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Zheng J, Hsu L. Risk projection for time-to-event outcome from population-based case-control studies leveraging summary statistics from the target population. LIFETIME DATA ANALYSIS 2024; 30:549-571. [PMID: 38805095 PMCID: PMC11283322 DOI: 10.1007/s10985-024-09626-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/04/2024] [Indexed: 05/29/2024]
Abstract
Risk stratification based on prediction models has become increasingly important in preventing and managing chronic diseases. However, due to cost- and time-limitations, not every population can have resources for collecting enough detailed individual-level information on a large number of people to develop risk prediction models. A more practical approach is to use prediction models developed from existing studies and calibrate them with relevant summary-level information of the target population. Many existing studies were conducted under the population-based case-control design. Gail et al. (J Natl Cancer Inst 81:1879-1886, 1989) proposed to combine the odds ratio estimates obtained from case-control data and the disease incidence rates from the target population to obtain the baseline hazard function, and thereby the pure risk for developing diseases. However, the approach requires the risk factor distribution of cases from the case-control studies be same as the target population, which, if violated, may yield biased risk estimation. In this article, we propose two novel weighted estimating equation approaches to calibrate the baseline risk by leveraging the summary information of (some) risk factors in addition to disease-free probabilities from the targeted population. We establish the consistency and asymptotic normality of the proposed estimators. Extensive simulation studies and an application to colorectal cancer studies demonstrate the proposed estimators perform well for bias reduction in finite samples.
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Affiliation(s)
- Jiayin Zheng
- Fred Hutchinson Cancer Center, 1100 Fairview Ave N, M3-B232, Seattle, Washington, 98109, USA
| | - Li Hsu
- Fred Hutchinson Cancer Center, 1100 Fairview Ave N, M3-B232, Seattle, Washington, 98109, USA.
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2
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Zaika V, Prakash MK, Cheng CY, Schlander M, Lang BM, Beerenwinkel N, Sonnenberg A, Krupka N, Misselwitz B, Poleszczuk J. Optimal timing of a colonoscopy screening schedule depends on adenoma detection, adenoma risk, adherence to screening and the screening objective: A microsimulation study. PLoS One 2024; 19:e0304374. [PMID: 38787836 PMCID: PMC11125540 DOI: 10.1371/journal.pone.0304374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Colonoscopy-based screening provides protection against colorectal cancer (CRC), but the optimal starting age and time intervals of screening colonoscopies are unknown. We aimed to determine an optimal screening schedule for the US population and its dependencies on the objective of screening (life years gained or incidence, mortality, or cost reduction) and the setting in which screening is performed. We used our established open-source microsimulation model CMOST to calculate optimized colonoscopy schedules with one, two, three or four screening colonoscopies between 20 and 90 years of age. A single screening colonoscopy was most effective in reducing life years lost from CRC when performed at 55 years of age. Two, three and four screening colonoscopy schedules saved a maximum number of life years when performed between 49-64 years; 44-69 years; and 40-72 years; respectively. However, for maximum incidence and mortality reduction, screening colonoscopies needed to be scheduled 4-8 years later in life. The optimum was also influenced by adenoma detection efficiency with lower values for these parameters favoring a later starting age of screening. Low adherence to screening consistently favored a later start and an earlier end of screening. In a personalized approach, optimal screening would start earlier for high-risk patients and later for low-risk individuals. In conclusion, our microsimulation-based approach supports colonoscopy screening schedule between 45 and 75 years of age but the precise timing depends on the objective of screening, as well as assumptions regarding individual CRC risk, efficiency of adenoma detection during colonoscopy and adherence to screening.
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Affiliation(s)
- Viktor Zaika
- Faculty of Medicine, Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
- Department of Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
| | - Meher K. Prakash
- Theoretical Sciences Unit, Jawaharlal Nehru Center for Advanced Scientific Research, Jakkur, Bangalore, India
| | - Chih-Yuan Cheng
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Schlander
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Brian M. Lang
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Niko Beerenwinkel
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Amnon Sonnenberg
- The Portland VA Medical Center, P3-GI, Portland, Oregon, United States of America
| | - Niklas Krupka
- Department of Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
| | - Benjamin Misselwitz
- Department of Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
| | - Jan Poleszczuk
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
- Department of Computational Oncology, Maria Skłodowska-Curie Institute-Oncology Center, Warsaw, Poland
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3
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Jagtap N, Kalapala R, Rughwani H, Singh AP, Inavolu P, Ramchandani M, Lakhtakia S, Manohar Reddy P, Sekaran A, Tandan M, Nabi Z, Basha J, Gupta R, Memon SF, Venkat Rao G, Sharma P, Nageshwar Reddy D. Application of machine-learning model to optimize colonic adenoma detection in India. Indian J Gastroenterol 2024:10.1007/s12664-024-01530-4. [PMID: 38758433 DOI: 10.1007/s12664-024-01530-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/05/2024] [Indexed: 05/18/2024]
Abstract
AIMS There is limited data on the prevalence and risk factors of colonic adenoma from the Indian sub-continent. We aimed at developing a machine-learning model to optimize colonic adenoma detection in a prospective cohort. METHODS All consecutive adult patients undergoing diagnostic colonoscopy were enrolled between October 2020 and November 2022. Patients with a high risk of colonic adenoma were excluded. The predictive model was developed using the gradient-boosting machine (GBM)-learning method. The GBM model was optimized further by adjusting the learning rate and the number of trees and 10-fold cross-validation. RESULTS Total 10,320 patients (mean age 45.18 ± 14.82 years; 69% men) were included in the study. In the overall population, 1152 (11.2%) patients had at least one adenoma. In patients with age > 50 years, hospital-based adenoma prevalence was 19.5% (808/4144). The area under the receiver operating curve (AUC) (SD) of the logistic regression model was 72.55% (4.91), while the AUCs for deep learning, decision tree, random forest and gradient-boosted tree model were 76.25% (4.22%), 65.95% (4.01%), 79.38% (4.91%) and 84.76% (2.86%), respectively. After model optimization and cross-validation, the AUC of the gradient-boosted tree model has increased to 92.2% (1.1%). CONCLUSIONS Machine-learning models may predict colorectal adenoma more accurately than logistic regression. A machine-learning model may help optimize the use of colonoscopy to prevent colorectal cancers. TRIAL REGISTRATION ClinicalTrials.gov (ID: NCT04512729).
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Affiliation(s)
- Nitin Jagtap
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India.
| | - Rakesh Kalapala
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Hardik Rughwani
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Aniruddha Pratap Singh
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Pradev Inavolu
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Mohan Ramchandani
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Sundeep Lakhtakia
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - P Manohar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Anuradha Sekaran
- Department of Pathology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Manu Tandan
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Zaheer Nabi
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Jahangeer Basha
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Rajesh Gupta
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Sana Fathima Memon
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - G Venkat Rao
- Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500 082, India
| | - Prateek Sharma
- The University of Kansas Medical Center, Kansas City, KS, USA
| | - D Nageshwar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
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Ma E, Ohira T, Miyazaki M, Fukasawa M, Yoshimoto M, Suzuki T, Furuyama A, Kataoka M, Yasumura S, Hosoya M. Prediction of the 4-Year Incidence Risk of Ischemic Stroke in Healthy Japanese Adults: The Fukushima Health Database. J Atheroscler Thromb 2024; 31:259-272. [PMID: 37661424 PMCID: PMC10918050 DOI: 10.5551/jat.64018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 07/20/2023] [Indexed: 09/05/2023] Open
Abstract
AIM Estimating the risk of developing ischemic stroke (IS) may assist health professionals in motivating individuals to modify their risk behavior. METHODS A predictive model was derived from 178,186 participants from Fukushima Health Database, aged 40-74 years, who attended the health checkup in 2014 and completed at least one annual health checkup by 2018 (Cohort I). Cox proportional hazard regression model was used to build a 4-year prediction model, thus the risk scores were based on the regression coefficients. External validation for the risk scores was conducted in another cohort of 46,099 participants following between 2015 and 2019 (Cohort II). RESULTS The 4-year cumulated incidence rate of IS was 179.80/100,000 person-years in Cohort I. The predictive model included age, sex, blood pressure, hypertension treatment, diabetes, low- and high-density lipoprotein cholesterol, smoking, walking pace, and body weight change of 3 kg within one year. Risk scores were interpreted based on the Cohort I predictive model function. The Harrell's C-statistics of the discrimination ability of the risk score model (95% confidence interval) was 0.744 (0.729-0.759) in Cohort I and 0.770 (0.743-0.797) in Cohort II. The overall agreement of the risk score probability of IS incidence for the observed/expected case ratio and 95% CI was 0.98 (0.92-1.05) in Cohort I and 1.08 (0.95-1.22) in Cohort II. CONCLUSIONS The 4-year risk prediction model revealed a good performance for IS incidence, and risk scores could be used to estimate individual incidence risk of IS. Updated models with additional confirmed risk variables may be needed.
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Affiliation(s)
- Enbo Ma
- Health Promotion Center, Fukushima Medical University, Fukushima, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tetsuya Ohira
- Health Promotion Center, Fukushima Medical University, Fukushima, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
- Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Makoto Miyazaki
- Health Promotion Center, Fukushima Medical University, Fukushima, Japan
- Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Maiko Fukasawa
- Health Promotion Center, Fukushima Medical University, Fukushima, Japan
| | - Masayo Yoshimoto
- Health Promotion Center, Fukushima Medical University, Fukushima, Japan
| | - Tomonori Suzuki
- Health Promotion Center, Fukushima Medical University, Fukushima, Japan
- Department of Computer Science and Engineering, University of Aizu, Fukushima, Japan
| | - Ayako Furuyama
- Health Promotion Center, Fukushima Medical University, Fukushima, Japan
| | - Mariko Kataoka
- Health Promotion Center, Fukushima Medical University, Fukushima, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Seiji Yasumura
- Health Promotion Center, Fukushima Medical University, Fukushima, Japan
- Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsuaki Hosoya
- Health Promotion Center, Fukushima Medical University, Fukushima, Japan
- Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
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Kastrinos F, Kupfer SS, Gupta S. Colorectal Cancer Risk Assessment and Precision Approaches to Screening: Brave New World or Worlds Apart? Gastroenterology 2023; 164:812-827. [PMID: 36841490 PMCID: PMC10370261 DOI: 10.1053/j.gastro.2023.02.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 02/27/2023]
Abstract
Current colorectal cancer (CRC) screening recommendations take a "one-size-fits-all" approach using age as the major criterion to initiate screening. Precision screening that incorporates factors beyond age to risk stratify individuals could improve on current approaches and optimally use available resources with benefits for patients, providers, and health care systems. Prediction models could identify high-risk groups who would benefit from more intensive screening, while low-risk groups could be recommended less intensive screening incorporating noninvasive screening modalities. In addition to age, prediction models incorporate well-established risk factors such as genetics (eg, family CRC history, germline, and polygenic risk scores), lifestyle (eg, smoking, alcohol, diet, and physical inactivity), sex, and race and ethnicity among others. Although several risk prediction models have been validated, few have been systematically studied for risk-adapted population CRC screening. In order to envisage clinical implementation of precision screening in the future, it will be critical to develop reliable and accurate prediction models that apply to all individuals in a population; prospectively study risk-adapted CRC screening on the population level; garner acceptance from patients and providers; and assess feasibility, resources, cost, and cost-effectiveness of these new paradigms. This review evaluates the current state of risk prediction modeling and provides a roadmap for future implementation of precision CRC screening.
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Affiliation(s)
- Fay Kastrinos
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York; Division of Digestive and Liver Diseases, Columbia University Medical Center and Vagelos College of Physicians and Surgeons, New York, New York.
| | - Sonia S Kupfer
- University of Chicago, Section of Gastroenterology, Hepatology and Nutrition, Chicago, Illinois
| | - Samir Gupta
- Division of Gastroenterology, Department of Internal Medicine, University of California, San Diego, La Jolla, California; Veterans Affairs San Diego Healthcare System, San Diego, California
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6
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Maratt JK, Imperiale TF. Using Online Colorectal Cancer Risk Calculators to Guide Screening Decision-Making. Am J Med 2023; 136:308-314.e3. [PMID: 36058308 DOI: 10.1016/j.amjmed.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Several online calculators estimate colorectal cancer risk, but their consistency is unknown. Our objectives were to quantify the variation in predicted risk and to determine which calculators are best used in the clinical setting. METHODS We used the Google search engine to identify online colorectal cancer risk calculators and assessed the output of each for 3 hypothetical screening scenarios (low-, average-, and high-risk), varied by age (50, 62, 75 years), sex, and race (Black, White), with risk levels based on risk-appropriate values for variables in each model. Estimated risks for models within a given scenario were rated as consistent or inconsistent based on comparison with either the absolute magnitude of difference or average lifetime risk of colorectal cancer. Summary statistics for consistent and inconsistent estimates were compared using chi-square and Fisher's exact tests. RESULTS We identified 5 online colorectal cancer risk calculators. Inconsistencies were found in none of 5-year, 19% of 10-year, and 81% of lifetime colorectal cancer risk estimate comparisons (P < .001). For a 50-year-old, 22% of risk estimate comparisons were inconsistent, vs 33% for a 62-year-old, and 36% for a 75-year-old (P = 0.14). CONCLUSIONS Online colorectal cancer risk models are more consistent in predicting colorectal cancer risk for 5- and 10-year time frames compared with lifetime. For a US population, the National Cancer Institute's Colorectal Cancer Risk Assessment Tool is a rigorously developed calculator that can be used in the clinical setting to provide 5-year and lifetime risk estimates.
