Evaluation of Screening Model for Advanced Colorectal Adenoma and Traditional Chinese Medicine Tongue Image Analysis Based on Real World Data

HUANG Peidi; ZHONG Zishao; LIU Shujun; YE Zhenhao; LI Zhuolin; WEI Sufen; ZHANG Haiyan; ZHANG Beiping

doi:10.13288/j.11-2166/r.2023.21.008

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Evaluation of Screening Model for Advanced Colorectal Adenoma and Traditional Chinese Medicine Tongue Image Analysis Based on Real World Data

更新时间：2023-10-26

- Evaluation of Screening Model for Advanced Colorectal Adenoma and Traditional Chinese Medicine Tongue Image Analysis Based on Real World Data
- Journal of Traditional Chinese Medicine Vol. 64, Issue 21, Pages: 2197-2207(2023)
- 作者机构：
  
  1.广州中医药大学第二临床医学院，广东省广州市白云区机场路12号，510405
  2.广州中医药大学第二附属医院/广东省中医院
- 作者简介：
- 基金信息：
- DOI：10.13288/j.11-2166/r.2023.21.008
  CLC：
- Received：19 April 2023，
  
  Revised：2023-08-01，
  
  Published：02 November 2023
- 稿件说明：
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黄佩娣,钟子劭,刘书君等.基于真实世界数据的结直肠进展期腺瘤的筛查模型评估与舌象分析[J].中医杂志,2023,64(21):2197-2207.

HUANG Peidi,ZHONG Zishao,LIU Shujun,et al.Evaluation of Screening Model for Advanced Colorectal Adenoma and Traditional Chinese Medicine Tongue Image Analysis Based on Real World Data[J].Journal of Traditional Chinese Medicine,2023,64(21):2197-2207.
黄佩娣,钟子劭,刘书君等.基于真实世界数据的结直肠进展期腺瘤的筛查模型评估与舌象分析[J].中医杂志,2023,64(21):2197-2207. DOI： 10.13288/j.11-2166/r.2023.21.008.

HUANG Peidi,ZHONG Zishao,LIU Shujun,et al.Evaluation of Screening Model for Advanced Colorectal Adenoma and Traditional Chinese Medicine Tongue Image Analysis Based on Real World Data[J].Journal of Traditional Chinese Medicine,2023,64(21):2197-2207. DOI： 10.13288/j.11-2166/r.2023.21.008.

摘要

目的

比较三种常用结直肠癌的风险评分模型作为无创手段识别结直肠进展期腺瘤的效果，并评估中医舌象在模型中的预测价值。

方法

纳入经病理检查确诊为结直肠腺瘤的患者，分为进展期和非进展期腺瘤，采集临床基础资料和舌象图片，应用亚太地区结直肠肿瘤筛查（APCS）评分模型及其修订版（M-APCS）、结直肠肿瘤预测（CNP）评分模型进行评价，比较三种模型对结直肠进展期腺瘤的预测效果、不同程度腺瘤患者临床资料及中医舌象特征的差异，以及各模型中舌象的异同。使用曲线下面积（AUC）及受试者工作特征（ROC）曲线评价三个风险模型的区分度；使用克朗巴赫信度系数及Hosmer-Lemeshow进行校准度评价即一致性分析。

结果

227例腺瘤患者中进展期腺瘤104例（45.82%）；进展期腺瘤中腻苔者（70例，67.3%）高于非腻苔（34例，32.7%，

＜0.05）；对比非进展腺瘤，进展期腺瘤的非腻苔

值为0.371（0.204~0.673，

＜0.01）。三个风险模型中，APCS高危组进展期腺瘤检出人数占比最高（63.3%），分别是中危组（42.6%）和低危组（31.1%）的1.49倍和2.04倍（

＜0.01），M-APCS和CNP高危组的进展期腺瘤人数占比稍高于中风险组或低风险组（

＞0.05）。各模型高危组的黄苔和腻苔占比高于中危组或低危组（

＜0.05）；三个模型的分组差异中，使用M-APCS模型比其他两个模型更容易分入高危组（

＜0.01）。模型区分度评价中，三个模型均对进展期腺瘤具有一定的区分度（

＜0.05），其中APCS的AUC为0.629（95%

：0.556~0.702），高于M-APCS（AUC为0.591）和CNP（AUC为0.586）。校准度评价中，三个模型的克朗巴赫信度系数为0.919（＞0.7），具有一致性；相关性矩阵中，APCS模型与M-APCS模型、CNP模型的相关系数分别为0.794、0.717，M-APCS模型与CNP模型的相关系数为0.873，Hosmer-Lemeshow

值为2.552，

＞0.05。

结论

三个模型均具有识别结直肠进展期腺瘤的效能，且校准能力均较好，其中APCS的识别效能最高，但识别准确率均有待提升；中医舌象中的腻苔是进展期腺瘤的潜在预测指标之一，可考虑纳入结直肠进展期腺瘤的风险模型中以提高准确率。

Abstract

Objective

To evaluate the effectiveness and consistency of three commonly used early colorectal cancer screening models for advanced colorectal adenoma as a noninvasive means， and to assess the predictive value of traditional Chinese medicine （TCM） tongue images in the models.

