BACKGROUND: Colorectal cancer (CRC) typically progresses from benign colorectal polyps, which represent a precursor to malignancy. Identifying the factors influencing this progression is crucial for early intervention and prevention. Although genetic and environmental factors have been widely studied, the role of lifestyle factors such as physical activity, diet, smoking, sleep, and stress remains underexplored, especially in patients with early stage CRC or polyps. Recent evidence suggests that lifestyle behaviors may influence cancer progression by modulating inflammatory pathways, metabolic health, and immune function. For instance, high levels of physical activity are linked to a reduced risk of CRC development, whereas poor dietary habits, smoking, and inadequate sleep have all been implicated in increased cancer risk and progression. Moreover, early-stage CRC patients, who are often asymptomatic or have minimal symptoms, may particularly benefit from lifestyle modifications to slow disease progression and improve overall prognosis. The gap in understanding the specific influence of these lifestyle factors on colorectal polyps and early stage cancer progression underscores the need for comprehensive studies. By assessing several modifiable lifestyle factors and their association with disease progression, clinicians can identify practical intervention points. These interventions could ultimately reduce the need for more aggressive treatments and improve the long-term outcomes in affected patients. AIM: To investigate the association between lifestyle factors and disease progression in patients with colorectal polyps and early stage cancer. METHODS: In this observational study conducted from January 2022 to December 2023, we recruited 120 patients with colorectal polyps or early stage cancer from Jiangshan People's Hospital. Lifestyle factors, including physical activity, dietary patterns, smoking status, sleep quality, and stress levels, were assessed using validated questionnaires. Disease progression was evaluated using standardized follow-up colonoscopies and pathological examinations. Cox proportional hazards models were used to analyze the association between lifestyle factors and disease progression after adjusting for potential confounders. RESULTS: During the median follow-up of 18.4 months, 42 (35.0%) patients experienced disease progression. High levels of physical activity were associated with reduced progression risk [adjusted hazard ratio (HR) 0.55, 95% confidence interval (CI): 0.38-0.80, = 0.002] compared to low activity levels. High adherence to a healthy dietary pattern showed similar protective effects (adjusted HR 0.62, 95%CI: 0.43-0.89, = 0.009). Current smoking (adjusted HR 1.92, 95%CI: 1.35-2.73, < 0.001) and poor sleep quality (adjusted HR 1.38, 95%CI: 1.05-1.82, = 0.021) were associated with increased progression risk. The impact of lifestyle factors was particularly pronounced in patients younger than 60 years and those with multiple polyps at baseline. CONCLUSION: This study demonstrated significant associations between lifestyle factors and disease progression in colorectal polyps and early stage cancer. Physical activity, dietary patterns, smoking status, and sleep quality have emerged as key modifiable factors influencing disease progression. These findings support the integration of lifestyle assessments and modifications in the clinical management of patients with colorectal neoplasia.