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Asia-Pacific Scoring System useful for determining CRC risk
Researchers found a scoring system based on age, gender, family history and smoking, to be useful for identifying asymptomatic patients at high risk for colorectal cancer and advanced adenoma.
“This study demonstrated that the [Asia-Pacific Scoring System] score is a simple and effective calculator to stratify the risk for advanced colorectal neoplasm in asymptomatic subjects undergoing screening tests,” the researchers wrote. “This strategy can detect the majority of [advanced neoplasm] and reduce colonoscopy by half. The procedure is simple enough to be used by family physicians and community health care providers to improve screening efficiency. This strategy should be considered for [colorectal cancer] screening and prevention in resource-constrained countries and regions.”
In a multicenter prospective study, researchers recruited 5,657 asymptomatic patients from December 2011 to December 2013 who were 40 years and older and were living in one of 12 Asia-Pacific regions.
The patients were classified by risk for advanced neoplasm according to their APCS score: low risk (n = 646, 11.4%), medium risk (n = 3,243, 57.3%), or high risk (n = 1,768, 31.3%). High-risk patients were referred for early colonoscopy, while low- and medium-risk patients were first recommended for fecal immunochemical test (FIT) and then colonoscopy if the FIT was positive. The researchers then examined all colonoscopy findings for each group and determined the proportion of patients with advanced neoplasms in each group.
In the low-risk group, 1.5% of the patients had advanced neoplasms, compared with 5.1% in the medium-risk and 10.9% in the high-risk group.
The researchers found that by using the APCS scoring system, asymptomatic patients were correctly referred for early colonoscopy. The medium-risk group had a 3.4-fold increased risk for advanced adenoma, and high-risk patients had a 7.8-fold increase, compared with low-risk patients.
“The present cohort was dominated by ethnic Chinese (55.8%), and other ethnicities were not sufficiently represented. However, when we compare results from the high-risk populations (Chinese, Japanese, and Koreans) to results from the low-risk populations (Malays, Indians, and Indonesians), our results again were consistent,” the researchers wrote. “Although we believe that the result of this study can be generalized to populations with either higher or lower CRC risk in the Asia-Pacific region, future validation studies in different ethnic groups, including Western population, are warranted.
“Use of the APCS score-based algorithm in triaging subjects for FIT or colonoscopy can substantially reduce colonoscopy workload,” they concluded.
Disclosures: The researchers report no relevant financial disclosures.