Quantitative Fecal Immunochemical Test for Advanced Colorectal Neoplasia Risk Stratification

This study aimed to develop and externally validate a risk stratification model for advanced colorectal neoplasia (ACRN) based on the quantitative fecal immunochemical test (FIT) and easily available clinical data.

Data were derived from a multicenter study, comprising 3,209 individuals in the development set and 1,678 in the validation set. Significant risk factors for ACRN were identified using multivariable logistic regression. The area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test were used to evaluate model performance. After point assignments based on the regression coefficients, patients in the validation set were categorized into low-, intermediate-, high-, and very high-risk tiers.

Age, sex, body mass index, habitual residence, alcohol intake, smoking, and fecal hemoglobin concentration were identified as significant risk factors for ACRN. The model demonstrated strong predictive performance (AUROC = 0.870) and good calibration (P = 0.929). The corresponding prevalence of ACRN in the low-, intermediate-, high-, and very high-risk tiers was 1.66%, 4.50%, 28.45%, and 60.64%, respectively. Subjects in the intermediate-, high-, and very high-risk tiers had 2.71-, 17.13-, and 36.51-fold higher risk of ACRN, respectively, compared with those in the low-risk tier.

This model can effectively stratify the risk of ACRN. Individuals in the high-risk and very high-risk groups should undergo colonoscopy promptly. Furthermore, it may help compensate for the low detection rate of FIT for advanced adenoma.

This model provides clinicians with a complementary approach to colorectal cancer screening strategy and may help optimize the efficiency of screening resource allocation.