Predictors of colorectal polyps complicating colorectal laterally spreading tumors and the risk factors for malignancy in coexistence / 中华消化内镜杂志

ABSTRACT

Objective:To investigate the independent predictors of colorectal polyps complicating colorectal laterally spreading tumors (CLST) and the independent risk factors for malignancy in CLST coexisting with colorectal polyps.Methods:Clinical data of 260 patients with CLST who underwent endoscopy and received treatment in the Second Affiliated Hospital of Dalian Medical University from January 2016 to December 2021 were retrospectively collected. Patients were divided into the coexisting group ( n=135) and the non-coexisting group ( n=125) according to the presence or absence of polyps. Differences in clinicopathological characteristics between the two groups were compared and binary logistic regression was used to analyse the predictors of coexistence. Then the coexisting group was further divided into coexisting malignant group ( n=38) and coexisting non-malignant group ( n=97) according to the infiltration depth of CLST, and binary logistic regression was used to analyse the risk factors for malignancy in CLST coexisting with colorectal polyps. Results:Male ( P=0.002, OR=2.355, 95% CI1.354-4.099), villous tubular adenoma ( P=0.022, OR=3.873, 95% CI 1.214-12.355) and polyps history ( P=0.001, OR=2.738, 95% CI 1.527-4.909) were independent predictors for colorectal polyps coexisting with CLST. Area under the curve (AUC) of the predictive model was 0.725 ( P<0.001, 95% CI 0.664-0.786). Polyp diameter≥10 mm ( P=0.007, OR=6.266, 95% CI1.634-24.034), CLST diameter≥20 mm ( P<0.001, OR=11.879, 95% CI4.078-34.601), granular-mixed type CLST ( P=0.003, OR=8.584, 95% CI 2.126-34.660), flat-elevated type CLST ( P=0.021, OR=4.399, 95% CI 1.250-15.482) and pseudo-depressed type CLST ( P<0.001, OR=31.426, 95% CI 4.975-198.509) were independent risk factors for malignancy in CLST coexisting with polyps. AUC of the predictive model was 0.854 ( P<0.001, 95% CI 0.775-0.933). Conclusion:Male CLST patients with polyps history and a pathological type of villous tubular adenoma are more likely to develop coexistence. In patients with CLST which is granular-mixed type, flat-elevated type and pseudo-depressed type coexisting with colorectal polyps, the larger the diameter of the polyp and the diameter of the CLST, the more likely it is to be malignant.