Methods

Patients diagnosed with colorectal adenoma who underwent colonoscopy and pathological examination were selected as the study participants. Basic clinical data and tongue image were collected. The prediction models of Asia-Pacific colorectal screening （APCS） model， its revision （M-APCS） and colorectal neoplasia predict （CNP） model were applied to compare the predictive effects of the three models on advanced stage adenomas of the colon， the differences in clinical data and traditional Chinese medicine tongue characteristics among patients with different degrees of adenomas， and the similarities and differences in tongue characteristics among the models. The discriminative ability of the three risk models was evaluated using the area under the curve （AUC） and receiver operating characteristic （ROC） curves. The calibration was assessed using the Kuder-Richardson coefficient and the Hosmer-Lemeshow test for consistency analysis.

Results

A total of 227 patients with adenoma were analyzed， including 104 patients （45.82%） with advanced adenoma. In the detection of advanced adenoma， those with greasy coating （70 cases， 67.3%） were higher than those without greasy coating （34 cases， 32.7%，

＜0.05）. After multivariate analysis， the odds ratio （OR） value of non-greasy coating was 0.371 （0.204~0.673，

＜0.01）， indicating that non-greasy coating was a protective factor for advanced adenomas. Among the three risk models， the detection rate of advanced adenoma in the high-risk group with APCS was the highest （63.3%）， which was 1.49 times and 2.04 times that of the medium-risk group （42.6%） and the low-risk group （31.1%，

＜0.01）. The detection rate of advanced adenomas in high-risk groups of M-APCS and CNP was slightly higher than that in moderate or low risk groups （

＞0.05）. The proportion of yellow and greasy coating in high-risk group was higher than that in the medium-risk or low-risk group （

＜0.05）. For the ability to distinguish advanced and non-advanced adenomas， the AUC of APCS was 0.629 （95%

： 0.556~0.702） and was higher than that of M-APCS （0.591） and CNP （0.586）. In calibration evaluation， Cronbach's alpha was 0.919 （＞0.7）， which indicated that the three models were consistent. In the correlation matrix， the correlation coefficients between APCS model and M-APCS model， and CNP model were 0.794 and 0.717， respectively， and the correlation coefficients between M-APCS model and CNP model were 0.873， Hosmer-Lemeshow χ

=2.552，

＞0.05， which suggested that the three models had good calibration ability.

Conclusion

All three models demonstrate the efficiency to identify advanced colorectal adenoma， and their calibration ability is considered to be good. Among the three models， the APCS exhibits the highest recognition efficiency， however， the recognition accuracy of the APCS model needs improvement. The presence of a greasy coating is identified as one of the potential predictors of advanced adenoma. Consequently， it can be considered for inclusion in the risk model of advanced colorectal adenoma to enhance the accuracy.

关键词

Keywords

references

郑荣寿，张思维，孙可欣，等 . 2016年中国恶性肿瘤流行情况分析［J］. 中华肿瘤杂志， 2023 ， 45 （ 3 ）： 212 - 220 .

张北平，魏玮，李爱民，等 . 结直肠腺瘤及早期结直肠癌中西医结合诊治专家共识（2021）［J］. 中医杂志， 2022 ， 63 （ 10 ）： 989 - 997 .

SIEGEL RL ， WAGLE NS ， CERCEK A ， et al . Colorectal cancer statistics， 2023 ［J］. CA Cancer J Clin ， 2023 ， 73 （ 3 ）： 233 - 254 .

范林锋 . 列线图构建结直肠肿瘤的临床预测模型及偏振光成像技术对结直肠肿瘤的诊断价值探究［D］. 广州：南方医科大学， 2021 .

SNINSKY JA ， SHORE BM ， LUPU GV ， et al . Risk factors for colorectal polyps and cancer ［J］. Gastrointest Endosc Clin N Am ， 2022 ， 32 （ 2 ）： 195 - 213 .

YEOH KG ， HO KY ， CHIU HM ， et al . The Asia-Pacific Colorectal Screening score： a validated tool that stratifies risk for colorectal advanced neoplasia in asymptomatic Asian subjects ［J］. Gut ， 2011 ， 60 （ 9 ）： 1236 - 1241 .

SUNG JJ ， NG SC ， CHAN FK ， et al . An updated Asia Pacific Consensus Recommendations on colorectal cancer screening ［J］. Gut ， 2015 ， 64 （ 1 ）： 121 - 132 .

WONG MC ， LAM TY ， TSOI KK ， et al . A validated tool to predict colorectal neoplasia and inform screening choice for asymptomatic subjects ［J］. Gut ， 2014 ， 63 （ 7 ）： 1130 - 1136 .

姜楠 . 初诊胃癌患者舌象特征的客观化研究［D］. 合肥：安徽中医药大学， 2022 .

SHERMAN RE ， ANDERSON SA ， PAN GJDAL ， et al . Real-world evidence：what is it and what can it tell us？［J］. N Engl J Med ， 2016 ， 375 （ 23 ）： 2293 - 2297 .

