Risk Stratification to Optimize Colorectal Cancer Screening: Development and Validation of a Decision-Tree Model for Colonoscopy Prioritization

IF 3.6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy Pub Date : 2026-07-15 DOI:10.1111/den.70224

María Capilla-Lozano, Carmen Quiñones-Torrelo, Lucas Sebastián-Peris, José Miguel Carot-Sierra, Concepción Gómez-Medina, Inmaculada Lorca, Clara Alfaro-Cervelló, Pilar Aguilar, Susana Castán-Cameo, Silvia Gimeno-Martos, Marta Ponce-Romero, Isabel Pascual-Moreno, Arturo Carratalá-Calvo, Andrés Peña, David Martí-Aguado

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Abstract

Background and Aims

Fecal immunochemical test-based colorectal cancer screening is effective; however, colonoscopy demand exceeds endoscopy capacity. Delays in colonoscopy after a positive test reduce screening effectiveness. We developed and validated a decision-tree model to stratify colorectal cancer risk among individuals with a positive test to prioritize colonoscopy for those at highest risk.

Methods

Prospective study including participants with a positive fecal immunochemical test referred for colonoscopy within a Spanish regional population-based screening program (2021–2024). Individuals were randomly assigned to derivation (65%) and validation (35%) cohorts using a stratified random split. Fecal hemoglobin concentration, clinical and laboratory data were collected to develop the decision-tree model. The primary outcomes were colorectal cancer and advanced-stage colorectal cancer.

Results

A total of 1773 participants were included. Colorectal cancer was detected in 97 participants (5.5%), including 25 cases (1.5%) with advanced-stage disease. The model stratified participants into low-, intermediate-, high-, and very high-risk groups. A progressive increase in the prevalence of colorectal cancer and advanced-stage disease was observed across risk groups in both cohorts (p < 0.001). The very high-risk group (fecal hemoglobin > 100 μg/g and > 65 years) included 6.7% of participants, with colorectal cancer and advanced-stage prevalence of 21.8% and 7.6%, respectively. Prioritizing colonoscopy for this group yielded a number needed to scope of 4.6 for colorectal cancer and 13.2 for advanced-stage disease, both significantly lower than the current one-size-fits-all strategy.

Conclusions

A decision-tree model was developed to stratify the risk of colorectal cancer and optimize endoscopic resources in screening programs.

Abstract Image

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风险分层优化结直肠癌筛查：结肠镜检查优先级决策树模型的开发和验证。

背景与目的：基于粪便免疫化学试验的结直肠癌筛查是有效的；然而，结肠镜检查的需求超过了内窥镜检查的能力。阳性检查后结肠镜检查的延误降低了筛查的有效性。我们开发并验证了一种决策树模型，用于对检测呈阳性的个体进行结直肠癌风险分层，以优先考虑高危人群的结肠镜检查。方法：前瞻性研究包括在西班牙区域人群筛查计划（2021-2024）中进行结肠镜检查的粪便免疫化学测试阳性的参与者。个体被随机分配到衍生（65%）和验证（35%）队列使用分层随机分割。收集粪便血红蛋白浓度、临床和实验室数据，建立决策树模型。主要结局是结直肠癌和晚期结直肠癌。结果：共纳入受试者1773人。97例（5.5%）被检测出结直肠癌，其中25例（1.5%）为晚期疾病。该模型将参与者分为低、中、高和高危组。在两个队列（p 100 μg/g和bbb65岁）的风险组中，观察到结直肠癌和晚期疾病的患病率逐渐增加，包括6.7%的参与者，结直肠癌和晚期患病率分别为21.8%和7.6%。优先考虑结肠镜检查的人群，结直肠癌患者所需的范围为4.6，晚期疾病患者所需的范围为13.2，两者都明显低于目前的一刀切策略。结论：建立了一个决策树模型来对结直肠癌的风险进行分层，并优化内镜筛查方案中的资源。

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

Digestive Endoscopy 医学-外科

CiteScore

10.10

自引率

15.10%

发文量

291

审稿时长

6-12 weeks

期刊介绍： Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.