大肠息肉癌变的影响因素

Study on Fluencing Factors of Colorectal Polyp Canceration

目的探讨大肠息肉癌变的影响因素,提高结直肠癌的早诊早治,降低发病率。方法回顾性选取2020年1月至2022年12月在昆明医科大学第一附属医院消化内科住院期间明确诊断为肠息肉的患者,收集临床资料:性别、年龄、身高、体重、吸烟史、饮酒史、糖尿病史、高血压史,肠癌家族史及个人史、息肉的部位、形态、大小、数量、病理类型,分析大肠息肉癌变的影响因素。结果共调查4700例患者,发生癌变665例,癌变率为14.1%。不同性别、不同BMI组、是否患糖尿病、是否饮酒、有无肠癌家族史的患者肠息肉癌变率的差异均无统计学意义(P>0.05)。不同年龄组、是否患高血压、是否吸烟、有无肠癌病史、不同息肉部位、不同息肉形态、不同息肉表面情况、不同息肉数量(单发或多发)、不同息肉直径的患者肠息肉癌变率的差异均有统计学意义(P<0.05)。非条件二分类Logistic回归分析结果显示年龄、高血压、吸烟、息肉部位、息肉形态、息肉表面情况和息肉大小是影响肠息肉癌变的因素(P<0.05)。在对病理类型与癌变的关系分析时,调查的4700例患者中绒毛状腺瘤5例,例数太少没有纳入分析,有69例结果是“腺癌”,无法查到癌变前的病理类型故没有纳入分析,最终纳入4626例患者,分析发现不同病理类型的癌变率差异有统计学意义(P<0.05)。进一步两两比较,两两间均有差异(P<0.001):管状绒毛状腺瘤组癌变率最高(42.0%),其次是管状腺瘤组(6.1%),最低是非肿瘤性息肉(0%)。结论大肠息肉病理类型以管状腺瘤多见,随着绒毛成分的增多息肉癌变风险增加。高危息肉的内镜下特征包括:位于直肠及乙状结肠、表面分叶、山田分型为Ⅱ型及Ⅲ型、息肉直径较大。大肠息肉癌变风险和年龄呈正相关,随着年龄增加,息肉癌变风险加大,特别是年龄超过60岁。吸烟和高血压是肠息肉癌变的影响因素。

Objective To investigate the influencing factors of colorectal polyp canceration,to improve the early diagnosis and treatment of colorectal cancer,and to reduce the incidence.Methods Patients diagnosed with intestinal polyps during hospitalization in the Department of Gastroenterology,the First Affiliated Hospital of Kunming Medical University from January 2020 to December 2022 were retrospectively selected.Clinical data including gender,age,height,weight,history of smoking,drinking,diabetes and hypertension,family and personal history of bowel cancer,the position,shape,size,number and pathological type of polyps were collected and analyzed.Results A total of 4700 patients were investigated and cancer occurred in 665 cases,with a cancer rate of 14.1%.There was no significant difference in the rate of intestinal polyp canceration in gender,BMI,diabetes mellitus,alcohol consumption or family history of bowel cancer groups(P>0.05).There were significant differences in intestinal polyp canceration rate among patients in different age groups,hypertension,smoking,history of bowel cancer,different polyp sites,different polyp morphology,different polyp surface conditions,different number of polyps(single or multiple),and different polyp diameters(P<0.05).The results of unconditioned binary Logistic regression analysis showed that age,hypertension,smoking,polyp location,morphology,surface and size were the factors affecting the carcinogenesis of intestinal polyps(P<0.05).When analyzing the relationship between pathological types and canceration,5 cases of villous adenoma among 4700 patients investigated were too few to be included in the analysis,but the number of cases was too small to be included in the analysis.69 cases were found to be“adenocarcinoma”,and the pathological types before canceration could not be identified,so they were not included in the analysis.Finally,4,626 patients were included in the analysis.The cancer rate of different pathological types was statistically significant(P<0.05).Pair�wise comparison showed that there were differences between the following groups(P<0.001):the cancer rate of tubulovillous adenoma was the highest(42.0%),followed by tubulovillous adenoma(6.1%),and the lowest non�neoplastic polyps(0%).Conclusion The most common pathological type of large intestine polyp is tubular adenoma,and the risk of polyp canceration increases with the increase of villi.The endoscopic characteristics of high-risk polyps include locating at rectal and sigmoid colon,lobed surface,typeⅡandⅢof Polyp field classification,large diameter polyps.The risk of colorectal polyp canceration was positively correlated with age,and the risk of polyp canceration increased with age,especially over 60 years old.Smoking and high blood pressure are the risk factors for intestinal polyp canceration.