Clinical Characteristics And Canceration Risk Factors Of Colorectal Laterally Spreading Tumors

Objective:In order to explore the clinical pathological characteristics of colorectal laterally spreading tumor(LST),analyze the risk factors associated with cancerous development of colorectal LST,explore the appropriate treatment options,prognosis evaluation methods,etc.Methods:The colorectal LST which discovered from January 2017 to December 2018 at endoscopy center of our hospital were retrospectively reviewed at this study.And compared it with the colorectal protruded-type adenoma in the same period.We analyzed the correlation between the clinical characteristics,general morphology,surface microstructure,image-enhanced endoscopic features and pathological histology.We also study the single factor analysis and multi factor analysis for the risk factors of cancer,observe the treatment and follow-up results.Results:1.A total of 135 colorectal LST patients were included,143 lesions,the ratio of men to women was 1.6:1,the average age was 58.4±12.2 years old,and the LST detection rate was 0.52%.The mean diameter was 20.9±14.9mm,98 of them were granular(LST-G),accounting for 68.5%,45 of them were non granular(LST-NG),accounting for 31.5%(45/143),16 of them were HGIN,13 of them were adenocarcinoma.There are 29 of them,accounting for 20.3%.The majority,93.1%,are located in the left hemicolon.2.Tubular adenoma accounted for 60.1%(86/143)in LST of colorectal,there were 24 villous tubular adenoma or villous adenomas,accounting for 16.8%(24/143).But the HGIN and canceration ratio of villous adenoma were significantly higher than that of tubular adenoma,the difference was statistically significant(χ~2=14.8,P<0.001).LST-NGPD cancerous rate is the highest,at 44.4%,followed by LST-GM,accounting for 33.3%,The comparison of the cancer rates of the four subtypes has statistical significance(χ~2=21.04,P<0.001).3.Under the assistance of image-enhanced endoscopy:Kudo’S pit pattern classification,in type Ⅰ no intraepithelial neoplasia was found,50%of type Ⅱ were serrated lesions,the accuracy rate of type Ⅲ_L for tubular adenoma was 73.3%,and type Ⅳ for villous tubular adenoma was 58.3%.Among Ⅴ_Itype and Ⅴ_N type,100%were cancerous,infiltrative cancer accounted for 18.75%and 80%respectively.NICE classification:In type 1,38.5%had no intraepithelial neoplasia and 56.4%had LGIN,Most LGIN are in type 2,accounted for 83.0%.In type 3 cancer rate is 87.5%,and leaching cancer accounts for 37.5%.NICE classification and pathology grade were all for the card-square examination,the difference is statistically significant(χ~2=47.86,P<0.001).JNET classification:In type 1 no intraepithelial neoplasiarate is 66.7%(2/3),LGIN in type 2A is 94.3%,type 2B precancerrate is 70.8%,type 3 leaching cancer accounts for 83.3%.there were significant difference(χ~2=93.4,P<0.001).4.A single-factor analysis of the colorectal LST group found that:The location of LST(χ~2=43.57,P<0.001)、the size of lesions(χ~2=19.64,P<0.001)and the LST type(χ~2=21.04,P<0.001)are the risk factors of colorectal LST canceration.Logistic regressive analysis showed that:The location and the size of lesions were the independent risk factors for colorectal LST canceration.The larger the lesions are,the higher the risk of cancer is.Rectal LST has a higher risk of cancer than the colon.The size of lesions(χ~2=5.689,P=0.017)is a relevant risk factor for PA cancer,and the larger the lesions,the higher the risk of PA cancer.The canceration rate of LST group was18.9%,and that of PA group was 15.9%,The difference in cancer rate between the two groups was not statistically significant(χ~2=1.031,P=0.31).5.For the EMR group and the ESD group,the total resection rate was 87.8%and100%,there were significant difference(P=0.008),and the curative resection rate was84.1%and 92.6%,The difference was not statistically significant(P=0.147).As for the EMR group,the local recurrence rate was 1.2%.There was not local recurrence for the ESD group;The complication rates of EMR group and ESD group were 1.2%and 7.4%,respectively.Conclusion:1.Image-enhanced endoscopy can improve the recognition degree of colorectal LST.Evaluation based on Kudo’S pit pattern classification,NICE classification and JNET classification,etc can improve the accuracy rate of diagnosis of lesions.2.The risk of LST-GM and LST-NGPD is higher than that of LST-GH and LST-NGF.The location and the size of lesions were the independent risk factors for colorectal LST canceration.The larger the lesions are,the higher the risk of cancer is.Rectal LST has a higher risk of cancer than the colon.The size of lesions is a relevant and independent risk factor for PA cancer,and the larger the lesions,the higher the risk of cancer is.