Characteristics and risk factor analyses of high-grade intraepithelial neoplasia in older patients with colorectal polyps

Background: According to the degree of intradermal neoplasia in the colorectal exhalation, it can be divided into two grades: Low-grade intraepithelial neoplasia (LGIN) and high-grade intraepithelial neoplasia (HGIN). Currently, it is difficult to accurately diagnose LGIN and HGIN through imaging, and clinical diagnosis depends on postoperative histopathological diagnosis. A more accurate method for evaluating HGIN preoperatively is urgently needed in the surgical treatment and nursing intervention of colorectal polyps.

Aim: To explore the characteristics and risk factors of HGIN in older patients with colorectal polyps.

Methods: We selected 84 older patients diagnosed with HGIN as the HGIN group (n = 95 colonic polyps) and 112 older patients diagnosed with LGIN as the LGIN group (n = 132 colonic polyps) from Shandong Provincial Hospital Affiliated to Shandong First Medical University. The endoscopic features, demographic characteristics, and clinical manifestations of the two patient groups were compared, and a logistic regression model was used to analyze the risk factors for HGIN in these patients.

Results: The HGIN group was older and had a higher number of sigmoid colon polyps, rectal polyps, pedunculated polyps, polyps ≥ 1.0 cm in size, polyps with surface congestion, polyps with surface depression, and polyps with villous/tubular adenomas, a higher proportion of patients with diabetes and a family history of colorectal cancer, patients who experienced rectal bleeding or occult blood, patients with elevated carcinoembryonic antigen (CEA) and cancer antigen 199 (CA199), and lower nutritional levels and higher frailty levels. The polyp location (in the sigmoid colon or rectum), polyp diameter (≥ 1.0 cm), pathological diagnosis of (villous/tubular adenoma), family history of colorectal cancer, rectal bleeding or occult blood, elevated serum CEA and CA199 levels, lower nutritional levels and higher frailty levels also are independent risk factors for HGIN.

Conclusion: The occurrence of high-grade neoplastic transformation in colorectal polyps is closely associated with their location, size, villous/tubular characteristics, family history, elevated levels of tumor markers, and lower nutritional levels and higher frailty levels.