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Title: Multicentre derivation and validation of a colitis-associated colorectal cancer risk prediction web tool
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
Keywords: clinical decision making
colorectal cancer
ulcerative colitis
Issue Date: 14-May-2021
Publisher: BMJ Publishing Group
Citation: 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 (2021-05-14). Multicentre derivation and validation of a colitis-associated colorectal cancer risk prediction web tool. Gut. ScholarBank@NUS Repository.
Rights: Attribution 4.0 International
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 ( can support treatment decision-making. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
Source Title: Gut
ISSN: 0017-5749
DOI: 10.1136/gutjnl-2020-323546
Rights: Attribution 4.0 International
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