Performance of the Asia-Pacific Colorectal Screening score in stratifying the risk of advanced colorectal neoplasia: A meta-analysis and systematic review

Mai Ngoc Luu ^1,2, Nhi Ai Trinh ³, Truc Le Thanh Tran ⁴

⁰Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.

Journal of Gastroenterology and Hepatology +

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March 1, 2024

View abstract on PubMed

Summary

The Asia-Pacific Colorectal Screening (APCS) score effectively identifies advanced colorectal neoplasia (ACN) risk. Combining APCS score with fecal immunochemical testing (FIT) further enhances the detection of high-risk individuals for colonoscopy.

Area Of Science

Gastroenterology
Preventive Medicine
Epidemiology

Background

Colorectal cancer (CRC) remains a significant global health concern.
Early detection through screening is crucial for improving patient outcomes.
Risk stratification tools are needed to optimize screening strategies.

Purpose Of The Study

To systematically review and meta-analyze the performance of the Asia-Pacific Colorectal Screening (APCS) score.
To evaluate the APCS score's effectiveness in stratifying the risk of advanced colorectal neoplasia (ACN).
To assess the added value of combining the APCS score with the fecal immunochemical test (FIT) for ACN risk identification.

Main Methods

Systematic literature search across 12 electronic databases and registers (updated to September 2023).
Inclusion of 13 eligible studies from the Asia-Pacific region involving 69,762 participants undergoing colonoscopy.
Application of random-effect models for pooled performance statistics of the APCS score.

Main Results

Pooled ACN prevalences: 0.9% (APCS 0-1, average-risk), 3.1% (APCS 2-3, moderate-risk), and 8.1% (APCS ≥4, high-risk).
The high-risk group (APCS ≥4) showed significantly higher ACN risk (DOR: 2.84).
APCS score demonstrated a sensitivity of 0.42 and specificity of 0.86 (AUC: 0.642).
Combination of APCS score and FIT significantly improved ACN risk identification (DORs: 4.02 and 5.44).

Conclusions

The APCS score is effective in stratifying ACN risk within the Asia-Pacific population.
Integrating FIT with the APCS score enhances the identification of high-risk individuals.
This combined approach can help prioritize individuals for timely colonoscopy screenings.

Keywords:

APCS Asia–Pacific advanced colorectal neoplasia colorectal neoplasms fecal immunochemical test