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Affiliation(s)
- Jennifer K Maratt
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis; Richard L. Roudebush VA Medical Center, Indianapolis, Ind; Regenstrief Institute, Inc., Indianapolis, Ind.
| | - Thomas F Imperiale
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis; Richard L. Roudebush VA Medical Center, Indianapolis, Ind; Regenstrief Institute, Inc., Indianapolis, Ind
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7
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Burnett B, Zhou SM, Brophy S, Davies P, Ellis P, Kennedy J, Bandyopadhyay A, Parker M, Lyons RA. Machine Learning in Colorectal Cancer Risk Prediction from Routinely Collected Data: A Review. Diagnostics (Basel) 2023; 13:301. [PMID: 36673111 PMCID: PMC9858109 DOI: 10.3390/diagnostics13020301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 01/15/2023] Open
Abstract
The inclusion of machine-learning-derived models in systematic reviews of risk prediction models for colorectal cancer is rare. Whilst such reviews have highlighted methodological issues and limited performance of the models included, it is unclear why machine-learning-derived models are absent and whether such models suffer similar methodological problems. This scoping review aims to identify machine-learning models, assess their methodology, and compare their performance with that found in previous reviews. A literature search of four databases was performed for colorectal cancer prediction and prognosis model publications that included at least one machine-learning model. A total of 14 publications were identified for inclusion in the scoping review. Data was extracted using an adapted CHARM checklist against which the models were benchmarked. The review found similar methodological problems with machine-learning models to that observed in systematic reviews for non-machine-learning models, although model performance was better. The inclusion of machine-learning models in systematic reviews is required, as they offer improved performance despite similar methodological omissions; however, to achieve this the methodological issues that affect many prediction models need to be addressed.
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Affiliation(s)
- Bruce Burnett
- Swansea University Medical School, Swansea SA2 8PP, UK
| | - Shang-Ming Zhou
- Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - Sinead Brophy
- Swansea University Medical School, Swansea SA2 8PP, UK
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Miao Y, Mu L, Chen Y, Tang X, Wang J, Quan W, Mi D. Construction and Validation of a Protein-associated Prognostic Model for Gastrointestinal Cancer. Comb Chem High Throughput Screen 2023; 26:191-206. [PMID: 35430986 DOI: 10.2174/1386207325666220414105743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/05/2022] [Accepted: 02/14/2022] [Indexed: 11/22/2022]
Abstract
Background Gastrointestinal cancer (GIC) is a prevalent and lethal malignant tumor. It is obligatory to investigate innovative biomarkers for the diagnosis and prognosis. Proteins play a crucial role in regulating the occurrence and progression of GIC. However, the prognostic value of proteins is unclear in GIC. OBJECTIVE This paper aims to identify the hub prognosis-related proteins (PAPs) and construct a prognosis model for GIC patients for clinical application. METHODS Protein expression data of GIC was obtained from The Cancer Proteome Atlas (TCPA) and downloaded the clinicopathological data from The Cancer Genome Atlas database (TCGA). Besides, hub proteins were filtrated via univariate and multivariate Cox regression analysis. Moreover, survival analysis and nomogram were used to predict overall survival (OS). We used the calibration curves to assess the consistency of predictive and actual survival rates. The consistency index (C-index) was used to evaluate the prognostic ability of the predictive model. Furthermore, functional enrichment analysis and protein co-expression of PAPs were used to explore their roles in GIC. RESULTS Finally, a prognosis model was conducted based on ten PAPs (CYCLIND1, DVL3, NCADHERIN, SYK, ANNEXIN VII, CD20, CMET, RB, TFRC, and PREX1). The risk score calculated by the model was an independent prognostic predictor. Compared with the high-risk subgroup, the low-risk subgroup had better OS. In the TCGA cohort, the area under the curve value of the receiver operating characteristic curve of the prognostic model was 0.692. The expression of proteins and risk score had a significant association with the clinicopathological characteristics of GIC. Besides, a nomogram based on GIC clinicopathological features and risk scores could properly predict the OS of individual GIC patients. The C-index is 0.71 in the TCGA cohort and 0.73 in the GEO cohort. CONCLUSION The results indicate that the risk score is an independent prognostic biomarker and is related to the malignant clinical features of GIC patients. Besides, several PAPs associated with the survival and clinicopathological characteristics of GIC might be potential biomarkers for GIC diagnosis and treatment.
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Affiliation(s)
- Yandong Miao
- The First Clinical Medical College, Lanzhou University, Lanzhou City, 730000, China
- Gansu Academy of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Linjie Mu
- The First Clinical Medical College, Lanzhou University, Lanzhou City, 730000, China
- The First Affiliated Hospital of Kunming Medical University, Kunming, 650000, China
| | - Yonggang Chen
- The Second Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Xiaolong Tang
- The First Clinical Medical College, Lanzhou University, Lanzhou City, 730000, China
| | - Jiangtao Wang
- The First Clinical Medical College, Lanzhou University, Lanzhou City, 730000, China
| | - Wuxia Quan
- Qingyang People's Hospital, Qingyang City, Gansu Province, P.R. China
| | - Denghai Mi
- The First Clinical Medical College, Lanzhou University, Lanzhou City, 730000, China
- Gansu Academy of Traditional Chinese Medicine, Lanzhou, 730000, China
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Hussan H, Zhao J, Badu-Tawiah AK, Stanich P, Tabung F, Gray D, Ma Q, Kalady M, Clinton SK. Utility of machine learning in developing a predictive model for early-age-onset colorectal neoplasia using electronic health records. PLoS One 2022; 17:e0265209. [PMID: 35271664 PMCID: PMC9064446 DOI: 10.1371/journal.pone.0265209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS The incidence of colorectal cancer (CRC) is increasing in adults younger than 50, and early screening remains challenging due to cost and under-utilization. To identify individuals aged 35-50 years who may benefit from early screening, we developed a prediction model using machine learning and electronic health record (EHR)-derived factors. METHODS We enrolled 3,116 adults aged 35-50 at average-risk for CRC and underwent colonoscopy between 2017-2020 at a single center. Prediction outcomes were (1) CRC and (2) CRC or high-risk polyps. We derived our predictors from EHRs (e.g., demographics, obesity, laboratory values, medications, and zip code-derived factors). We constructed four machine learning-based models using a training set (random sample of 70% of participants): regularized discriminant analysis, random forest, neural network, and gradient boosting decision tree. In the testing set (remaining 30% of participants), we measured predictive performance by comparing C-statistics to a reference model (logistic regression). RESULTS The study sample was 55.1% female, 32.8% non-white, and included 16 (0.05%) CRC cases and 478 (15.3%) cases of CRC or high-risk polyps. All machine learning models predicted CRC with higher discriminative ability compared to the reference model [e.g., C-statistics (95%CI); neural network: 0.75 (0.48-1.00) vs. reference: 0.43 (0.18-0.67); P = 0.07] Furthermore, all machine learning approaches, except for gradient boosting, predicted CRC or high-risk polyps significantly better than the reference model [e.g., C-statistics (95%CI); regularized discriminant analysis: 0.64 (0.59-0.69) vs. reference: 0.55 (0.50-0.59); P<0.0015]. The most important predictive variables in the regularized discriminant analysis model for CRC or high-risk polyps were income per zip code, the colonoscopy indication, and body mass index quartiles. DISCUSSION Machine learning can predict CRC risk in adults aged 35-50 using EHR with improved discrimination. Further development of our model is needed, followed by validation in a primary-care setting, before clinical application.
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Affiliation(s)
- Hisham Hussan
- Division of Gastroenterology, Hepatology, and Nutrition, Department of
Internal Medicine, The Ohio State University, Columbus, Ohio, United States of
America
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio,
United States of America
| | - Jing Zhao
- Department of Biomedical Informatics, College of Medicine, The Ohio State
University, Columbus, Ohio, United States of America
| | - Abraham K. Badu-Tawiah
- Division of Gastroenterology, Hepatology, and Nutrition, Department of
Internal Medicine, The Ohio State University, Columbus, Ohio, United States of
America
- Department of Chemistry and Biochemistry, The Ohio State University,
Columbus, Ohio, United States of America
- Department of Microbial Infection and Immunity, The Ohio State
University, Columbus, Ohio, United States of America
| | - Peter Stanich
- Division of Gastroenterology, Hepatology, and Nutrition, Department of
Internal Medicine, The Ohio State University, Columbus, Ohio, United States of
America
| | - Fred Tabung
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio,
United States of America
- Division of Medical Oncology, Department of Internal Medicine, College of
Medicine, The Ohio State University, Columbus, Ohio, United States of
America
| | - Darrell Gray
- Division of Gastroenterology, Hepatology, and Nutrition, Department of
Internal Medicine, The Ohio State University, Columbus, Ohio, United States of
America
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio,
United States of America
| | - Qin Ma
- Department of Biomedical Informatics, College of Medicine, The Ohio State
University, Columbus, Ohio, United States of America
| | - Matthew Kalady
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio,
United States of America
- Division of Colon and Rectal Surgery, Department of Surgery, The Ohio
State University, Columbus, Ohio, United States of America
| | - Steven K. Clinton
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio,
United States of America
- Division of Medical Oncology, Department of Internal Medicine, College of
Medicine, The Ohio State University, Columbus, Ohio, United States of
America
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Jantzen R, Payette Y, de Malliard T, Labbé C, Noisel N, Broët P. Five-year absolute risk estimates of colorectal cancer based on CCRAT model and polygenic risk scores: A validation study using the Quebec population-based cohort CARTaGENE. Prev Med Rep 2022; 25:101678. [PMID: 35127357 PMCID: PMC8800052 DOI: 10.1016/j.pmedr.2021.101678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/21/2021] [Accepted: 12/24/2021] [Indexed: 11/06/2022] Open
Abstract
The objective was to evaluate the predictive performance of the Colorectal Cancer Risk Assessment Tool (CCRAT) and three polygenic risk scores (Hsu et al., 2015; Law et al., 2019, Archambault et al., 2020) to predict the occurrence of colorectal cancer at five years in a Quebec population-based cohort. By using the CARTaGENE cohort, we computed the absolute risk of colorectal cancer with the CCRAT model, the polygenic risk scores (PRS) and combined clinico-genetic models (CCRAT + PRS). We also tailored the CCRAT model by using the marginal age-specific colorectal incidence rates in Canada and the risk score distribution. We reported the calibration and the discrimination. Performances of the PRSs, combined and tailored CCRAT models were compared to the original CCRAT model. The expected-to-observed ratio of the original CCRAT model was 0.54 [0.43-0.68]. The c-index was 74.79 [68.3-80.5]. The tailored CCRAT model improved the expected-to-observed ratio (0.74 [0.59-0.94]) and c-index (76.39 [69.7-82.1]). All PRS improved the expected-to-observed ratios (around 0.83, confidence intervals including one). PRSs' c-indexes were not significantly different from CCRAT models. Results from the combined models were close to those from the PRS models, Archambault combined model's c-index being significantly higher than the original and tailored CCRAT models (78.67 [70.8-86.5]; p < 0.001 and p = 0.028, respectively). In this Quebec cohort, CCRAT model has a good discrimination with a poor calibration. While the tailored CCRAT provides some gain in calibration, clinico-genetic models improved both calibration and discrimination. However, better calibrations must be obtained before a practical use among the inhabitants of Quebec province.
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Affiliation(s)
- Rodolphe Jantzen
- CARTaGENE, Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
- Université de Montréal, Montréal, Québec, Canada
| | - Yves Payette
- CARTaGENE, Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
| | | | - Catherine Labbé
- CARTaGENE, Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Nolwenn Noisel
- CARTaGENE, Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
- Université de Montréal, Montréal, Québec, Canada
| | - Philippe Broët
- CARTaGENE, Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
- Université de Montréal, Montréal, Québec, Canada
- University Paris-Saclay, CESP, INSERM, Villejuif, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris-Sud, Hôpital Paul Brousse, 12 Avenue Paul Vaillant Couturier, 94807 Villejuif, France
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11
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Xu JY, Wang YT, Li XL, Shao Y, Han ZY, Zhang J, Yang LB, Deng J, Li T, Wu T, Lu XL, Cheng Y. Prediction Model Using Readily Available Clinical Data for Colorectal Cancer in Chinese Population. Am J Med Sci 2022; 364:59-65. [PMID: 35120920 DOI: 10.1016/j.amjms.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/16/2021] [Accepted: 01/25/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND In China, health screening has become common, although colonoscopy is not always available or acceptable. We sought to develop a prediction model of colorectal cancer (CRC) for health screening population based on readily available clinical data to reduce labor and economic costs. METHODS We conducted a cross-sectional study based on a health screening population in Karamay Central Hospital. By collecting clinical data and basic information from participants, we identified independent risk factors and established a prediction model of CRC. Internal and external validation, calibration plot, and decision curve analysis were employed to test discriminating ability, calibration ability, and clinical practicability. RESULTS Independent risk factors of CRC, which were readily available in basic public health institutions, included high-density lipoprotein cholesterol, male sex, total cholesterol, advanced age, and hemoglobin. These factors were successfully incorporated into the prediction model (AUC 0.740, 95% CI 0.713-0.767). The model demonstrated a high degree of discrimination and calibration, in addition to a high degree of clinical practicability in high-risk people. CONCLUSIONS The prediction model exhibits good discrimination and calibration and is pragmatic for CRC screening in rural areas and basic public health institutions.
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Affiliation(s)
- Jing-Yuan Xu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Ya-Tao Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Xiao-Ling Li
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Yong Shao
- Community Health Service Center of Jinxi Town, Kunshan 215300, China
| | - Zhi-Yi Han
- Karamay Central Hospital of Xinjiang, Karamay 834000, China
| | - Jie Zhang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Long-Bao Yang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Jiang Deng
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Ting Li
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Ting Wu
- Community Health Service Center of Jinxi Town, Kunshan 215300, China
| | - Xiao-Lan Lu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China; Department of Gastroenterology, Shanghai Pudong Hospital of Fudan University, Shanghai 201399, China.
| | - Yan Cheng
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China.
