Development and validation of a lifestyle-based model for colorectal cancer risk prediction: the LiFeCRC score

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskrift


Background: Nutrition and lifestyle have been long established as risk factors for colorectal cancer (CRC). Modifiable lifestyle behaviours bear potential to minimize long-term CRC risk; however, translation of lifestyle information into individualized CRC risk assessment has not been implemented. Lifestyle-based risk models may aid the identification of high-risk individuals, guide referral to screening and motivate behaviour change. We therefore developed and validated a lifestyle-based CRC risk prediction algorithm in an asymptomatic European population. Methods: The model was based on data from 255,482 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study aged 19 to 70 years who were free of cancer at study baseline (1992–2000) and were followed up to 31 September 2010. The model was validated in a sample comprising 74,403 participants selected among five EPIC centres. Over a median follow-up time of 15 years, there were 3645 and 981 colorectal cancer cases in the derivation and validation samples, respectively. Variable selection algorithms in Cox proportional hazard regression and random survival forest (RSF) were used to identify the best predictors among plausible predictor variables. Measures of discrimination and calibration were calculated in derivation and validation samples. To facilitate model communication, a nomogram and a web-based application were developed. Results: The final selection model included age, waist circumference, height, smoking, alcohol consumption, physical activity, vegetables, dairy products, processed meat, and sugar and confectionary. The risk score demonstrated good discrimination overall and in sex-specific models. Harrell’s C-index was 0.710 in the derivation cohort and 0.714 in the validation cohort. The model was well calibrated and showed strong agreement between predicted and observed risk. Random survival forest analysis suggested high model robustness. Beyond age, lifestyle data led to improved model performance overall (continuous net reclassification improvement = 0.307 (95% CI 0.264–0.352)), and especially for young individuals below 45 years (continuous net reclassification improvement = 0.364 (95% CI 0.084–0.575)). Conclusions: LiFeCRC score based on age and lifestyle data accurately identifies individuals at risk for incident colorectal cancer in European populations and could contribute to improved prevention through motivating lifestyle change at an individual level.


  • Krasimira Aleksandrova
  • Robin Reichmann
  • Rudolf Kaaks
  • Mazda Jenab
  • H. Bas Bueno-de-Mesquita
  • Christina C. Dahm
  • Anne Kirstine Eriksen
  • Anne Tjønneland
  • Fanny Artaud
  • Marie Christine Boutron-Ruault
  • Gianluca Severi
  • Anika Hüsing
  • Antonia Trichopoulou
  • Anna Karakatsani
  • Eleni Peppa
  • Salvatore Panico
  • Giovanna Masala
  • Sara Grioni
  • Carlotta Sacerdote
  • Rosario Tumino
  • Sjoerd G. Elias
  • Anne M. May
  • Kristin B. Borch
  • Torkjel M. Sandanger
  • Guri Skeie
  • Maria Jose Sánchez
  • José María Huerta
  • Núria Sala
  • Aurelio Barricarte Gurrea
  • José Ramón Quirós
  • Pilar Amiano
  • Bethany van Guelpen
  • Sophia Harlid
  • Tim Key
  • Elisabete Weiderpass
  • Elom K. Aglago
  • Amanda J. Cross
  • Konstantinos K. Tsilidis
  • Elio Riboli
  • Marc J. Gunter
Enheter & grupper
Externa organisationer
  • German Institute of Human Nutrition
  • University of Potsdam
  • Leibniz Institute for Prevention Research and Epidemiology
  • German Cancer Research Centre
  • International Agency for Research on Cancer, World Health Organization
  • National Institute for Public Health and the Environment (RIVM)
  • Imperial College London
  • Aarhus University
  • Danish Cancer Society Research Center
  • University of Paris-Saclay
  • Institut Gustave Roussy
  • University of Florence
  • Hellenic Health Foundation, Athens
  • National and Kapodistrian University of Athens
  • University of Naples Federico II
  • Institute for Cancer Research, Prevention and Clinical Network (ISPRO)
  • Istituto Nazionale dei Tumori
  • Citta' della Salute e della Scienza Hospital-University of Turin
  • University Medical Center Utrecht
  • UiT The Arctic University of Norway, Tromsø
  • Instituto de Investigación Biosanitaria de Granada (Granada.ibs)
  • CIBER Epidemiology and Public Health (CIBERESP)
  • University of Granada
  • Murcia Regional Health Council
  • Catalan Institute of Oncology
  • Bellvitge Biomedical Research Institute
  • Health Research Institute of Navarra (IDISNA)
  • Public Health Directorate
  • Instituto BIO-Donostia
  • Umeå University
  • University of Oxford
  • University of Ioannina
  • Provincial Health Authority (ASP) Ragusa
  • Utrecht University
  • Andalusian School of Public Health
  • Navarre Public Health Institute (ISPN)
  • San Sebastian

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Cancer och onkologi
  • Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi


TidskriftBMC Medicine
Utgåva nummer1
StatusPublished - 2021
Peer review utfördJa