Journal article
Multicentre derivation and validation of a colitis-associated colorectal cancer risk prediction web tool
- Abstract:
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Objective Patients with ulcerative colitis (UC) diagnosed with low-grade dysplasia (LGD) have increased risk of developing advanced neoplasia (AN: high-grade dysplasia or colorectal cancer). We aimed to develop and validate a predictor of AN risk in patients with UC with LGD and create a visual web tool to effectively communicate the risk.
Design In our retrospective multicentre validated cohort study, adult patients with UC with an index diagnosis of LGD, identified from four UK centres between 2001 and 2019, were followed until progression to AN. In the discovery cohort (n=246), a multivariate risk prediction model was derived from clinicopathological features using Cox regression. Validation used data from three external centres (n=198). The validated model was embedded in a web tool to calculate patient-specific risk.
Results Four clinicopathological variables were significantly associated with AN progression in the discovery cohort: endoscopically visible LGD >1 cm (HR 2.7; 95% CI 1.2 to 5.9), unresectable or incomplete endoscopic resection (HR 3.4; 95% CI 1.6 to 7.4), moderate/severe histological inflammation within 5 years of LGD diagnosis (HR 3.1; 95% CI 1.5 to 6.7) and multifocality (HR 2.9; 95% CI 1.3 to 6.2). In the validation cohort, this four-variable model accurately predicted future AN cases with overall calibration Observed/Expected=1.01 (95% CI 0.64 to 1.52), and achieved 100% specificity for the lowest risk group over 13 years of available follow-up.
Conclusion Multicohort validation confirms that patients with large, unresected, multifocal LGD and recent moderate/severe inflammation are at highest risk of developing AN. Personalised risk prediction provided via the Ulcerative Colitis-Cancer Risk Estimator ( www.UC-CaRE.uk ) can support treatment decision-making.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 3.3MB, Terms of use)
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- Publisher copy:
- 10.1136/gutjnl-2020-323546
Authors
- Grant:
- NIHR-RP-R3-12-026
- NF-SI-0617-10139
- NIHR201410
- NF-SI-0515-10005
- Publisher:
- BMJ Publishing Group
- Journal:
- Gut More from this journal
- Volume:
- 71
- Issue:
- 4
- Pages:
- 705-715
- Place of publication:
- England
- Publication date:
- 2021-05-14
- Acceptance date:
- 2021-04-18
- DOI:
- EISSN:
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1468-3288
- ISSN:
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0017-5749
- Pmid:
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33990383
- Language:
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English
- Keywords:
- Pubs id:
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1179955
- Local pid:
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pubs:1179955
- Deposit date:
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2022-10-26
- ARK identifier:
Terms of use
- Copyright holder:
- Curtius et al.
- Copyright date:
- 2022
- Rights statement:
- This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
- Licence:
- CC Attribution (CC BY)
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