Modified scoring model incorporating waist-hip ratio for predicting advanced colorectal neoplasia

Table 1 Characteristics of the derivation and validation cohorts, n (%)

	Derivation cohort (n = 4592)	Validation cohort (n = 1891)	P value
Age (years), mean ± SD	45.8 ± 12.4	47.1 ± 12.4	0.000
Sex, male	2458 (53.5)	1035 (54.7)	0.381
Regular excise	2090 (45.6)	670 (35.4)	0.000
Smoking	809 (17.6)	378 (20.0)	0.029
Alcohol consumption	606 (13.2)	352 (18.6)	0.000
Use of non-steroidal anti-inflammatory drugs	105 (2.3)	89 (4.7)	0.000
Hypertension	542 (11.8)	276 (14.6)	0.003
Diabetes mellitus	222 (4.9)	104 (5.5)	0.289
Hyperlipemia	410 (8.9)	266 (14.1)	0.000
Colorectal cancer family history	347 (7.6)	136 (7.2)	0.640
Post-cholecystectomy	130 (2.9)	34 (1.8)	0.015
Rectal bleeding	199 (4.3)	90 (4.8)	0.499
Change of bowel habit	275 (6.0)	120 (6.3)	0.585
Abdominal pain	731 (15.9)	354 (18.7)	0.105
Body mess index (kg/m2), mean ± SD	23.3 ± 3.3	23.4 ± 3.3	0.264
Waist circumference (cm), mean ± SD	82.5 ± 10.3	83.4 ± 10.8	0.003
Waist-hip ratio, mean ± SD	0.885 ± 0.79	0.891 ± 0.89	0.014
Normal/diverticulum/colitis/neuroendocrine neoplasms/hyperplastic polyps	3124 (68.0)	1241 (65.6)	0.061
Advanced colorectal neoplasia	372 (8.1)	161 (8.5)	0.582
Cancer	58 (1.3)	20 (1.1)	0.490

Table 2 Relationships between clinical features and presence of advanced colorectal neoplasia in derivation cohort, n (%)

