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Background <p>Early-onset colorectal cancer (CRC) requires identifying adults at heightened risk of advanced colorectal neoplasia (AN) who may warrant colonoscopy initiation &lt; age 45&#xa0;years. <b>Aims</b>: We aim to develop and validate a model estimating the likelihood of AN in adults age &lt; 45&#xa0;years.</p> Methods <p>We performed a cross-sectional analysis of adults’ ages 18–44&#xa0;years who underwent a colonoscopy between 2011 and 2021 at a tertiary center. Subjects with AN constituted the case group while those with a normal colonoscopy or non-advanced neoplasia (NAN) formed the control group. We used backward elimination multivariable logistic regression methods to construct a model based on significant associations (<i>p</i> &lt; 0.05) between risk factors and the presence of AN in a randomly selected training set and confirmed the associations in a validation set.</p> Results <p>AN was detected in 346 (3.7%) of the 9,446 participants included. The reduced logistic regression model based on the training set identified BMI (<i>p</i> = 0.0157), family history of CRC (first-degree relative &lt; 60, <i>p</i> &lt; 0.0001; other family history of CRC <i>p</i> = 0.0117), and tobacco use (current vs. never, <i>p</i> = 0.0015, former vs. never, <i>p</i> = 0.0009) as risk factors for AN. In the validation set, the model exhibited moderate discriminatory power (<i>c</i>-statistic 0.645). The prediction score estimated the likelihood of detecting AN in the complete dataset, from 1.8% for individuals scoring 1 to &gt; 14% for individuals scoring ≥ 9.</p> Conclusion <p>We developed and internally validated a simple score using clinical factors which successfully predicts the likelihood of AN in adults &lt; 45&#xa0;years undergoing colonoscopy. Once externally validated, the proposed risk score may be useful for individualized CRC screening strategies.</p>

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A Score to Predict Advanced Colorectal Neoplasia in Adults Younger than Age 45

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月13日

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  • Sarah Wehbe,
  • Raj Jessica Thomas,
  • Jacquelyn Bolwell,
  • Robert Butler,
  • Carol A. Burke,
  • David Liska,
  • Carole Macaron

摘要

Background

Early-onset colorectal cancer (CRC) requires identifying adults at heightened risk of advanced colorectal neoplasia (AN) who may warrant colonoscopy initiation < age 45 years. Aims: We aim to develop and validate a model estimating the likelihood of AN in adults age < 45 years.

Methods

We performed a cross-sectional analysis of adults’ ages 18–44 years who underwent a colonoscopy between 2011 and 2021 at a tertiary center. Subjects with AN constituted the case group while those with a normal colonoscopy or non-advanced neoplasia (NAN) formed the control group. We used backward elimination multivariable logistic regression methods to construct a model based on significant associations (p < 0.05) between risk factors and the presence of AN in a randomly selected training set and confirmed the associations in a validation set.

Results

AN was detected in 346 (3.7%) of the 9,446 participants included. The reduced logistic regression model based on the training set identified BMI (p = 0.0157), family history of CRC (first-degree relative < 60, p < 0.0001; other family history of CRC p = 0.0117), and tobacco use (current vs. never, p = 0.0015, former vs. never, p = 0.0009) as risk factors for AN. In the validation set, the model exhibited moderate discriminatory power (c-statistic 0.645). The prediction score estimated the likelihood of detecting AN in the complete dataset, from 1.8% for individuals scoring 1 to > 14% for individuals scoring ≥ 9.

Conclusion

We developed and internally validated a simple score using clinical factors which successfully predicts the likelihood of AN in adults < 45 years undergoing colonoscopy. Once externally validated, the proposed risk score may be useful for individualized CRC screening strategies.