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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Risk scoring system combined with traditional Chinese medicine constitution identification improves colorectal advanced neoplasms screening effectiveness for early colonoscopy
Qing-Hua Liu, Yue Hou, Shu Li, Yun-Long Gu, Chen-Xi Huang, Qian Kang, Ya-Jing Fan, Ling-Qin Zhu, Li Sun, Rui-Cheng Men, Xiao-Yan Li, Hui Wang, Xiu-Ying Wei, Zhao-Gang Sun, Yu-Qi He
Qing-Hua Liu, Yue Hou, Shu Li, Qian Kang, Ya-Jing Fan, Ling-Qin Zhu, Zhao-Gang Sun, Yu-Qi He, Department of Gastroenterology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
Yun-Long Gu, Li Sun, Rui-Cheng Men, Xiao-Yan Li, Xiu-Ying Wei, Department of Gastroenterology, Wuhai Hospital of Traditional Chinese and Mongolian Medicine, Wuhai 016000, Inner Mongolia Autonomous Region, China
Chen-Xi Huang, Yu-Qi He, Department of Physical Examination Center, The Affiliated Panjin Liaohe Oilfield Gem Flower Hospital of Jinzhou Medical University, Panjin 124120, Liaoning Province, China
Chen-Xi Huang, Department of Physical Examination Center, Taizhou Fourth People’s Hospital, Taizhou 225300, Jiangsu Province, China
Hui Wang, Department of Urology, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou 225300, Jiangsu Province, China
Co-first authors: Qing-Hua Liu and Yue Hou.
Co-corresponding authors: Zhao-Gang Sun and Yu-Qi He.
Author contributions: Liu QH, Hou Y, Li S, Gu YL Sun ZG, and He YQ were responsible for the conception; Liu QH and Hou Y contributed equally to this article, and they are the co-first authors of this manuscript; Liu QH wrote the original draft; Hou Y, Huang CX, Zhu LQ, Sun L, Wang H, Wei XY, Sun ZG, and He YQ conducted the formal analysis; Li S, Gu YL, Huang CX, Kang Q, Fan YJ, Zhu LQ, Sun L, Men RC, and Li XY conducted the data curation; Wang H, Wei XY, Sun ZG, and He YQ wrote, reviewed, and edited the manuscript; He YQ carried out the financing acquisition; Sun ZG and He YQ contributed equally to this article, and they are the co-corresponding authors of this manuscript; All authors have agreed to the publication of this manuscript.
Supported by the Capital’s Funds for Health Improvement and Research, No. 2022-1-5082; National Natural Science Foundation of China, No. 82273245; and Inner Mongolia Autonomous Region Science and Technology Program, No. 2022YFSH0041.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Taizhou People’s Hospital, approval No. 2023-EC/TZFH-035; the Medical Ethics Committee of Wuhai Hospital of Traditional Chinese and Mongolian Medicine; and the Medical Ethics Committee of Beijing Chest Hospital.
Informed consent statement: All patients who were invited to the study consented to participate and signed the informed consent form.
Conflict-of-interest statement: All authors reported no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are 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:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Yu-Qi He, MD, PhD, Department of Gastroenterology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, No. 9 Beiguan Street, Tongzhou District, Beijing 101149, China.
endohe@163.com
Received: May 9, 2025
Revised: June 8, 2025
Accepted: August 20, 2025
Published online: October 16, 2025
Processing time: 161 Days and 4.6 Hours
BACKGROUND
The Asia-Pacific Colorectal Screening (APCS) score was designed with the purpose of distinguishing individuals at high risk (HR) for colorectal advanced neoplasia (AN). Traditional Chinese medicine (TCM) constitution was also linked with colorectal cancer (CRC).
AIM
To integrate the APCS score with TCM constitution identification as a new algorithm to screen for CRC.
METHODS
A cross-sectional multicenter study was carried out in three hospitals, enrolling 1430 patients who were asymptomatic and undergoing screening colonoscopy from 2022 to 2023. Patients were considered to have average risk, moderate risk, or HR with their APCS score. Odd ratios assessed the relationship between TCM constitution and disease progression. A TCM constitution risk score was created. The sensitivity and specificity of the new algorithm were calculated to evaluate diagnostic performance in detecting advanced adenoma (AA), CRC, and AN.
RESULTS
Of the 1430 patients, 370 (25.9%) were categorized as average risk, 755 (52.8%) as moderate risk, and 305 (21.3%) as HR. Using the combined APCS score and the TCM constitution (damp-heat, qi-deficiency, yang-deficiency, phlegm-dampness, and inherited special constitution as positive) algorithm, 72.2% of patients with AA and 73.7% of patients with AN were detected. Compared with the APCS score alone, the new algorithm significantly improved the sensitivity for screening AA [72.2%, 95% confidence interval (CI): 64.4%-80.0% vs 49.2%, 95%CI: 40.5%-57.9%] and AN (73.7%, 95%CI: 66.4%-81.1% vs 51.1%, 95%CI: 42.7%-59.5%).
CONCLUSION
The combination of APCS and TCM constitution identification questionnaires was valuable in identifying Chinese individuals who were asymptomatic for colorectal screening prioritization.
Core Tip: Based on this cross-sectional multicenter study, we found that the combination of the Asia-Pacific Colorectal Screening score and traditional Chinese medicine constitution identification was more convenient and cost-effective compared with the Asia-Pacific Colorectal Screening score alone and was suitable for Chinese individuals. Patients with high-risk colorectal neoplasm could be screened early using the new method to reduce the burden of colonoscopy.
