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COLOFIT: Development and internal-external validation of models using age, sex, faecal immunochemical and blood tests to optimise diagnosis of colorectal cancer in symptomatic patients
Crooks, Colin J. West, Joe Jones, James Banerjea, Ayan Humes, David J
Crooks, Colin J.
West, Joe
Jones, James
Banerjea, Ayan
Humes, David J
Abstract
Background: Colorectal cancer (CRC) is the third most common cancer in the United Kingdom and the second largest cause of cancer death. Aim(s): To develop and validate a model using available information at the time of faecal immunochemical testing (FIT) in primary care to improve selection of symptomatic patients for CRC investigations. Method(s): We included all adults (>= 18 years) referred to Nottingham University Hospitals NHS Trust between 2018 and 2022 with symptoms of suspected CRC who had a FIT. Predicted 1-year CRC diagnosis were calculated, and externally validated, using Cox proportional hazards modelling with selected multiple fractional polynomial transformations for age, faecal haemoglobin concentration (f-Hb) value, mean corpuscular volume (MCV), platelet count and sex. Result(s): At a CRC risk threshold of 0.6% (equivalent to f-Hb = 10 mug Hb/g (mug/g)) overall performance of the validated model across age strata using Harrell's C index was >= 0.91% (overall C-statistic 93%, 95% CI 92%-95%) with acceptable calibration. Using this model yields similar numbers of detected and missed cancers, but requires ~20% fewer investigations than a f-Hb >= 10 mug/g strategy. For approximately 100,000 people per year with symptoms of suspected CRC, we predict it might save > 4500 colonoscopies with no evidence that more cancers would be missed if we used our model compared to using FIT f-Hb >= 10 mug/g. Conclusion(s): Including age, sex, MCV, platelets and f-Hb in a survival analysis model to predict the risk of CRC yields greater diagnostic utility than a simple binary cut off f-Hb >= 10 mug/g.Copyright © 2025 The Author(s). Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.
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2025
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Crooks C.J., West J., Jones J., Hamilton W., Bailey S.E.R., Abel G., Banerjea A., Rees C.J., Tamm A., Nicholson B.D., Benton S.C., Hunt N. and Humes D.J. (2025) 'COLOFIT: Development and internal-external validation of models using age, sex, faecal immunochemical and blood tests to optimise diagnosis of colorectal cancer in symptomatic patients', Alimentary Pharmacology and Therapeutics, 61(5), pp. 852–864. doi: 10.1111/apt.18459 https://doi.org/10.1111/apt.18459.