ArticleInternational journal of colorectal disease2026
Development and internal validation of a nomogram to predict colorectal cancer risk in patients with diverticulitis.
Article in International journal of colorectal disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimDiverticulitis, considered a benign condition, has emerging evidence linking it to colorectal cancer (CRC). Current guidelines lack standardised risk stratification tools to guide post-diverticulitis surveillance. This study aims to create and validate a nomogram to predict CRC risk in patients with diverticulitis.
methodThis retrospective cohort study included 1546 patients diagnosed with diverticulitis at a UK tertiary hospital between January 2021 and December 2023. Patients aged ≥ 18 years who underwent endoscopic assessment following a diverticulitis episode were included. A logistic regression model with L2 regularisation and balanced class weights (C = 0.1) was developed to predict a binary outcome: high CRC risk (histologically confirmed cancer) versus low/moderate risk (no cancer), designed to guide referral for flexible sigmoidoscopy (FS).
resultsThe mean age of the cohort was 69.2 years, with near-equal sex distribution. CRC was identified in 42 patients (2.7%). Significant predictors of high CRC risk included older age, male sex, and CT-detected colonic wall thickening, whereas abdominal pain, PR bleeding, and diverticulosis were associated with lower risk. The model achieved a cross-validated mean AUC of 0.736 (95% CI 0.661-0.811) and full-sample AUC of 0.784. At the Youden-optimal threshold (0.523), sensitivity was 72.1% and specificity 73.8%.
conclusionWe developed and internally validated a nomogram to predict CRC risk in patients with diverticulitis, using a binary classification to guide FS referral. The tool demonstrated robust discriminative ability and could reduce unnecessary colonoscopies while prioritising high-risk patients for timely evaluation. Unlike existing CRC risk models targeting asymptomatic individuals, our nomogram is tailored to diverticulitis patients. External validation in multi-centre cohorts is required before adoption into routine clinical practice.
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