Multicentre derivation and validation of a colitis-associated colorectal cancer risk prediction web tool. Issue 4 (14th May 2021)

• Record Type: Journal Article
• Authors: Curtius, Kit; Kabir, Misha; Al Bakir, Ibrahim; Choi, Chang Ho Ryan; Hartono, Juanda L; Johnson, Michael; East, James E; Lindsay, James O; Vega, Roser; Thomas-Gibson, Siwan; Warusavitarne, Janindra; Wilson, Ana; Graham, Trevor A; Hart, Ailsa
• Other Names: author non-byline.; Allan Philip author non-byline.; Ambrose Tim author non-byline.; Arancibia-Cárcamo Carolina author non-byline.; Bailey Adam author non-byline.; Barnes Ellie author non-byline.; Bird-lieberman Elizabeth author non-byline.; Bornschein Jan author non-byline.; Braden Barbara author non-byline.; Brain Oliver author non-byline.; Collier Jane author non-byline.; Culver Emma author non-byline.; East James author non-byline.; Geremia Alessandra author non-byline.; George Bruce author non-byline.; Howarth Lucy author non-byline.; Jones Kelsey author non-byline.; Klenerman Paul author non-byline.; Leedham Simon author non-byline.; Palmer Rebecca author non-byline.; Powrie Fiona author non-byline.; Rodrigues Astor author non-byline.; Satsangi Jack author non-byline.; Simmons Alison author non-byline.; Travis Simon author non-byline.; Uhlig Holm author non-byline.; Walsh Alissa author non-byline.
• Is Part Of: Gut. Volume 71:Issue 4(2022)
• Page Start: 705
• Page End: 715
• Publication Date: 2021-05-14
• Subjects: ulcerative colitis -- colorectal cancer -- clinical decision making -- dysplasia; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2020-323546
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : 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.