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ObjectiveTo evaluate the effectiveness and consistency of three commonly used early colorectal cancer screening models for advanced colorectal adenoma as a noninvasive means， and to assess the predictive value of traditional Chinese medicine （TCM） tongue images in the models. MethodsPatients diagnosed with colorectal adenoma who underwent colonoscopy and pathological examination were selected as the study participants. Basic clinical data and tongue image were collected. The prediction models of Asia-Pacific colorectal screening （APCS） model， its revision （M-APCS） and colorectal neoplasia predict （CNP） model were applied to compare the predictive effects of the three models on advanced stage adenomas of the colon， the differences in clinical data and traditional Chinese medicine tongue characteristics among patients with different degrees of adenomas， and the similarities and differences in tongue characteristics among the models. The discriminative ability of the three risk models was evaluated using the area under the curve （AUC） and receiver operating characteristic （ROC） curves. The calibration was assessed using the Kuder-Richardson coefficient and the Hosmer-Lemeshow test for consistency analysis. ResultsA total of 227 patients with adenoma were analyzed， including 104 patients （45.82%） with advanced adenoma. In the detection of advanced adenoma， those with greasy coating （70 cases， 67.3%） were higher than those without greasy coating （34 cases， 32.7%， P＜0.05）. After multivariate analysis， the odds ratio （OR） value of non-greasy coating was 0.371 （0.204~0.673， P＜0.01）， indicating that non-greasy coating was a protective factor for advanced adenomas. Among the three risk models， the detection rate of advanced adenoma in the high-risk group with APCS was the highest （63.3%）， which was 1.49 times and 2.04 times that of the medium-risk group （42.6%） and the low-risk group （31.1%， P＜0.01）. The detection rate of advanced adenomas in high-risk groups of M-APCS and CNP was slightly higher than that in moderate or low risk groups （P＞0.05）. The proportion of yellow and greasy coating in high-risk group was higher than that in the medium-risk or low-risk group （P＜0.05）. For the ability to distinguish advanced and non-advanced adenomas， the AUC of APCS was 0.629 （95% CI： 0.556~0.702） and was higher than that of M-APCS （0.591） and CNP （0.586）. In calibration evaluation， Cronbach's alpha was 0.919 （＞0.7）， which indicated that the three models were consistent. In the correlation matrix， the correlation coefficients between APCS model and M-APCS model， and CNP model were 0.794 and 0.717， respectively， and the correlation coefficients between M-APCS model and CNP model were 0.873， Hosmer-Lemeshow χ2 =2.552， P＞0.05， which suggested that the three models had good calibration ability. ConclusionAll three models demonstrate the efficiency to identify advanced colorectal adenoma， and their calibration ability is considered to be good. Among the three models， the APCS exhibits the highest recognition efficiency， however， the recognition accuracy of the APCS model needs improvement. The presence of a greasy coating is identified as one of the potential predictors of advanced adenoma. Consequently， it can be considered for inclusion in the risk model of advanced colorectal adenoma to enhance the accuracy.
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ObjectiveTo preliminarily establish and verify the quantitative diagnosis method of dampness syndrome of colorectal adenoma， so as to provide evidence for the diagnosis of colorectal adenoma syndrome. MethodsThis study included 334 patients with colorectal adenoma， who were grouped into 200 in the training group and 134 in the validation group by clinical visits chronologically. According to the data from the four examinations of traditional Chinese medicine， patients in training group were subgrouped into dampness syndrome subgroup and non-dampness syndrome subgroup. After eliminating items with response rate less than 3%， the factors showed statistical difference in frequency between the subgroups were screened as diagnostic items. The diagnostic items were assigned scores using the conditional probability formula conversion method， and the diagnostic thresholds and grading criteria were determined by the maximum likelihood discriminant method， so as to establish the quantitative criteria preliminarily. Retrospective and prospective tests were conducted respectively on patients in training group and validation group， including the sensitivity， specificity， accuracy， positive likelihood ratio and other indexes， to evaluate the quantitative criteria. ResultsThe training group included 176 participants as dampness syndrome subgroup and 24 participants as non-dampness syndrome subgroup， who applied 40 diagnostic items， and 19 related factors were identified as significant differences. After assigning the scores in turn， the quantitative diagnostic threshold was determined as 45， and the quantitative diagnostic criteria for colorectal adenoma with dampness syndrome were as follows： greasy coating （7 scores）， thick coating （8 scores）， heaviness of head （9 scores）， heaviness of whole body （6 scores）， heaviness of limbs （6 scores）， sticky and greasy stool （6 scores）， sticky and greasy mouth （10 scores）， obesity （6 scores）， sleepiness （12 scores）， laziness （13 scores）， epigastric fullness （8 scores）， abdominal distension and pain （11 scores）， lumbar and knee aches and heaviness （8 scores）， joint and muscle aches and pains （9 scores）， loose stools （12 scores）， fetid mouth odor （15 scores）， slippery pulse （8 scores）， overabundance of eye secretion （7 scores）， and large touge （10 scores）. Grading criteria： 45 ≤ points ＜ 61 as mild， 61 ≤ points ≤ 104 as moderate， points ＞ 104 as severe. In the test retrospective of the training group involving 200 patients， the sensitivity， specificity， accuracy， and positive likelihood ratio were 86.36%， 95.83%， 87.50%， and 20.73 respectively； In the test prospective of the verification group involving 134 patients， the sensitivity， specificity， accuracy， and positive likelihood ratio were 76.64%%， 96.30%， 80.60%， and 20.69， respectively. ConclusionIt is effective to diagnose and identify the dampness syndrome of colorectal adenoma by preliminarily establish a quantitative diagnostic method with a combined model of disease and evidence， and the method may provide support for future related studies.
