Stacked random forest model for colorectal cancer detection using complete blood counts

In China, adherence to screening colonoscopy among eligible individuals remains suboptimal, primarily due to cost concerns and potential adverse effects. A machine learning model utilizing complete blood count (CBC) data could help prioritize colonoscopy referrals and improve screening participation. This multicenter study included participants who underwent CBC testing within three months before colonoscopy. CBC data were classified into three types (A, B, and C) based on hematology analyzer capabilities, with Type C excluded from analysis. Using Types A and B, we developed a stacking machine learning model incorporating 24 CBC features and 5 combined CBC components to predict colorectal cancer (CRC). Model performance was evaluated using the area under the curve (AUC), specificity, and sensitivity. The study included 1795 CRC cases and 26,380 cancer-free individuals with CBC data. On external validation, the model achieved 80.3% specificity and 65.2% sensitivity. Notably, it demonstrated 41% sensitivity for Stage I CRC and 57.6% sensitivity for Stages I-III combined. CBC testing, combined with electronic medical record data, is a low-cost and widely accessible tool. Our robust CRC risk prediction model can serve as a preliminary screening method, aiding in colonoscopy referral decisions and improving CRC screening efficiency.