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12
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Ghajari H, Sadeghi A, Khodakarim S, Zali M, Nazari SSH. Designing a Predictive Model for Colorectal Neoplasia Diagnosis Based on Clinical and Laboratory Findings in Colonoscopy Candidate Patients. J Gastrointest Cancer 2021; 53:880-887. [PMID: 34851503 DOI: 10.1007/s12029-021-00737-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Health authorities have expanded two strategies to diminish CRC-related influence: CR screening and improve diagnostic process in symptomatic patients. The aim of the current study is to design a predictive model to identify the most important risk factors that can efficiently predict patients who have high risk of colorectal neoplasia. METHOD A cross-sectional study was constructed to include all patients who had positive test for FIT or had one or more risk factors for colorectal cancer based on the guidelines of detecting high-risk groups for colorectal cancer in Iran. Multivariable binary logistic regression model was constructed for prediction of colorectal neoplasia. We used sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio to check the accuracy. The Hosmer-Lemeshow test, chi-square test, and p value were used to determine the precision of model. RESULT Following an AIC stepwise selection model, only nine potential variables, namely gender, watery diarrhea, IBD, abdominal pain, melena, body mass index, depression drug, anti-inflammatory drug, and age, were found to be a predictor of colorectal neoplasia. The best cut-point probability in the final model was 0.27 and results of sensitivity and specificity, based on maximizing these two criteria, were 66% and 62%, respectively. CONCLUSION Overall, our model prediction was comparable with other risk prediction models for colorectal cancer. It had a modest discriminatory power to distinguish an individual's neoplasia colorectal risk.
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Affiliation(s)
- H Ghajari
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Khodakarim
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S S Hashemi Nazari
- Safety Promotion and Injury Prevention Research Center, Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Chamran Highway, Daneshjoo Blvd, 198353-5511, Velenjak Tehran, PC, Iran
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13
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Gao R, Zhu Y, Kong C, Xia K, Li H, Zhu Y, Zhang X, Liu Y, Zhong H, Yang R, Chen C, Qin N, Qin H. Alterations, Interactions, and Diagnostic Potential of Gut Bacteria and Viruses in Colorectal Cancer. Front Cell Infect Microbiol 2021; 11:657867. [PMID: 34307189 PMCID: PMC8294192 DOI: 10.3389/fcimb.2021.657867] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/18/2021] [Indexed: 12/11/2022] Open
Abstract
Gut microbiome alteration was closely associated with colorectal cancer (CRC). Previous studies had demonstrated the bacteria composition changes but lacked virome profiles, trans-kindom interactions, and reliable diagnostic model explorations in CRC. Hence, we performed metagenomic sequencing to investigate the gut microbiome and microbial interactions in adenoma and CRC patients. We found the decreased microbial diversity in CRC and revealed the taxonomic alterations of bacteria and viruses were highly associated with CRC at the species level. The relative abundance of oral-derived species, such as Fusobacterium nucleatum, Fusobacterium hwasookii, Porphyromonas gingivalis, and Bacteroides fragilis, increased. At the same time, butyrate-producing and anti-inflammatory microbes decreased in adenoma and CRC by non-parametric Kruskal-Wallis test. Despite that, the relative abundance of Escherichia viruses and Salmonella viruses increased, whereas some phages, including Enterobacteria phages and Uncultured crAssphage, decreased along with CRC development. Gut bacteria was negatively associated with viruses in CRC and healthy control by correlation analysis (P=0.017 and 0.002, respectively). Viruses were much more dynamic than the bacteria as the disease progressed, and the altered microbial interactions were distinctively stage-dependent. The degree centrality of microbial interactions decreased while closeness centrality increased along with the adenoma to cancer development. Uncultured crAssphage was the key bacteriophage that enriched in healthy controls and positively associated with butyrate-producing bacteria. Diagnostic tests based on bacteria by random forest confirmed in independent cohorts showed better performance than viruses for CRC. In conclusion, our study revealed the novel CRC-associated bacteria and viruses that exhibited specific differences and intensive microbial correlations, which provided a reliable diagnostic panel for CRC.
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Affiliation(s)
- Renyuan Gao
- Diagnostic and Treatment Center for Refractory Diseases of Abdomen Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Institute for Intestinal Diseases, Tongji University School of Medicine, Shanghai, China
| | - Yefei Zhu
- Institute for Intestinal Diseases, Tongji University School of Medicine, Shanghai, China.,Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Cheng Kong
- Institute for Intestinal Diseases, Tongji University School of Medicine, Shanghai, China.,Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kai Xia
- Diagnostic and Treatment Center for Refractory Diseases of Abdomen Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Institute for Intestinal Diseases, Tongji University School of Medicine, Shanghai, China
| | - Hao Li
- Institute for Intestinal Diseases, Tongji University School of Medicine, Shanghai, China.,Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yin Zhu
- Institute for Intestinal Diseases, Tongji University School of Medicine, Shanghai, China.,Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaohui Zhang
- Institute for Intestinal Diseases, Tongji University School of Medicine, Shanghai, China.,Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yongqiang Liu
- Institute for Intestinal Diseases, Tongji University School of Medicine, Shanghai, China.,Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui Zhong
- Department of Pediatrics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rong Yang
- Department of Pediatrics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chunqiu Chen
- Diagnostic and Treatment Center for Refractory Diseases of Abdomen Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Institute for Intestinal Diseases, Tongji University School of Medicine, Shanghai, China
| | - Nan Qin
- Institute for Intestinal Diseases, Tongji University School of Medicine, Shanghai, China.,Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huanlong Qin
- Institute for Intestinal Diseases, Tongji University School of Medicine, Shanghai, China.,Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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14
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Future Incidence of Malignant Mesothelioma in South Korea: Updated Projection to 2038. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126614. [PMID: 34205400 PMCID: PMC8296497 DOI: 10.3390/ijerph18126614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/10/2021] [Accepted: 06/13/2021] [Indexed: 11/23/2022]
Abstract
Malignant mesothelioma (MM) is a cancer that is largely caused by exposure to asbestos. Although asbestos is no longer used in South Korea, the incidence of MM continues to increase due to its long latent period. We aimed to update the previous prediction of MM incidence until 2038. We predicted the incidence of MM over the next 20 years (2019–2038) in South Korea using Møller’s age–period–cohort (APC) model and a Poisson regression model based on asbestos consumption. The APC model predicted that the crude incidence rate would increase sharply in men and slowly in women. Despite the sex discrepancy in the rate of increase, the incidence rate for both sexes is expected to continue increasing until 2038. In the Poisson model, the crude incidence rate was predicted to increase continuously until 2038, and far more cases of MM were predicted to occur compared with the results of the APC model. When compared with actual incidence data, the APC model was deemed more suitable than the Poisson model. The APC model predicted a continuous increase over the next 20 years with no peak, suggesting that the incidence of MM will continue to rise far into the future.
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15
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Imperiale TF, Monahan PO, Stump TE, Ransohoff DF. Derivation and validation of a predictive model for advanced colorectal neoplasia in asymptomatic adults. Gut 2021; 70:1155-1161. [PMID: 32994311 DOI: 10.1136/gutjnl-2020-321698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/27/2020] [Accepted: 08/30/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Knowing risk for advanced colorectal neoplasia (AN) could help patients and providers choose among screening tests, improving screening efficiency and uptake. We created a risk prediction model for AN to help decide which test might be preferred, a use not considered for existing models. DESIGN Average-risk 50-to-80-year olds undergoing first-time screening colonoscopy were recruited from endoscopy units in Indiana. We measured sociodemographic and physical features, medical and family history and lifestyle factors and linked these to the most advanced finding. We derived a risk equation on two-thirds of the sample and assigned points to each variable to create a risk score. Scores with comparable risks were collapsed into risk categories. The model and score were tested on the remaining sample. RESULTS Among 3025 subjects in the derivation set (mean age 57.3 (6.5) years; 52% women), AN prevalence was 9.4%. The 13-variable model (c-statistic=0.77) produced three risk groups with AN risks of 1.5% (95% CI 0.72% to 2.74%), 7.06% (CI 5.89% to 8.38%) and 27.26% (CI 23.47% to 31.30%) in low-risk, intermediate-risk and high-risk groups (p value <0.001), containing 23%, 59% and 18% of subjects, respectively. In the validation set of 1475 subjects (AN prevalence of 8.4%), model performance was comparable (c-statistic=0.78), with AN risks of 2.73% (CI 1.25% to 5.11%), 5.57% (CI 4.12% to 7.34%) and 25.79% (CI 20.51% to 31.66%) in low-risk, intermediate-risk and high-risk subgroups, respectively (p<0.001), containing proportions of 23%, 59% and 18%. CONCLUSION Among average-risk persons, this model estimates AN risk with high discrimination, identifying a lower risk subgroup that may be screened non-invasively and a higher risk subgroup for which colonoscopy may be preferred. The model could help guide patient-provider discussions of screening options, may increase screening adherence and conserve colonoscopy resources.
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Affiliation(s)
- Thomas F Imperiale
- Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA .,Center for Innovation, Health Services Research and Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA.,The Regenstrief Institute Inc, Indianapolis, IN, USA
| | - Patrick O Monahan
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Timothy E Stump
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David F Ransohoff
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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16
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Fang Z, Hang D, Wang K, Joshi A, Wu K, Chan AT, Ogino S, Giovannucci EL, Song M. Risk prediction models for colorectal cancer: Evaluating the discrimination due to added biomarkers. Int J Cancer 2021; 149:1021-1030. [PMID: 33948940 DOI: 10.1002/ijc.33621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/07/2021] [Accepted: 04/20/2021] [Indexed: 02/05/2023]
Abstract
Most risk prediction models for colorectal cancer (CRC) are based on questionnaires and show a modest discriminatory ability. Therefore, we aim to develop risk prediction models incorporating plasma biomarkers for CRC to improve discrimination. We assessed the predictivity of 11 biomarkers in 736 men in the Health Professionals Follow-up Study and 639 women in the Nurses' Health Study. We used stepwise logistic regression to examine whether a set of biomarkers improved the predictivity on the basis of predictors in the National Cancer Institute's (NCI) Colorectal Cancer Risk Assessment Tool. Model discrimination was assessed using C-statistics. Bootstrap with 500 randomly sampled replicates was used for internal validation. The models containing each biomarker generated a C-statistic ranging from 0.50 to 0.59 in men and 0.50 to 0.54 in women. The NCI model demonstrated a C-statistic (95% CI) of 0.67 (0.62-0.71) in men and 0.58 (0.54-0.63) in women. Through stepwise selection of biomarkers, the C-statistic increased to 0.70 (0.66-0.74) in men after adding growth/differentiation factor 15, total adiponectin, sex hormone binding globulin and tumor necrosis factor receptor superfamily member 1B (P for difference = 0.008); and increased to 0.62 (0.57-0.66) in women after further including insulin-like growth factor 1 and insulin-like growth factor-binding protein 3 (P for difference = .06). The NCI + selected biomarkers model was internally validated with a C-statistic (95% CI) of 0.73 (0.70-0.77) in men and 0.66 (0.61-0.70) in women. Circulating plasma biomarkers may improve the performance of risk factor-based prediction model for CRC.
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Affiliation(s)
- Zhe Fang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Dong Hang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Kai Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Amit Joshi
- Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kana Wu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Shuji Ogino
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Edward L Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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17
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Randomized Controlled Trial of Personalized Colorectal Cancer Risk Assessment vs Education to Promote Screening Uptake. Am J Gastroenterol 2021; 116:391-400. [PMID: 33009045 DOI: 10.14309/ajg.0000000000000963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 08/27/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Risk stratification has been proposed as a strategy to improve participation in colorectal cancer (CRC) screening, but evidence is lacking. We performed a randomized controlled trial of risk stratification using the National Cancer Institute's Colorectal Cancer Risk Assessment Tool (CCRAT) on screening intent and completion. METHODS A total of 230 primary care patients eligible for first-time CRC screening were randomized to risk assessment via CCRAT or education control. Follow-up of screening intent and completion was performed by record review and phone at 6 and 12 months. We analyzed change in intent after intervention, time to screening, overall screening completion rates, and screening completion by CCRAT risk score tertile. RESULTS Of the patients, 61.7% of patients were aged <60 years, 58.7% female, and 94.3% with college or higher education. Time to screening did not differ between arms (hazard ratio 0.78 [95% confidence interval (CI) 0.52-1.18], P = 0.24). At 12 months, screening completion was 38.6% with CCRAT vs 44.0% with education (odds ratio [OR] 0.80 [95% CI 0.47-1.37], P = 0.41). Changes in screening intent did not differ between the risk assessment and education arms (precontemplation to contemplation: OR 1.52 [95% CI 0.81-2.86], P = 0.19; contemplation to precontemplation: OR 1.93 [95% CI 0.45-8.34], P = 0.38). There were higher screening completion rates at 12 months in the top CCRAT risk tertile (52.6%) vs the bottom (32.4%) and middle (31.6%) tertiles (P = 0.10). DISCUSSION CCRAT risk assessment did not increase screening participation or intent. Risk stratification might motivate persons classified as higher CRC risk to complete screening, but unintentionally discourage screening among persons not identified as higher risk.
