TY - JOUR
T1 - The fecal hemoglobin concentration, age and sex test score
T2 - Development and external validation of a simple prediction tool for colorectal cancer detection in symptomatic patients
AU - Cubiella, Joaquín
AU - Digby, Jayne
AU - Rodríguez-Alonso, Lorena
AU - Vega, Pablo
AU - Salve, María
AU - Díaz-Ondina, Marta
AU - Strachan, Judith A.
AU - Mowat, Craig
AU - McDonald, Paula J.
AU - Carey, Francis A.
AU - Godber, Ian M.
AU - Ben Younes, Hakim
AU - Rodriguez-Moranta, Francisco
AU - Quintero, Enrique
AU - Álvarez-Sánchez, Victoria
AU - Fernández-Bañares, Fernando
AU - Boadas, Jaume
AU - Campo, Rafel
AU - Bujanda, Luis
AU - Garayoa, Ana
AU - Ferrandez, Ángel
AU - Piñol, Virginia
AU - Rodríguez-Alcalde, Daniel
AU - Guardiola, Jordi
AU - Steele, Robert J. C.
AU - Fraser, Callum G.
AU - on behalf of the COLONPREDICT study investigators
N1 - This study was funded by a grant from Instituto de Salud Carlos III (PI11/00094). JC has received an intensification grant through the European Commission funded "BIOCAPS" project (FP-7-REGPOT 2012-2013-1, Grant agreement no. FP7-316265). The validation cohort recruitment was funded by a grant from Fundació de la Marató TV3 2012 (785/U/2013). JD was supported by a grant from Tenovus Tayside, Scotland
PY - 2017/5/15
Y1 - 2017/5/15
N2 - Prediction models for colorectal cancer (CRC) detection in symptomatic patients, based on easily obtainable variables such as faecal haemoglobin concentration (f-Hb), age and sex, may simplify CRC diagnosis. We developed, and then externally validated, a multivariable prediction model, the FAST Score, with data from five diagnostic test accuracy studies that evaluated quantitative faecal immunochemical tests in symptomatic patients referred for colonoscopy. The diagnostic accuracy of the Score in derivation and validation cohorts was compared statistically with the area under the curve (AUC) and the Chi-square test.1,572 and 3,976 patients were examined in these cohorts, respectively. For CRC, the odds ratio (OR) of the variables included in the Score were: age (years): 1.03 (95% confidence intervals (CI): 1.02-1.05), male sex: 1.6 (95% CI: 1.1-2.3) and f-Hb (0-<20 µg Hb/g faeces): 2.0 (95% CI: 0.7-5.5), (20-<200 µg Hb/g): 16.8 (95% CI: 6.6-42.0), ≥200 µg Hb/g: 65.7 (95% CI: 26.3-164.1). The AUC for CRC detection was 0.88 (95% CI: 0.85-0.90) in the derivation and 0.91 (95% CI: 0.90-093; p = 0.005) in the validation cohort. At the two Score thresholds with 90% (4.50) and 99% (2.12) sensitivity for CRC, the Score had equivalent sensitivity, although the specificity was higher in the validation cohort (p<0.001). Accordingly, the validation cohort was divided into three groups: high (21.4% of the cohort, positive predictive value - PPV: 21.7%), intermediate (59.8%, PPV: 0.9%) and low (18.8%, PPV: 0.0%) risk for CRC. The FAST Score is an easy to calculate prediction tool, highly accurate for CRC detection in symptomatic patients.
AB - Prediction models for colorectal cancer (CRC) detection in symptomatic patients, based on easily obtainable variables such as faecal haemoglobin concentration (f-Hb), age and sex, may simplify CRC diagnosis. We developed, and then externally validated, a multivariable prediction model, the FAST Score, with data from five diagnostic test accuracy studies that evaluated quantitative faecal immunochemical tests in symptomatic patients referred for colonoscopy. The diagnostic accuracy of the Score in derivation and validation cohorts was compared statistically with the area under the curve (AUC) and the Chi-square test.1,572 and 3,976 patients were examined in these cohorts, respectively. For CRC, the odds ratio (OR) of the variables included in the Score were: age (years): 1.03 (95% confidence intervals (CI): 1.02-1.05), male sex: 1.6 (95% CI: 1.1-2.3) and f-Hb (0-<20 µg Hb/g faeces): 2.0 (95% CI: 0.7-5.5), (20-<200 µg Hb/g): 16.8 (95% CI: 6.6-42.0), ≥200 µg Hb/g: 65.7 (95% CI: 26.3-164.1). The AUC for CRC detection was 0.88 (95% CI: 0.85-0.90) in the derivation and 0.91 (95% CI: 0.90-093; p = 0.005) in the validation cohort. At the two Score thresholds with 90% (4.50) and 99% (2.12) sensitivity for CRC, the Score had equivalent sensitivity, although the specificity was higher in the validation cohort (p<0.001). Accordingly, the validation cohort was divided into three groups: high (21.4% of the cohort, positive predictive value - PPV: 21.7%), intermediate (59.8%, PPV: 0.9%) and low (18.8%, PPV: 0.0%) risk for CRC. The FAST Score is an easy to calculate prediction tool, highly accurate for CRC detection in symptomatic patients.
KW - Advanced colorectal neoplasia
KW - Colonoscopy
KW - Colorectal cancer
KW - Diagnostic accuracy
KW - Faecal immunochemical test
KW - Inflammatory bowel disease
KW - Risk stratification
U2 - 10.1002/ijc.30639
DO - 10.1002/ijc.30639
M3 - Article
C2 - 28187494
SN - 0020-7136
VL - 140
SP - 2201
EP - 2211
JO - International Journal of Cancer
JF - International Journal of Cancer
IS - 10
ER -