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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(s) -
Cubiella Joaquín,
Digby Jayne,
RodríguezAlonso Lorena,
Vega Pablo,
Salve María,
DíazOndina Marta,
Strachan Judith A.,
Mowat Craig,
McDonald Paula J.,
Carey Francis A.,
Godber Ian M.,
Younes Hakim Ben,
RodriguezMoranta Francisco,
Quintero Enrique,
ÁlvarezSánchez Victoria,
FernándezBañares Fernando,
Boadas Jaume,
Campo Rafel,
Bujanda Luis,
Garayoa Ana,
Ferrandez Ángel,
Piñol Virginia,
RodríguezAlcalde Daniel,
Guardiola Jordi,
Steele Robert J.C.,
Fraser Callum G.
Publication year - 2017
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.30639
Subject(s) - medicine , colonoscopy , colorectal cancer , cohort , odds ratio , confidence interval , gastroenterology , area under the curve , feces , cancer , predictive value of tests , logistic regression , biology , paleontology
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.