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18
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Aleksandrova K, Reichmann R, Kaaks R, Jenab M, Bueno-de-Mesquita HB, Dahm CC, Eriksen AK, Tjønneland A, Artaud F, Boutron-Ruault MC, Severi G, Hüsing A, Trichopoulou A, Karakatsani A, Peppa E, Panico S, Masala G, Grioni S, Sacerdote C, Tumino R, Elias SG, May AM, Borch KB, Sandanger TM, Skeie G, Sánchez MJ, Huerta JM, Sala N, Gurrea AB, Quirós JR, Amiano P, Berntsson J, Drake I, van Guelpen B, Harlid S, Key T, Weiderpass E, Aglago EK, Cross AJ, Tsilidis KK, Riboli E, Gunter MJ. Development and validation of a lifestyle-based model for colorectal cancer risk prediction: the LiFeCRC score. BMC Med 2021; 19:1. [PMID: 33390155 PMCID: PMC7780676 DOI: 10.1186/s12916-020-01826-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/23/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Nutrition and lifestyle have been long established as risk factors for colorectal cancer (CRC). Modifiable lifestyle behaviours bear potential to minimize long-term CRC risk; however, translation of lifestyle information into individualized CRC risk assessment has not been implemented. Lifestyle-based risk models may aid the identification of high-risk individuals, guide referral to screening and motivate behaviour change. We therefore developed and validated a lifestyle-based CRC risk prediction algorithm in an asymptomatic European population. METHODS The model was based on data from 255,482 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study aged 19 to 70 years who were free of cancer at study baseline (1992-2000) and were followed up to 31 September 2010. The model was validated in a sample comprising 74,403 participants selected among five EPIC centres. Over a median follow-up time of 15 years, there were 3645 and 981 colorectal cancer cases in the derivation and validation samples, respectively. Variable selection algorithms in Cox proportional hazard regression and random survival forest (RSF) were used to identify the best predictors among plausible predictor variables. Measures of discrimination and calibration were calculated in derivation and validation samples. To facilitate model communication, a nomogram and a web-based application were developed. RESULTS The final selection model included age, waist circumference, height, smoking, alcohol consumption, physical activity, vegetables, dairy products, processed meat, and sugar and confectionary. The risk score demonstrated good discrimination overall and in sex-specific models. Harrell's C-index was 0.710 in the derivation cohort and 0.714 in the validation cohort. The model was well calibrated and showed strong agreement between predicted and observed risk. Random survival forest analysis suggested high model robustness. Beyond age, lifestyle data led to improved model performance overall (continuous net reclassification improvement = 0.307 (95% CI 0.264-0.352)), and especially for young individuals below 45 years (continuous net reclassification improvement = 0.364 (95% CI 0.084-0.575)). CONCLUSIONS LiFeCRC score based on age and lifestyle data accurately identifies individuals at risk for incident colorectal cancer in European populations and could contribute to improved prevention through motivating lifestyle change at an individual level.
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Affiliation(s)
- Krasimira Aleksandrova
- Nutrition, Immunity and Metabolism Senior Scientist Group, Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany.
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany.
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
| | - Robin Reichmann
- Nutrition, Immunity and Metabolism Senior Scientist Group, Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mazda Jenab
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - H Bas Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | | | | | | | - Fanny Artaud
- CESP, Faculté de Medicine, Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
| | | | - Gianluca Severi
- CESP, Faculté de Medicine, Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
- Dipartimento di Statistica, Informatica e Applicazioni "G. Parenti" (DISIA), University of Florence, Florence, Italy
| | - Anika Hüsing
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece
| | | | - Salvatore Panico
- EPIC Centre of Naples, Dipartimento di Medicina Clinica e Chirurgia, University of Naples Federico II, Naples, Italy
| | - Giovanna Masala
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP), Ragusa, Italy
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kristin B Borch
- Department of Community Medicine, Health Faculty, UiT-the Arctic university of Norway, Tromsø, Norway
| | - Torkjel M Sandanger
- Department of Community Medicine, Health Faculty, UiT-the Arctic university of Norway, Tromsø, Norway
| | - Guri Skeie
- Department of Community Medicine, Health Faculty, UiT-the Arctic university of Norway, Tromsø, Norway
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universidad de Granada, Granada, Spain
| | - José María Huerta
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Núria Sala
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Translational Research Laboratory, Catalan Institute of Oncology (ICO), Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Aurelio Barricarte Gurrea
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | | | - Pilar Amiano
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Ministry of Health of the Basque Government, Public Health Division of Gipuzkoa, Biodonostia Health Research Institute, Donostia-San Sebastian, Spain
| | - Jonna Berntsson
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Isabel Drake
- Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
| | - Bethany van Guelpen
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Sophia Harlid
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Tim Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Elom K Aglago
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Marc J Gunter
- International Agency for Research on Cancer, World Health Organization, Lyon, France
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AGA White Paper: Roadmap for the Future of Colorectal Cancer Screening in the United States. Clin Gastroenterol Hepatol 2020; 18:2667-2678.e2. [PMID: 32634626 DOI: 10.1016/j.cgh.2020.06.053] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/26/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023]
Abstract
The American Gastroenterological Association's Center for Gastrointestinal Innovation and Technology convened a consensus conference in December 2018, entitled, "Colorectal Cancer Screening and Surveillance: Role of Emerging Technology and Innovation to Improve Outcomes." The goal of the conference, which attracted more than 60 experts in screening and related disciplines, including the authors, was to envision a future in which colorectal cancer (CRC) screening and surveillance are optimized, and to identify barriers to achieving that future. This White Paper originates from that meeting and delineates the priorities and steps needed to improve CRC outcomes, with the goal of minimizing CRC morbidity and mortality. A one-size-fits-all approach to CRC screening has not and is unlikely to result in increased screening uptake or desired outcomes owing to barriers stemming from behavioral, cultural, and socioeconomic causes, especially when combined with inefficiencies in deployment of screening technologies. Overcoming these barriers will require the following: efficient utilization of multiple screening modalities to achieve increased uptake; continued development of noninvasive screening tests, with iterative reassessments of how best to integrate new technologies; and improved personal risk assessment to better risk-stratify patients for appropriate screening testing paradigms.
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Miao YD, Wang JT, Yang Y, Ma XP, Mi DH. Identification of prognosis-associated immune genes and exploration of immune cell infiltration in colorectal cancer. Biomark Med 2020; 14:1353-1369. [PMID: 33064017 DOI: 10.2217/bmm-2020-0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022] Open
Abstract
Aim: To identify prognosis-related immune genes (PRIGs) and construct a prognosis model of colorectal cancer (CRC) patients for clinical use. Materials & methods: Expression profiles were obtained from The Cancer Genome Atlas database and identified differentially expressed PRIGs of CRC. Results: A prognostic model was conducted based on nine PRIGs. The risk score, based on prognosis model, was an independent prognostic predictor. Five PRIGs and risk score were significantly associated with the clinical stage of CRC and five immune cells related to the risk score. Conclusion: The risk score was an independent prognostic biomarker for CRC patients. The research excavated immune genes that were associated with survival and that could be potential biomarkers for prognosis and treatment for CRC patients.
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Affiliation(s)
- Yan-Dong Miao
- The First Clinical Medical College of Lanzhou University, Lanzhou City, Gansu Province, PR China
| | - Jiang-Tao Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou City, Gansu Province, PR China
| | - Yuan Yang
- The First Clinical Medical College of Lanzhou University, Lanzhou City, Gansu Province, PR China
| | - Xue-Ping Ma
- Second People's Hospital of Gansu Province, Lanzhou City, Gansu Province, PR China
| | - Deng-Hai Mi
- The First Clinical Medical College of Lanzhou University, Lanzhou City, Gansu Province, PR China
- Gansu Academy of Traditional Chinese medicine, Lanzhou City, Gansu Province, PR China
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21
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Dwomoh D, Adu B, Dodoo D, Theisen M, Iddi S, Gerds TA. Evaluating the predictive performance of malaria antibodies and FCGR3B gene polymorphisms on Plasmodium falciparum infection outcome: a prospective cohort study. Malar J 2020; 19:307. [PMID: 32854708 PMCID: PMC7450914 DOI: 10.1186/s12936-020-03381-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 08/19/2020] [Indexed: 12/03/2022] Open
Abstract
Background Malaria antigen-specific antibodies and polymorphisms in host receptors involved in antibody functionality have been associated with different outcomes of Plasmodium falciparum infections. Thus, to identify key prospective malaria antigens for vaccine development, there is the need to evaluate the associations between malaria antibodies and antibody dependent host factors with more rigorous statistical methods. In this study, different statistical models were used to evaluate the predictive performance of malaria-specific antibodies and host gene polymorphisms on P. falciparum infection in a longitudinal cohort study involving Ghanaian children. Methods Models with different functional forms were built using known predictors (age, sickle cell status, blood group status, parasite density, and mosquito bed net use) and malaria antigen-specific immunoglobulin (Ig) G and IgG subclasses and FCGR3B polymorphisms shown to mediate antibody-dependent cellular functions. Malaria antigens studied were Merozoite surface proteins (MSP-1 and MSP-3), Glutamate Rich Protein (GLURP)-R0, R2, and the Apical Membrane Antigen (AMA-1). The models were evaluated through visualization and assessment of differences between the Area Under the Receiver Operating Characteristic Curve and Brier Score estimated by suitable internal cross-validation designs. Results This study found that the FCGR3B-c.233C>A genotype and IgG against AMA1 were relatively better compared to the other antibodies and FCGR3B genotypes studied in classifying or predicting malaria risk among children. Conclusions The data supports the P. falciparum, AMA1 as an important malaria vaccine antigen, while FCGR3B-c.233C>A under the additive and dominant models of inheritance could be an important modifier of the effect of malaria protective antibodies.
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Affiliation(s)
- Duah Dwomoh
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana.
| | - Bright Adu
- Department of Immunology, Noguchi Memorial Institute of Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Daniel Dodoo
- Department of Immunology, Noguchi Memorial Institute of Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Michael Theisen
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark.,Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Samuel Iddi
- Department of Statistics and Actuarial Sciences, University of Ghana, Accra, Ghana
| | - Thomas A Gerds
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Juchli F, Zangger M, Schueck A, von Wolff M, Stute P. Chronic non-communicable disease risk calculators - An overview, part I. Maturitas 2020; 143:25-35. [PMID: 33308633 DOI: 10.1016/j.maturitas.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/21/2020] [Accepted: 07/28/2020] [Indexed: 11/26/2022]
Abstract
This review identifies the different risk assessment tools that stratify the individual's risk of four of the eight leading causes of death in women: breast cancer, lung cancer, colorectal cancer and osteoporosis. It will be followed by the publication of a second paper that summarizes the risk assessment tools for the other four leading causes of death (myocardial infarction, stroke, diabetes mellitus type 2 and dementia). The different tools were compared by their use of different variables and validation criteria. To corroborate the validation process, validation study papers were considered for each risk assessment tool. Four tables, one for each illness, were designed. The tables provide an outline for each risk assessment tool, which includes its inventor/company, required variables, advantages, disadvantages and validity. These tables simplify the comparison of the different tools and enable the identification of the most suitable one for each patient.
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Affiliation(s)
- Fabienne Juchli
- Department of General Internal Medicine, Muri Hospital, Muri, Switzerland
| | - Martina Zangger
- Department of General Internal Medicine, Thun Hospital, Thun, Switzerland
| | - Andrea Schueck
- Department of Anesthesiology, Lachen Hospital, Lachen, Switzerland
| | - Michael von Wolff
- Department of Obstetrics and Gynecology, University Women's Hospital, Bern, Switzerland
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Women's Hospital, Bern, Switzerland.
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Tian T, Bi H, Liu Y, Li G, Zhang Y, Cao L, Hu F, Zhao Y, Yuan H. Copy number variation of ubiquitin- specific proteases genes in blood leukocytes and colorectal cancer. Cancer Biol Ther 2020; 21:637-646. [PMID: 32364424 PMCID: PMC7515516 DOI: 10.1080/15384047.2020.1750860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 03/12/2020] [Accepted: 03/25/2020] [Indexed: 12/23/2022] Open
Abstract
Ubiquitin-specific proteases (USPs) play important roles in the regulation of many cancer-related biological processes. USPs copy number variation (CNVs) may affect the risk and prognosis of colorectal cancer (CRC). We detected CNVs of USPs genes in 468 matched CRC patients and controls, estimated the associations between the USPs genes CNVs and CRC risk and prognosis and their interactions with environmental factors on CRC risk. Finally, we generated five CRC risk predictive models with different CNVs patterns combining with environmental factors (EF). We identified significant association between CYLD deletion and CRC risk (ORadj = 4.18, 95% CI: 2.03-8.62), significant association between USP9X amplification and CRC risk (ORadj = 2.30, 95% CI: 1.48-3.57), and significant association between USP11 deletion and CRC risk (ORadj = 3.49, 95% CI: 1.49-8.64). There were significant gene-environment and gene-gene interactions on CRC risk. The area under the receiver operating characteristic curve (AUC) of EF + SIG (deletion of CYLD and USP11, amplification of USP9X) model was significantly larger than any other models (AUC = 0.75, 95% CI: 0.74-0.77). We did not identify significant associations between CNVs of the three genes and CRC prognosis. CNVs of CYLD, USP9X, and USP11 are significantly associated with the risk of CRC. Gene-gene and gene-environment interactions might also play an important role in the development of CRC.
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Affiliation(s)
- Tian Tian
- Department of Epidemiology, Public Health College of Harbin Medical University, Harbin, P.R. China
| | - Haoran Bi
- Department of Epidemiology, Public Health College of Harbin Medical University, Harbin, P.R. China
| | - Yupeng Liu
- Department of Epidemiology, Public Health College of Harbin Medical University, Harbin, P.R. China
| | - Guangxiao Li
- Department of Epidemiology, Public Health College of Harbin Medical University, Harbin, P.R. China
| | - Yiwei Zhang
- Department of Epidemiology, Public Health College of Harbin Medical University, Harbin, P.R. China
| | - Liming Cao
- Department of Epidemiology, Public Health College of Harbin Medical University, Harbin, P.R. China
| | - Fulan Hu
- Department of Epidemiology, Public Health College of Harbin Medical University, Harbin, P.R. China
| | - Yashuang Zhao
- Department of Epidemiology, Public Health College of Harbin Medical University, Harbin, P.R. China
| | - Huiping Yuan
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin, P.R. China
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Development of a comprehensive health-risk prediction tool for postmenopausal women. ACTA ACUST UNITED AC 2020; 26:1385-1394. [PMID: 31567871 DOI: 10.1097/gme.0000000000001411] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to develop a web-based calculator that predicts the likelihood of experiencing multiple, competing outcomes prospectively over 5, 10, and 15 years. METHODS Baseline demographic and medical data from a healthy and racially and ethnically diverse cohort of 161,808 postmenopausal women, aged 50 to 79 at study baseline, who participated in the Women's Health Initiative (WHI), were used to develop and evaluate a risk-prediction calculator designed to predict individual risk for morbidity and mortality outcomes. Women were enrolled from 40 sites arranged in four regions of the United States. The calculator predicts all-cause mortality, adjudicated outcomes of health events (ie, myocardial infarction [MI], stroke, and hip fracture), and disease (lung, breast, and colorectal cancer). A proportional subdistribution hazards regression model was used to develop the calculator in a training dataset using data from three regions. The calculator was evaluated using the C-statistic in a test dataset with data from the fourth region. RESULTS The predictive validity of our calculator measured by the C-statistic in the test dataset for a first event at 5 and 15 years was as follows: MI 0.77, 0.61, stroke 0.77, 0.72, lung cancer 0.82, 0.79, breast cancer 0.60, 0.59, colorectal cancer 0.67, 0.60, hip fracture 0.79, 0.76, and death 0.74, 0.72. CONCLUSION This study represents the first large-scale study to develop a risk prediction calculator that yields health risk prediction for several outcomes simultaneously. Development of this tool is a first step toward enabling women to prioritize interventions that may decrease these risks. : Video Summary:http://links.lww.com/MENO/A463.
