Analysis Of The Related Risk Factors For The Formation And Recurrence Of Colorectal Adenomas

BACKGROUNDAccording to the latest global cancer statistics,there will be a total of 1931590 colorectal cancer(CRC)cases and 935173 deaths from colorectal cancer worldwide in 2020.Colorectal cancer accounts for the third place in the incidence of all malignant tumors,and the second place in mortality.The latest research statistics in China show that the incidence of colorectal cancer is 370,000 and the number of deaths is 187,000,accounting for the fourth place in the incidence of all malignant tumors,and the fifth place in mortality.The path of occurrence of colorectal cancer can be divided into adenoma-adenocarcinoma pathway,inflammation-cancer pathway,and de novo pathway.The main precancerous disease of colorectal cancer is colorectal adenoma(accounting for 85%-90%of all precancerous diseases of colorectal cancer)and ulcerative colitis,Crohn’s disease and other inflammatory bowel diseases.Most patients with colorectal cancer are already in the middle and advanced stages when they are diagnosed,and the treatment effect is not good,so early detection and early prevention are very important for colorectal cancer patients.The prevention of colorectal cancer includes the prevention and treatment of the above-mentioned precancerous diseases.Preventing the occurrence of colorectal adenoma and preventing its recurrence or malignant transformation after removal of colorectal adenoma can be attributed to the primary prevention of colorectal cancer.Endoscopic removal of colorectal adenomas can prevent most part of colorectal cancers,but the recurrence rate of colorectal adenomas after removal is high,and prevention is still needed.AIMThis study aims to summarize the clinical and adenoma characteristics of patients with colorectal adenoma,analyze the related risk factors for the formation and recurrence of colorectal adenomas after endoscopic removal,and provide reference for the prevention of the formation,recurrence and follow-up of adenoma,so as to improve the understanding of clinicians on colorectal adenoma and guide the primary prevention of colorectal cancer.Research objects and methodsWe retrospectively collected the clinical data,including demographic characteristics,clinical manifestations,previous history and medication history,personal history and family history,laboratory examination,endoscopic features,pathological characteristics and treatment methods of the 203 patients who underwent colonoscopy and the pathological diagnosis of adenoma at Qilu Hospital of Shandong University from January 2017 to December 2017.A total of 210 cases were selected as the control group,and the demographic characteristics,clinical manifestations,previous history and medication history,personal history and family history,and laboratory examination differences between the two groups were compared to summarize the related risk factors for the formation of colorectal adenomas.Patients in the adenoma group who underwent colonoscopy review after 6 months to 3 years after endoscopic adenoma resection were selected and divided into the recurrence group and the non-recurrence group.The differences in the clinical data collected retrospectively between the two groups were studied to explore the related risk factors that may affect the recurrence after colorectal adenoma resection.RESULTSCompared with the control group,univariate analysis showed that gender,age,BMI,hypertension,drinking history,change in fecal habit,positive fecal occult blood were related to the formation of colorectal adenoma.The above results were included in multivariate Logistic regression analysis,and the results showed that age(OR:1.042,95%CI:1.022-1.062),BMI(OR:1.064,95%CI:1.002-1.131),change in fecal habit(OR:1.806,95%CI:1.032-3.158),positive fecal occults blood(OR:2.262,95%CI:1.288-3.974)P<0.05.Compared with the non-recurrence group,univariate analysis showed that history of abdominal pain,smoking history,drinking history,positive fecal occult blood,the number of adenoma,the diameter of the adenoma,the location of the adenoma,high-grade intraepithelial neoplasia,and advanced adenomas were associated with adenoma recurrence.The above results were included in multivariate Logistic regression analysis,the result shows that drinking history(OR:1.024,95%CI:1.295-5.984),diameter of colorectal adenoma(OR:2.005,95%CI:3.251-16.951),atypia of colorectal adenoma(OR:2.239,95%CI:1.062-83.015)P<0.05.CONCLUSIONS1.Colorectal adenoma is more common in middle-aged and elderly men,and its clinical manifestations are diverse.2.Adenomas are common in the diameter less than 1cm,number of less than 3,smooth surface mucosa,sessile adenoma,tubular adenoma,low-grade intraepithelial neoplasia,and location in the left colon.3.Age>45 years old,BMI>24.0kg/m2,change in fecal habits and positive fecal occult blood were independent risk factors for colorectal adenoma.4.Colorectal adenomas with the characteristics of the number of more than 3,diameter more than 1cm,located in the left colon,with high-grade intraepithelial neoplasia,and of high-risk adenomas are more likely to recurrence.Drinking history,adenoma diameter more than 1cm,and high-grade intraepithelial neoplasia of adenoma were independent risk factors for colorectal adenoma recurrence.