Clinical factors associated with advanced colorectal neoplasia in average risk, asymptomatic individuals.

Abstract

e15679 Background: Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in the U.S. Advanced precancerous lesions (APL) are at heightened risk of becoming CRC, and along with CRC, comprise the group of lesions called advanced colorectal neoplasia (ACN). Factors associated with ACN for screen-eligible persons remain imperfectly understood due to analyses based on retrospective cohorts, limited sample size, and inclusion of high risk individuals. This analysis quantifies the association between clinical risk factors and ACN in PREEMPT CRC, a large, prospective, multicenter clinical study designed to validate a blood test for early detection of CRC. Methods: Detailed clinical information was collected for over 27,000 average-risk 45- to 85-year-olds (9.6% had ACN) with disease status determined by colonoscopy and histopathology. Clinical factors considered for analysis were based on literature. Best-subset selection of variables was performed based on minimizing AIC to select a final multivariate model. Both unadjusted (i.e. univariate) and adjusted (multivariate) odds ratios (ORs) were reported. Results: The direction and magnitude were generally consistent for univariate vs. multivariate ORs (Table). Older age, male sex, Non-Hispanic ethnicity, higher BMI, tobacco / alcohol use, and hypertension were associated with increased risk of ACN (OR range of 1.01 [95%CI, 1.01-1.02] per age-year to 1.70 [1.47-1.97] for current smokers), whereas other Non-White races were at lower risk vs. Whites (ORs of 0.63 [0.51-0.78] to 0.91 [0.35-1.98]). Conclusions: In PREEMPT CRC, ACN risk is associated with clinical factors, including modifiable risk factors such as smoking and alcohol use, highlighting the importance of behavioral intervention and other risk mitigation strategies. Clinical trial information: NCT04369053 . Factor Univariate OR (95% CI) Multivariate OR(95% CI) Factor Univariate OR(95% CI) Multivariate OR(95% CI) Age 1.01 (1.01-1.02) 1.01 (1.01-1.02) BMI 1.03(1.02-1.04) 1.03(1.02-1.04) Sex: M v F 1.60(1.48-1.73) 1.49 (1.35-1.64) Tobacco Use: Current v NeverFormer v Never 1.73(1.53-1.96)1.37(1.24-1.51) 1.70(1.47-1.97)1.12(0.99-1.26) Race: American Indian or Alaska Native v White 1.08(0.50-2.05) 0.91(0.35-1.98) Alcohol Use: Current v NeverFormer v Never 1.22(1.12-1.33)1.51(1.29-1.76) 1.11(1.00-1.24)1.33(1.09-1.60) Asian v White 0.56(0.47-0.66) 0.63(0.51-0.78) Diabetes: Y v N 1.31(1.12-1.53) 1.15(0.98-1.35) Black or African American v White 0.78(0.68-0.89) 0.70(0.60-0.82) Chronic Kidney Disease: Y v N 2.01(1.29-3.03) 1.49(0.94-2.27) Native Hawaiian or Other Pacific Islander v White 1.38(0.69-2.51) 1.60(0.73-3.13) Hypertension: Y v N 1.33(1.21-1.47) 1.16(1.05-1.29) Other v White 0.76(0.63-0.90) 0.79(0.61-1.01) Ethnicity: Not Hispanic or Latino v Hispanic or Latino 1.48(1.29-1.70) 1.57(1.31-1.89) Unknown v Hispanic or Latino 1.45(1.17-1.80) 1.67(1.26-2.21)