Risk Factors For Colorectal Adenoma With High-Grade Intraepithelial Neoplasia

Objective:In this study,the review of the clinical features of colorectal adenomas with high-grade intraepithelial neoplasia(HGIN)and the features of the adenomas themselves was conducted,and the risk factors of colorectal adenoma complicated with HGIN were discussed.To raise clinicians’ awareness of the risk factors for colorectal adenomas in HGIN for better early diagnosis and treatment of colorectal cancer.Methods:A total of 677 adenomas were chosen from 439 patients admitted to the Second Hospital of Jilin University from May 2020 to May 2022 and diagnosed as colorectal adenomas by colonoscopy.The patients were divided into 93 patients in HGIN group and 346 patients without HGIN group according to the presence or absence of HGIN.There were 104 adenomas in the HGIN ’group and 573 in the HGIN’ free group.The clinical characteristics and the characteristics of the adenomas were retrospectively analyzed,and the risk factors of colorectal adenomas with HGIN were analyzed and summarized.The data were analyzed using SPSS 26.0 statistical software.P<0.05 was regarded as statistically significant between the two groups.Results:(1)General information: A total of 439 patients with 677 adenomas were included in this study.The average age of the subjects was(57.83 ± 10.58)years,with a youngest age of 28 years and an oldest age of 86 years.There were 277 males and162 females,93 patients with HGIN and 346 patients without HGIN.A total of 677 adenomas were found,104 with HGIN and 573 without HGIN.(2)Analysis of clinical characteristics of the two groups of patients: more than half of the patients showed no obvious symptoms,and the patients with clinical manifestations lacked specificity,such as abdominal pain,abdominal distension,changes in bowel habits,etc.Univariate analysis indicated that patients with HGIN had higher rates of smoking,BMI(≥28kg/m2)and diabetes than those without HGIN and the differences were statistically significant(p<0.05).The effects of smoking,BMI and diabetes mellitus on the occurrence of HGIN are different in different age groups.Among them,the effects of smoking and diabetes mellitus are more obvious in patients after 40 years old,while the effects of BMI are more obvious in patients≥60 years old.The results of multivariate analysis showed that smoking(OR=2.111,95%CI=1.315-3.388)and diabetes(OR=2.313,95%CI= 1.332-4.018)were independent risk factors.(3)Analysis of the characteristics of adenoma itself,located in the rectum,diameter ≥ 10 mm,peduncle,lobulation,surface hyperemia and roughness,pathological classification of villous tubular adenoma and villous adenoma the difference being statistically significant between the two groups(p<0.05),multivariate analysis showed that diameter size(≥ 10 mm)and pathological classification(villous tubular adenoma,villous adenoma)were independent risk factors,among which the occurrence of HGIN in ≥ 10 mm diameter adenoma was3.239 times that of adenoma with a diameter of <10mm;The incidence of HGIN in villous adenoma was 14.103 times and 6.700 times that of tubular adenoma,respectively.Conclusion:(1)Among the clinical features of patients,smoking and diabetes are independent risk factors for the development of HGIN in colorectal adenomas,and there are certain differences in different age groups,among which the influence is more significant in patients ≥40 years old.(2)Among the characteristics of the adenoma itself,the diameter ≥10mm,villous tubular adenoma and villous adenoma were independent risk factors for HGIN.