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Objective:To investigate the risk factors that affected pathological diagnosis upgrading after resection of colorectal adenoma.Methods:From January 2017 to December 2022, a total of 1 059 patients who underwent adenoma resection after pathologically diagnosed as adenoma by endoscopic forceps biopsy(EFB)were included in General Hospital of Ningxia Medical University. The patients were divided into the pathologically no difference group (1 003 cases) and the pathologically upgraded group (56 cases) based on the comparison of pathological diagnosis of EFB specimens and the specimens after adenoma resection. Clinical information and endoscopic characteristics of the adenoma were compared between the 2 groups. The clinical information included smoking history, family history of colorectal cancer, and the endoscopic characteristics included maximum diameter, morphological characteristics, surface depression, erosion or ulceration, and surface color of adenoma. Chi-square test and Fisher′s exact test were used for statistical analysis. Multivariate logistic regression model was used to analyze the risk factors for pathological diagnosis upgrading after adenoma resection.Results:The proportions of patients with smoking history, family history of colorectal cancer, concomitant hypertension, and coronary heart disease in the pathologically upgraded group were higher than those in the pathologically no difference group (46.43%, 26/56 vs.26.12%, 262/1 003; 8.93%, 5/56 vs.0.70%, 7/1 003; 46.43%, 26/56 vs.30.11%, 302/1 003; 21.43%, 12/56 vs.9.27%, 93/1 003), and the differences were statistically significant( χ2=11.05, Fisher′s exact test, χ2=6.61 and 8.78; all P<0.05). There were statistically significant differences between the pathologically no difference group and pathologically upgraded group in the maximum diameter (929 cases (92.62%) and 23 cases (41.07%) of < 20 mm, and 74 cases (7.38%) and 33 cases (58.93%) of ≥20 mm, respectively), morphological characteristics (220 cases (21.93%) and 28 cases (50.00%) with pedicle, and 783 cases (78.07%) and 28 cases (50.00%) without pedicle, respectively), surface color (347 cases (34.60%) and 3 cases (5.36%) of near normal mucosa, 613 cases (61.12%) and 50 cases (89.29%) of red surface color, and 43 cases (4.29%) and 3 cases (5.36%) of white surface color, respectively), erosion or ulceration (78 cases (7.78%) and 36 cases (64.29%) had erosion or ulceration, and 925 cases (92.22%) and 20 cases (35.71%) had no erosion or ulceration, respectively), and surface depression (6 cases (0.60%) and 8 cases (14.29%) of depression, and 997 cases (99.40%) and 48 cases (85.71%) of non depression, respectively) ( χ2=155.18, 23.30, 20.58 and 176.31, Fisher′s exact test; all P<0.001). The result of multivariate logistic regression analysis showed that surface depression ( OR=25.198, 95% confidence interval (95% CI) 5.812 to 109.246, P<0.001), erosion or ulceration( OR=9.913, 95% CI 4.652 to 21.124, P<0.001), red surface color ( OR=4.276, 95% CI 1.053 to 17.363, P=0.042), white surface color ( OR=8.803, 95% CI 1.398 to 55.435, P=0.021), maximum diameter≥20 mm ( OR=4.689, 95% CI 2.265 to 9.706, P<0.001), family history of colorectal cancer ( OR=8.764, 95% CI 1.418 to 54.162, P=0.019) and smoking history ( OR=2.713, 95% CI 1.376 to 5.349, P=0.004) were independent risk factors for pathological diagnosis upgrading after adenoma resection. Conclusion:Surface depression, maximum diameter ≥20 mm, erosion or ulceration, white or red surface color, family history of colorectal cancer and smoking history may enhance the heterogeneity of adenomas, interfere with the accuracy of EFB pathology, and lead to an upgrade of pathological diagnosis after adenoma resection.
