Risk prediction rule for advanced neoplasia on screening colonoscopy for average-risk individuals

Table 1 Univariate analysis of clinical features and detection of advanced neoplasia

Characteristic	Total	Absence of AN	Presence of AN	P value
	n (%)	n (%)	n (%)
Age (mean ± SD)	980 (100)	61 ± 8	63 ± 9	0.242
Median, IQR		60, 12	63, 13
Male	479 (48.9)	448 (48.2)	31(62.0)	0.07
Smoking	460 (46.9)	425 (45.7)	35 (70.0)	0.01
Daily bowel movement	859 (87.7)	814 (87.6)	45 (90.0)	0.62
Caffeine	885 (90.3)	836 (89.9)	49 (98.0)	0.06
Exercise	544 (55.5)	52 (56.5)	19 (38.0)	0.01
Alcohol	491 (50.1)	468 (50.3)	23 (46.0)	0.55
Daily red meat consumption	90 (9.2)	81 (8.7)	9 (18.0)	0.03
Daily poultry consumption	39 (4.0)	37 (4.0)	2 (4.0)	0.99
Daily dairy consumption	744 (75.9)	703 (75.6)	41 (82.0)	0.30
Daily fruit/vegetable consumption	909 (92.8)	865 (93.0)	44 (88.0)	0.18
NSAID use	177 (18.1)	171 (18.4)	6 (12.0)	1.31
Aspirin use	312 (31.8)	294 (31.6)	18 (36.0)	0.42
Multi vitamin/antixoidant use	415 (42.3)	397 (42.7)	18 (36.0)	0.87
Oral contraceptive pills/hormone replacement therapy used	126 (12.9)	121 (13.0)	5 (10.0)	0.38
Calcium supplementation	429 (43.8)	413 (44.4)	16 (32.0)	0.30
Diabetes mellitus	80 (8.2)	74 (8.0)	6 (12.0)	1.04
Body Mass Index (BMI)				0.01
mean ± SD	980 (100)	26.7 ± 4.1	28.4 ± 3.3	0.01
Median, IQR		26.7, 5.1	28.5, 4.5
< 25a	330 (33.7)	322 (34.6)	8 (16.0)
25-30	454 (46.3)	429 (46.1)	25 (50.0)
> 30a	196 (20.0)	179 (19.2)	17 (34.0)
Pack years				< 0.01
mean ± SD	980 (100)	13 ± 21	29 ± 33	< 0.01
Median, IQR		0, 20	18, 40
≤ 10a	520 (53.1)	505 (54.3)	15 (30.0)
11-40a	331 (33.8)	311 (33.4)	20 (40.0)
> 40a	129 (13.2)	114 (12.3)	15 (30.0)
Frequency of alcohol intake				0.8
None	489 (49.9)	462 (49.7)	27 (54.0)
< 1 drink daily	391 (39.9)	377 (40.5)	14 (28.0)
At least 1 drink daily	100 (10.2)	91 (9.8)	9 (18.0)
Daily alcohol consumption	100 (10.2)	91 (9.8)	9 (18.0)	0.06
Body surface area (mean ± SD)		1.8 ± 2.045	1.9 ± 0.02	0.02
Median, IQR		1.8, 0.28	1.9, 0.22

^aIndicates significance on post-hoc analysis (P < 0.05), AN: Advanced neoplasia.

Table 2 Binary logistic regression and internal validation

Patient factors	Binary logistic regression				1000 bootstrap
	β-coefficient	SE	P value	OR (95%CI)	P value	AOR (95%CI)
Age (yr)	0.035	0.018	0.048	1.04 (1-1.07)	0.047	1.04 (1-1.08)
BMI category
Normal (< 25 kg/m2)	0		0.018	1.00 (ref)
Overweight (25-29.99 kg/m2)	0.794	0.417	0.057	2.21 (0.98-5)	0.042	2.21 (1.09-6.49)
Obese (≥ 30 kg/m2)	1.265	0.447	0.005	3.54 (1.48-8.51)	0.004	3.54 (1.5-11.32)
Smoking (pack-years)
No			0.002	1.00 (ref)
< 40 pack-years	0.697	0.353	0.048	2.01 (1.01-4.01)	0.048	2.01 (0.95-4.37)
≥ 40 pack-years	1.376	0.385	0.000	3.96 (1.86-8.42)	0.001	3.96 (1.78-9.24)
Daily red meat	0.702	0.400	0.079	2.02 (0.92-4.42)	0.082	2.02 (0.72-4.41)
Constant	-6.467	1.213	0.000		0.001

SE: Standard error, OR: Odds ratio, AOR: Adjusted odds ratio.

Table 3 Existing risk prediction studies by design, age, exclusion of family history and previous colonoscopy

Ref.	Design	Positive family history excluded	Age for inclusion	Mean age (SD)	Included only first screening colonoscopy
Betés et al[25], 2003	Prospective	Yes	≥ 40	58 (8.6)	No1
Cai et al[27], 2012	Prospective	No	≥ 40	60 (11.1)	No1
Chen et al[33], 2014	Prospective	Yes	≥ 40	62.7 (9.7)	No1
Hong et al[34], 2017	Prospective	Yes	≥ 20	49.9 (9.3)	Yes
Imperiale et al[35], 2015	Prospective	No	50-80	57.3 (6.6)	Yes
Imperiale et al[36], 2016	Prospective	No	30-49	57.2 (6.6)	No2
Jung et al[24], 2017	Prospective	No	< 50	38.9 (5.3)	Yes
Kaminski et al[29], 2014	Retrospective	No	50-80	55.6 (5.2)	No2
Kim et al[37], 2019	Retrospective	No	< 50	38.9 (5.3)	Yes
Ladabaum et al[38], 2016	Prospective	Yes	50-80	Median (IQR) 58 (52 – 65)	No
Li et al[39], 2016	Prospective	No	40-75	52 (IQR 47 – 59)	No
Lin et al[40], 2016	Prospective	No	≥ 50	59.6 (8.1)	No1
Murchie et al[41], 2017	Retrospective	Yes	40-49	51.5	Yes
Park et al[42], 2017	Retrospective	No	50-59	44.8 (2.8)	Yes
Ruco et al[43], 2015	Prospective	No	50-74	58.3 (6.2)	No2
Schroy et al[44], 2015	Prospective	Yes†	50-79	74.7% aged 50-59	No
Sekiguchi et al[26], 2018	Retrospective	No	≥ 40	56 (40–88)	Yes
Sung et al[45], 2017	Prospective	No	≥ 50	57.6 (4.9)	No1
Tao et al, 2014[46]	Prospective	No	≥ 55	63.5 (6.7)	No1
Wong et al[45], 2016	Prospective	No	50-70	57.7 (4.93)	No
Yang et al[47], 2017	Retrospective	No	≥ 50	41.6 (8.3)	Yes
Yeoh et al[48], 2011	Prospective	No	≥ 16	54 (11.6)	No1
Current study	Prospective	Yes	≥ 50	61 (8)	Yes

Participants with a family history of colorectal cancer and/or colorectal polyps detected above the age of 60 were included. Those below the age of 60 were excluded. Included subjects with prior colonoscopic screening (≥ 5 yr¹ or ≥ 10 yr²).