Risk scoring system combined with traditional Chinese medicine constitution identification improves colorectal advanced neoplasms screening effectiveness for early colonoscopy

Table 1 Demographics of the study population

Characteristics	n (%)
Age (year), mean ± SD	54.4 ± 9.1
Age ≤ 55	836 (58.5)
Age > 55	594 (41.5)
BMI upon admission (kg/m2), mean ± SD	23.7 ± 2.8
Normal and low (BMI < 24.0)	845 (59.1)
Overweight (BMI: 24.0-27.9)	494 (34.5)
Obese (BMI ≥ 28.0)	91 (6.4)
CRC family history	27 (1.9)
Sex
Male	818 (57.2)
Female	612 (42.8)
Hospital
Beijing Chest Hospital	93 (6.5)
Wuhai Hospital	238 (16.6)
Taizhou Fourth People’s Hospital	1099 (76.9)
Cigarette smoking
Nonsmoker	974 (68.1)
Past smoker	152 (10.6)
Current smoker	304 (21.3)
TCM constitution
Yang-deficiency	68 (4.8)
Inherited special	16 (1.1)
Balanced	1040 (72.7)
Damp-heat	78 (5.5)
Qi-deficiency	57 (4.0)
Qi-stagnation	26 (1.8)
Phlegm-dampness	71 (5.0)
Blood stasis	27 (1.9)
Yin-deficiency	47 (3.3)
APCS
Average risk	370 (25.9)
Moderate risk	755 (52.8)
High risk	305 (21.3)
CRC findings
Negative	1293 (90.4)
Advanced adenoma	126 (8.8)
CRC	11 (0.8)

BMI: Body mass index; TCM: Traditional Chinese medicine; APCS: Asia-Pacific Colorectal Screening; CRC: Colorectal cancer; SD: Standard deviation.

Table 2 Distribution of colorectal neoplasms and Asia-Pacific Colorectal Screening score risk groups

Lesion characteristics	AR	MR	HR	P value	OR (95%CI)
Negative	358 (25.0)	700 (49.0)	235 (16.4)	MR vs AR: 0.007	MR vs AR: 0.4 (0.2-0.8)
				HR vs AR: < 0.001	HR vs AR: 0.1 (0.0-0.2)
				HR vs MR: < 0.001	HR vs MR: 0.3 (0.2-0.4)
Advanced adenoma	12 (0.8)	52 (3.6)	62 (4.3)	MR vs AR: 0.013	MR vs AR: 2.2 (1.2-4.2)
				HR vs AR: < 0.001	HR vs AR: 7.6 (4.0-14.4)
				HR vs MR: < 0.001	HR vs MR: 3.4 (2.3-5.1)
Colorectal cancer	0 (0)	3 (0.2)	8 (0.6)	MR vs AR: 0.555	MR vs AR: -
				HR vs AR: 0.005	HR vs AR: -
				HR vs MR: 0.004	HR vs MR: 6.8 (1.8-25.6)

Odds ratio could not be calculated as there was no colorectal cancer in the average risk group. OR: Odds ratio; AR: Average risk; MR: Moderate risk; HR: High risk; CI: Confidence interval.

Table 3 Univariate logistic regression was used to determine which traditional Chinese medicine constitution had a statistically significant effect on disease progression

TCM constitution	OR (95%CI)	P value
Yang-deficiency	5.6 (2.9-10.8)	< 0.001
Damp-heat	10.8(6.2-18.8)	< 0.001
Qi-deficiency	9.2 (4.8-17.4)	< 0.001
Qi-stagnation	3.9 (1.3-11.9)	0.015
Phlegm-dampness	6.8 (3.7-12.6)	< 0.001
Blood stasis	4.9 (1.8-13.6)	0.002
Yin-deficiency	2.6 (1.0-6.8)	0.057
Inherited special	5.0 (1.4-18.1)	0.015

CI: Confidence interval; OR: Odds ratio; TCM: Traditional Chinese medicine.

Table 4 Risk score of traditional Chinese medicine constitution

TCM constitution	Score
Yang-deficiency	3
Damp-heat	5
Qi-deficiency	5
Qi stagnation	2
Phlegm-dampness	3
Blood stasis	2
Yin-deficiency	1
Inherited special	3
Balanced	0

TCM: Traditional Chinese medicine.

Table 5 Distribution of lesion characteristics and traditional Chinese medicine constitutions in the average-risk and moderate-risk groups

Lesion characteristics	Average risk					Moderate risk
	n (%)	Class 1		Class 2		n (%)	Class 1		Class 2
		TCM constitution (negative)	TCM constitution (positive)	TCM constitution (negative)	TCM constitution (positive)		TCM constitution (negative)	TCM constitution (positive)	TCM constitution (negative)	TCM constitution (positive)
Negative	358 (96.8)	348	10	329	29	700 (92.7)	660	40	613	87
Advanced adenoma	12 (3.2)	9	3	5	7	52 (6.9)	39	13	30	22
Colorectal cancer	0 (0.0)	0	0	0	0	3 (0.4)	2	1	1	2
Total	370 (100.0)	357	13	334	36	755 (100.0)	701	54	644	111

Class 1: Damp-heat and qi-deficiency were positive while other constitutions were negative; Class 2: Yang-deficiency, damp-heat, qi-deficiency, phlegm-dampness, and inherited special constitution were positive and other constitutions were negative; TCM: Traditional Chinese medicine.

Table 6 Diagnostic performance of the various tests or algorithms

Characteristics	AA (95%CI)			Cancer (95%CI)			AA + cancer (95%CI)
	SEN %	SPE %	PPV %	SEN %	SPE %	PPV %	SEN %	SPE %	PPV %
APCS	49.2 (40.5-57.9)	81.4 (79.3-83.5)	20.3 (15.8-24.8)	72.7 (46.4-99.0)	79.1 (77.0-81.2)	2.6 (0.8-4.4)	51.1 (42.7-59.5)	81.8 (79.7-83.9)	23 (18.2-27.7)
APCS plus class 1 +	61.9a (53.4-70.4)	77.5 (75.2-79.7)	21 (16.8-25.1)	81.8 (59.0-104.6)	74.4 (72.1-76.7)	2.4 (0.9-4.0)	63.5a (55.4-71.6)	78 (75.7-80.2)	23.4 (19.1-27.7)
APCS plus class 2 +	72.2b (64.4-80.0)	72.3 (69.9-74.7)	20.1 (16.4-23.8)	90.9 (73.9-107.9)	68.9 (66.4-71.3)	2.2 (0.9-3.6)	73.7b (66.4-81.1)	72.9 (70.4-75.3)	22.3 (18.5-26.2)

^aP < 0.05.

^bP < 0.001.

The P value of sensitivity was compared with Asia-Pacific Colorectal Screening and Asia-Pacific Colorectal Screening plus. APCS: Asia-Pacific Colorectal Screening; AA: Advanced adenoma; SEN: Sensitivity; SPE: Specificity; PPV: Positive predictive value; CI: Confidence interval.