Intest Res.  2019 Apr;17(2):253-264. 10.5217/ir.2018.00062.

Development and validation of a scoring system for advanced colorectal neoplasm in young Korean subjects less than age 50 years

Affiliations
  • 1Division of Gastroenterology, Department of Internal Medicine, Mediplex Sejong Hospital, Incheon, Korea.
  • 2The Research Institute of Basic Sciences, Seoul National University, Korea.
  • 3Department of Statistics, Seoul National University, Seoul, Korea.
  • 4Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. diksmc.park@samsung.com

Abstract

BACKGROUND/AIMS
Colorectal cancer incidence among patients aged ≤50 years is increasing. This study aimed to develop and validate an advanced colorectal neoplasm (ACRN) screening model for young adults aged <50 years in Korea.
METHODS
This retrospective cross-sectional study included 59,575 consecutive asymptomatic Koreans who underwent screening colonoscopy between 2003 and 2012 at a single comprehensive health care center. Young Adult Colorectal Screening (YCS) score was developed as an optimized risk stratification model for ACRN using multivariate analysis and was internally validated. The predictive power and diagnostic performance of YCS score was compared with those of Asia-Pacific Colorectal Screening (APCS) and Korean Colorectal Screening (KCS) scores.
RESULTS
41,702 and 17,873 subjects were randomly allocated into the derivation and validation cohorts, respectively, by examination year. ACRN prevalence was 0.9% in both cohorts. YCS score comprised sex, age, alcohol, smoking, obesity, glucose metabolism abnormality, and family history of CRC, with score ranges of 0 to 10. In the validation cohort, ACRN prevalence was 0.6% in the low-risk tier (score, 0-4), 1.5% in the moderate-risk tier (score, 5-7), and 3.4% in the high-risk tier (score, 8-10). ACRN risk increased 2.5-fold (95% confidence interval [CI], 1.8-3.4) in the moderate-risk tier and 5.8-fold (95% CI, 3.4-9.8) in the high-risk tier compared with the low-risk tier. YCS score identified better balanced accuracy (53.9%) than APCS (51.5%) and KCS (50.7%) scores and had relatively good discriminative power (area under the curve=0.660).
CONCLUSIONS
YCS score based on clinical and laboratory risk factors was clinically effective and beneficial for predicting ACRN risk and targeting screening colonoscopy in adults aged <50 years.

Keyword

Colorectal neoplasm; Risk assessment; Early detection of cancer; Young adults

MeSH Terms

Adult
Cohort Studies
Colonoscopy
Colorectal Neoplasms*
Comprehensive Health Care
Cross-Sectional Studies
Early Detection of Cancer
Glucose
Humans
Incidence
Korea
Mass Screening
Metabolism
Multivariate Analysis
Obesity
Prevalence
Retrospective Studies
Risk Assessment
Risk Factors
Smoke
Smoking
Young Adult
Glucose
Smoke
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