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25
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Matthias MS, Imperiale TF. A risk prediction tool for colorectal cancer screening: a qualitative study of patient and provider facilitators and barriers. BMC FAMILY PRACTICE 2020; 21:43. [PMID: 32102659 PMCID: PMC7045431 DOI: 10.1186/s12875-020-01113-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 02/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Despite proven effectiveness of colorectal cancer (CRC) screening, at least 35% of screen-eligible adults are not current with screening. Decision aids and risk prediction tools may help increase uptake, adherence, and efficiency of CRC screening by presenting lower-risk patients with options less invasive than colonoscopy. The purpose of this qualitative study was to determine patient and provider perceptions of facilitators and barriers to use of a risk prediction tool for advanced colorectal neoplasia (CRC and advanced, precancerous polyps), to maximize its chances of successful clinical implementation. METHODS We conducted qualitative, semi-structured interviews with patients aged 50-75 years who were not current with CRC screening, and primary care providers (PCPs) at an academic and a U.S. Department of Veterans Affairs Medical Center in the Midwest from October 2016 through March 2017. Participants were asked about their current experiences discussing CRC screening, then were shown the risk tool and asked about its acceptability, barriers, facilitators, and whether they would use it to guide their choice of a screening test. The constant comparative method guided analysis. RESULTS Thirty patients and PCPs participated. Among facilitators were the tool's potential to increase screening uptake, reduce patient risk, improve resource allocation, and facilitate discussion about CRC screening. PCP-identified barriers included concerns about the tool's accuracy, consistency with guidelines, and time constraints. CONCLUSIONS Patients and PCPs found the risk prediction tool useful, with potential to increase uptake, safety, and efficiency of CRC screening, indicating potential acceptability and feasibility of implementation into clinical practice.
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Affiliation(s)
- Marianne S Matthias
- Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, 1481 W. 10th Street 11H, Indianapolis, IN, 46202, USA.
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
- Regenstrief Institute, Inc, Indianapolis, IN, USA.
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
| | - Thomas F Imperiale
- Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, 1481 W. 10th Street 11H, Indianapolis, IN, 46202, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
- Richard M Fairbanks School of Public Health, Indiana University-Purdue University of Indianapolis, Indianapolis, USA
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Olson JE, Kirsch EJ, Edwards V DK, Kirt CR, Kneedler B, Laffin JJ, Weaver AL, St Sauver JL, Yost KJ, Finney Rutten LJ. Colorectal cancer outcomes after screening with the multi-target stool DNA assay: protocol for a large-scale, prospective cohort study (the Voyage study). BMJ Open Gastroenterol 2020; 7:e000353. [PMID: 32128228 PMCID: PMC7039604 DOI: 10.1136/bmjgast-2019-000353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/26/2019] [Accepted: 01/07/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction Population-level screening has been shown to reduce the incidence and mortality of colorectal cancer (CRC). Unfortunately, adherence to screening recommendations among eligible US adults remains below national goals. A relatively new non-invasive screening modality, the Food and Drug Administration-approved multi-target stool DNA (mt-sDNA) assay (commercialised as Cologuard), which combines the detection of haemoglobin and DNA abnormalities, has been completed by more than 3 million individuals. Given mt-sDNA's recent availability, the effectiveness of mt-sDNA screening with respect to CRC incidence and mortality reduction has not yet been established. Methods and analysis Through an academic-industry collaboration, a prospective cohort study (Voyage) was designed with an initial enrolment target of 150 000 individuals with mt-sDNA ordered by their healthcare provider for CRC screening. Consented participants will be asked to complete a baseline questionnaire to collect sociodemographic and health information. Additional questionnaires will be provided after 1 year, and every 3 years thereafter, to collect data regarding CRC screening follow-up in order to estimate rates of CRC incidence and other health outcomes. Linkage to the National Death Index will be used to estimate mortality rates. Ethics and dissemination The Voyage study will be conducted in accordance with international guidelines and local regulatory requirements and laws. Data will be stored and retained at Mayo Clinic. Only limited data elements required for research purposes will be transmitted between Mayo Clinic and Exact Sciences Laboratories. Results of the Voyage study will be disseminated through scientific presentations and publications. Trial registration number NCT04124406.
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Affiliation(s)
- Janet E Olson
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Emily J Kirsch
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | | | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer L St Sauver
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathleen J Yost
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
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Miao Y, Li Q, Wang J, Quan W, Li C, Yang Y, Mi D. Prognostic implications of metabolism-associated gene signatures in colorectal cancer. PeerJ 2020; 8:e9847. [PMID: 32953273 PMCID: PMC7474523 DOI: 10.7717/peerj.9847] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common and deadly malignancies. Novel biomarkers for the diagnosis and prognosis of this disease must be identified. Besides, metabolism plays an essential role in the occurrence and development of CRC. This article aims to identify some critical prognosis-related metabolic genes (PRMGs) and construct a prognosis model of CRC patients for clinical use. We obtained the expression profiles of CRC from The Cancer Genome Atlas database (TCGA), then identified differentially expressed PRMGs by R and Perl software. Hub genes were filtered out by univariate Cox analysis and least absolute shrinkage and selection operator Cox analysis. We used functional enrichment analysis methods, such as Gene Ontology, Kyoto Encyclopedia of Genes and Genomes, and Gene Set Enrichment Analysis, to identify involved signaling pathways of PRMGs. The nomogram predicted overall survival (OS). Calibration traces were used to evaluate the consistency between the actual and the predicted survival rate. Finally, a prognostic model was constructed based on six metabolic genes (NAT2, XDH, GPX3, AKR1C4, SPHK1, and ADCY5), and the risk score was an independent prognostic prognosticator. Genetic expression and risk score were significantly correlated with clinicopathologic characteristics of CRC. A nomogram based on the clinicopathological feature of CRC and risk score accurately predicted the OS of individual CRC cancer patients. We also validated the results in the independent colorectal cancer cohorts GSE39582 and GSE87211. Our study demonstrates that the risk score is an independent prognostic biomarker and is closely correlated with the malignant clinicopathological characteristics of CRC patients. We also determined some metabolic genes associated with the survival and clinical stage of CRC as potential biomarkers for CRC diagnosis and treatment.
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Affiliation(s)
- Yandong Miao
- The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, PR China
| | - Qiutian Li
- Department of Oncology, The 920th Hospital of the Chinese People’s Liberation Army Joint Logistic Support Force, Kunming City, Yunnan Province, PR China
| | - Jiangtao Wang
- The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, PR China
| | - Wuxia Quan
- Qingyang People’s Hospital, Qingyang City, Gansu Province, PR China
| | - Chen Li
- The 3rd Affiliated Hospital, Kunming Medical College, Tumor Hospital of Yunnan Province, Kunming City, Yunnan Province, PR China
| | - Yuan Yang
- The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, PR China
| | - Denghai Mi
- The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, PR China
- Gansu Academy of Traditional Chinese Medicine, Lanzhou City, Gansu Province, PR China
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28
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Ladabaum U, Mannalithara A, Mitani A, Desai M. Clinical and Economic Impact of Tailoring Screening to Predicted Colorectal Cancer Risk: A Decision Analytic Modeling Study. Cancer Epidemiol Biomarkers Prev 2019; 29:318-328. [PMID: 31796524 DOI: 10.1158/1055-9965.epi-19-0949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/26/2019] [Accepted: 11/26/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Global increases in colorectal cancer risk have spurred debate about optimal use of screening resources. We explored the potential clinical and economic impact of colorectal cancer screening tailored to predicted colorectal cancer risk. METHODS We compared screening tailored to predicted risk versus uniform screening in a validated decision analytic model, considering the average risk population's actual colorectal cancer risk distribution, and a risk-prediction tool's discriminatory ability and cost. Low, moderate, and high risk tiers were identified as colorectal cancer risk after age 50 years of ≤3%, >3 to <12%, and ≥12%, respectively, based on threshold analyses with willingness-to-pay <$50,000/quality-adjusted life-year (QALY) gained. Tailored colonoscopy (once at age 60 years for low risk, every 10 years for moderate risk, and every 5 years for high risk) was compared with colonoscopy every 10 years for all. Tailored fecal immunochemical testing (FIT)/colonoscopy (annual FIT for low and moderate risk, colonoscopy every 5 years for high risk) was compared with annual FIT for all. RESULTS Assuming no colorectal cancer risk misclassification or risk-prediction tool costs, tailored screening was preferred over uniform screening. Tailored colonoscopy was minimally less effective than uniform colonoscopy, but saved $90,200-$889,000/QALY; tailored FIT/colonoscopy yielded more QALYs/person than annual FIT at $10,600-$60,000/QALY gained. Relatively modest colorectal cancer risk misclassification rates or risk-prediction tool costs resulted in uniform screening as the preferred approach. CONCLUSIONS Current risk-prediction tools may not yet be accurate enough to optimize colorectal cancer screening. IMPACT Uniform screening is likely to be preferred over tailored screening if a risk-prediction tool is associated with even modest misclassification rates or costs.
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Affiliation(s)
- Uri Ladabaum
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California. .,Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Ajitha Mannalithara
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California.,Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Aya Mitani
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Manisha Desai
- Department of Medicine, Stanford University School of Medicine, Stanford, California.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
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Musselwhite LW, Redding TS, Sims KJ, O'Leary MC, Hauser ER, Hyslop T, Gellad ZF, Sullivan BA, Lieberman D, Provenzale D. Advanced neoplasia in Veterans at screening colonoscopy using the National Cancer Institute Risk Assessment Tool. BMC Cancer 2019; 19:1097. [PMID: 31718588 PMCID: PMC6852743 DOI: 10.1186/s12885-019-6204-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/24/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Adapting screening strategy to colorectal cancer (CRC) risk may improve efficiency for all stakeholders however limited tools for such risk stratification exist. Colorectal cancers usually evolve from advanced neoplasms that are present for years. We applied the National Cancer Institute (NCI) CRC Risk Assessment Tool, which calculates future risk of CRC, to determine whether it could be used to predict current advanced neoplasia (AN) in a veteran cohort undergoing a baseline screening colonoscopy. METHODS This was a prospective assessment of the relationship between future CRC risk predicted by the NCI tool, and the presence of AN at screening colonoscopy. Family, medical, dietary and physical activity histories were collected at the time of screening colonoscopy and used to calculate absolute CRC risk at 5, 10 and 20 years. Discriminatory accuracy was assessed. RESULTS Of 3121 veterans undergoing screening colonoscopy, 94% had complete data available to calculate risk (N = 2934, median age 63 years, 100% men, and 15% minorities). Prevalence of AN at baseline screening colonoscopy was 11 % (N = 313). For tertiles of estimated absolute CRC risk at 5 years, AN prevalences were 6.54% (95% CI, 4.99, 8.09), 11.26% (95% CI, 9.28-13.24), and 14.21% (95% CI, 12.02-16.40). For tertiles of estimated risk at 10 years, the prevalences were 6.34% (95% CI, 4.81-7.87), 11.25% (95% CI, 9.27-13.23), and 14.42% (95% CI, 12.22-16.62). For tertiles of estimated absolute CRC risk at 20 years, current AN prevalences were 7.54% (95% CI, 5.75-9.33), 10.53% (95% CI, 8.45-12.61), and 12.44% (95% CI, 10.2-14.68). The area under the curve for predicting current AN was 0.60 (95% CI; 0.57-0.63, p < 0.0001) at 5 years, 0.60 (95% CI, 0.57-0.63, p < 0.0001) at 10 years and 0.58 (95% CI, 0.54-0.61, p < 0.0001) at 20 years. CONCLUSION The NCI tool had modest discriminatory function for estimating the presence of current advanced neoplasia in veterans undergoing a first screening colonoscopy. These findings are comparable to other clinically utilized cancer risk prediction models and may be used to inform the benefit-risk assessment of screening, particularly for patients with competing comorbidities and lower risk, for whom a non-invasive screening approach is preferred.
