The Risk Factors For The Occurrence Of Colorectal Adenoma:A Meta-analysis

Research Background:Colorectal adenoma(CRA)is a common benign intestinal tumor,accounting for80%-90% of colorectal polyp types,with an incidence rate of 1.8%-17.2% in the general population,and prevalence in people over 50 years old.The rate is as high as 30%-40%.CRA is currently recognized as one of the precancerous lesions of colorectal cancer(CRC),which can develop into CRC through the "adenomatous-adenocarcinoma pathway" with a window period of about 5-10 years.Regular colonoscopy can detect CRA early and deal with it in time,which is an important means to reduce the morbidity and mortality of CRC.However,colonoscopy is an invasive examination with poor patient compliance;at the same time,affected by bowel preparation and operator skills,colonoscopy results have a certain rate of missed diagnosis.Therefore,identifying the risk factors of CRA and implementing primary prevention can reduce the risk of CRC earlier and more effectively.At present,there are a large number of studies on the risk factors of CRA at home and abroad,but the results of each study are not completely consistent,and there are differences in the risk factors of CRA in different regions and different populations.Therefore,this study intends to systematically evaluate the risk factors of CRA through Meta-analysis,and provide scientific basis for preventing and reducing the occurrence of CRA and reducing the incidence and mortality of CRC.Objective:By collecting literatures related to the risk factors of CRA,using the method of meta-analysis to systematically evaluate the risk factors of CRA,to provide evidence-based evidence for the prevention of CRA and CRC.Methods:The Chinese and English literatures on the risk factors of CRA published in databases such as Pub Med,Embase,Wanfang,VIP,and China National Knowledge Infrastructure(CNKI)before June 2021 were retrieved.Strictly follow the inclusion and exclusion criteria for secondary screening of the initially screened literature,and use the Newcastle-Ottawa Scale(NOS)to evaluate the quality of the final included literature and extract the data required for this meta-analysis,and finally use Rev Man5.4 software for statistical analysis.If there was heterogeneity between studies,a sensitivity analysis was used to look for sources of heterogeneity.Results:1.Literature search results: The preliminary search literature was deduplicated,and after reading the title,abstract and full text,the literature review,meeting minutes,incomplete data and literature that did not match the theme of risk factors for CRA were excluded.Finally,a total of 12 literatures were included.All were case-control studies,including 7,800 subjects,including 3,335 in the adenoma group and 4,465 in the control group.2.Analysis of statistical results:(1)Male(OR=2.06,95%CI: 1.73-2.46),age ≥50 years(OR=1.91,95%CI:1.53-2.40),smoking(OR=1.60,95%CI: 1.35-1.90),drinking(OR=1.42,95%CI:1.05~1.90)people were more likely to develop CRA;(2)People with a family history of tumors had a higher risk of developing CRA(OR=1.93,95%CI: 1.61-2.31);(3)Patients with Helicobacter pylori(Hp)infection had a higher risk of developing CRA than the normal population(OR=3.33,95%CI: 1.42-7.79);(4)Patients with overweight(BMI≥24kg/m2),fatty liver,and hyperlipidemia had a higher risk of developing CRA(OR=2.25,95%CI: 1.44-3.50;OR=2.09,95%CI:1.60-2.72;OR= 1.70,95%CI: 1.44-2.00);(5)The risk of developing CRA was higher in those who frequently consumed red meat(OR=1.71,95%CI: 1.19-2.46).3.Sensitivity analysis: The fixed-effect model and the random-effect model were used to conduct sensitivity analysis and comparison of each risk factor.The results showed that the data of the two groups were relatively close,indicating that the results of this meta-analysis were stable.The source of heterogeneity was found by removing a single study.The results showed that the heterogeneity came from the literature of Zhu Jiangyi,Chen Zhitao and Feng Kaiyu,and the heterogeneity among the studies was significantly reduced after exclusion(I2=0%,OR=1.20,95%CI: 1.04~1.39,P=0.01;I2=46%,OR=4.58,95%CI: 2.86-7.33,P<0.00001;I2=3%,OR=1.78,95%CI: 1.29-2.48,P=0.0005).Conclusion:Male,age≥50 years old,smoking,drinking,family history of tumors,Hp infection,overweight(BMI≥24kg/m2),fatty liver,hyperlipidemia,and red-meat intake are all risk factors for the occurrence of CRA.