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Int J Cancer. 2017 May 15;140(10):2201-2211. doi: 10.1002/ijc.30639. Epub 2017 Mar 6.

The fecal hemoglobin concentration, age and sex test score: Development and external validation of a simple prediction tool for colorectal cancer detection in symptomatic patients.

Author information

1
Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.
2
Instituto de Investigación Biomedica (IBI) Ourense, Pontevedra y Vigo, Vigo, Spain.
3
Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom.
4
Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
5
Ciber de Epidemiología y Salud Pública (CIBERESP), Spain.
6
Clinical Analysis Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.
7
Blood Sciences, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom.
8
Department of Gastroenterology, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom.
9
Kings Cross Hospital, Scottish Bowel Screening Centre, Dundee, Scotland, United Kingdom.
10
Department of Pathology, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom.
11
Department of Biochemistry, Monklands Hospital, Airdrie, Lanarkshire, Scotland, United Kingdom.
12
Department of Surgery, Wishaw General Hospital, Wishaw, Lanarkshire, Scotland, United Kingdom.
13
Gastroenterology Department, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Universidad de La Laguna, Tenerife, Spain.
14
Gastroenterology Department, Complejo Hospitalario de Pontevedra, Pontevedra, Spain.
15
Gastroenterology Department, Hospital Universitari Mútua de Terrassa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Terrassa, Spain.
16
Gastroenterology Department, Consorci Sanitari de Terrassa, Terrassa, Spain.
17
Gastroenterology Department, Hospital de Sabadell, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain.
18
Donostia Hospital, Biodonostia Institute, University of the Basque Country UPV/EHU (CIBERehd), San Sebastian, Spain.
19
Gastroenterology Department, Hospital de Sagunto, Sagunto, Valencia, Spain.
20
Servicio de Aparato Digestivo, Hospital Clínico Universitario, IIS Aragón, University of Zaragoza, (CIBERehd), Zaragoza, Spain.
21
Gastroenterology Department, Hospital Dr. Josep Trueta, Girona, Spain.
22
Digestive Disease Section, Hospital Universitario de Móstoles, Madrid, Spain.

Abstract

Prediction models for colorectal cancer (CRC) detection in symptomatic patients, based on easily obtainable variables such as fecal haemoglobin concentration (f-Hb), age and sex, may simplify CRC diagnosis. We developed, and then externally validated, a multivariable prediction model, the FAST Score, with data from five diagnostic test accuracy studies that evaluated quantitative fecal immunochemical tests in symptomatic patients referred for colonoscopy. The diagnostic accuracy of the Score in derivation and validation cohorts was compared statistically with the area under the curve (AUC) and the Chi-square test. 1,572 and 3,976 patients were examined in these cohorts, respectively. For CRC, the odds ratio (OR) of the variables included in the Score were: age (years): 1.03 (95% confidence intervals (CI): 1.02-1.05), male sex: 1.6 (95% CI: 1.1-2.3) and f-Hb (0-<20 µg Hb/g feces): 2.0 (95% CI: 0.7-5.5), (20-<200 µg Hb/g): 16.8 (95% CI: 6.6-42.0), ≥200 µg Hb/g: 65.7 (95% CI: 26.3-164.1). The AUC for CRC detection was 0.88 (95% CI: 0.85-0.90) in the derivation and 0.91 (95% CI: 0.90-093; p = 0.005) in the validation cohort. At the two Score thresholds with 90% (4.50) and 99% (2.12) sensitivity for CRC, the Score had equivalent sensitivity, although the specificity was higher in the validation cohort (p < 0.001). Accordingly, the validation cohort was divided into three groups: high (21.4% of the cohort, positive predictive value-PPV: 21.7%), intermediate (59.8%, PPV: 0.9%) and low (18.8%, PPV: 0.0%) risk for CRC. The FAST Score is an easy to calculate prediction tool, highly accurate for CRC detection in symptomatic patients.

KEYWORDS:

advanced colorectal neoplasia; colonoscopy; colorectal cancer; diagnostic accuracy; fecal immunochemical test; inflammatory bowel disease; risk stratification

PMID:
28187494
DOI:
10.1002/ijc.30639
[Indexed for MEDLINE]
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