INTRODUCTION

METHODS
1. Study Population for Development of the Risk Score
2. Measurements and Diagnosis of Colorectal Neoplasm
3. Development of the Risk Scoring System
4. Calculation and Validation of the Risk Scoring System
5. Statistical Analyses

RESULTS
1. Characteristics of Subjects in the Derivation and Validation Cohorts
Table 1.
Characteristic | Derivation cohort (n=41,702) | Validation cohort (n=17,873) | P-value |
---|---|---|---|
Age (yr) | 38.9±5.3 | 38.9±5.4 | 0.878 |
<30 | 345 (0.8) | 163 (0.9) | |
30-39 | 21,776 (52.2) | 9,397 (52.6) | |
40-49 | 19,581 (47.0) | 8,313 (46.5) | |
Sex | 0.679 | ||
Female | 11,933 (28.6) | 5,145 (28.8) | |
Male | 29,769 (71.4) | 12,728 (71.2) | |
Alcohol drinking | |||
No | 12,878 (30.9) | 5,563 (31.1) | |
Non-heavy drinker | 27,548 (66.0) | 11,741 (65.7) | 0.495 |
Heavy drinkera | 1,276 (3.1) | 569 (3.2) | 0.566 |
Smoking | |||
Never | 23,091 (55.4) | 9,864 (55.2) | |
Former smoker | 6,646 (15.9) | 2,927 (16.4) | 0.231 |
Current smoker | 11,965 (28.7) | 5,082 (28.4) | 0.789 |
Family history of colorectal cancer | 0.445 | ||
No | 40,242 (96.5) | 17,224 (96.4) | |
Yes | 1,460 (3.5) | 649 (3.6) | |
Exercise | 0.608 | ||
No | 18,436 (44.2) | 7,860 (44.0) | |
Yesb | 23,266 (55.8) | 10,013 (56.0) | |
BMI (kg/m2) | 23.8±3.2 | 23.8±3.2 | 0.820 |
Obesity | 0.578 | ||
No | 27,757 (66.6) | 11,939 (66.8) | |
Yesc | 13,945 (33.4) | 5,934 (33.2) | |
Diabetes | 0.247 | ||
No | 32,605 (78.2) | 14,051 (78.6) | |
Yes | 9,097 (21.8) | 3,822 (21.4) | |
Insulin (μIU/mL) | 5.1±3.3 | 5.1±3.3 | 0.952 |
HbA1c (%) | 5.6±0.5 | 5.6±0.4 | 0.363 |
<6.5 | 40,681 (97.5) | 17,413 (97.4) | |
≥6.5 | 1,021 (2.5) | 460 (2.6) | |
Glucose (mg/dL) | 92.9±13.7 | 92.9±13.7 | 0.565 |
<100 | 33,472 (80.3) | 14,383 (80.5) | |
≥100 | 8,230 (19.7) | 3,490 (19.5) | |
Total cholesterol (mg/dL) | 199.8±34.2 | 199.0±34.5 | 0.053 |
<200 | 19,189 (46.0) | 9,465 (53.0) | |
≥200 | 22,513 (54.0) | 8,408 (47.0) | |
HDL-cholesterol (mg/dL) | 55.1±13.7 | 55.3±13.9 | 0.065 |
≥40 (male), ≥50 (female) | 35,602 (85.4) | 15,287 (85.5) | |
<40 (male), <50 (female) | 6,100 (14.6) | 2,586 (14.5) | |
LDL-cholesterol (mg/dL) | 124.0±31.7 | 124.3±31.82 | 0.296 |
<100 | 9,441 (22.6) | 4,071 (22.8) | |
≥100 | 32,261 (77.4) | 13,802 (77.2) | |
Triglyceride (mg/dL) | 115.1±76.2 | 115.7±78.1 | 0.375 |
≤150 | 32,712 (78.4) | 13,962 (78.1) | |
>150 | 8,990 (21.6) | 3,911 (21.9) | |
SBP (mmHg) | 113.0±12.9 | 112.9±12.9 | 0.799 |
DBP (mmHg) | 72.3±9.6 | 72.3±9.5 | 0.943 |
ACRN | 0.999 | ||
No | 41,309 (99.1) | 17,704 (99.1) | |
Yes | 393 (0.9) | 169 (0.9) | |
Colorectal cancer | 0.999 | ||
No | 41,684 (99.96) | 17,866 (99.96) | |
Yes | 18 (0.04) | 7 (0.04) |
2. Univariate and Multivariate Analyses of Risk Factors for ACRN in Derivation Cohort
Table 2.
Variable | Total cohort | ACRN (n=393) | Non-ACRN (n=41,309) | Univariate analysis P-value | Multivariate analysis P-value |
---|---|---|---|---|---|
Age (yr) | 41.1±5.0 | 38.9±5.3 | <0.001 | <0.001 | |
Sex | 0.016 | 0.164 | |||
Female | 11,933 | 91 (0.8) | 11,842 (99.2) | ||
Male | 29,769 | 302 (1.0) | 29,467 (99.0) | ||
Alcohol | |||||
No | 12,878 | 141 (1.1) | 12,737 (98.9) | ||
Non-heavy drinker | 27,548 | 240 (0.9) | 27,308 (99.1) | 0.030 | 0.005 |
Heavy drinkera | 1,276 | 12 (0.9) | 1,264 (99.1) | 0.611 | 0.209 |
Smoking | |||||
Never | 23,091 | 204 (0.9) | 22,887 (99.1) | ||