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Objective:To investigate the change of the detection rate of colorectal cancer (CRC), colorectal adenoma and advanced adenoma in adults under colonoscopy in Shihezi in the past ten years.Methods:Data of patients who completed colonoscopy in the First Affiliated Hospital of Shihezi University School of Medicine from January 1, 2010 to December 31, 2019 were investigated. The medical records were collected by consulting the electronic medical record system, including the age and sex of patients and the location, quantity, size and pathological type of lesions. The detection rates, including the overall detection rate in the past 10 years, those in the first 5 years (from 2010 to 2014) and the second 5 years (from 2015 to 2019) of colorectal adenomas, advanced colorectal adenomas and CRC, were studied.Results:A total of 50 645 cases were included, 14 931 cases were excluded by the exclusion criteria, and finally a total of 35 714 cases were included in the data analysis. The 10-year overall detection rates of colorectal adenoma, advanced colorectal adenoma and CRC were 17.65% (6 302/35 714), 4.45% (1 589/35 714) and 3.71% (1 324/35 714), respectively. The overall detection rates of colorectal adenoma and advanced colorectal adenoma in the second 5 years were higher respectively than those in the first 5 years [20.33% (4 565/22 457) VS 13.10% (1 737/13 257), 4.69% (1 053/22 457) VS 4.04% (536/13 257)]. The overall detection rate of CRC in the second 5 years [3.30% (741/22 457)] was lower than that in the first 5 years [4.40% (583/13 257)].Conclusion:Compared with 2010 to 2014, the detection rate of colorectal adenoma in Shihezi area in 2015 to 2019 increased significantly, the detection rate of advanced colorectal adenoma increased slightly, and the detection rate of CRC decreased slightly. Therefore, the detection and resection of colorectal adenoma by colonoscopy may be important in reducing the incidence of CRC.
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ObjectiveTo determine the risk factors associated with colorectal adenoma among the residents in Nanchang city， and provide scientific evidence for primary preventive measures against colorectal cancer. MethodsA matched case-control study was conducted. A total of 155 patients newly diagnosed with colorectal adenomas during 2018‒2019 were selected as cases， and 155 healthy persons attending the screening as controls. Both the case group and control group completed the questionnaires on the risk factors. Conditional logistic regression analysis was performed using SPSS 25.0. ResultsAge， gender， and educational level were used for match between case group and control group. Conditional multivariate logistic regression analysis showed that salted and dried food intake（OR=5.634， 95%CI：1.308‒24.256）， smoking（OR=3.266， 95%CI：1.419‒7.518）， passive smoking（OR=3.125，95%CI：1.415‒6.898）， and hyperlipidemia（OR=3.975， 95%CI：1.643‒9.618）were associated with higher risk of colorectal adenoma. In contrast， coarse grain intake ≥500 g/week（OR=0.377， 95%CI：0.177‒0.805） was a protective factor. ConclusionColorectal adenoma may be caused by multiple risk factors， particularly salted and dried food intake， smoking， passive smoking and hyperlipidemia. It warrants specific intervention to reduce the risk of colorectal adenoma.
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Abstract Objective Type-I collagen (Col-I) is one of the main macromolecules of the extracellular matrix, and it is involved in the desmoplastic stromal reaction, an indicator of worse prognosis in cases of colorectal cancer (CRC). The purpose of the present study was to investigate Col-I expression in cases of CRC and adenoma and to correlate with the clinical data and the data regarding the lifestyle of the patients. Methods A retrospective study including 22 patients with adenoma and 15 with CRC treated at a coloproctology service. The clinical and lifestyle data were obtained through medical records, and Col-I expression was investigated by immunohistochemistry. Results Women represented most cases of adenoma (63.64%), whereas CRC was found mainly in men (73.33%) (p=0.0448). Immunoexpression of Col-I showed a basement membrane thickening in areas of lining of epithelium and around the glands in both lesions. The cases of CRC had a quite evident fibrosis process in the stroma. The quantitative analysis demonstrated a higher protein expression in CRCs compared to adenomas (p=0.0109), as well as in female patients (p=0.0214), patients aged ≥ 50 years (p=0.0400), and in those with a positive family history of colorectal disease (p=0.0292). These results suggested a remodeling of the microenvironment of the Worked developed at the Department of Morphology, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, ES, Brazil. Conclusion The immunohistochemical analysis encourages the performance of more comprehensive studies to ascertain if our results could be a tool for the diagnosis and monitoring of the patients.
Resumo Objetivo O colágeno tipo I (Col-I) é uma das principais macromoléculas da matriz extracelular, e está envolvido na reação desmoplástica estromal, um indicador de pior prognóstico em casos de câncer colorretal (CCR). O objetivo foi investigar a expressão do Col-I emcasos de CCR e adenoma, e correlacioná-la comdados clínicos e de estilo de vida dos pacientes. Metodologia Foi realizado umestudoretrospectivo com22pacientes comadenoma e 15 comCCR tratadosemumserviço de coloproctologia.Os dados dos pacientes foramobtidos dos prontuários médicos, e a expressão do Col-I foi investigada por imunohistoquímica. Resultados As mulheres representaram a maioria dos casos de adenomas (63,64%), enquanto o CCR (73,33%) (p=0,0448) foi mais comum entre os homens. A imunoexpressão de Col-I mostrou espessamento da membrana basal em áreas de revestimento do epitélio e em volta de glândulas em ambas as lesões. O CCR apresentou fibrose no estroma. As análises quantitativas demonstraram maior expressão proteica no CCR (p=0,0109), assim como em mulheres (p=0,0214), pacientes com idade ≥ 50 anos (p=0,0400), e em pacientes com histórico positivo de doença colorretal na família (p=0,0292). Estes resultados sugerem a remodelação do microambiente tumoral na carcinogênese do CCR. As correlações clínico-patológicas positivas mostram uma ligação plausível entre o perfil do paciente e os achados imunohistoquímcos, o que indica uma possível forma de estratificação dos pacientes. Conclusão As análises imunohistoquímicas estimulam a execução de estudos mais abrangentes para confirmar se nossos resultados poderão ser uma ferramenta para o diagnóstico e o monitoramento dos pacientes.
