The Classification Capability of Asia Pacific Colorectal Screening Score in Korea: An analysis of the Cancer Screenee Cohort

Objectives This study aimed to validate a simple risk assessment tool for estimating the advanced colorectal neoplasia (ACN) risk at colonoscopy screening; and the potential factors for cooperating with this tool in Korean population. Method Our study analyzed data of the Cancer screenee cohort - National Cancer Center, Korea. The risk level was assessed by the Asia Pacific Colorectal Screening Score (APCS) developed by the Asia-Pacific Working Group on Colorectal Cancer. The logistic regression models were recruited to assess the association between colorectal-related outcomes and the risk level by APCS. The discriminatory performance of the APCS score for various colorectal related outcomes was assessed by the C-statistics. Results A total of 12,520 individuals was included in our analysis, in which 317 ACN cases and 4,528 adenoma cases were founded. Our results revealed that the APCS had successfully classified our population into different risk groups, where significant differences in ACN rate and other outcomes were observed. The score performed acceptable discrimination capability with AUC value ranged from 0.62 to 0.65 for different outcomes. The result of the multivariate logistic regression model revealed that the high-risk group had 3.1 folds higher risk of having ACN (95% CI: 2.08- 4.67). Besides, BMI was reported as the significant predictor for ACN in both multivariate and subgroup analysis. Conclusion Our study highlighted significant differences in colorectal related outcomes detection between colorectal risk levels by APCS score and the potential cooperation with BMI for improving the discriminatory capability of APCS.