A self-reported symptom-based decision-making model helps to rule out outpatient cases at low risk for CRC before colonoscopy
Zhe Luan,
Fangfang Liu,
Li Zhang,
Jun Chen,
Yiming Zhao,
Congyong Li,
Zhaoyun Liu,
Huawei Li,
Li Dong,
Funing Zang,
Lingyan Han,
Tianyue Zhao,
Qiao Wang,
Gang Sun,
Shufang Wang
Affiliations
Zhe Luan
Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
Fangfang Liu
Department of Oncology, 5th Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
Li Zhang
Department of Gastroenterology, Taiyuan Central Hospital, Shanxi Medical University, Taiyuan, 030009, China
Jun Chen
Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
Yiming Zhao
Department of Gastroenterology and Hepatology, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, China
Congyong Li
Sixth Health Care Department, Second Medical Center of PLA General Hospital, Beijing, 100853, China
Zhaoyun Liu
Department of Gastroenterology, Ningde Hospital of Traditional Chinese Medicine Affiliated to Fujian University of Traditional Chinese Medicine, Ningde, 352100, China
Huawei Li
Department of Gastroenterology, Panjin Central Hospital, Panjin, 124013, China
Li Dong
Department of Gastroenterology, Taiyuan Central Hospital, Shanxi Medical University, Taiyuan, 030009, China
Funing Zang
Department of Gastroenterology, Pizhou City Hospital of Traditional Chinese Medicine, Pizhou, 221300, China
Lingyan Han
Department of Gastroenterology, Shanxi Traditional Chinese Medical Hospital, Taiyuan, 030012, China
Tianyue Zhao
Department of Gastroenterology, Panjin Central Hospital, Panjin, 124013, China
Qiao Wang
Department of Gastroenterology, Ningde Hospital of Traditional Chinese Medicine Affiliated to Fujian University of Traditional Chinese Medicine, Ningde, 352100, China
Gang Sun
Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
Shufang Wang
Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China; Corresponding author.
Objectives: Effective exclusion of low-risk symptomatic outpatient cases for colorectal cancer (CRC) remains diagnostic challenges. We aimed to develop a self-reported symptom-based decision-making model for application in outpatient scenarios. Methods: In total, 8233 symptomatic cases at risk for CRC, as judged by outpatient physicians, were involved in this study at seven medical centers. A decision-making model was constructed using 60 self-reported symptom parameters collected from the questionnaire. Further internal and external validation cohorts were built to evaluate the discriminatory power of the CRC model. The discriminatory power of the CRC model was assessed by the C-index and calibration plot. After that, the clinical utility and user experience of the CRC model were evaluated. Results: Nine symptom parameters were identified as valuable predictors used for modeling. Internal and external validation cohorts verified the adequate discriminatory power of the CRC model. In the clinical application step, all 17 physicians found the model easy to grasp, 99.9 % of the patients were satisfied with the survey form. Application of this model detected all CRC cases. The total consistency ratio of outpatient cases undergoing colonoscopy was 81.4 %. None of the low-risk patients defined by the CRC model had been diagnosed with CRC. Conclusion: This multicenter study developed and validated a simple and user-friendly decision-making model covering self-reported information. The CRC model has been demonstrated to perform well in terms of rapid outpatient decision-making scenarios and clinical utility, particularly because it can better rule out low-risk outpatient cases.