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Humans , Male , Female , Colorectal Neoplasms/metabolism , Colorectal Neoplasms/pathology , Adenocarcinoma/diagnosis , Biomarkers, Tumor/metabolism , Gene Expression Regulation, Neoplastic , Collagen Type I/genetics , Extracellular Matrix/metabolism , Tumor Microenvironment/immunologyABSTRACT
Objective:To explore the risk factors of occurrence of colorectal adenoma after endoscopic polypectomy.Methods:From January 2014 to December 2019, at the Department of Day Surgery Centre in West China Hospital, Sichuan University, 6 430 patients with 20 351 polyps who underwent endoscopic colorectal polypectomy were retrospectively analyzed. Patients were divided into adenomas group (4 573 patients) and non-adenomas group (1 857 patients) according to whether they had at least one adenomatous polyp. According to the results of postoperative histopathology, colorectal polyps were divided into adenomatous polyp group (10 656 polyps) and non-adenomatous polyp group (9 695 polyps). The propensity score matching (PSM) method was applied, with 1∶1 matching, in the patients with adenoma group and the patients with non-adenoma group, as well as in adenomatous polyps group and non-adenomatous polyps group. A total of 1 824 pairs of patients and 7 362 pairs of colorectal polyps were successfully matched. After PSM, patients-related factors as gender (male), age (<40 and 40 to 60 years old), number of polyps (>2), obesity (body mass index ≥28 kg/m 2), melanosis, family history of colorectal cancer in first-degree relatives, polyps-related factors as the maximum diameter (6 to 10 and >10 mm), distribution (distal colon), and morphological classification (sessile and flat polyps) were included in the analysis of risk factors of colorectal adenoma. Univariate analysis and multivariate logistic regression were used for statistical analysis. Results:Among 6 430 patients with colorectal polyps, the detection rate of adenoma was 71.12% (4 573/6 430). After PSM, the results of univariate analysis showed that obesity, family history of colorectal cancer in first-degree relatives, the maximum diameter of polyps >10 mm were all correlated with the occurrence of adenoma (odds ratio ( OR)=1.483, 1.426 and 1.503, 95% confidence interval ( CI)1.063 to 2.067, 1.015 to 2.004, 1.198 to 1.887, all P<0.05). The results of multivariate logistic regression analysis indicated that obesity, family history of colorectal cancer in first-degree relatives, the maximum diameter of polyps >10 mm, sessile or flat polyps in morphological classification were independent risk factors of the occurence of colorectal adenomas ( OR=1.425, 1.411, 1.629, 1.165 and 1.151, 95% CI1.019 to 1.994, 1.001 to 1.988, 1.290 to 2.058, 1.030 to 1.316 and 1.012 to 1.310, all P < 0.05). Conclusions:Obesity, family history of colorectal cancer in first-degree relatives, maximum diameter of polyps >10 mm, sessile polyps or flat polyps were the independent risk factors of the occurrence of colorectal adenomas.