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Affiliation(s)
- Laura W Musselwhite
- VA Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.,Levine Cancer Institute, Atrium Health, 100 Medical Park Drive, Suite 110 Concord, Charlotte, NC, 28025, USA
| | - Thomas S Redding
- VA Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Kellie J Sims
- VA Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Meghan C O'Leary
- VA Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Elizabeth R Hauser
- VA Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.,Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA
| | - Terry Hyslop
- Duke University Medical Center, Duke University, 2424 Erwin Road, 8037 Hock Plaza, Durham, NC, 27705, USA
| | - Ziad F Gellad
- VA Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Brian A Sullivan
- VA Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - David Lieberman
- Veterans Affairs Portland Health Care System, 3710 Sw US Veterans Hospital Road, Portland, OR, 97239, USA.,Oregon Health & Science University, 3181 Sw Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Dawn Provenzale
- VA Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA. .,Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
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30
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Yang J, McDowell A, Kim EK, Seo H, Lee WH, Moon CM, Kym SM, Lee DH, Park YS, Jee YK, Kim YK. Development of a colorectal cancer diagnostic model and dietary risk assessment through gut microbiome analysis. Exp Mol Med 2019; 51:1-15. [PMID: 31582724 PMCID: PMC6802675 DOI: 10.1038/s12276-019-0313-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/09/2019] [Accepted: 06/25/2019] [Indexed: 12/15/2022] Open
Abstract
Colorectal cancer (CRC) is the third most common form of cancer and poses a critical public health threat due to the global spread of westernized diets high in meat, cholesterol, and fat. Although the link between diet and colorectal cancer has been well established, the mediating role of the gut microbiota remains elusive. In this study, we sought to elucidate the connection between the gut microbiota, diet, and CRC through metagenomic analysis of bacteria isolated from the stool of CRC (n = 89) and healthy (n = 161) subjects. This analysis yielded a dozen genera that were significantly altered in CRC patients, including increased Bacteroides, Fusobacterium, Dorea, and Porphyromonas prevalence and diminished Pseudomonas, Prevotella, Acinetobacter, and Catenibacterium carriage. Based on these altered genera, we developed two novel CRC diagnostic models through stepwise selection and a simplified model using two increased and two decreased genera. As both models yielded strong AUC values above 0.8, the simplified model was applied to assess diet-based CRC risk in mice. Mice fed a westernized high-fat diet (HFD) showed greater CRC risk than mice fed a regular chow diet. Furthermore, we found that nonglutinous rice, glutinous rice, and sorghum consumption reduced CRC risk in HFD-fed mice. Collectively, these findings support the critical mediating role of the gut microbiota in diet-induced CRC risk as well as the potential of dietary grain intake to reduce microbiota-associated CRC risk. Further study is required to validate the diagnostic prediction models developed in this study as well as the preventive potential of grain consumption to reduce CRC risk.
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Affiliation(s)
- Jinho Yang
- MD Healthcare Inc., Seoul, Republic of Korea
- Department of Health and Safety Convergence Science, Korea University, Seoul, Republic of Korea
| | | | | | - Hochan Seo
- MD Healthcare Inc., Seoul, Republic of Korea
| | - Won Hee Lee
- MD Healthcare Inc., Seoul, Republic of Korea
| | - Chang-Mo Moon
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sung-Min Kym
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Young-Koo Jee
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea.
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31
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Liao J, Mawditt C, Scholes S, Lu W, Umeda M, Muniz Terrera G, Hao Y, Mejía S. Similarities and differences in health-related behavior clustering among older adults in Eastern and Western countries: A latent class analysis of global aging cohorts. Geriatr Gerontol Int 2019; 19:930-937. [PMID: 31309695 DOI: 10.1111/ggi.13737] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 11/26/2022]
Abstract
AIM To quantify variations in health-related behaviors (HRB) clustering of older adults in Western and Eastern countries. METHODS Using six aging cohorts from the USA, England, Europe, Japan, Korea and China, latent class analysis was applied to access the clustering of smoking, alcohol consumption, physical activity and social activity. RESULTS A total of 104 552 participants (55% women) aged ≥50 years in 2010 were included. Despite a different number of clusters identified, three consistent cluster profiles emerged: "Multiple-HRB" (ex-/never smoking, moderate drinking, frequent physical and social activity); "Inactives" (socially and physically inactive without other risk behaviors); and "(ex-)Smokers with Risk Behaviors". Sex and cohort variations were shown. For men in Western cohorts, "Multiple-HRB" was the predominant cluster, whereas their Asian counterparts were more likely to be members of the "Smokers with risk behavior" and "Inactives" clusters. Most women, particularly those in Asian cohorts, were never smokers and non-drinkers, and most of them belonged to the socially "Inactives" cluster. CONCLUSIONS We provide a person-centered understanding of HRB clustering of older adults over selected countries by sex, informing tailored health promotion for the target population. Geriatr Gerontol Int 2019; 19: 930-937.
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Affiliation(s)
- Jing Liao
- Department of Medical Statistics and Epidemiology, Sun Yat-sen University Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Claire Mawditt
- Derby Teaching Hospitals NHS Foundation Trust, London, UK
| | - Shaun Scholes
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Wentian Lu
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Maki Umeda
- Research Centers, Global Health Nursing, Research Institute of Nursing Care for People and Community, University of Hyogo, Hyogo, Japan
| | - Graciela Muniz Terrera
- Research Centers, Center for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology, Sun Yat-sen University Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Shannon Mejía
- Department of Kinesiology & Community Health College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
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Samarakoon YM, Gunawardena NS, Pathirana A, Perera MN, Hewage SA. Prediction of colorectal cancer risk among adults in a lower middle-income country. J Gastrointest Oncol 2019; 10:445-452. [PMID: 31183194 DOI: 10.21037/jgo.2019.01.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Globally, colorectal cancer (CRC) is ranked as the third most common cancer in men and the second in women. Use of a simple, validated risk prediction tool will offer a low-cost mechanism to identify the high-risk individuals for CRC. This will increase efficient use of limited resources and early identification of patients. The aim of our study was to develop and validate a risk prediction model for developing CRC for Sri Lankan adults. Methods The risk predictors were based on the risk factors identified through a logistic regression model along with expert opinion. A case control design utilizing 65 CRC new cases and 65 hospital controls aged 30 years or more was used to assess the criterion validity and reliability of the model. The information was obtained using an interviewer administered questionnaire based on the risk prediction model. Results The developed model consisted of eight predictors with an area under the curve (AUC) of 0.849 (95% CI: 0.8 to 0.9, P<0.001). It has a sensitivity of 76.9%, specificity of 83.1%, positive predictive value (PPV) of 82.0%, negative predictive value (NPV) of 79.3%. Positive and negative likelihood ratios are 4.6 and 0.3. Test re-test reliability revealed a Kappa coefficient of 0.88. Conclusions The model developed to predict the risk of CRC among adults aged 30 years and above was proven to be valid and reliable and it is an effective tool to be used as the first step to identify the high-risk population who should be referred for colonoscopy examination.
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Affiliation(s)
- Yasara Manori Samarakoon
- National Cancer Control Programme, Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | | | - Aloka Pathirana
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Manuja N Perera
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Sumudu Avanthi Hewage
- National Cancer Control Programme, Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
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Glynn RJ, Colditz GA, Tamimi RM, Chen WY, Hankinson SE, Willett WW, Rosner B. Comparison of Questionnaire-Based Breast Cancer Prediction Models in the Nurses' Health Study. Cancer Epidemiol Biomarkers Prev 2019; 28:1187-1194. [PMID: 31015199 DOI: 10.1158/1055-9965.epi-18-1039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/06/2018] [Accepted: 04/11/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The Gail model and the model developed by Tyrer and Cuzick are two questionnaire-based approaches with demonstrated ability to predict development of breast cancer in a general population. METHODS We compared calibration, discrimination, and net reclassification of these models, using data from questionnaires sent every 2 years to 76,922 participants in the Nurses' Health Study between 1980 and 2006, with 4,384 incident invasive breast cancers identified by 2008 (median follow-up, 24 years; range, 1-28 years). In a random one third sample of women, we also compared the performance of these models with predictions from the Rosner-Colditz model estimated from the remaining participants. RESULTS Both the Gail and Tyrer-Cuzick models showed evidence of miscalibration (Hosmer-Lemeshow P < 0.001 for each) with notable (P < 0.01) overprediction in higher-risk women (2-year risk above about 1%) and underprediction in lower-risk women (risk below about 0.25%). The Tyrer-Cuzick model had slightly higher C-statistics both overall (P < 0.001) and in age-specific comparisons than the Gail model (overall C, 0.63 for Tyrer-Cuzick vs. 0.61 for the Gail model). Evaluation of net reclassification did not favor either model. In the one third sample, the Rosner-Colditz model had better calibration and discrimination than the other two models. All models had C-statistics <0.60 among women ages ≥70 years. CONCLUSIONS Both the Gail and Tyrer-Cuzick models had some ability to discriminate breast cancer cases and noncases, but have limitations in their model fit. IMPACT Refinements may be needed to questionnaire-based approaches to predict breast cancer in older and higher-risk women.
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Affiliation(s)
- Robert J Glynn
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. .,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Graham A Colditz
- Alvin J. Siteman Cancer Center and Department of Surgery, Division of Public Health Sciences, School of Medicine, Washington University of St. Louis, St. Louis, Missouri
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Wendy Y Chen
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Susan E Hankinson
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Division of Biostatistics and Epidemiology, School of Public Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Walter W Willett
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Bernard Rosner
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Smith T, Muller DC, Moons KGM, Cross AJ, Johansson M, Ferrari P, Fagherazzi G, Peeters PHM, Severi G, Hüsing A, Kaaks R, Tjonneland A, Olsen A, Overvad K, Bonet C, Rodriguez-Barranco M, Huerta JM, Barricarte Gurrea A, Bradbury KE, Trichopoulou A, Bamia C, Orfanos P, Palli D, Pala V, Vineis P, Bueno-de-Mesquita B, Ohlsson B, Harlid S, Van Guelpen B, Skeie G, Weiderpass E, Jenab M, Murphy N, Riboli E, Gunter MJ, Aleksandrova KJ, Tzoulaki I. Comparison of prognostic models to predict the occurrence of colorectal cancer in asymptomatic individuals: a systematic literature review and external validation in the EPIC and UK Biobank prospective cohort studies. Gut 2019; 68:672-683. [PMID: 29615487 PMCID: PMC6580880 DOI: 10.1136/gutjnl-2017-315730] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/09/2018] [Accepted: 03/03/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To systematically identify and validate published colorectal cancer risk prediction models that do not require invasive testing in two large population-based prospective cohorts. DESIGN Models were identified through an update of a published systematic review and validated in the European Prospective Investigation into Cancer and Nutrition (EPIC) and the UK Biobank. The performance of the models to predict the occurrence of colorectal cancer within 5 or 10 years after study enrolment was assessed by discrimination (C-statistic) and calibration (plots of observed vs predicted probability). RESULTS The systematic review and its update identified 16 models from 8 publications (8 colorectal, 5 colon and 3 rectal). The number of participants included in each model validation ranged from 41 587 to 396 515, and the number of cases ranged from 115 to 1781. Eligible and ineligible participants across the models were largely comparable. Calibration of the models, where assessable, was very good and further improved by recalibration. The C-statistics of the models were largely similar between validation cohorts with the highest values achieved being 0.70 (95% CI 0.68 to 0.72) in the UK Biobank and 0.71 (95% CI 0.67 to 0.74) in EPIC. CONCLUSION Several of these non-invasive models exhibited good calibration and discrimination within both external validation populations and are therefore potentially suitable candidates for the facilitation of risk stratification in population-based colorectal screening programmes. Future work should both evaluate this potential, through modelling and impact studies, and ascertain if further enhancement in their performance can be obtained.
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Affiliation(s)
- Todd Smith
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - David C Muller
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, Umc Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Mattias Johansson
- International Agency for Research on Cancer (IARC), Genetic Epidemiology Group, Lyon, France
| | - Pietro Ferrari
- Nutritional Methodology and Biostatistics Group (NMB), International Agency for Research on Cancer, Lyon, France
| | - Guy Fagherazzi
- Inserm U1018, Gustave Roussy, Universite Paris-Sud, Villejuif, France
| | - Petra H M Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gianluca Severi
- Inserm U1018, Gustave Roussy, Universite Paris-Sud, Villejuif, France
| | - Anika Hüsing
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Anja Olsen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Catalina Bonet
- Catalan Institute of Oncology-IDIBELL, L’Hospitalet de Llobregat, Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Barcelona, Spain
| | | | - Jose Maria Huerta
- Murcia Regional Health Council, IMIB-Arrixaca, CIBER de Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | | | - Kathryn E Bradbury
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | - Philippos Orfanos
- Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, WHO Collaborating Center for Nutrition and Health, National and Kapodistrian University of Athens, Athens, Greece
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute – ISPO, Florence, Italy
| | - Valeria Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Vineis
- Italian Institute for Genomic Medicine, Turin, Italy
| | - Bas Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Bodil Ohlsson
- Department of Internal Medicine, Lund University, Skane University Hospital, Malmo, Sweden
| | - Sophia Harlid
- Department of Radiation Sciences, Oncology, Umea University, Umea, Sweden
| | | | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromso, The Arctic University of Norway, Tromso, Norway
| | - Elisabete Weiderpass
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Mazda Jenab
- Nutritional Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Neil Murphy
- Nutritional Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Marc J Gunter
- Nutritional Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Krasimira Jekova Aleksandrova
- Nutrition, Immunity and Metabolism Start-up Lab, Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrucke, Germany
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Chi S, Li X, Tian Y, Li J, Kong X, Ding K, Weng C, Li J. Semi-supervised learning to improve generalizability of risk prediction models. J Biomed Inform 2019; 92:103117. [DOI: 10.1016/j.jbi.2019.103117] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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van Bronswijk SC, Lemmens LH, Keefe JR, Huibers MJ, DeRubeis RJ, Peeters FP. A prognostic index for long-term outcome after successful acute phase cognitive therapy and interpersonal psychotherapy for major depressive disorder. Depress Anxiety 2019; 36:252-261. [PMID: 30516871 PMCID: PMC6587800 DOI: 10.1002/da.22868] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/21/2018] [Accepted: 11/08/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) has a highly recurrent nature. After successful treatment, it is important to identify individuals who are at risk of an unfavorable long-term course. Despite extensive research, there is no consensus yet on the clinically relevant predictors of long-term outcome in MDD, and no prediction models are implemented in clinical practice. The aim of this study was to create a prognostic index (PI) to estimate long-term depression severity after successful and high quality acute treatment for MDD. METHODS Data come from responders to cognitive therapy (CT) and interpersonal psychotherapy (IPT) in a randomized clinical trial (n = 85; CT = 45, IPT = 40). Primary outcome was depression severity, assessed with the Beck Depression Inventory II, measured throughout a 17-month follow-up phase. We examined 29 variables as potential predictors, using a model-based recursive partitioning method and bootstrap resampling in conjunction with backwards elimination. The selected predictors were combined into a PI. Individual PI scores were estimated using a cross-validation approach. RESULTS A total of three post-treatment predictors were identified: depression severity, hopelessness, and self-esteem. Cross-validated PI scores evidenced a strong correlation (r = 0.60) with follow-up depression severity. CONCLUSION Long-term predictions of MDD are multifactorial, involving a combination of variables that each has a small prognostic effect. If replicated and validated, the PI can be implemented to predict follow-up depression severity for each individual after acute treatment response, and to personalize long-term treatment strategies.