李鹏，王拥军，陈光勇，等 . 中国早期结直肠癌及癌前病变筛查与诊治共识［J］. 中国实用内科杂志， 2015 ， 35 （ 3 ）： 211 - 227 .

邓铁涛，陈群，郭振球，等 . 中医诊断学（修订版）［M］. 上海：上海科学技术出版社， 2022 ： 30 - 40 .

LAI EJ ， CALDERWOOD AH ， DOROS G ， et al . The Boston bowel preparation scale： a valid and reliable instrument for colonoscopy-oriented research ［J］. Gastrointest Endosc ， 2009 ， 69 （ 3 Pt. 2 ）： 620 - 625 .

CRONBACH LJ . Coefficient alpha and the internal structure of tests ［J］. Psychometrika ， 1951 ， 16 （ 3 ）： 297 - 334 .

HASAN S ， SULIEMAN H ， BABI H ， et al . Development and psychometric evaluation of the Antibiotic Knowledge and Consumption Tool （AKCT）［J］. Antibiotics （Basel）， 2022 ， 11 （ 12 ）： 1744 .

KONG Y ， ZHUO L ， DONG D ， et al . Validation of the Asia-Pacific colorectal screening score and its modified versions in predicting colorectal advanced neoplasia in Chinese population ［J］. BMC Cancer ， 2022 ， 22 （ 1 ）： 961 .

XU J ， RONG L ， GU F ， et al . Asia-Pacific colorectal screening score combined with stool DNA test improves the detection rate for colorectal advanced neoplasms ［J］. Clin Gastroenterol Hepatol ， 2023 ， 21 （ 6 ）： 1627 - 1636 .

翟爱军，杜丽娜，张续乾，等 . 亚太结直肠癌筛查评分系统在我国体检人群结直肠癌机会性筛查中的应用［J］. 中华胃肠内镜电子杂志， 2018 ， 5 （ 3 ）： 114 - 117 .

郭兰伟，郑黎阳，陈琼，等 . 亚太结直肠癌风险评分系统在我国北方无症状人群筛查中的应用［J］. 中国肿瘤， 2022 ， 31 （ 8 ）： 649 - 654 .

孔蕴馨，董栋，卓朗，等 . 三种结直肠癌筛查评分模型在徐州市人群中诊断效果的验证与比较［J］. 中国肿瘤， 2021 ， 30 （ 11 ）： 813 - 819 .

KIM JY ， CHOI S ， PARK T ， et al . Development and validation of a scoring system for advanced colorectal neoplasm in young Korean subjects less than age 50 years ［J］. Intest Res ， 2019 ， 17 （ 2 ）： 253 - 264 .

KANG Q ， LI N ， WANG RF ， et al . Preliminary application of the Asia-Pacific colorectal screening score combined with the quantitative fecal occult blood in colorectal neoplasia screening ［J］. Natl Med J China ， 2021 ， 101 （ 46 ）： 3825 - 3828 .

朱柠，黄彦钦，宋永茂，等 . 高危因素量化问卷与亚太结直肠癌筛查评分及分别联合粪便免疫化学检测在进展期结直肠肿瘤筛查中效果的比较［J］. 中华胃肠外科杂志， 2022 ， 25 （ 7 ）： 612 - 620 .

许庆玲 . 冠心病患者结直肠肿瘤的患病率和进展性腺瘤肠道菌群的检测［D］. 上海：上海交通大学， 2016 .

苏婉，许家佗，屠立平，等 . 207例肺癌患者舌象在不同临床因素中分布规律研究［J］. 中华中医药学刊， 2015 ， 33 （ 11 ）： 2703 - 2706 .

龙思丹 . 基于风险分层肠腺瘤患者舌象特征与LTB4/BLT1轴的相关研究［D］. 北京：北京中医药大学， 2021 .

程怡，李健民，赵喜颖，等 . 基于“伏毒致病”学说探讨预防结直肠腺瘤复发的证治思路［J］. 广州中医药大学学报， 2020 ， 37 （ 7 ）： 1387 - 1391 .

黄海洋 . 伺机性筛查新模式在结直肠肿瘤患者一级亲属及配偶的探索性研究［D］. 北京：北京协和医学院， 2022 .

蒋海洋，王慧雯，李莉，等 . 慢性胃炎不同病理阶段中医舌象与舌苔菌群的关联性分析［J］. 世界科学技术-中医药现代化， 2021 ， 23 （ 9 ）： 3050 - 3055 .

JUNG YS ， KIM NH ， YANG HJ ， et al . Association between waist circumference and risk of colorectal neoplasia in normal-weight adults ［J］. J Gastroenterol Hepatol ， 2020 ， 35 （ 1 ）： 43 - 49 .

KIM B ， KIM BC ， NAM SY ， et al . Visceral adipose tissue volume and the occurrence of colorectal adenoma in follow-up colonoscopy for screening and surveillance ［J］. Nutr Cancer ， 2017 ， 69 （ 5 ）： 739 - 745 .

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