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Although many modalities can be used to prolong the remission of colorectal cancer (CRC), early diagnosis is essential to improve the therapeutic outcomes. The conventional ways of diagnosing and monitoring the progresses from adenoma to CRC are colonoscopy and fecal occult blood test (FOBT). However, colonoscopy is expensive and invasive; while the FOBT is not sensitive. miRNAs may be a new modality to monitor the transition from adenoma to CRC. We reviewed publications of miRNA profile differences from colorectal normal mucosa (NM) to adenoma, and to CRC and tried to find the roles of miRNA in these transitions. This review also highlighted the possibility of serum miRNAs as markers for monitoring these transitions. The miRNA profiles are different from normal colorectal mucosa to adenoma and to CRC. The miRNAs may have pro- or anti-CRC effects through oncogenes such as c-Met and KRAS. Others may interfere with the immune system. More interestingly, some miRNAs are continuously increased from NM to adenoma and to CRC; others, such as miRNA-30b, are consequently decreased. The literature shows that miRNAs are involved in the whole process of the colorectal carcinogenesis. The miRNAs may be the biomarkers in monitoring the transition from adenoma to CRC
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Objective@#To explore the correlation between obesity and the risk of colorectal adenoma, so as to provide theoretic evidence for the intervention of the high-risk population for colorectal cancer.@*Methods@#Based on the Screen Project of Early Diagnosis and Treatment of Colorectal Cancer in Jiashan County, from August 2012 to March 2018, the results of colonoscopy and body measurement information of the high-risk population for colorectal cancer were collected. According to the results of colonoscopy, 3 895 patients with colorectal adenoma and 11 232 healthy controls were enrolled. Multivariate logistic regression was used to analyze the correlation between overweight (body mass index (BMI) 24.0 to 27.9 kg/m2), obesity (BMI≥28.0 kg/m2) and the risk of colorectal adenoma.@*Results@#After adjusting for gender and age, compared with that of individuals with normal weight (BMI 18.5 to 23.9 kg/m2), the risk of colorectal adenoma of obese patients increased by 36% (odds ratio (OR)=1.36, 95% confidence interval (CI) 1.18 to 1.56). After stratifing by gender, compared with that of individuals with normal weight, the risk of colorectal adenoma of obese males increased by 30% (OR=1.30, 95%CI 1.07 to 1.59), the risk of colorectal adenoma of overweight females and obese females increased by 15% (OR=1.15, 95%CI 1.01 to 1.31) and 40% (OR=1.40, 95%CI 1.14 to 1.71), respectively. After stratifing by age, compared with that of individuals with normal weight, the risk of colorectal adenoma of obese patients aged between 40 and 59 years increased by 31% (OR=1.31, 95%CI 1.07 to 1.61), and the risk of colorectal adenoma of overweight and obese patients aged between 60 and 74 years increased by 13% (OR=1.13, 95%CI 1.01 to 1.27) and 39% (OR=1.39, 95%CI 1.15 to 1.70), respectively. The results of subgroup analysis according to pathological types indicated that the risk of non-advanced adenoma and advanced adenoma of obese patients increased by 35% (OR=1.35, 95%CI 1.16 to 1.57) and 39% (OR=1.39, 95%CI 1.06 to 1.83), respectively.@*Conclusions@#Obesity is correlated with colorectal adenoma, which is more significant in women, individuals aged between 60 and 74 years and advanced adenoma. The intervention of high-risk population for colorectal cancer should include body mass control.
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Objective To explore the correlation between obesity and the risk of colorectal adenoma,so as to provide theoretic evidence for the intervention of the high-risk population for colorectal cancer.Methods Based on the Screen Project of Early Diagnosis and Treatment of Colorectal Cancer in Jiashan County,from August 2012 to March 2018,the results of colonoscopy and body measurement information of the high-risk population for colorectal cancer were collected.According to the results of colonoscopy,3 895 patients with colorectal adenoma and 11 232 healthy controls were enrolled.Multivariate logistic regression was used to analyze the correlation between overweight (body mass index (BMI) 24.0 to 27.9 kg/m2),obesity (BMI≥ 28.0 kg/m2) and the risk of colorectal adenoma.Results After adjusting for gender and age,compared with that of individuals with normal weight (BMI 18.5 to 23.9 kg/m2),the risk of colorectal adenoma of obese patients increased by 36％ (odds ratio (OR) =1.36,95％ confidence interval (CI) 1.18 to 1.56).After stratifing by gender,compared with that of individuals with normal weight,the risk of colorectal adenoma of obese males increased by 30％ (OR =1.30,95％ CI 1.07 to 1.59),the risk of colorectal adenoma of overweight females and obese females increased by 15％ (OR =1.15,95％ CI 1.01 to 1.31) and 40％ (OR =1.40,95％ CI 1.14 to l.71),respectively.After stratifing by age,compared with that of individuals with normal weight,the risk of colorectal adenoma of obese patients aged between 40 and 59 years increased by 31％ (OR =1.31,95％ CI 1.07 to 1.61),and the risk of colorectal adenoma of overweight and obese patients aged between 60 and 74 years increased by 13％ (OR=1.13,95％CI 1.01 to 1.27) and 39％ (OR=1.39,95％ CI 1.15 to 1.70),respectively.The results of subgroup analysis according to pathological types indicated that the risk of non-advanced adenoma and advanced adenoma of obese patients increased by 35％ (OR =1.35,95％CI 1.16 to 1.57) and 39％ (OR=1.39,95％CI 1.06 to 1.83),respectively.Conclusions Obesity is correlated with colorectal adenoma,which is more significant in women,individuals aged between 60 and 74 years and advanced adenoma.The intervention of high-risk population for colorectal cancer should include body mass control.
