Gastroenterology Report: Prediction of risk factors for eventual colorectal disease in patients at high risk of colorectal cancer

Colorectal cancer (CRC) is one of the most common cancers worldwide, with the third highest incidence and the second highest
mortality rate of all types of cancer.
The incidence of CRC has continued to rise in recent decades
.
In 2015, the incidence and mortality of CRC ranked third and fifth among all cancers in China
, respectively.
Large-scale population screening can identify patients with early colorectal lesions to facilitate early and timely intervention
.
At present, large-scale CRC screening has been carried out in large Chinese cities such as Shanghai and Tianjin, and the Guangzhou municipal government launched a large-scale CRC screening program in 2015 [subjects with positive results in immunochemical fecal occult blood test (FOBT) or high-risk factor questionnaire (HRFQ) are classified as high risk and recommended for colonoscopy
.
However, no more than 30% of positive, high-risk individuals have undergone colonoscopy
.
This study wanted to construct a risk prediction score (RPS) in patients at high risk of CRC to achieve more accurate risk stratification and to motivate and improve the rate of colonoscopy implementation
.

A total of 12,628 participants in this study were classified as high-risk patients based on a positive immunochemical fecal occult blood test or the Risk Factors Questionnaire and underwent colonoscopy
.
RPS was derived using logistic regression and the association of RPS with colorectal lesions was analyzed, giving odds ratios (OR) and 95% confidence intervals (CI).

The results of the study showed that among all participants, male (OR = 1.
73, 95% CI = 1.
58–1.
90), older (≥ 65 years; 1.
41, 1.
31-1.
53), high BMI (≥28 kg/m²; 1.
22, 1.
07-1.
39), smoking (1.
47, 1.
31-1.
65) and weekly alcohol consumption (1.
28, 1.
09-1.
52) were associated
with a higher risk of colorectal lesions.
The researchers assigned 1 to each of the five risk factors mentioned above and derived an RPS from 0 to 5, with higher scores indicating higher risk
.
RPS of 1, 2, 3, and 4–5 showed a higher risk of colorectal lesions compared with 0 RPS, with OR values and (95% CI) intervals of 1.
50 (1.
37–1.
63), 2.
34 (2.
12–2.
59), 3.
58 (3.
13–4.
10), and 3.
91 (3.
00–5.
10),
respectively.

This study confirmed a 1-point increase in RPS and a significantly increased risk of colorectal lesions in participants, suggesting the
urgency of measuring colonoscopy in this very high-risk population.
High-risk strategies combined with RPS can be used to achieve higher colonoscopy performance rates
.

Original source:

Lixin Liang.
et al.
A risk-prediction score for colorectal lesions on 12,628 participants at high risk of colorectal cancer.
Gastroenterology Report.
2022.