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BMC Medicine
Published in: BMC Medicine 1/2021

Open Access 01-12-2021 | Colorectal Cancer | Research article

Development and validation of a lifestyle-based model for colorectal cancer risk prediction: the LiFeCRC score

Authors: Krasimira Aleksandrova, Robin Reichmann, Rudolf Kaaks, Mazda Jenab, H. Bas Bueno-de-Mesquita, Christina C. Dahm, Anne Kirstine Eriksen, Anne Tjønneland, Fanny Artaud, Marie-Christine Boutron-Ruault, Gianluca Severi, Anika Hüsing, Antonia Trichopoulou, Anna Karakatsani, Eleni Peppa, Salvatore Panico, Giovanna Masala, Sara Grioni, Carlotta Sacerdote, Rosario Tumino, Sjoerd G. Elias, Anne M. May, Kristin B. Borch, Torkjel M. Sandanger, Guri Skeie, Maria-Jose Sánchez, José María Huerta, Núria Sala, Aurelio Barricarte Gurrea, José Ramón Quirós, Pilar Amiano, Jonna Berntsson, Isabel Drake, Bethany van Guelpen, Sophia Harlid, Tim Key, Elisabete Weiderpass, Elom K. Aglago, Amanda J. Cross, Konstantinos K. Tsilidis, Elio Riboli, Marc J. Gunter

Published in: BMC Medicine | Issue 1/2021

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Abstract

Background

Nutrition and lifestyle have been long established as risk factors for colorectal cancer (CRC). Modifiable lifestyle behaviours bear potential to minimize long-term CRC risk; however, translation of lifestyle information into individualized CRC risk assessment has not been implemented. Lifestyle-based risk models may aid the identification of high-risk individuals, guide referral to screening and motivate behaviour change. We therefore developed and validated a lifestyle-based CRC risk prediction algorithm in an asymptomatic European population.

Methods

The model was based on data from 255,482 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study aged 19 to 70 years who were free of cancer at study baseline (1992–2000) and were followed up to 31 September 2010. The model was validated in a sample comprising 74,403 participants selected among five EPIC centres. Over a median follow-up time of 15 years, there were 3645 and 981 colorectal cancer cases in the derivation and validation samples, respectively. Variable selection algorithms in Cox proportional hazard regression and random survival forest (RSF) were used to identify the best predictors among plausible predictor variables. Measures of discrimination and calibration were calculated in derivation and validation samples. To facilitate model communication, a nomogram and a web-based application were developed.

Results

The final selection model included age, waist circumference, height, smoking, alcohol consumption, physical activity, vegetables, dairy products, processed meat, and sugar and confectionary. The risk score demonstrated good discrimination overall and in sex-specific models. Harrell’s C-index was 0.710 in the derivation cohort and 0.714 in the validation cohort. The model was well calibrated and showed strong agreement between predicted and observed risk. Random survival forest analysis suggested high model robustness. Beyond age, lifestyle data led to improved model performance overall (continuous net reclassification improvement = 0.307 (95% CI 0.264–0.352)), and especially for young individuals below 45 years (continuous net reclassification improvement = 0.364 (95% CI 0.084–0.575)).

Conclusions

LiFeCRC score based on age and lifestyle data accurately identifies individuals at risk for incident colorectal cancer in European populations and could contribute to improved prevention through motivating lifestyle change at an individual level.
Appendix
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Metadata
Title
Development and validation of a lifestyle-based model for colorectal cancer risk prediction: the LiFeCRC score
Authors
Krasimira Aleksandrova
Robin Reichmann
Rudolf Kaaks
Mazda Jenab
H. Bas Bueno-de-Mesquita
Christina C. Dahm
Anne Kirstine Eriksen
Anne Tjønneland
Fanny Artaud
Marie-Christine Boutron-Ruault
Gianluca Severi
Anika Hüsing
Antonia Trichopoulou
Anna Karakatsani
Eleni Peppa
Salvatore Panico
Giovanna Masala
Sara Grioni
Carlotta Sacerdote
Rosario Tumino
Sjoerd G. Elias
Anne M. May
Kristin B. Borch
Torkjel M. Sandanger
Guri Skeie
Maria-Jose Sánchez
José María Huerta
Núria Sala
Aurelio Barricarte Gurrea
José Ramón Quirós
Pilar Amiano
Jonna Berntsson
Isabel Drake
Bethany van Guelpen
Sophia Harlid
Tim Key
Elisabete Weiderpass
Elom K. Aglago
Amanda J. Cross
Konstantinos K. Tsilidis
Elio Riboli
Marc J. Gunter
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2021
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-020-01826-0

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