| Objective Give a research to the canceration factors for colorectal polyps and to investigate the endoscopic and pathologic characteristics of colorectal high-risk adenomas for a reasonable follow-up colonoscopy. To investigate the expression of decorin in colorectal adenomas,otherwise to analyze the relationship of the expression with clinicopathologic and risk factors.Methods 583 colon polyp patients who underwent colonoscopic resection between 2005 and 2008 at the department of gastroenterology,the first affiliated hospital of anhui medical university (some cases underwent surgical resection)were analyzed retrospective. According to the 2006 postpolypectomy colonoscopy surveillance guideline,583cases with colonic polyps were stratified at their baseline into lower risk group,increased risk group and non-adenomatous polyps group,moreover,undertook statistical treatment to related clinical parameter.Immunohistochemical methods(S-P) were used to detect decorin protein in 16 inflammatory or hyperplastic polyps and 70 colorectal adenomas paraffinembedded tissue specimens,18 colon cancer and 86 colon polyps tissue as control groups.Results 1.Clinical analysis of colorectal advanced adenomas The number of patients with colonic polyps was 583, including 243 non-adenomatous polyps,83 low-risk adenomas,257 high-risk adenomas. The average age of adenomatous polyps patients was older than that of the non-adenomatous polyps patients(58.90±13.28 vs 55.51±15.66,P<0.05);Compared with non-adenomatous polyposis, adenomatous polyposis is significantly diferent in size and number of polyps, adenomatous polyps Patients whose polyps≥lcm and≥3adenomas was more than non-adenomatouss polyps patients (62.0%Vs21.5%,24.1%Vs14.0%,P<0.01,respectively),and there was a significant difference the incidence in cancerous polyps than in non-adenomatous polyps patients (9.1%vs0.8%, P<0.001).The high-risk adenomas has higher incidence of hematochezia (51.8%Vs37.3%,P<0.05),more lobular and mucosal pathological change than low-risk adenomas.33 cases were cancerated in our study, in which, canceration rate of polyps≥2.0cm in diameter and the number of polyps≥3were 21.1% and 11.2%, were significantly higher than those polyps≥1.0cm in diameter (4.2%, P＜0.001) and the number of<3 (4.3%, P<0.05); there was a higher canceration rate for the polyps with Surface lobulation(19.3%),than their with non-Surface lobulation(2.2%)(P＜0.001);The canceration rate of villous adenoma(26.8%) and tubular-villous adenoma (21.1%)was higher than tubular adenoma (2.3%) (P＜0.001, respectively).2.Expression of decorin in colon polyps Normal tissue and non-adenomatous polyps and the majority of tubular adenomas showed strong expression of decorin in the stroma(high expression rates were 90.0%,87.5%,84.4%, respectively),adenomas with villous features and the high grade colon intraepithelial neoplasia and adenocarcinoma showed moderate and very low decorin immunoreactivity(high expression rates were 63.2%,53.3%%,44.4%) (P<0.05, respectively);In the 6 cases of malignant adenomas, high decorin expression rate was only 33.3%, significantly lower than non-cancerous adenomas 76.6%(P<0.05).Decorin expression levels were significantly related to histological features and dysplasia grade of adenomas.Conclusion The high-risk adenomas has higher incidence of hematochezia,more lo-bular and mucosal pathological change than low-risk adenomas. The totality of evidence suggests that multiplicity, size, villous features, and more lobular and mucosal path-ological change are predictors of future advanced adenomas or cancers;The test of expression of decorin protein is helpful in assessing the malignant extent of colorectal polyps... |
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