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Affiliation(s)
- Suzanne C. van Bronswijk
- Department of Psychiatry and PsychologyMaastricht University Medical CenterMaastrichtthe Netherlands,School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht UniversityMaastrichtthe Netherlands
| | - Lotte H.J.M. Lemmens
- Department of Clinical Psychological ScienceMaastricht UniversityMaastrichtthe Netherlands
| | - John R. Keefe
- Department of PsychologyUniversity of PennsylvaniaPhiladelphiaPAUnited States,Department of PsychiatryWeill Cornell Medical CollegeNew YorkUnited States
| | - Marcus J.H. Huibers
- Department of PsychologyUniversity of PennsylvaniaPhiladelphiaPAUnited States,Department of Clinical PsychologyVU University AmsterdamAmsterdamthe Netherlands
| | - Robert J. DeRubeis
- Department of PsychologyUniversity of PennsylvaniaPhiladelphiaPAUnited States
| | - Frenk P.M.L. Peeters
- Department of Psychiatry and PsychologyMaastricht University Medical CenterMaastrichtthe Netherlands,School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht UniversityMaastrichtthe Netherlands
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Sekiguchi M, Kakugawa Y, Matsumoto M, Matsuda T. A scoring model for predicting advanced colorectal neoplasia in a screened population of asymptomatic Japanese individuals. J Gastroenterol 2018; 53:1109-1119. [PMID: 29359244 DOI: 10.1007/s00535-018-1433-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Risk stratification of screened populations could help improve colorectal cancer (CRC) screening. Use of the modified Asia-Pacific Colorectal Screening (APCS) score has been proposed in the Asia-Pacific region. This study was performed to build a new useful scoring model for CRC screening. METHODS Data were reviewed from 5218 asymptomatic Japanese individuals who underwent their first screening colonoscopy. Multivariate logistic regression was used to investigate risk factors for advanced colorectal neoplasia (ACN), and a new scoring model for the prediction of ACN was developed based on the results. The discriminatory capability of the new model and the modified APCS score were assessed and compared. Internal validation was also performed. RESULTS ACN was detected in 225 participants. An 8-point scoring model for the prediction of ACN was developed using five independent risk factors for ACN (male sex, higher age, presence of two or more first-degree relatives with CRC, body mass index of > 22.5 kg/m2, and smoking history of > 18.5 pack-years). The prevalence of ACN was 1.6% (34/2172), 5.3% (127/2419), and 10.2% (64/627) in participants with scores of < 3, ≥ 3 to < 5, and ≥ 5, respectively. The c-statistic of the scoring model was 0.70 (95% confidence interval, 0.67-0.73) in both the development and internal validation sets, and this value was higher than that of the modified APCS score [0.68 (95% confidence interval, 0.65-0.71), P = 0.03]. CONCLUSIONS We built a new simple scoring model for prediction of ACN in a Japanese population that could stratify the screened population into low-, moderate-, and high-risk groups.
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Affiliation(s)
- Masau Sekiguchi
- Cancer Screening Center, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. .,Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan. .,Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
| | - Yasuo Kakugawa
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Minori Matsumoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takahisa Matsuda
- Cancer Screening Center, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.,Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Tariq H, Kamal MU, Patel H, Patel R, Ameen M, Elona S, Khalifa M, Azam S, Zhang A, Kumar K, Baiomi A, Shaikh D, Makker J. Predicting the presence of adenomatous polyps during colonoscopy with National Cancer Institute Colorectal Cancer Risk-Assessment Tool. World J Gastroenterol 2018; 24:3919-3926. [PMID: 30228785 PMCID: PMC6141329 DOI: 10.3748/wjg.v24.i34.3919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 07/25/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the National Cancer Institute (NCI) Colorectal Cancer (CRC) Risk Assessment Tool as a predictor for the presence of adenomatous polyps (AP) found during screening or surveillance colonoscopy.
METHODS This is a retrospective single center observational study. We collected data of adenomatous polyps in each colonoscopy and then evaluated the lifetime CRC risk. We calculated the AP prevalence across risk score quintiles, odds ratios of the prevalence of AP across risk score quintiles, area under curves (AUCs) and Youden’s indexes to assess the optimal risk score cut off value for AP prevalence status.
RESULTS The prevalence of AP gradually increased throughout the five risk score quintiles: i.e., 27.63% in the first and 51.35% in the fifth quintile. The odd ratios of AP prevalence in the fifth quintile compared to the first and second quintile were 2.76 [confidence interval (CI): 1.71-4.47] and 2.09 (CI: 1.32-3.30). The AUC for all patients was 0.62 (CI: 0.58-0.66). Youden’s Index indicated the optimal risk score cutoff value discriminating AP prevalence status was 3.60.
CONCLUSION Patients with the higher NCI risk score have higher risk of AP and subsequent CRC; therefore, measures to increase the effectiveness of CRC detection in these patients include longer withdrawal time, early surveillance colonoscopy, and choosing flexible colonoscopy over other CRC screening modalities.
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Affiliation(s)
- Hassan Tariq
- Division of Gastroenterology, Department of Medicine, BronxCare Health system, Bronx, NY 10457, United States
| | - Muhammad Umar Kamal
- Department of Medicine, BronxCare Health system, Bronx, NY 10457, United States
| | - Harish Patel
- Division of Gastroenterology, Department of Medicine, BronxCare Health system, Bronx, NY 10457, United States
| | - Ravi Patel
- Department of Medicine, BronxCare Health system, Bronx, NY 10457, United States
| | - Muhammad Ameen
- Department of Medicine, BronxCare Health system, Bronx, NY 10457, United States
| | - Shehi Elona
- Department of Medicine, BronxCare Health system, Bronx, NY 10457, United States
| | - Maram Khalifa
- Department of Medicine, BronxCare Health system, Bronx, NY 10457, United States
| | - Sara Azam
- Department of Medicine, BronxCare Health system, Bronx, NY 10457, United States
| | - Aiyi Zhang
- Department of Medicine, BronxCare Health system, Bronx, NY 10457, United States
| | - Kishore Kumar
- Division of Gastroenterology, Department of Medicine, BronxCare Health system, Bronx, NY 10457, United States
| | - Ahmed Baiomi
- Department of Medicine, BronxCare Health system, Bronx, NY 10457, United States
| | - Danial Shaikh
- Department of Medicine, BronxCare Health system, Bronx, NY 10457, United States
| | - Jasbir Makker
- Division of Gastroenterology, Department of Medicine, BronxCare Health system, Bronx, NY 10457, United States
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40
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Addington J, Goldstein BI, Wang JL, Kennedy SH, Bray S, Lebel C, Hassel S, Marshall C, MacQueen G. Youth at-risk for serious mental illness: methods of the PROCAN study. BMC Psychiatry 2018; 18:219. [PMID: 29976184 PMCID: PMC6034268 DOI: 10.1186/s12888-018-1801-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 06/26/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Most mental disorders begin in adolescence; however, there are gaps in our understanding of youth mental health. Clinical and policy gaps arise from our current inability to predict, from amongst all youth who experience mild behavioural disturbances, who will go on to develop a mental illness, what that illness will be, and what can be done to change its course and prevent its worsening to a serious mental illness (SMI). There are also gaps in our understanding of how known risk factors set off neurobiological changes that may play a role in determining who will develop a SMI. Project goals are (i) to identify youth at different stages of risk of SMI so that intervention can begin as soon as possible and (ii) to understand the triggers of these mental illnesses. METHOD This 2-site longitudinal study will recruit 240 youth, ages 12-25, who are at different stages of risk for developing a SMI. The sample includes (a) healthy individuals, (b) symptom-free individuals who have a first-degree relative with a SMI, (c) youth who are experiencing distress and may have mild symptoms of anxiety or depression, and (d) youth who are already demonstrating attenuated symptoms of SMI such as bipolar disorder or psychosis. We will assess, every 6 months for one year, a wide range of clinical and psychosocial factors to determine which factors can be used to predict key outcomes. We will also assess neuroimaging and peripheral markers. We will develop and validate a prediction algorithm that includes demographic, clinical and psychosocial predictors. We will also determine if adding biological markers to our algorithm improves prediction. DISCUSSION Outcomes from this study include an improved clinical staging model for SMI and prediction algorithms that can be used by health care providers as decision-support tools in their practices. Secondly, we may have a greater understanding of clinical, social and cognitive factors associated with the clinical stages of development of a SMI, as well as new insights from neuroimaging and later neurochemical biomarker studies regarding predisposition to SMI development and progression through the clinical stages of illness.
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Affiliation(s)
- Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Mathison Centre, 3280 Hospital Dr NW, Calgary, AB, Calgary, AB T2N 4Z6 Canada
| | - Benjamin I. Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, ON Canada
- Departments of Psychiatry and Pharmacology, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Jian Li Wang
- Work & Mental health Research Unit, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Sidney H. Kennedy
- Department of Psychiatry, University Health Network, Toronto, Ontario Canada
- Department of Psychiatry, St. Michael’s Hospital, Toronto, Ontario Canada
- Arthur Sommer Rotenberg Chair in Suicide and Depression Studies, St. Michael’s Hospital, Toronto, Ontario Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario Canada
| | - Signe Bray
- Department of Radiology, University of Calgary, Calgary, Alberta Canada
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
- Child & Adolescent Imaging Research (CAIR) Program, Calgary, Alberta Canada
| | - Catherine Lebel
- Department of Radiology, University of Calgary, Calgary, Alberta Canada
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
- Child & Adolescent Imaging Research (CAIR) Program, Calgary, Alberta Canada
| | - Stefanie Hassel
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Mathison Centre, 3280 Hospital Dr NW, Calgary, AB, Calgary, AB T2N 4Z6 Canada
| | - Catherine Marshall
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Mathison Centre, 3280 Hospital Dr NW, Calgary, AB, Calgary, AB T2N 4Z6 Canada
| | - Glenda MacQueen
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Mathison Centre, 3280 Hospital Dr NW, Calgary, AB, Calgary, AB T2N 4Z6 Canada
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Usher-Smith JA, Harshfield A, Saunders CL, Sharp SJ, Emery J, Walter FM, Muir K, Griffin SJ. External validation of risk prediction models for incident colorectal cancer using UK Biobank. Br J Cancer 2018; 118:750-759. [PMID: 29381683 PMCID: PMC5846069 DOI: 10.1038/bjc.2017.463] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/23/2017] [Accepted: 11/24/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND This study aimed to compare and externally validate risk scores developed to predict incident colorectal cancer (CRC) that include variables routinely available or easily obtainable via self-completed questionnaire. METHODS External validation of fourteen risk models from a previous systematic review in 373 112 men and women within the UK Biobank cohort with 5-year follow-up, no prior history of CRC and data for incidence of CRC through linkage to national cancer registries. RESULTS There were 1719 (0.46%) cases of incident CRC. The performance of the risk models varied substantially. In men, the QCancer10 model and models by Tao, Driver and Ma all had an area under the receiver operating characteristic curve (AUC) between 0.67 and 0.70. Discrimination was lower in women: the QCancer10, Wells, Tao, Guesmi and Ma models were the best performing with AUCs between 0.63 and 0.66. Assessment of calibration was possible for six models in men and women. All would require country-specific recalibration if estimates of absolute risks were to be given to individuals. CONCLUSIONS Several risk models based on easily obtainable data have relatively good discrimination in a UK population. Modelling studies are now required to estimate the potential health benefits and cost-effectiveness of implementing stratified risk-based CRC screening.
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Affiliation(s)
- J A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
| | - A Harshfield
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
| | - C L Saunders
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
| | - S J Sharp
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge CB2 0QQ, UK
| | - J Emery
- Department of General Practice, Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, VIC 3010, Australia
| | - F M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
| | - K Muir
- Institute of Population Health, University of Manchester, Manchester M13 9PL, UK
| | - S J Griffin
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge CB2 0QQ, UK
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42
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Sung JJY, Wong MCS, Lam TYT, Tsoi KKF, Chan VCW, Cheung W, Ching JYL. A modified colorectal screening score for prediction of advanced neoplasia: A prospective study of 5744 subjects. J Gastroenterol Hepatol 2018; 33:187-194. [PMID: 28561279 DOI: 10.1111/jgh.13835] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 05/18/2017] [Accepted: 05/21/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM We validated a modified risk algorithm based on the Asia-Pacific Colorectal Screening (APCS) score that included body mass index (BMI) for prediction of advanced neoplasia. METHODS Among 5744 Chinese asymptomatic screening participants undergoing a colonoscopy in Hong Kong from 2008 to 2012, a random sample of 3829 participants acted as the derivation cohort. The odds ratios for significant risk factors identified by binary logistic regression analysis were used to build a scoring system ranging from 0 to 6, divided into "average risk" (AR): 0; "moderate risk" (MR): 1-2; and "high risk" (HR): 3-6. The other 1915 subjects formed a validation cohort, and the performance of the score was assessed. RESULTS The prevalence of advanced neoplasia in the derivation and validation cohorts was 5.4% and 6.0%, respectively (P = 0.395). Old age, male gender, family history of colorectal cancer, smoking, and BMI were significant predictors in multivariate regression analysis. A BMI cut-off at > 23 kg/m2 had better predictive capability and lower number needed to screen than that of > 25 kg/m2 . Utilizing the score developed, 8.4%, 57.4%, and 34.2% in the validation cohort were categorized as AR, MR, and HR, respectively. The corresponding prevalence of advanced neoplasia was 3.8%, 4.3%, and 9.3%. Subjects in the HR group had 2.48-fold increased prevalence of advanced neoplasia than the AR group. The c-statistics of the modified score had better discriminatory capability than that using predictors of APCS alone (c-statistics = 0.65 vs 0.60). CONCLUSIONS Incorporating BMI into the predictors of APCS score was found to improve risk prediction of advanced neoplasia and reduce colonoscopy resources.