Clinical feature	Total	Advanced colorectal neoplasia
		Univariate analysis				Multivariate analysis
		Present (n = 372)	Absent (n = 4220)	OR (95%CI)	P value	OR (95%CI)	P value
Sex
Female	2134	134 (6.3)	2000 (93.7)	1 (Reference)		1 (Reference)
Male	2458	238 (9.7)	2220 (90.3)	1.54 (1.26-1.89)	0.000	1.49 (1.14-1.93)	0.003
Age (years)
< 40	1636	46 (2.8)	1590 (97.2)	1 (Reference)		1 (Reference)
40–49	1315	111 (8.4)	1204 (91.6)	3.00 (2.15-4.20)		3.11 (2.17-4.44)
50–59	934	101 (10.8)	833 (89.2)	3.85 (2.74-5.41)		3.93 (2.71-5.71)
60–69	519	81 (15.6)	438 (84.4)	5.56 (3.92-7.87)		5.56 (3.70-8.35)
≥ 70	188	33 (17.6)	155 (84.4)	6.25 (4.10-9.52)	0.000	6.10 (3.64-10.2)	0.000
Regular exercise
No	2491	193 (7.7)	2298 (92.3)	1 (Reference)
Yes	2091	177 (8.5)	1914 (91.5)	1.09 (0.90-1.33)	0.373
Smoking
No	3783	275 (7.3)	3508 (92.7)	1 (Reference)		1 (Reference)
Yes	809	97 (12.0)	712 (88.0)	1.65 (1.33-2.05)	0.000	1.50 (1.14-1.98)	0.004
Alcohol drinking
No	3986	314 (7.9)	3673 (92.1)	1 (Reference)
Current or past drinker	606	58 (9.6)	548 (90.4)	1.21 (0.93-1.59)	0.158
Regular intake of non-steroidal anti-inflammatory drugs
No	4437	350 (7.9)	4087 (92.1)	1 (Reference)		1 (Reference)
Yes	105	18 (17.0)	87 (83.0)	2.16 (1.340-3.32)	0.001	1.11 (0.64-1.93)	0.707
Hypertension
No	4050	296 (7.3)	3754 (92.7)	1 (Reference)		1 (Reference)
Yes	542	76 (14.0)	466 (86.0)	1.92 (1.51-2.43)	0.000	1.13 (0.83-1.54)	0.423
Diabetes mellitus
No	4370	342 (7.8)	4028 (92.2)	1 (Reference)		1 (Reference)
Yes	222	30 (13.5)	192 (86.5)	1.72 (1.21-2.43)	0.003	0.92 (0.60-1.42)	0.718
Hyperlipemia
No	4182	324 (7.7)	3858 (92.3)	1 (Reference)		1 (Reference)
Yes	410	48 (11.7)	362 (88.3)	1.51 (1.13-2.01)	0.005	1.03 (0.74-1.45)	0.848
Colorectal cancer family history
No	4239	344 (8.1)	3895 (91.9)	1 (Reference)
Yes	347	28 (8.1)	319 (91.9)	1.01 (0.69-1.44)	0.976
Post cholecystectomy
No	4462	357 (8.0)	4105 (92.0)	1 (Reference)
Yes	130	15 (11.5)	115 (88.5)	1.43 (0.88-2.33)	0.154
Rectal bleeding
No	4393	349 (7.9)	4044 (92.1)	1 (Reference)		1 (Reference)
Yes	199	23 (11.6)	176 (88.4)	1.51 (0.97-2.37)	0.068	1.55 (0.97-2.45)	0.064
Change of bowel habit
No	4317	348 (8.1)	3969 (91.9)	1 (Reference)
Yes	275	24 (8.7)	251 (91.3)	1.09 (0.71-1.68)	0.695
Abdominal pain
No	3861	320 (8.3)	3541 (91.7)	1 (Reference)
Yes	731	52 (7.1)	679 (92.9)	0.85 (0.63-1.15)	0.286
Body mass index (kg/m²)
≤ 23	1961	121 (6.2)	1840 (93.8)	1 (Reference)		1 (Reference)
> 23	2621	249 (9.5)	2372 (90.5)	1.54 (1.25-1.90)	0.000	1.10 (0.84-1.44)	0.500
Waist circumference (cm)
Normal	2865	203 (7.1)	2662 (92.9)	1 (Reference)		1 (Reference)
Higher (> 90, males; > 80, females)	1727	169 (9.8)	1558 (90.2)	1.38 (1.14-1.68)	0.001	0.90 (0.68-1.20)	0.487
Waist-hip ratio
Normal	2957	190 (6.4)	2767 (93.6)	1 (Reference)		1 (Reference)
Higher (> 0.9, males; > 0.85, females)	1635	182 (11.1)	1453 (88.9)	1.73 (1.43-2.11)	0.000	1.46 (1.11-1.92)	0.006

OR: Odds ratio.

Table 3 Development of a scoring model to predict advanced colorectal neoplasia

Clinical features	Odds ratio (95%CI)	Beta coefficient	Risk score	P value
Sex
Female	1 (Reference)	0	0
Male	1.49 (1.14-1.93)	0.396	1	0.003
Age (years)
< 40	1 (Reference)	0	0
40–49	3.11 (2.17-4.44)	1.134	2
50–59	3.93 (2.71-5.71)	1.370	3
60–69	5.56 (3.70-8.35)	1.715	3
≥ 70	6.10 (3.64-10.2)	1.807	4	0.000
Smoking
No	1 (Reference)	0	0
Yes	1.50 (1.14-1.98)	0.406	1	0.004
Waist-hip ratio
Normal	1 (Reference)	0	0
Higher (> 0.9, males; > 0.85, females)	1.46 (1.11-1.92)	0.378	1	0.006

Table 4 Prevalence of advanced colorectal neoplasia according to scores and subgroups in the derivation cohort