Former smoker | 6,646 | 49 (0.7) | 6,597 (99.3) | 0.254 | 0.330 |
Current smoker | 11,965 | 140 (1.2) | 11,825 (98.8) | 0.010 | 0.009 |
Family history of colorectal cancer | 0.537 | 0.991 | |||
No | 40,242 | 377 (0.9) | 39,865 (99.1) | ||
Yes | 1,460 | 16 (1.1) | 1,444 (98.9) | ||
Exercise | 0.592 | 0.798 | |||
No | 18,436 | 179 (1.0) | 18,257 (99.0) | ||
Yesb | 23,266 | 214 (0.9) | 23,052 (99.1) | ||
Obesity | <0.001 | 0.114 | |||
No | 27,757 | 227 (0.8) | 27,530 (99.2) | ||
Yesc | 13,945 | 166 (1.2) | 13,779 (98.8) | ||
Diabetes | <0.001 | 0.678 | |||
No | 32,605 | 269 (0.8) | 32,336 (99.2) | ||
Yes | 9,097 | 124 (1.4) | 8,973 (98.6) | ||
Insulin (FB) | 5.6±3.4 | 5.1±3.3 | 0.003 | 0.750 | |
HbA1c ≥6.5% | <0.001 | 0.015 | |||
No | 40,681 | 367 (0.9) | 40,314 (99.1) | ||
Yes | 1,021 | 26 (2.5) | 995 (97.5) | ||
Glucose ≥100 (mg/dL) | <0.001 | 0.262 | |||
No | 33,472 | 277 (0.8) | 33,195 (99.2) | ||
Yes | 8,230 | 116 (1.4) | 8,114 (98.6) | ||
Total cholesterol (mg/dL) | 204.4±35.4 | 198.4±34.2 | <0.001 | 0.413 | |
HDL-cholesterol (mg/dL) | 53.3±12.9 | 55.1±13.7 | 0.008 | 0.501 | |
LDL-cholesterol (mg/dL) | 129.4±31.8 | 124.0±31.7 | <0.001 | 0.242 | |
Triglyceride (mg/dL) | 130.6±85.9 | 115.0±76.1 | <0.001 | 0.255 | |
SBP (mmHg) | 113.0±13.4 | 113.0±12.9 | 0.890 | 0.698 | |
DBP (mmHg) | 72.2±9.7 | 72.3±9.6 | 0.325 | 0.469 |
3. New Logistic Regression Model and Development of the Risk Score
Table 3.
Variable | Coefficients | OR (95% CI) | P-value | Points assigned |
---|---|---|---|---|
Sex | ||||
Female | 1 (Reference) | 0 | ||
Male | 0.1996 | 1.22 (0.95–1.56) | 0.113 | 1 |
Age (yr) | ||||
<40 | 1 (Reference) | 0 | ||
40–49 | 0.7142 | 2.04 (1.66–2.52) | <0.001 | 3 |
Alcohol | ||||
Never or non-heavy drinker | 1 (Reference) | 0 | ||
Heavy drinkera | 0.3394 | 1.40 (1.13–1.74) | 0.002 | 1 |
Smoking | ||||
Never or former smoker | 1 (Reference) | 0 | ||
Current smoker | 0.3443 | 1.41 (1.14–1.75) | 0.002 | 1 |
Obesity | ||||
No | 1 (Reference) | 0 | ||
Yesb | 0.2543 | 1.29 (1.04–1.59) | 0.018 | 1 |
HbA1c ≥6.5% or glucose ≥100 mg/dL | ||||
No | 1 (Reference) | 0 | ||
Yes | 0.4377 | 1.55 (1.24–1.93) | <0.001 | 2 |
Family history of colorectal cancer | ||||
No | 1 (Reference) | 0 | ||
Yes | 0.0843 | 1.09 (0.66–1.80) | 0.743 | 1 |
Table 4.
Table 5.
Values are presented as number (%).
APCS, Asia-Pacific Colorectal Screening; KCS, Korean Colorectal Screening; YCS, Young adult Colorectal Screening; ACRN, advanced colorectal neoplasm.
APCS score risk category: low (0-1), moderate (2-3), high (4-7); KCS score risk category: low (0-1), moderate (2-3), high (4-8); YCS score risk category: low (0-4), moderate (5-7), high (8-10).
4. Validation of the Risk Scoring Model for ACRN in Young Adults
5. Diagnostic Performance of ACRN by Risk Category in Young Adults
![]() | Fig. 1.ROC curve for YCS, APCS and KCS score models. AUC for the risk score was significantly higher in the YCS score (0.660; 95% CI, 0.65–0.77) than APCS score (0.595; 95% CI, 0.59–0.60; P=0.007) and KCS score (0.606; 95% CI, 0.60–0.61; P=0.012), when results of APCS and KCS score were deducted by using the validation cohort of the present study. ROC, receiver operating characteristic; AUC, area under the curve; YCS, Young Adult Colorectal Screening; APCS, Asia-Pacific Colorectal Screening; KCS, Korean Colorectal Screening. |
Table 6.

DISCUSSION