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Background: Colorectal cancer (CRC) is one of the most common malignant tumors in digestive system. Colorectal adenoma (CRA) is recognized as a precancerous lesion of CRC. Therefore, it is of great significance to find the risk factors of CRA for the prevention of CRC. Aims: To investigate the relationship between components of metabolic syndrome (MS) and clinicopathological characteristics of CRA. Methods: A total of 460 patients with CRA from December 2014 to December 2016 at the Affiliated Hospital of Inner Mongolia Medical University were enrolled. Components of MS and clinicopathological characteristics were recorded. Correlation of MS with clinicopathological characteristics of CRA were analyzed by χ2 test or Spearman's rank correlation. Influencing factors of clinicopathological characteristics of CRA were analyzed by multivariate Logistic regression analysis. Results: MS was related to pathological type, pedicle, and size of CRA (P0.05). Hypertension, diabetes, high triglyceride (TG), high waistline increased the risk of villous adenoma (P0.05). Diabetes, high waistline were the risk factors of size of CRA (P0.05). Conclusions: MS is correlated with pathological type, pedicle, and size of CRA. Hypertension, diabetes, high TG, high waistline are the risk factors of villous adenoma; while age, high waistline are the risk factors of tubulovillous adenoma. Hypertension, high TG, high waistline are the risk factors for CRA with pedicle. Age is the risk factor for CRA in the whole colon. Diabetes, high waistline are the risk factors for size of CRA.
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Background:Reduction of incidence and recurrence rates of colorectal adenoma (CRA)are the keys for reducing the incidence of colorectal cancer. Studies have shown that insulin resistance is involved in this process. Aims:To investigate the correlation of insulin resistance with incidence and recurrence of CRA. Methods:Clinical data of 238 CRA patients were collected,and 200 patients with normal colonoscopy results were served as controls. Waist to hip ratio (WHR), fasting blood glucose (FPG),total cholesterol (TC),triglyceride (TG),high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C),adiponectin,fasting insulin (FINS),HOMA-IR were compared between the two groups. Correlation of insulin resistance with incidence and recurrence of CRA was analyzed. Results:WHR,FPG, TG,FINS,adiponectin and HOMA-IR were statistically different between CRA group and controls (P＜0.05),however, no significant differences in BMI,DBP,TC,HDL-C,LDL-C were found between the two groups. Incidence rate of CRA (80.1% vs. 41.4%)and recurrence rate of CRA (62.4% vs. 46.3%)were significantly increased in patients with insulin resistance than those in patients without insulin resistance. Logistic regression analysis showed that family history, metabolic syndrome and HOMA-IR were independent risk factors for incidence of CRA (P ＜0. 05 ),and metabolic syndrome,family history of adenoma,adenoma number,adenoma size,pathological type and HOMA-IR were independent risk factors for recurrence of CRA (P＜0.05). Conclusions:The incidence and recurrence rates of CRA are higher in patients with insulin resistance than those without insulin resistance.
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Objective To analyze the factors that might affect the recurrence after endoscopic resection of colorectal adenoma,we aim to provide a reference for the regular follow-up of colorectal adenoma after endoscopic resection.Methods In the Department of Gastroenterology,Huadong Hospital from Jan.,2013 to Dec.,2014,patients received endoscopic resection during hospital stay and postoperative follow-up colonoscopy.We collected their information of gender,age,smoking history,drinking history,hypertension,diabetes,fatty liver,cholecystectomy history,Helicobacter pylori (H.pylori) infection,related metabolic indicators,number of adenoma,size of adenoma,location of adenoma and pathology of adenoma.Multivariate and univariate analysis were performed by Logistic regression analysis to explore factors influencing the recurrence risk of colorectal adenoma.Results A total of 283 cases were enrolled.The recurrence rate of low-risk and high-risk adenoma was 39.3 ％ and 56.3 ％,respectively,and therate of all adenoma was 52.7％.Multivariate and univariate analysis both found that H.pylori infection (P＜0.001,OR:3.316 and 2.802,95％CI:1.869-5.884 and 1.660-4.728) and adenoma number (P＜0.001,OR:2.799 and 2.789,95％ CI:1.578-4.963 and 1.667-4.668) were risk factors for colorectal adenoma recurrence after endoscopic excision.Conclusions H.pylori infection and the number of base colorectal adenoma maybe associated with colorectal adenoma recurrence.
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Objective To estimate the value of fecal tumor M2-PK in the detection of colorectal adenoma and to evaluate its potential as a screening tool for colorectal adenoma.Methods Enzyme-linked immunosorbent assay (ELISA) was used to detect the fecal tumor M2-PK in stool samples of 65 patients with colorectal adenoma and 25 controls.At the same time,the peripheral blood tumor markers such as carcinoembryonic antigen (CEA),carbohydrate antigen (CA) 19-9,CA24-2 and fecal occult blood test (FOBT) were detected in the colorectal adenoma group.Results The detection value of fecal tumor M2-PK in the colorectal adenoma group showed a significant increase,compared with the control group((6.033±4.123) U/ml vs.(2.782±1.464) U/ml,t=-3.839,P=0.000).The highest detection value was found in the group where the diameter of adenoma was greater than or equal to 2 cm ((8.775±6.548) U/ml,t=9.635,P=0.034).The larger the diameter of adenoma,the higher the positive rate of fecal tumor M2-PK (85.7% vs.41.7% vs.29.6%,χ2=11.977,P=0.003).In the colorectal adenoma group,The positive detection rate of fecal tumor M2-PK was significantly higher than that of CEA,CA19-9,CA24-2 and FOBT (46.2% vs.6.2% vs.1.5% vs.1.5% vs.27.7%,?2=76.607,P=0.000).Conclusion Fecal tumor M2 pyruvate kinase has a good clinical value in the diagnosis of colorectal adenoma.