Score	Proportion of individuals with ACN	95%CI	Subgroups	Proportion of individuals with ACN	95%CI
0	2.5% (13/530)	1.3–4.2	Low-risk group (0–2)	3.3% (63/1938)	2.4-4.0
1	2.6% (19/730)	1.6–4.0
2	4.6% (31/678)	3.1–6.4
3	7.3% (69/944)	5.7–9.2	Moderate-risk group (3–4)	9.3% (185/1983)	8.3-10.9
4	11.2% (116/1039)	9.3–13.2
5	17.4% (84/482)	14.1–21.1	High-risk group (5–7)	18.5% (124/671)	15.6-21.6
6	20.6% (35/170)	14.8–27.5
7	26.3% (5/19)	9.1–51.2
Total	8.1% (372/4592)	7.3–8.9

ACN: Advanced colorectal neoplasia.

Table 5 Prevalence of advanced colorectal neoplasia by risk tier, n (%)

Risk tier (risk score)	Derivation cohort		Validation cohort			Validation cohort (male)			Validation cohort (female)
	Number of subjects	ACN	Number of subjects	ACN	Relative risk (95%CI)	Number of subjects	ACN	Relative risk (95%CI)	Number of subjects	Advanced colorectal neoplasia	Relative risk (95%CI)
Low risk (0–2)	1938 (42.2)	63 (3.3)	943 (49.9)	47 (5.0)	1 (Reference)	356 (34.4)	16 (4.5)	1 (Reference)	587 (68.6)	31 (5.3)	1 (Reference)
Moderate risk (3–4)	1983 (43.2)	185 (9.3)	727 (38.4)	75 (10.3)	2.07 (1.46-2.94)	489 (47.2)	42 (8.6)	1.91 (1.09-3.34)	238 (27.8)	33 (13.9)	2.62 (1.65-4.18)
High risk (5–7)	671 (14.6)	124 (18.5)	221 (11.7)	39 (17.6)	3.55 (2.38-5.26)	190 (18.4)	32 (16.8)	3.75 (2.11-6.67)	31 (3.6)	7 (22.6)	4.27 (2.05-8.93)
Total	4592	372 (8.1)	1891	161 (8.5)		1035 (54.7)	90 (8.7)		856 (45.3)	71 (8.3)

ACN: Advanced colorectal neoplasia.

Table 6 Validity of the newly developed score model and comparison with Asia-Pacific Colorectal Screening model and modified Asia-Pacific Colorectal Screening model, n (%)

Validation cohort (risk score model of this study) (age, male, smoking, and high wait-to-hip ratio)			Validation cohort (according to APCS model) (age, male, smoking, family history of CRC)			Validation cohort (according to modified APCS model) (age, male, smoking, family history of CRC and body mass index )
Risk tier (risk score)	ACN	Relative risk (95%CI)	Risk tier (risk score)	ACN	Relative risk (95%CI)	Risk tier (risk score)	Advanced colorectal neoplasia	Relative risk (95%CI)
LR (0-2)	47 (5.0)	1	LR (0-1)	46 (5.1)	1	LR (0)	15 (4.9)	1
MR (3-4)	75 (10.3)	2.07 (1.46-2.94)	MR (2-3)	81 (10.4)	2.03 (1.48-2.87)	MR (1–2)	86 (7.7)	1.58 (0.93-2.70)
HR (5-7)	39 (17.6)	3.55 (2.38-5.26)	HR (4-7)	34 (16.2)	3.16 (2.09-4.81)	HR (3–6)	60 (12.9)	2.65 (1.53-4.57)
Hosmer-lemeshow goodness-of-fit statistic	0.71		Hosmer-lemeshow goodness-of-fit statistic	0.59		Hosmer-lemeshow goodness-of-fit statistic	0.27
C-statistic	0.66 ± 0.02		C-statistic	0.63 ± 0.02		C-statistic	0.62 ± 0.02

APCS: Asia-Pacific Colorectal Screening model; CRC: Colorectal cancer; HR: High risk; LR: Low risk; MR: Moderate risk.