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Abstract
Background The Asia-Pacific colorectal screening (APCS) score, a simple tool for stratifying the risk of advanced colorectal neoplasia (ACN), has been developed and well validated in several Asian populations. This study aimed to systematically review and meta-analyze the performance of APCS score in stratifying the ACN risk.
Methods On October 20th, 2021, a systematic search for relevant articles was conducted on 12 electronic databases, including PubMed, Scopus, Web of Science, Google Scholar, Cochrane, WHO Global Health Library, Clinical trials, Embase, Grey Literature Report database, SIGLE, Controlled Trials, and Virtual Health Library. An updated search was conducted on June 1st, 2022. Studies were included if they reported the performance of APCS score in stratifying ACN risk. Data from eligible studies were extracted and synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines (IDDF2022-ABS-0222-Figure 1. Prisma flow diagram of the study selection process). Random-effects models were used to obtain the pooled prognostic performance statistics of the APCS score.
Results From 94 records screened, eleven eligible studies (one from Vietnam, four from China, four from Korea, one from Australia, and one conducted in 11 Asian cities) involving 65,188 subjects who had undergone screening colonoscopy were enrolled. Overall, 43.0%, 43.8% and 13.2% of participants were stratified as average-risk (AR) tier (APCS 0–1), moderate-risk (MR) tier (APCS 2–3) and high-risk (HR) tier (APCS ≥4). Pooled incidences of ACN in the AR, MR, and HR groups were 0.9%, 2.6%, and 6.9%, respectively. Compared with the combined AR-MR group, the HR group was significantly associated with a higher risk of ACN (OR: 3.46, 95%CI: 2.75–4.37, p<0.001) (IDDF2022-ABS-0222-Figure 2. Forest plot demonstrating the association between APCS score and ACN risk). The pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio for predicting the ACN risk were 0.38 (95%CI: 0.35–0.40), 0.87 (95%CI: 0.87–0.88), 2.44 (95%CI: 2.00–2.98), and 0.72 (95%CI: 0.61–0.86), respectively (IDDF2022-ABS-0222-Figure 3. Forest plots demonstrating the prognostic performance of ACPS score for predicting the ACN risk). The weighted area under the curve for predicting ACN was 0.67±0.03 (IDDF2022-ABS-0222-Figure 4. Summary ROC curve demonstrating the prognostic performance of APCS score for predicting the ACN risk).
Conclusions The APCS score could effectively stratify the ACN risk in the Asia-Pacific region. Colonoscopy should be prioritized in individuals with the HR tier.