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Objective To analyze the clinical and pathological features of upper gastrointestinal serrated lesions.Methods A total of 21 patients with upper gastrointestinal serrated lesions in Tianjin Medical University General Hospital between January 2011 and December 2015 were retrospective analyzed.Data of the patients including demographics, clinical and pathological features were collected.Among the 21 patients, 18 patients, who underwent colonoscopy simultaneously or within six months, were selected as the study group, each patient was compared to 4 randomly selected controls without serrated lesions, who also underwent colonoscopy within the same time period.Differences of colorectal neoplasia detection were analyzed between the cases and controls.Results The mean age of 21 patients was 55.3±17.2 years, and 11 cases were male.Involving the locations of serrated lesions, 17 cases were found in the stomach (including 3 in the cardia, 9 in the corpus, and 5 in the antrum), and followed by 3 in the duodenum and 1 in lower esophagus.The mucosa pathological morphology showed that 6 cases were serrated hyperplasia, 8 cases were hyperplastic polyps, 6 cases were serrated adenomas with low grade dysplasia and 1 case was in the duodenum intramucosal carcinoma.Seven (38.9%) colorectal adenomas were found in the study group, including 3 (16.7%) non-advanced colorectal adenomas and 4 (22.2%) advanced colorectal adenomas.Eight (11.1%) colorectal adenomas were found in the control group, including 5 (6.9%) non-advanced colorectal adenomas and 3 (4.2%) advanced colorectal adenomas.The rate of colorectal adenoma detection in the study group was significantly higher than that in the control group (38.9% VS 11.1%, P=0.010, OR=5.091, 95%CI:1.534-16.890).Conclusion Upper gastrointestinal serrated lesions can be found in various mucosal lesions with different pathological morphologies.Moreover colonoscopy is likely to be recommended to detect concurrent colorectal adenoma for these patients.
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Objective:To compare the detection rate of colorectal adenoma (CRA) and its risk factors in different areas. Methods:Pa-tients with CRA from the 7th People's Hospital of Chongqing were designated to area group A (n=2182), and those from the 281 Hospi-tal of PLA in Qinhuangdao were designated to area group B (n=1866). The high risk group was screened on the basis of the following factors:①positive fecal occult blood;②colorectal cancer history of first-degree relatives;③intestinal adenoma history;④can-cer history;⑤change in defecation habit;and⑥history of at least two of the following:chronic diarrhea, chronic constipation, mu-cus and bloody stool, chronic appendicitis or appendix removal, and chronic cholecystitis or gallbladder removal. The detection rate of CRA and the high risk groups, the distribution of risk factors, and the detection rate of CRA in every risk factor in the two groups were compared. Results:The detection rate of CRA (15.6%) and the high risk group (25.8%) in area group A were similar to those in area group B (15.2%, 25.4%) (P>0.05). The distributions of risk factors from high to low in the two groups were⑤,⑥,①,③,②, and④. The distribution of risk factor⑤was higher in area group A (36.4%) than in area group B (30.6%) (χ2=3.900, P=0.048). The detec-tion rate of CRA in area group A (57.6%) with factor⑤was higher than that in area group B (44.1%) (χ2=6.131, P=0.013). Conclusion:The detection rate of CRA and the high risk group in the 7th People's Hospital of Chongqing were similar to those in the 281 Hospital of PLA. By contrast, the distributions of risk factors differ in the two area groups. Therefore, the screening direction of CRA in different areas should be based on the risk factors.
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Objective To observe the recurrence rate of colorectal adenoma and to explore its correlations to obesity and body weight changes.Methods A total of 1 236 cases of patients with colorectal adenoma admitted to our hospital from 2010 to 2012 were selected.Among them,913 cases of patients who had completed the 2-years follow-up were recruited in this study.According to body mass index (BMI),patients were divided into three gorups:normal weight group (BMI＜24 kg/m2),overweight group (BMI:24-＜28 kg/m2) and obesity group (BMI≥28 kg/m2).Colonoscopy was defined as the end-point performed after 2-years follow-up,and the body weights were remeasured.The correlations of recurrence rate of colorectal adenoma to patients' basal body mass and body weight change were analysed.Results A total of 361 patients (39.5％) suffered from recurrent colorectal adenoma.The recurrence rates of colorectal adenoma in the normal weight group,overweight group and obesity group were 34.5 ％,41.0％ and 41.9 ％,respectively;the recurrence rates in the overweight group and obesity group were higher than that in the normal weight group,there were statistically significant differences (P＜0.05).However,There was no significant difference in the recurrence rate of colorectal adenoma between patients with body weight changes of 2.5 kg or more and those with body weight changes less than 2.5 kg(P＞0.05).Conclusion The recurrence of colorectal adenoma is associated with obesity,but changes in body weight in the short term (two years) have no significant effect on the recurrence rate.
