AI contributed to study conception, design and supervision; oversight of data collection and interpretation; review of literature; drafting of the manuscript; guarantor of the study; El Mokahal A and Harb AH contributed to review of the literature, regulatory administration, data entry and analysis, drafting and critical review of the manuscript; Khalaf N contributed to review of the literature, data analysis, critical review and editing of the manuscript; Sarkis F, El-Halabi MM, Mansour NM and Malli A contributed to regulatory administration, data entry and analysis, critical review and editing of the manuscript; Habib R contributed to interpretation of data, statistical expertise, critical review and editing of the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the institutional review board of the American University of Beirut Medical Center (AUBMC).
Informed consent statement: All study participants or their legal guardian provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript have no conflict of interest to disclose.
Data sharing statement: No additional data available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ala I Sharara, AGAF, FACG, FRCP, MD, Attending Doctor, Professor, Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Cairo Street, PO Box 11-0236/16-B, Beirut 1107 2020, Lebanon.
as08@aub.edu.lb
Received: April 17, 2020
Peer-review started: April 17, 2020
First decision: May 15, 2020
Revised: May 20, 2020
Accepted: September 12, 2020
Article in press: September 12, 2020
Published online: October 7, 2020
Processing time: 163 Days and 18.7 Hours
BACKGROUND
In resource-limited countries, risk stratification can be used to optimize colorectal cancer screening. Few prospective risk prediction models exist for advanced neoplasia (AN) in true average-risk individuals.
AIM
To create and internally validate a risk prediction model for detection of AN in average-risk individuals.
METHODS
Prospective study of asymptomatic individuals undergoing first screening colonoscopy. Detailed characteristics including diet, exercise and medications were collected. Multivariate logistic regression was used to elucidate risk factors for AN (adenoma ≥1 cm, villous histology, high-grade dysplasia or carcinoma). The model was validated through bootstrapping, and discrimination and calibration of the model were assessed.
RESULTS
980 consecutive individuals (51% F; 49% M) were enrolled. Adenoma and AN detection rates were 36.6% (F 29%: M 45%; P < 0.001) and 5.1% (F 3.8%; M 6.5%) respectively. On multivariate analysis, predictors of AN [OR (95%CI)] were age [1.036 (1.00-1.07); P = 0.048], BMI [overweight 2.21 (0.98-5.00); obese 3.54 (1.48-8.50); P = 0.018], smoking [< 40 pack-years 2.01 (1.01-4.01); ≥ 40 pack-years 3.96 (1.86-8.42); P = 0.002], and daily red meat consumption [2.02 (0.92-4.42) P = 0.079]. Nomograms of AN risk were developed in terms of risk factors and age separately for normal, overweight and obese individuals. The model had good discrimination and calibration.
CONCLUSION
The prevalence of adenoma and AN in average-risk Lebanese individuals is similar to the West. Age, smoking, and BMI are important predictors of AN, with obesity being particularly powerful. Though external validation is needed, this model provides an important platform for improved risk-stratification for screening programs in regions where universal screening is not currently employed.
Core Tip: Colonoscopy is a powerful tool for colorectal cancer screening, but its wide adoption may incur a large burden on healthcare systems. Risk stratification may be an attractive strategy particularly in resource-constrained settings. Previously developed risk calculators have important limitations including retrospective design and/or inclusion of at-risk individuals such as those with a positive family history. Using 4 easy-to-obtain baseline variables (BMI, smoking, age, and red meat consumption), we present a risk calculator for advanced neoplasia in true average-risk individuals. This simple tool can be used to stratify patients for colorectal cancer screening but requires external validation.
