Mukundan A, Gupta D, Karmakar R, Wang HC. Novel approach to risk stratification: Integrating waist-hip ratio for predicting advanced colorectal neoplasia. World J Clin Oncol 2025; 16(10): 109843 [DOI: 10.5306/wjco.v16.i10.109843]
Corresponding Author of This Article
Hsiang-Chen Wang, Professor, Department of Mechanical Engineering, National Chung Cheng University, No. 168 University Road, Chiayi 62102, Taiwan. hcwang@ccu.edu.tw
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Oncology
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Oct 24, 2025 (publication date) through Oct 27, 2025
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World Journal of Clinical Oncology
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2218-4333
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Mukundan A, Gupta D, Karmakar R, Wang HC. Novel approach to risk stratification: Integrating waist-hip ratio for predicting advanced colorectal neoplasia. World J Clin Oncol 2025; 16(10): 109843 [DOI: 10.5306/wjco.v16.i10.109843]
World J Clin Oncol. Oct 24, 2025; 16(10): 109843 Published online Oct 24, 2025. doi: 10.5306/wjco.v16.i10.109843
Novel approach to risk stratification: Integrating waist-hip ratio for predicting advanced colorectal neoplasia
Arvind Mukundan, Devansh Gupta, Riya Karmakar, Hsiang-Chen Wang
Arvind Mukundan, Riya Karmakar, Hsiang-Chen Wang, Department of Mechanical Engineering, National Chung Cheng University, Chiayi 62102, Taiwan
Devansh Gupta, Department of Computer Science & Engineering, Thapar Institute of Engineering & Technology, Patiala 147001, Punjab, India
Co-first authors: Arvind Mukundan and Devansh Gupta.
Co-corresponding authors: Riya Karmakar and Hsiang-Chen Wang.
Author contributions: Karmakar R, Gupta D, Mukundan A and Wang HC conceptualized and designed the research; Gupta D, Karmakar R, Mukundan A and Wang HC performed data curation; Mukundan A and Wang HC performed formal analysis; Mukundan A and Wang HC acquired the funding for this research; Karmakar R and Gupta D carried out investigation; Karmakar R, Gupta D and Mukundan A developed the methodology; Mukundan A and Wang HC conducted project administration; Mukundan A and Wang HC provided resources; Karmakar R and Gupta D were responsible for software; Wang HC supervised the research; Gupta D wrote the original draft; Karmakar R, Gupta D, Mukundan A and Wang HC performed writing-review and editing. Mukundan A and Gupta D contributed equally to this work as co-first authors. We have designated Karmakar R and Wang HC as co-corresponding authors because each has played a critical and complementary role in the conceptualization, execution, and dissemination of this work. Karmakar R spearheaded the experimental design, oversaw data collection and statistical analysis, and led the drafting of the Methods and Results sections. Her in-depth involvement in day-to-day study operations ensures she can respond comprehensively to methodological inquiries. Dr. Wang HC provided the overarching study concept, secured funding, supervised all laboratory and analytical activities, and shaped the interpretation of findings within a clinical oncology context. His senior leadership and strategic guidance guarantee authoritative responses to questions regarding study rationale, clinical relevance, and future translational applications. Together, their joint correspondence support ensures that all technical, analytical, and clinical aspects of the manuscript are addressed promptly and expertly.
Conflict-of-interest statement: The authors declare no conflicts of interest.
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: Hsiang-Chen Wang, Professor, Department of Mechanical Engineering, National Chung Cheng University, No. 168 University Road, Chiayi 62102, Taiwan. hcwang@ccu.edu.tw
Received: May 26, 2025 Revised: July 3, 2025 Accepted: August 8, 2025 Published online: October 24, 2025 Processing time: 154 Days and 3.8 Hours
Abstract
The urgent necessity for enhanced risk stratification to improve the efficiency of colonoscopy screening is underscored by the fact that colorectal cancer (CRC) continues to be a primary cause of global cancer mortality. Conventional models mostly rely on generalized obesity markers including body mass index (BMI), which does not effectively represent oncogenic risk linked with abdominal obesity. Liu et al undertook a large-scale case-control study comprising 6484 first-time colonoscopy patients at a prominent Chinese hospital between 2020 and 2023 to overcome this restriction. Age, male sex, smoking status, and raised waist-hip ratio (WHR) were found by multivariate logistic regression as independent predictors of advanced colorectal neoplasia (ACN). In a validation cohort of 1891 individuals, a new 7-point risk scoring model was created and stratified into low- (5.0%) ACN prevalence, moderate- (10.3%) and high-risk (17.6%). With C-statistic = 0.66 the model showed better discriminating ability than the Asia-Pacific Colorectal Screening (APCS) score (C-statistic = 0.63) and the BMI-modified APCS model. These results fit newly published data showing central obesity as a major carcinogenic driver via pro-inflammatory visceral adipokine channels. With the use of WHR, patient risk classification is greatly improved, providing a practical tool to make the most of screening resources in the face of rising CRC incidence rates. Finally, multi-ethnic validation is necessary for the WHR-based scoring model to be considered for integration into global CRC preventive frameworks, since it improves the accuracy of ACN risk prediction.
Core Tip: This work presents a novel approach to estimate the risk of advanced colorectal neoplasia by means of waist-hip ratio (WHR), an indicator of abdominal obesity. Although traditional models largely rely on body mass index (BMI), BMI does not entirely depict the risk resulting from fat around the waist. A new scoring method was made in this study by using WHR along with age, gender, and smoking habits. To save time, money, and lives, WHR can improve the efficacy of colonoscopy screening and assist doctors identify high-risk patients earlier.
