Risk factors for high-grade dysplasia or carcinoma in colorectal adenoma cases treated with endoscopic polypectomy.
OBJECTIVE
Our aim is to establish the risk factors for carrying high-grade dysplasia or carcinoma by analyzing endoscopically treated adenoma cases.


METHODS
Patients who underwent endoscopic polypectomy at our hospitals between January 2003 and August 2004 were analyzed.


RESULTS
A total of 889 patients (mean age: 63+/-11 years), and 1486 adenomas resected from these patients, were included in the analysis. Seventy-five adenomas (5%) from 72 patients (8%) were found to have high-grade dysplasia or carcinoma. Among patient factors, female sex [odds ratio (OR) 2.25, 95% confidence intervals (CI)=1.34-3.76], presence of multiple adenomas (OR=2.15, 95% CI=1.15-4.00), older age (OR=1.02, 95% CI=1.00-1.04), and rectal bleeding as the indication for colonoscopy (OR=2.57, 95% CI=1.34-4.92) were identified as the significant risk factors for carrying high-grade dysplasia or carcinoma using the multivariate analysis. In addition, a size of > or = 10 mm (OR=10.83, 95% CI=5.86-20.0), flat appearance (OR=3.91, 95% CI=2.20-6.95), and location on the left side of the colon (OR=1.80, 95% CI=1.03-3.13) were identified as tumor risk factors.


CONCLUSIONS
Distinct factors were proved to be associated with high-grade dysplasia or carcinoma. These results are useful to select lesions that require immediate treatment. Moreover, female sex as a risk factor raises an interesting problem regarding the progression from adenoma to carcinoma.
Kurome
Manabu
M
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kagawa, Japan.
Kato
Jun
J
Nawa
Toru
T
Fujimoto
Tsuyoshi
T
Yamamoto
Hiroshi
H
Shiode
Junji
J
Wato
Masaki
M
Kuwaki
Kenji
K
Okada
Hiroyuki
H
Sakaguchi
Kohsaku
K
Shiratori
Yasushi
Y
D000236:Adenoma / Q000473:pathology* / Q000601:surgery; D000367:Age Factors; D000368:Aged; D003111:Colonic Polyps / Q000473:pathology* / Q000601:surgery; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors