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The Asia-Pacific Colorectal Screening score: a validated tool that stratifies risk for colorectal advanced neoplasia in asymptomatic Asian subjects
  1. Khay-Guan Yeoh1,
  2. Khek-Yu Ho1,
  3. Han-Mo Chiu2,
  4. Feng Zhu1,
  5. Jessica Y L Ching3,
  6. Deng-Chyang Wu4,
  7. Takahisa Matsuda5,
  8. Jeong-Sik Byeon6,
  9. Sang-Kil Lee7,
  10. Khean-Lee Goh8,
  11. Jose Sollano9,
  12. Rungsun Rerknimitr10,
  13. Rupert Leong11,
  14. Kelvin Tsoi3,
  15. Jaw-Town Lin2,
  16. Joseph J Y Sung3,
  17. for the Asia-Pacific Working Group on Colorectal Cancer
  1. 1Department of Medicine, National University of Singapore, Singapore, Singapore
  2. 2Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
  3. 3Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong (SAR), People's Republic of China
  4. 4Department of Gastroenterology, Kaohsiung Medical University, Kaohsiung, Taiwan
  5. 5Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
  6. 6Department of Internal Medicine, University of Ulsan, Seoul, Korea
  7. 7Department of Gastroenterology, Yonsei University, Seoul, Korea
  8. 8Department of Gastroenterology and Hepatology, University of Malaya, Kuala Lumpur, Malaysia
  9. 9Department of Gastroenterology, University of Santo Tomas, Manila, Philippines
  10. 10Department of Internal Medicine, Chulalongkorn University, Bangkok, Thailand
  11. 11Department of Medicine, The University of New South Wales, Sydney, Australia
  1. Correspondence to K G Yeoh, Department of Medicine, National University of Singapore, Department of Gastroenterology & Hepatology, National University Hospital, Lower Kent Ridge Road (119074), Singapore; mdcykg{at}


Objective To develop and validate a clinical risk score predictive of risk for colorectal advanced neoplasia for Asia.

Methods A prospective, cross-sectional and multicentre study was carried out in tertiary hospitals in 11 Asian cities. The subjects comprise 2752 asymptomatic patients undergoing screening colonoscopy. From a development set of 860 asymptomatic subjects undergoing screening colonoscopy, multiple logistic regression was applied to identify significant risk factors for advanced colorectal neoplasia defined as invasive carcinoma or advanced adenoma. The ORs for significant risk factors were utilised to develop a risk score ranging from 0 to 7 (Asia-Pacific Colorectal Screening (APCS) score). Three tiers of risk were arbitrarily defined: 0–1 ‘average risk’ (AR); 2–3 ‘moderate risk’ (MR); and 4–7 ‘high risk’ (HR). Subjects undergoing screening colonoscopy between July 2006 and December 2007 were prospectively enrolled to form an independent validation group. Each subject had a personal APCS score calculated by summing the points attributed from the presence of risk factors in the individuals. The performance of the APCS score in predicting risk of advanced neoplasia was evaluated.

Results There were 860 subjects in the derivation set and 1892 subjects in the validation set, with a baseline prevalence of advanced neoplasia of 4.5% and 3%, respectively. Applying the APCS stratification in the validation set, 559 subjects (29.5%) were in the AR tier, 966 subjects (51.1%) in the MR tier and 367 (19.4%) subjects in the HR tier. The prevalence of advanced neoplasia in the AR, MR and HR groups was 1.3, 3.2 and 5.2%, respectively. The subjects in the MR and HR tiers had 2.6-fold (95% CI 1.1 to 6.0) and 4.3-fold (95% CI 1.8 to 10.3) increased prevalence of advanced neoplasia, respectively, than those in the AR tier.

Conclusions The APCS score based on age, gender, family history and smoking is useful in selecting asymptomatic Asian subjects for priority of colorectal screening.

  • Colorectal cancer
  • advanced adenoma
  • screening
  • risk stratification
  • adenoma

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  • The members of the Asia-Pacific Working Group on Colorectal Cancer are: China—Joseph J Y Sung, James Lau, W K Leung and Francis K L Chan (Hong Kong); M H Chen and C J Li (Guangzhou), Kai Chun Wu (Xi'an); India—R Tandon, Govind Makharia (New Delhi); Indonesia—Murdan Abdullah (Jakarta); Japan—Rikiya Fujita and Takahisa Matsuda (Tokyo); South Korea—Jeong-Sik Byeon Jin Yong Kim, Hyo Jong Kim, Won Ho Kim, Tae II Kim, Sang-Kil Lee and Suk-Kyun Yang (Seoul); Malaysia—Ida Hilmi and K L Goh (Kuala Lumpur); Philippines—Jose Sollano, Euan Ong and Jose Tan (Manila); Singapore—Khek-Yu Ho and Khay-Guan Yeoh (Singapore); Taiwan—Han-Mo Chiu, Jaw-Town Lin and Cheng-yi Wang (Taipei); Deng-Chyang Wu and Huang-Ming Hu (Kaohsiung); Thailand—Pradermchai Kongkam, Pinit Kullavanijaya and Rungsun Rerknimitr (Bangkok); Australia—Rupert Leong (Sydney). The study is also supported by the Asia-Pacific Society of Digestive Endoscopy, which is an affiliate of Organisation Mondiale d'Endoscopy Digestive (OMED).

  • Competing interests None.

  • Ethical approval The domain-specific Review Board of the National Healthcare Group, Singapore approved ‘Colorectal Neoplasm Risk Stratification in Asia Population’.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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