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. 2024 Feb 20:14:1320020.
doi: 10.3389/fonc.2024.1320020. eCollection 2024.

Retrospective cohort study investigating association between precancerous gastric lesions and colorectal neoplasm risk

Hui Pan  1 , Yu-Long Zhang #  2 , Chao-Ying Fang #  3 , Yu-Dai Chen  1 , Li-Ping He  3 , Xiao-Ling Zheng  1 , Xiaowen Li  1
Affiliations

Retrospective cohort study investigating association between precancerous gastric lesions and colorectal neoplasm risk

Hui Pan et al. Front Oncol. .

Abstract

Background: Colorectal cancer (CRC) is considered the most prevalent synchronous malignancy in patients with gastric cancer. This large retrospective study aims to clarify correlations between gastric histopathology stages and risks of specific colorectal neoplasms, to optimize screening and reduce preventable CRC.

Methods: Clinical data of 36,708 patients undergoing gastroscopy and colonoscopy from 2005-2022 were retrospectively analyzed. Correlations between gastric and colorectal histopathology were assessed by multivariate analysis. Outcomes of interest included non-adenomatous polyps (NAP), conventional adenomas (CAs), serrated polyps (SPs), and CRC. Statistical analysis used R version 4.0.4.

Results: Older age (≥50 years) and Helicobacter pylori infection (HPI) were associated with increased risks of conventional adenomas (CAs), serrated polyps (SPs), non-adenomatous polyps (NAP), and colorectal cancer (CRC). Moderate to severe intestinal metaplasia specifically increased risks of NAP and CAs by 1.17-fold (95% CI 1.05-1.3) and 1.19-fold (95% CI 1.09-1.31), respectively. For CRC risk, low-grade intraepithelial neoplasia increased risk by 1.41-fold (95% CI 1.08-1.84), while high-grade intraepithelial neoplasia (OR 3.76, 95% CI 2.25-6.29) and gastric cancer (OR 4.81, 95% CI 3.25-7.09) showed strong associations. More advanced gastric pathology was correlated with progressively higher risks of CRC.

Conclusion: Precancerous gastric conditions are associated with increased colorectal neoplasm risk. Our findings can inform screening guidelines to target high-risk subgroups, advancing colorectal cancer prevention and reducing disease burden.

Keywords: atrophic gastritis; colorectal adenoma; helicobacter pylori; intestinal metaplasia; serrated lesions.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study design. PJS, Peutz–Jeghers syndrome; FAP, familial adenomatous polyposis; NAP, non-adenomatous polyps; CAs, conventional adenomas; SPs, serrated polyps; CRC, colorectal cancer; NP, no polyps.
Figure 2
Figure 2
The result of multivariate logistic regression for the NAP group. IM, intestinal metaplasia; LGIN, low-grade intraepithelial neoplasia; HGIN, high-grade intraepithelial neoplasia; GC, gastric cancer.
Figure 3
Figure 3
The result of multivariate logistic regression for the CAs group. IM, intestinal metaplasia; LGIN, low-grade intraepithelial neoplasia; HGIN, high-grade intraepithelial neoplasia; GC, gastric cancer.
Figure 4
Figure 4
The result of multivariate logistic regression for the SPs group. IM, intestinal metaplasia; LGIN, low-grade intraepithelial neoplasia; HGIN, high-grade intraepithelial neoplasia; GC, gastric cancer.
Figure 5
Figure 5
The result of multivariate logistic regression for the CRC group. IM, intestinal metaplasia; LGIN, low-grade intraepithelial neoplasia; HGIN, high-grade intraepithelial neoplasia; GC, gastric cancer.
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