Clin Gastroenterol Hepatol. 2024 Aug;22(8):1697-1708. doi: 10.1016/j.cgh.2024.02.014.Epub 2024 Feb 29.

Anouk M Wijnands ¹, Bas B L Penning de Vries ², Maurice W M D Lutgens ³, Zeinab Bakhshi ⁴, Ibrahim Al Bakir ⁵, Laurent Beaugerie ⁶, Charles N Bernstein ⁷, Ryan Chang-Ho Choi ⁸, Nayantara Coelho-Prabhu ⁴, Trevor A Graham ⁹, Ailsa L Hart ¹⁰, Joren R Ten Hove ¹, Steven H Itzkowitz ¹¹, Julien Kirchgesner ⁶, Erik Mooiweer ¹², Seth R Shaffer ⁷, Shailja C Shah ¹³, Sjoerd G Elias ², Bas Oldenburg ¹⁴; Dutch Initiative on Crohn and Colitis (ICC)

Collaborators, Affiliations collapse

Collaborators

Dutch Initiative on Crohn and Colitis (ICC): 

Adriaan A van Bodegraven, Herma H Fidder, Meike M C Hirdes, Frank Hoentjen, Jeroen M Jansen, Nofel Mahmmod, Andrea E van der Meulen-de Jong, Cyriel Y Ponsioen, Fiona D M van Schaik, C Janneke van der Woude

Author information

¹Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.

²Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.

³Department of Gastroenterology and Hepatology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.

⁴Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.

⁵Department of Gastroenterology, Chelsea and Westminster Hospital, London, United Kingdom.

⁶Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hôpital Saint-Antoine, Paris, France.

⁷University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.

⁸Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.

⁹Evolution and Cancer Laboratory, Centre for Genomics and Computational Biology, Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Genomics and Evolutionary Dynamics Laboratory, Centre for Evolution and Cancer, Institute of Cancer Research, London, United Kingdom.

¹⁰Inflammatory Bowel Disease Unit, St Mark's Hospital, London, United Kingdom.

¹¹Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.

¹²Department of Gastroenterology and Hepatology, Hospital St Jansdal, Harderwijk, The Netherlands.

¹³Division of Gastroenterology, University of California, San Diego, La Jolla, California; Gastroenterology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California.

¹⁴Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands. Electronic address: boldenbu@umcutrecht.nl.

Abstract

Background & aims: Colonoscopic surveillance is recommended in patients with colonic inflammatory bowel disease (IBD) given their increased risk of colorectal cancer (CRC). We aimed to develop and validate a dynamic prediction model for the occurrence of advanced colorectal neoplasia (aCRN, including high-grade dysplasia and CRC) in IBD.

Methods: We pooled data from 6 existing cohort studies from Canada, The Netherlands, the United Kingdom, and the United States. Patients with IBD and an indication for CRC surveillance were included if they underwent at least 1 follow-up procedure. Exclusion criteria included prior aCRN, prior colectomy, or an unclear indication for surveillance. Predictor variables were selected based on the literature. A dynamic prediction model was developed using a landmarking approach based on Cox proportional hazard modeling. Model performance was assessed with Harrell's concordance-statistic (discrimination) and by calibration curves. Generalizability across surveillance cohorts was evaluated by internal-external cross-validation.

Results: The surveillance cohorts comprised 3731 patients, enrolled and followed-up in the time period from 1973 to 2021, with a median follow-up period of 5.7 years (26,336 patient-years of follow-up evaluation); 146 individuals were diagnosed with aCRN. The model contained 8 predictors, with a cross-validation median concordance statistic of 0.74 and 0.75 for a 5- and 10-year prediction window, respectively. Calibration plots showed good calibration. Internal-external cross-validation results showed medium discrimination and reasonable to good calibration.

Conclusions: The new prediction model showed good discrimination and calibration, however, generalizability results varied. Future research should focus on formal external validation and relate predicted aCRN risks to surveillance intervals before clinical application.