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Published on: February 16, 2024
Endoscopic characterization and development of a prediction model for colorectal adenomatous polyps
Wen-Cai Luo1, Yuan-Fu Yang2, Yao Wang3
1Department of Gastroenterology, The People's Hospital of Guanghan, Deyang 618300, Sichuan Province, China. lwc641105@163.com.
Background:
Colorectal cancer carries a high mortality rate worldwide. Adenocarcinoma is its most common type, which is progressed following an adenoma-dysplasia-carcinoma sequence. Early accurate identification of individuals with a high risk for adenomas could facilitate prompt removal of adenomas and reduce colorectal cancer incidence.
Aim:
To investigate the endoscopic features of colorectal adenomatous polyps and develop a prediction model for their occurrence.
Methods:
A total of 202 individuals undergoing their first colonoscope between January 2023 and January 2024 were selected. Endoscopic characteristics, demographics, clinical information, and laboratory results were compared between individuals with or without colorectal adenomas. Logistic regression was performed to identify risk factors for colorectal adenomatous polyps and construct a prediction model. A nomogram was developed using R (v3.5.2). Internal validation was conducted with 1000 bootstrap resamples to assess calibration and discrimination. External valuation was conducted in another 240 individuals.
Results:
In 202 participants, 75 (37.13%) and 127 (62.87%) had or had no colorectal adenomas, respectively. These adenomas varied in shape, size, and locations. Age ≥ 60 years, smoking, alcohol, fatty liver, gallbladder polyps, and abnormal glycosylated hemoglobin (HbA1c) were risk factors and were used to construct nomogram Logit(P) = -5.602 + 1.791 × age ≥ 60 years + 1.115 × smoking + 1.894 × alcohol + 1.727 × fatty liver + 1.749 × gallbladder polyps + 1.903 × abnormal HbA1c. Internal validation demonstrated excellent agreement between apparent and bias-corrected curves, strong discriminative ability (area under the curve of 0.889, 95% confidence interval: 0.841-0.938), and high net clinical benefit (threshold probability range 0.1-0.9). External validation also suggested excellent model performance.
Conclusion:
Colorectal adenomas exhibit diverse characteristics. A nomogram incorporating age, smoking, alcohol, fatty liver, gallbladder polyps, and HbA1c provides a robust and accurate prediction for the risk of colorectal adenomas.
