Predictive Factors for the Coexistence of Colorectal Lateral Spreading Tumors and Colorectal Polyps, and Risk Factors for Malignant Transformation

Abstract

Purpose Lateral spreading tumors (LSTs) and colorectal polyps are both considered precursors to colorectal cancer and often coexist. This study aimed to identify independent predictive factors for the coexistence of LSTs with colorectal polyps and the independent risk factors for malignancy in LSTs with colorectal polyps. Methods This retrospective study included 229 patients diagnosed with LSTs via colonoscopy at Lianyungang First People's Hospital from January 2020 to March 2024. Patients were divided into two groups based on the presence of colorectal polyps: polyp group (n = 139) and non-polyp group (n = 90). Clinicopathological characteristics were compared between the two groups, and binary logistic regression was used to identify predictive factors for coexistence. The polyp group was further subdivided into malignant group (n = 62) and non-malignant group (n = 77) based on the degree of dysplasia. Binary logistic regression was also used to analyze the risk factors for malignant transformation of LSTs with colorectal polyps. Results Male gender (OR = 0.330, 95% CI: 0.186 - 0.586, P < 0.001) and age between 50 - 75 years (OR = 4.293, 95% CI: 1.060 - 17.376, P = 0.041) were identified as predictive factors for the coexistence of colorectal polyps with LSTs. The area under the receiver operating characteristic curve (AUC) for the predictive model was 0.703 (95% CI: 0.633 - 0.773; P < 0.001). LST diameter ≥ 2 cm (OR = 4.574, 95% CI: 1.754 - 11.933, P = 0.002), LST-G-H subtype (OR = 8.761, 95 % CI: 2.788 - 27.530, P < 0.001), and LST-G-M subtype (OR = 0.182, 95%CI: 0.039 - 0.845, P = 0.030) were identified as risk factors for malignant transformation of LSTs with colorectal polyps. The AUC for this predictive model was 0.873 (95% CI: 0.814 - 0.931, P < 0.001). Conclusion Men aged 50 - 75 with LSTs are more likely to have coexisting colorectal polyps. Larger LST diameter and mixed nodular subtype increase the risk of malignant transformation when coexisting with colorectal polyps, whereas homogeneous granular subtype may reduce this risk.