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Objective To observe the recurrence rate of colorectal adenoma and to explore its correlations to obesity and body weight changes.Methods A total of 1 236 cases of patients with colorectal adenoma admitted to our hospital from 2010 to 2012 were selected.Among them,913 cases of patients who had completed the 2-years follow-up were recruited in this study.According to body mass index (BMI),patients were divided into three gorups:normal weight group (BMI＜24 kg/m2),overweight group (BMI:24-＜28 kg/m2) and obesity group (BMI≥28 kg/m2).Colonoscopy was defined as the end-point performed after 2-years follow-up,and the body weights were remeasured.The correlations of recurrence rate of colorectal adenoma to patients' basal body mass and body weight change were analysed.Results A total of 361 patients (39.5％) suffered from recurrent colorectal adenoma.The recurrence rates of colorectal adenoma in the normal weight group,overweight group and obesity group were 34.5 ％,41.0％ and 41.9 ％,respectively;the recurrence rates in the overweight group and obesity group were higher than that in the normal weight group,there were statistically significant differences (P＜0.05).However,There was no significant difference in the recurrence rate of colorectal adenoma between patients with body weight changes of 2.5 kg or more and those with body weight changes less than 2.5 kg(P＞0.05).Conclusion The recurrence of colorectal adenoma is associated with obesity,but changes in body weight in the short term (two years) have no significant effect on the recurrence rate.
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PURPOSE: Limited data are available regarding the associations between parameters of glucose and lipid metabolism and the occurrence of metachronous adenomas. We investigated whether these parameters affect the occurrence of adenomas detected on surveillance colonoscopy. MATERIALS AND METHODS: This longitudinal study was performed on 5289 subjects who underwent follow-up colonoscopy between 2012 and 2013 among 62171 asymptomatic subjects who underwent an initial colonoscopy for a health check-up between 2010 and 2011. The risk of adenoma occurrence was assessed using Cox proportional hazards modeling. RESULTS: The mean interval between the initial and follow-up colonoscopy was 2.2±0.6 years. The occurrence of adenomas detected by the follow-up colonoscopy increased linearly with the increasing quartiles of fasting glucose, hemoglobin A1c (HbA1c), insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and triglycerides measured at the initial colonoscopy. These associations persisted after adjusting for confounding factors. The adjusted hazard ratios for adenoma occurrence comparing the fourth with the first quartiles of fasting glucose, HbA1c, insulin, HOMA-IR, and triglycerides were 1.50 [95% confidence interval (CI), 1.26–1.77; p(trend)<0.001], 1.22 (95% CI, 1.04–1.43; p(trend)=0.024), 1.22 (95% CI, 1.02–1.46; p(trend)=0.046), 1.36 (95% CI, 1.14–1.63; p(trend)=0.004), and 1.19 (95% CI, 0.99–1.42; p(trend)=0.041), respectively. In addition, increasing quartiles of low-density lipoprotein-cholesterol and apolipoprotein B were associated with an increasing occurrence of adenomas. CONCLUSION: The levels of parameters of glucose and lipid metabolism were significantly associated with the occurrence of adenomas detected on surveillance colonoscopy. Improving the parameters of glucose and lipid metabolism through lifestyle changes or medications may be helpful in preventing metachronous adenomas.
Subject(s)
Adenoma , Apolipoproteins , Colonoscopy , Dyslipidemias , Fasting , Follow-Up Studies , Glucose , Homeostasis , Insulin , Insulin Resistance , Life Style , Lipid Metabolism , Longitudinal Studies , Proportional Hazards Models , TriglyceridesABSTRACT
BACKGROUND/OBJECTIVES: The relationship between folate and colorectal neoplasia remains controversial. We examined the association between serum folate concentrations and colorectal adenomas in a case-control study of Korean adults and conducted a meta-analysis. SUBJECTS/METHODS: Our case-control study included 113 pairs of case and control who underwent colonoscopy and provided blood samples. We used multivariable conditional logistic regression models to obtain the odds ratios and 95% confidence interval (CIs). For meta-analysis, we identified the relevant studies by searching the PubMed database up to February 2017, included our case-control study and combined the study-specific relative risks (RRs) using a random-effects model. RESULTS: In this case-control study, we included 58 men and 55 women with colorectal adenomas and sex and fasting status matched the controls. We did not find any significant association between the serum folate levels and colorectal adenomas in either men or women. For meta-analysis, a total of eleven studies were included in our analysis and classified into two groups; polyp clearance group (PC) for the studies that included participants who underwent endoscopies and had their polyps removed at baseline; and no polyp clearance group (NPC) for the studies that included participants whose histories of endoscopies were unknown or who underwent their first endoscopies. Four PC (1,311 cases and 1,672 non-cases) and eight NPC studies (3,501 cases and 11,347 non-cases) were included. The combined RRs (95% CIs) comparing the bottom with the top categories of circulating folate levels were 1.07 (0.97-1.18) for the NPC group but 1.45 (1.16-1.74) for the PC group. CONCLUSIONS: Low circulating folate levels were associated with new adenoma formation.