Development and internal validation of a nomogram to predict colorectal cancer risk in patients with diverticulitis.

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

International Journal of Colorectal Disease Pub Date : 2026-06-23 DOI:10.1007/s00384-026-05181-z

Muhammad Usman, Elon Correa, Wen Yuan Chung, Sayyada Nuha Farazi, Konstantinos Baronos, Lasitha Samarakoon, Sudarshan Rao Kadri

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引用次数: 0

Abstract

Aim: Diverticulitis, considered a benign condition, has emerging evidence linking it to colorectal cancer (CRC). Current guidelines lack standardised risk stratification tools to guide post-diverticulitis surveillance. This study aims to create and validate a nomogram to predict CRC risk in patients with diverticulitis.

Method: This retrospective cohort study included 1546 patients diagnosed with diverticulitis at a UK tertiary hospital between January 2021 and December 2023. Patients aged ≥ 18 years who underwent endoscopic assessment following a diverticulitis episode were included. A logistic regression model with L2 regularisation and balanced class weights (C = 0.1) was developed to predict a binary outcome: high CRC risk (histologically confirmed cancer) versus low/moderate risk (no cancer), designed to guide referral for flexible sigmoidoscopy (FS).

Results: The mean age of the cohort was 69.2 years, with near-equal sex distribution. CRC was identified in 42 patients (2.7%). Significant predictors of high CRC risk included older age, male sex, and CT-detected colonic wall thickening, whereas abdominal pain, PR bleeding, and diverticulosis were associated with lower risk. The model achieved a cross-validated mean AUC of 0.736 (95% CI 0.661-0.811) and full-sample AUC of 0.784. At the Youden-optimal threshold (0.523), sensitivity was 72.1% and specificity 73.8%.

Conclusion: We developed and internally validated a nomogram to predict CRC risk in patients with diverticulitis, using a binary classification to guide FS referral. The tool demonstrated robust discriminative ability and could reduce unnecessary colonoscopies while prioritising high-risk patients for timely evaluation. Unlike existing CRC risk models targeting asymptomatic individuals, our nomogram is tailored to diverticulitis patients. External validation in multi-centre cohorts is required before adoption into routine clinical practice.

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一种预测憩室炎患者结直肠癌风险的图线图的开发和内部验证。

目的：憩室炎，被认为是一种良性疾病，有新的证据表明它与结直肠癌（CRC）有关。目前的指南缺乏标准化的风险分层工具来指导憩室炎后的监测。本研究旨在建立并验证一种预测憩室炎患者结直肠癌风险的nomogram方法。方法：这项回顾性队列研究纳入了2021年1月至2023年12月在英国一家三级医院诊断为憩室炎的1546例患者。年龄≥18岁的患者在憩室炎发作后接受内窥镜评估。建立了L2正则化和平衡类权（C = 0.1）的逻辑回归模型来预测二元结果：高CRC风险（组织学证实的癌症）与低/中等风险（无癌症），旨在指导转诊柔性乙状结肠镜（FS）。结果：队列的平均年龄为69.2岁，性别分布接近均匀。42例（2.7%）患者发现结直肠癌。结直肠癌高风险的重要预测因素包括年龄较大、男性和ct检测到的结肠壁增厚，而腹痛、PR出血和憩室病与风险较低相关。该模型的交叉验证平均AUC为0.736 (95% CI 0.661-0.811)，全样本AUC为0.784。在约登最佳阈值（0.523）下，敏感性为72.1%，特异性为73.8%。结论：我们开发并内部验证了一种预测憩室炎患者结直肠癌风险的nomogram，使用二元分类来指导FS转诊。该工具显示出强大的鉴别能力，可以减少不必要的结肠镜检查，同时优先考虑高风险患者进行及时评估。与现有的针对无症状个体的CRC风险模型不同，我们的nomogram是为憩室炎患者量身定制的。在应用于常规临床实践之前，需要在多中心队列中进行外部验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Colorectal Disease 医学-外科

CiteScore

4.90

自引率

3.60%

发文量

206

审稿时长

3-8 weeks

期刊介绍： The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies. The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.