Li Dong-Lin, Ma Ling-Ling, Guan Zhong-An, Zhao Yu-Xin, Jiang Chuan
The First College of Clinical Medicine, Shandong Traditional Chinese Medicine University, Jinan, Shandong 250000, P.R. China.
Department of Gastroenterology, Dongying People's Hospital (Dongying Hospital of Shandong Provincial Hospital Group), Dongying, Shandong 257091, P.R. China.
Oncol Lett. 2025 May 2;30(1):322. doi: 10.3892/ol.2025.15068. eCollection 2025 Jul.
Colorectal adenomas are benign tumors of the colorectal mucosal epithelium that have malignant potential and are regarded as precancerous lesions of colorectal cancer, for which the specific risk factors are unclear. The present study aimed to identify independent risk factors for colorectal adenoma to develop a prediction model and test its predictive value. A retrospective analysis was performed using data from patients who underwent electronic colonoscopy at the Department of Proctology (Affiliated Hospital of Shandong University of Traditional Chinese Medicine; Jinan, China) from January 2013 to December 2023 and had polyps removed during colonoscopy. Patients with colorectal adenoma were included in the case group, whilst those with no visible abnormalities on endoscopy or with non-adenomatous polyps were included as a control group. The patients were randomly divided into a training and validation group in a 7:3 ratio. Variables were screened using single-component analysis and the filtered variables were employed in multivariate logistic regression to create a clinical prediction model. Finally, the model was internally and externally validated. A total of 730 patients were included in the present study, with 286 assigned to the case group and 444 to the control group. After the initial screening of 39 variables, 12 continued to the next round, resulting in four potential predictors including age, daily number of bowel movements, thrombin time and the number of polyps. A prediction model was created based on these variables. Regarding internal validation, the C-index was 0.7054 [95% confidence interval (CI), 0.6596-0.7512] and the prediction probability in the calibration curve was close to the diagonal line of the calibration graph, indicating that the prediction probability of the model was reasonable. Regarding external validation, the C-index in the validation cohort was 0.6306 (95% CI, 0.5560-0.7053) and the calibration curve also demonstrated good identification capabilities. The Hosmer-Lemeshow test revealed that the model had a reasonable calibration degree, with χ=9.7893, degree of freedom=8 and P=0.28. The receiver operating characteristic curve and decision curve analysis for the training and validation cohorts demonstrated good efficacy and an ideal application value. In conclusion, the model constructed in the present study demonstrated moderate predictive accuracy for colorectal adenoma risk, laying the groundwork for early detection of colorectal adenoma and secondary prevention of colorectal cancer.
结直肠腺瘤是结直肠黏膜上皮的良性肿瘤，具有恶变潜能，被视为结直肠癌的癌前病变，其具体危险因素尚不清楚。本研究旨在确定结直肠腺瘤的独立危险因素，以建立预测模型并检验其预测价值。采用回顾性分析方法，使用2013年1月至2023年12月在山东中医药大学附属医院肛肠科接受电子结肠镜检查并在结肠镜检查期间切除息肉的患者的数据。结直肠腺瘤患者纳入病例组，而内镜检查无明显异常或有非腺瘤性息肉的患者纳入对照组。患者按7:3的比例随机分为训练组和验证组。使用单因素分析筛选变量，并将筛选出的变量用于多因素逻辑回归以建立临床预测模型。最后，对该模型进行内部和外部验证。本研究共纳入730例患者，其中286例分配至病例组，444例分配至对照组。在对39个变量进行初步筛选后，12个变量进入下一轮，最终得到4个潜在预测因素，包括年龄、每日排便次数、凝血酶时间和息肉数量。基于这些变量建立了预测模型。在内部验证方面，C指数为0.7054 [95%置信区间（CI），0.6596 - 0.7512]，校准曲线中的预测概率接近校准图的对角线，表明模型的预测概率合理。在外部验证方面，验证队列中的C指数为0.6306（95% CI，0.5560 - 0.7053），校准曲线也显示出良好的鉴别能力。Hosmer - Lemeshow检验显示该模型具有合理的校准度，χ = 9.7893，自由度 = 8，P = 0.28。训练队列和验证队列的受试者工作特征曲线及决策曲线分析显示出良好的效能和理想的应用价值。总之，本研究构建的模型对结直肠腺瘤风险具有中等预测准确性，为结直肠腺瘤的早期检测和结直肠癌的二级预防奠定了基础。
