Risk factors associated with colorectal adenomas and the formulation of prediction models

Colorectal adenomas (CRAs) are the primary precancerous lesions in the development of colorectal cancer; establishing a simple, cost-effective and non-invasive tool for distinguishing adenomatous from non-neoplastic polyps in patients already scheduled for or undergoing endoscopy is of great significance for risk stratification.

To investigate the association between peripheral blood metabolic and inflammatory markers and the risk of colorectal adenomas, and to develop a personalised risk prediction model for distinguishing adenomatous from non-neoplastic polyps in patients already scheduled for or undergoing endoscopy.

This study was a single-centre retrospective case-control study conducted at the Affiliated Hospital of Shandong Second Medical University. The study included 2,437 patients with colorectal polyps who underwent endoscopic resection between January 2020 and December 2025.

Demographic characteristics, lifestyle factors and peripheral blood biochemical markers, with a particular focus on the triglyceride-to-glucose (TyG) ratio and markers of systemic inflammation.

Patients with colorectal adenomas confirmed by histopathology. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration curves and decision curve analysis (DCA).

The study included 2,437 participants (mean age 58.57 years; 1,323 men [54.29%]), patients in the adenoma group (n=1,584) were significantly older and had a higher proportion of men compared with the control group (n=853). Multivariate logistic regression analysis revealed that male sex (OR, 1.621; 95% CI, 1.269-2.074), age ≥56.5 years (OR, 1.868; 95% CI, 1.515-2.205) and a TyG index ≥8.562 (OR, 1.271; 95% CI, 1.015-1.590) were independent risk factors for the development of colorectal adenomas. The AUC of this predictive model was 0.631 and 0.607 in the training and validation sets, respectively, indicates moderate discriminatory power. The model is well calibrated; analysis of the decision curve shows that, across a range of threshold probabilities, the model yields a positive net benefit compared with strategies involving either universal treatment or universal non-treatment.

The findings suggest that male gender, advanced age and an elevated TyG index are independently associated with the risk of colorectal adenomas. The non-invasive nomogram developed in this study provides a simple risk stratification tool to aid in distinguishing adenomatous from non-neoplastic polyps in patients already scheduled for or undergoing endoscopy.