Comparing the Asia-Pacific Colorectal Screening and adjusted Asia-Pacific Colorectal Screening scores for risk stratification of advanced colorectal neoplasia in asymptomatic Vietnamese: a cross-sectional study

OBJECTIVE: The Asia-Pacific Colorectal Screening (APCS) score is a validated tool for predicting advanced colorectal neoplasia (ACN) in the Asia-Pacific region. An adjusted APCS (A-APCS) score was recently developed by incorporating body mass index into the original score and was reported to outperform the original score but lacked external validation. This study aimed to compare the A-APCS score with the original APCS score in asymptomatic Vietnamese individuals. DESIGN: A cross-sectional study. SETTING: Dai Phuoc Polyclinic, Ho Chi Minh City, Vietnam. PARTICIPANTS: Asymptomatic individuals underwent colonoscopy screening. OUTCOME MEASURES: Participants were categorised into three risk groups based on the sum of the APCS and A-APCS scores: average risk (AR), moderate risk (MR) and high risk (HR). The performance of the two scores was compared via receiver operating characteristic (ROC) analysis and McNemar tests. RESULTS: A total of 714 participants (median age 51 years, range: 18-79; female-to-male ratio: 1:1.46) were included, with an ACN prevalence of 9.0%. Both scores indicated effective predictive ability for ACN in the HR group compared with the AR group, with OR=3.878 (95% CI 1.777 to 8.068) and 3.266 (95% CI 1.617 to 6.595), respectively. The A-APCS score was more effective than the APCS score in predicting ACN in the MR group than in the AR group. However, no significant differences in area under the ROC curve were observed between the two scores for ACN prediction. CONCLUSIONS: Compared with the APCS score, the A-APCS score may not provide improved ACN risk stratification in asymptomatic Vietnamese individuals. Both scores are suboptimal and should be used to prioritise, rather than exclude, candidates for colonoscopy.