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Affiliation(s)
- Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong.,State Key Laboratory for Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong.,Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Martin C S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong.,State Key Laboratory for Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong.,School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong.,Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Kelvin K F Tsoi
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Victor C W Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong
| | - Wilson Cheung
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Jessica Y L Ching
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong
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Rieger AK, Mansmann UR. A Bayesian scoring rule on clustered event data for familial risk assessment - An example from colorectal cancer screening. Biom J 2017; 60:115-127. [PMID: 29114914 DOI: 10.1002/bimj.201600264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 08/03/2017] [Accepted: 08/20/2017] [Indexed: 11/06/2022]
Abstract
Colorectal cancer screening is well established. The identification of high risk populations is the key to implement effective risk-adjusted screening. Good statistical approaches for risk prediction do not exist. The family's colorectal cancer history is used for identification of high risk families and usually assessed by a questionnaire. This paper introduces a prediction algorithm to designate a family for colorectal cancer risk and discusses its statistical properties. The new algorithm uses Bayesian reasoning and a detailed family history illustrated by a pedigree and a Lexis diagram. The algorithm is able to integrate different hereditary mechanisms that define complex latent class or random factor structures. They are generic and do not reflect specific genetic models. This is comparable to strategies in complex segregation analysis. Furthermore, the algorithm can integrate different statistical penetrance models for right censored event data. Computational challenges related to the handling of the likelihood are discussed. Simulation studies assess the predictive quality of the new algorithm in terms of ROC curves and corresponding AUCs. The algorithm is applied to data of a recent study on familial colorectal cancer risk. Its predictive performance is compared to that of a questionnaire currently used in screening for familial colorectal cancer. The results of the proposed algorithm are robust against different inheritance models. Using the simplest hereditary mechanism, the simulation study provides evidence that the algorithm improves detection of families with high cancer risk in comparison to the currently used questionnaire. The applicability of the algorithm goes beyond the field of colorectal cancer.
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Affiliation(s)
- Anna K Rieger
- Institute for Medical Information Sciences, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität München, München, Germany
| | - Ulrich R Mansmann
- Institute for Medical Information Sciences, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität München, München, Germany
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Chow EJ, Chen Y, Hudson MM, Feijen EAM, Kremer LC, Border WL, Green DM, Meacham LR, Mulrooney DA, Ness KK, Oeffinger KC, Ronckers CM, Sklar CA, Stovall M, van der Pal HJ, van Dijk IWEM, van Leeuwen FE, Weathers RE, Robison LL, Armstrong GT, Yasui Y. Prediction of Ischemic Heart Disease and Stroke in Survivors of Childhood Cancer. J Clin Oncol 2017; 36:44-52. [PMID: 29095680 DOI: 10.1200/jco.2017.74.8673] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose We aimed to predict individual risk of ischemic heart disease and stroke in 5-year survivors of childhood cancer. Patients and Methods Participants in the Childhood Cancer Survivor Study (CCSS; n = 13,060) were observed through age 50 years for the development of ischemic heart disease and stroke. Siblings (n = 4,023) established the baseline population risk. Piecewise exponential models with backward selection estimated the relationships between potential predictors and each outcome. The St Jude Lifetime Cohort Study (n = 1,842) and the Emma Children's Hospital cohort (n = 1,362) were used to validate the CCSS models. Results Ischemic heart disease and stroke occurred in 265 and 295 CCSS participants, respectively. Risk scores based on a standard prediction model that included sex, chemotherapy, and radiotherapy (cranial, neck, and chest) exposures achieved an area under the curve and concordance statistic of 0.70 and 0.70 for ischemic heart disease and 0.63 and 0.66 for stroke, respectively. Validation cohort area under the curve and concordance statistics ranged from 0.66 to 0.67 for ischemic heart disease and 0.68 to 0.72 for stroke. Risk scores were collapsed to form statistically distinct low-, moderate-, and high-risk groups. The cumulative incidences at age 50 years among CCSS low-risk groups were < 5%, compared with approximately 20% for high-risk groups ( P < .001); cumulative incidence was only 1% for siblings ( P < .001 v low-risk survivors). Conclusion Information available to clinicians soon after completion of childhood cancer therapy can predict individual risk for subsequent ischemic heart disease and stroke with reasonable accuracy and discrimination through age 50 years. These models provide a framework on which to base future screening strategies and interventions.
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Affiliation(s)
- Eric J Chow
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yan Chen
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Melissa M Hudson
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth A M Feijen
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Leontien C Kremer
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William L Border
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel M Green
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lillian R Meacham
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel A Mulrooney
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kirsten K Ness
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kevin C Oeffinger
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cécile M Ronckers
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles A Sklar
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marilyn Stovall
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Helena J van der Pal
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Irma W E M van Dijk
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Flora E van Leeuwen
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rita E Weathers
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Leslie L Robison
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gregory T Armstrong
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yutaka Yasui
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
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Maida M, Macaluso FS, Ianiro G, Mangiola F, Sinagra E, Hold G, Maida C, Cammarota G, Gasbarrini A, Scarpulla G. Screening of colorectal cancer: present and future. Expert Rev Anticancer Ther 2017; 17:1131-1146. [PMID: 29022408 DOI: 10.1080/14737140.2017.1392243] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) is the third most common cancer in males and second in females, and the fourth most common cause of cancer death worldwide. Currently, about 60-70% of diagnosed cases in symptomatic patients are detected at an advanced stage of disease. Earlier stage detection through the use of screening strategies would allow for better outcomes in terms of reducing the disease burden. Areas covered: The aim of this paper is to review the current published evidence from literature which assesses the performance and effectiveness of different screening tests for the early detection of CRC. Expert commentary: Adequate screening strategies can reduce CRC incidence and mortality. In the last few decades, several tests have been proposed for CRC screening. To date, there is still insufficient evidence to identify which approach is definitively superior, and no screening strategy for CRC can therefore be defined as universally ideal. The best strategy would be the one that can be economically viable and to which the patient can adhere best to over time. The latest guidelines suggest colonoscopy every 10 years or annual fecal immuno-chemical test (FIT) for people with normal risk, while for individuals with high risk or hereditary syndromes specific recommendations are provided.
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Affiliation(s)
- Marcello Maida
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
| | | | - Gianluca Ianiro
- c Internal Medicine, Gastroenterology & Liver Unit , Università Cattolica Sacro Cuore , Rome , Italy
| | - Francesca Mangiola
- c Internal Medicine, Gastroenterology & Liver Unit , Università Cattolica Sacro Cuore , Rome , Italy
| | - Emanuele Sinagra
- d Gastroenterology and Endoscopy Unit , Fondazione Istituto San Raffaele Giglio , Cefalù , Italy
| | - Georgina Hold
- e School of Medicine, Medical Sciences and Nutrition , University of Aberdeen , Aberdeen , UK
| | - Carlo Maida
- f Section of Internal Medicine , DIBIMIS, University of Palermo , Palermo , Italy
| | - Giovanni Cammarota
- c Internal Medicine, Gastroenterology & Liver Unit , Università Cattolica Sacro Cuore , Rome , Italy
| | - Antonio Gasbarrini
- c Internal Medicine, Gastroenterology & Liver Unit , Università Cattolica Sacro Cuore , Rome , Italy
| | - Giuseppe Scarpulla
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
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Abstract
The primary goal of cancer screening is early detection of cancer to reduce cancer-specific mortality and morbidity. The benefits of screening in older adults are uncertain due to paucity of evidence. Extrapolating data from younger populations, evidence suggests that the benefit occurs years later from the time of initial screening and therefore may not be applicable in those older adults with limited life expectancy. Contrast this with the harms of screening, which are more immediate and increase with age and comorbidities. An individualized approach to cancer screening takes these factors into consideration, allowing for thoughtful decision making for older adults.
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Affiliation(s)
- Kimberley T Lee
- Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F Lord Building Center Tower, Room 711, Baltimore, MD 21224, USA.
| | - Russell P Harris
- Division of General Medicine and Clinical Epidemiology, Sheps Center for Health Services Research, University of North Carolina, 101 Parkview Crescent, Chapel Hill, NC 27516, USA
| | - Nancy L Schoenborn
- Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F Lord Building Center Tower, Room 711, Baltimore, MD 21224, USA
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Hong SN, Son HJ, Choi SK, Chang DK, Kim YH, Jung SH, Rhee PL. A prediction model for advanced colorectal neoplasia in an asymptomatic screening population. PLoS One 2017; 12:e0181040. [PMID: 28841657 PMCID: PMC5571924 DOI: 10.1371/journal.pone.0181040] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/26/2017] [Indexed: 12/15/2022] Open
Abstract
Background An electronic medical record (EMR) database of a large unselected population who received screening colonoscopies may minimize sampling error and represent real-world estimates of risk for screening target lesions of advanced colorectal neoplasia (CRN). Our aim was to develop and validate a prediction model for assessing the probability of advanced CRN using a clinical data warehouse. Methods A total of 49,450 screenees underwent their first colonoscopy as part of a health check-up from 2002 to 2012 at Samsung Medical Center, and the dataset was constructed by means of natural language processing from the computerized EMR system. The screenees were randomized into training and validation sets. The prediction model was developed using logistic regression. The model performance was validated and compared with existing models using area under receiver operating curve (AUC) analysis. Results In the training set, age, gender, smoking duration, drinking frequency, and aspirin use were identified as independent predictors for advanced CRN (adjusted P < .01). The developed model had good discrimination (AUC = 0.726) and was internally validated (AUC = 0.713). The high-risk group had a 3.7-fold increased risk of advanced CRN compared to the low-risk group (1.1% vs. 4.0%, P < .001). The discrimination performance of the present model for high-risk patients with advanced CRN was better than that of the Asia-Pacific Colorectal Screening score (AUC = 0.678, P < .001) and Schroy’s CAN index (AUC = 0.672, P < .001). Conclusion The present 5-item risk model can be calculated readily using a simple questionnaire and can identify the low- and high-risk groups of advanced CRN at the first screening colonoscopy. This model may increase colorectal cancer risk awareness and assist healthcare providers in encouraging the high-risk group to undergo a colonoscopy.
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Affiliation(s)
- Sung Noh Hong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Jung Son
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Center for Health Promotion, Samsung Medical Center, Seoul, South Korea
| | - Sun Kyu Choi
- Biostatistics and Bioinformatics Center, Samsung Cancer Research Institute, Samsung Medical Center, Seoul, Korea
| | - Dong Kyung Chang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Ho Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sin-Ho Jung
- Biostatistics and Bioinformatics Center, Samsung Cancer Research Institute, Samsung Medical Center, Seoul, Korea
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States of America
| | - Poong-Lyul Rhee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
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Liu Y, Wang Y, Hu F, Sun H, Zhang Z, Wang X, Luo X, Zhu L, Huang R, Li Y, Li G, Li X, Lin S, Wang F, Liu Y, Rong J, Yuan H, Zhao Y. Multiple gene-specific DNA methylation in blood leukocytes and colorectal cancer risk: a case-control study in China. Oncotarget 2017; 8:61239-61252. [PMID: 28977860 PMCID: PMC5617420 DOI: 10.18632/oncotarget.18054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/07/2017] [Indexed: 12/17/2022] Open
Abstract
The relationship between gene-specific DNA methylation in peripheral blood leukocytes and colorectal cancer (CRC) susceptibility is unclear. In this case-control study, the methylation status of a panel of 10 CRC-related genes in 428 CRC cases and 428 cancer-free controls were detected with methylation-sensitive high-resolution melting analysis. We calculated a weighted methylation risk score (MRS) that comprehensively combined the methylation status of the panel of 10 genes and found that the MRS_10 was significantly associated with CRC risk. Compared with MRS-Low group, MRS-High group and MRS-Medium group exhibited a 6.51-fold (95% CI, 3.77-11.27) and 3.85-fold (95% CI, 2.72-5.45) increased risk of CRC, respectively. Moreover, the CRC risk increased with increasing MRS_10 (Ptrend < 0.0001). Stratified analyses demonstrated that the significant association retained in both men and women, younger and older, and normal weight or underweight and overweight or obese subjects. The area under the receiver operating characteristic curves for the MRS_10 model was 69.04% (95% CI, 65.57-72.66%) and the combined EF and MRS_10 model yielded an AUC of 79.12% (95% CI, 76.22-82.15%). Together, the panel of 10 gene-specific DNA methylation in leukocytes was strongly associated with the risk of CRC and might be a useful marker of susceptibility for CRC.
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Affiliation(s)
- Yupeng Liu
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Yibaina Wang
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Fulan Hu
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Hongru Sun
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Zuoming Zhang
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Xuan Wang
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Xiang Luo
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Lin Zhu
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Rong Huang
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Yan Li
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Guangxiao Li
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Xia Li
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Shangqun Lin
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Fan Wang
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Yanhong Liu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Jiesheng Rong
- Department of Orthopedics Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Huiping Yuan
- Key Laboratory of Ophthalmology, Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Yashuang Zhao
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
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Magrath M, Yang E, Singal AG. Personalizing Colon Cancer Screening: Role of Age and Comorbid Conditions. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Personalized medicine for prevention: can risk stratified screening decrease colorectal cancer mortality at an acceptable cost? Cancer Causes Control 2017; 28:299-308. [DOI: 10.1007/s10552-017-0864-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/01/2017] [Indexed: 12/15/2022]
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