| Background Colorectal normal tissue-adenoma-adencarcinoma sequence is the recognized Hypothesis of tumorigenesis of the colorectal cancer. Some researches show that there is close correlation between survivin ,osteopotin(OPN) and colorectal cancer. But the studies of their expression and the effect in canceration of colorectal adenoma have no report.Objective To carry out a research into the clinical-pathological characteristics of colorectal adenoma and related cancerated mechanism. To detect the expressions of survivin and OPN in the cells of normal tissues, low- risk colon adenoma, high- risk colon adenoma ,colon adenoma complicated by colorectal cancer and cancerated adenoma. To study the value of survivin and osteopotin in cancerated adenoma, as well as in the diagnosis of colorectal cancer at early stage.Method Firstly, collect 266 cases of the patients with colorectal polyp who underwent colonoscopy and verified by pathological from August 1990 to December 2006 at the First People's Hospital of Chaohu in Anhui Province. Secondly, classify the polyps according to the diagnostic criteria in"the Guidelines for Colonoscopy Surveillance after Polypectomy"in 2006. And then the colonoscopy clinical-pathological characteristics and canceration factors for 266 cases of colorectal polyp were analyzed retrospectively: choose 99 cases of colon adenoma, including 30 cases of low -risk colon adenoma 40 cases of high- risk colon adenoma, at the same time , 21 cases of colon adenoma complicated by colorectal cancer, 8 cases of cancerated adenoma ,53 cases of colorectal cancer in every stage and 20 cases of normal tissue were chosen. Finally, identify the expression of survivin and OPN through S-P immunchistochmical method in every group, and investigate the relationship between the clinicopathologic features of the all groups and the expression of survivin and OPN. Parts of the patients were treated by colonoscopy and followed. All 8 cases of cancerated adenoma were followed after surgery.Result (1) Of the 266 colon polyps,38 cases were proliferate polyp,64 cases were inflammatory polyp, none of them is cancerated ,164 cases were adenoma ,among the adenomas,21 cases were colon adenoma complicated by colorectal cancer ,8 cases were cancerated. There was a higher canceration rate for the number≥3 than that of 1 and 2(P<0.05), there was a higher canceration rate for the big ones with diameter≥1.0 cm than the small ones with diameter <1.0 cm(P<0.05),the canceration rate of villous adenoma was higher than tubular-villous adenoma(P<0.05) and tubular adenoma(P<0.05). The canceration rate of adenomas with high-grade dysphasia is higher than the ones without dysphasia(P<0.05). The canceration rate between adenomas of long base short base and no base have no difference(P>0.05). (2)The positive rates of survivin in normal tissues, low risk colon adenoma,high risk colon adenoma,colon adenoma complicated by colorectal cancer ,cancerated adenoma and colorectal cancer were respectively 15.00%,43.33%,57.50%,61.91%,75.00% and 71.70%,which were obviously difference in normal tissues, low risk colon adenoma and high risk colon adenoma(P<0.05). The positive rates of survivin between high risk colon adenoma and colon adenoma complicated by colorectal cancer have no difference(P>0.05).The positive rates of survivin between colon adenoma complicated by colorectal cancer and cancerated adenoma have obviously difference(P<0.05). The positive rates of survivin between cancerated adenoma and colorectal cancer have no difference(P>0.05).(3)The positive rates of OPN in normal tissues, low risk colon adenoma, high risk colon adenoma, colon adenoma complicated by colorectal cancer ,cancerated adenoma and colorectal cancer were respectively 10.00%,23.33%,47.50%,57.14%,87.50% and 79.25%,The positive rates of OPN in normal tissues and low risk colon adenoma have no difference(P>0.05).There were obviously difference(P<0.05)between low risk colon adenoma and high risk colon adenoma. There were not obviously difference(P>0.05)between high risk colon adenoma and colon adenoma complicated by with colorectal cancer,The positive rates of OPN in colon adenoma complicated by colorectal cancer and cancerated colon adenoma have obviously difference(P<0.05). There were not obviously difference(P>0.05)between cancerated colon adenoma and colorectal cancer. The expression of Survivin and OPN in 21 cases of colon adenoma complicated by colorectal cancer have correalation(P<0.05). The expression of Survivin and OPN in 8 cases of cancerated colon adenoma have not correalation(P>0.05).(4)Among the 53 cases of colorectal cancer, the expression of survivin to the clinical-pathological type have no difference(P>0.05). The expression of OPN was not related to the size of tumor and the pathological type(P>0.05),but was positively related to the depth of invasion,Duke's stage and lymph node matatasis(P<0.05). The expression of survivin and OPN in colorectal cancer have close relation(P<0.01).Conclusion The number of the adenomas≥3, high-grade dysphasia ,villous adenoma and the diameter≥1.0cm were higher dangerous adenoma, we should treat and follow them seriously. The number of the adenomas 1～2 ones, tubular, without high-grade dysphasia and the adenomas with diameter<1.0cm were lower dangerous adenoma, we may follow them for the endoscope and pathlogic detection. Proliferate polyp and inflammatory polyp may not be followed as usual.The expression of survivin in normal tissues, low risk colon adenoma, high risk colon adenoma and cancerated adenoma increases gradually,which indicates survivin plays an important role in adenoma development and canceration ,survivin is an early event in the tumorigenesis of the colorectal cancer ,it can be regarded as a standard in colon adenoma and colorectal carcinoma. The expression of OPN in low risk colon adenoma, high risk colon adenoma and cancerated adenoma increases gradually, which also indicates that OPN has close relation with adenoma canceration. OPN may be regarded as a standard in colorectal adenoma canceration.It also play an important role in the invasion and metatasis of cancer cells.
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