The Potential Value of Gastric Histopathology for Predicting Colorectal Adenomatous Polyps Among the Chinese Population: A Retrospective Cross-Sectional Study

Abstract

Background: It remains unknown whether gastric histopathology is associated with the occurrence of colonic neoplasms. We aimed to clarify the association between gastric histopathology and different types of colorectal polyps (CP) and colorectal cancer (CRC), and whether various gastric histopathologies are risk factors for different types of CP and CRC.

Methods: A retrospective cross-sectional study was conducted on 5,986 patients who underwent gastroscopy and colonoscopy simultaneously at Shaoxing People's Hospital from August 1, 2019, to May 31, 2020. The Pearson χ² test was used to analyze the occurrence of various gastric histopathologies in different types of CP and CRC, and logistic regression was used to determine whether various gastric histopathologies were risk factors for different types of CP and CRC.

Results: For the Chinese population, male sex (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.41-1.97, P < 0.001) and old age (OR 1.03, 95% CI 1.02-1.04, P < 0.001) were risk factors for non-adenomatous polyps (NAP), but Helicobacter pylori (H. pylori) and various gastric histopathologies were not significant in the NAP compared with the normal group. Nevertheless, it is noteworthy that, similar to male sex and old age, H. pylori (OR 1.22, 95% CI 1.08-1.38, P = 0.002), low-grade intraepithelial neoplasia (LGIN) (OR 1.79, 95% CI 1.21-2.66, P = 0.004), gastric fundus gland polyps (FGPs) (OR 1.44, 95% CI 1.11-1.87, P = 0.007), hyperplastic/inflammatory gastric polyps (GHP or GIP) (OR 1.50, 95% CI 1.06-2.12, P = 0.022), and atrophy/intestinal metaplasia (AG or IM) (OR 1.27, 95% CI 1.13-1.43, P < 0.001) were all risk factors for colorectal adenomatous polyps (AP). However, the results of CRC showed that old age (OR 1.13, 95% CI 1.10-1.16, P < 0.001) and H. pylori (OR 1.67, 95% CI 0.99-2.75, P < 0.05) were risk factors for CRC (OR 1.67, 95% CI 0.99-2.75, P < 0.05), but not sex and various gastric histopathologies (P > 0.05).

Conclusion: Gastric histopathology, such as AG or IM, LGIN, FGP, and GHP or GIP, were risk factors for AP, but not for NAP and CRC, indicating that gastric histopathology has potential predictive value for AP in the Chinese population.

Keywords: colorectal adenomatous polyps; colorectal cancer; gastric histopathology; logistic regression analysis; retrospective cross-sectional study.

Figure 1

Flowchart of case selection.

Figure 2

The results of multivariate logistic regression for the NAP group compared with the normal group. 95% CI, 95% confidence interval; NAG, non-atrophic gastritis; AG or IM, atrophy/intestinal metaplasia; FGP, gastric fundus gland polyp; GHP or GIP, hyperplastic/inflammatory gastric polyp; LGIN, low-grade intraepithelial neoplasia. Complex model: All variables were included, and then P values were calculated separately. Simple model: Based on the complex model and the stepwise regression method, an optimal simple model is obtained, which is automatically screened according to the Akaike information criterion (AIC) minimization principle.

Figure 3

The result of multivariate logistic regression for the AP group compared with the normal group. 95% CI, 95% confidence interval; NAG, non-atrophic gastritis; AG or IM, atrophy/intestinal metaplasia; FGP, gastric fundus gland polyps; GHP or GIP, hyperplastic/inflammatory gastric polyps; LGIN, low-grade intraepithelial neoplasia. Complex model: All variables were included, and then P values were calculated separately. Simple model: Based on the complex model and the stepwise regression method, an optimal simple model is obtained, which is automatically screened according to the Akaike information criterion (AIC) minimization principle.

Figure 4

The result of multivariate logistic regression for the CRC group compared with the normal group. 95% CI, 95% confidence interval; NAG, non-atrophic gastritis; AG or IM, atrophy/intestinal metaplasia; FGP, gastric fundus gland polyps; GHP or GIP, hyperplastic/inflammatory gastric polyps; LGIN, low-grade intraepithelial neoplasia. Complex model: All variables were included, and then P values were calculated separately. Simple model: Based on the complex model and the stepwise regression method, an optimal simple model is obtained, which is automatically screened according to the Akaike information criterion (AIC) minimization principle.