Abstract
Background and AimsLaterally spreading tumor (LST) is a colorectal pre-cancerous lesion. Previous studies have demonstrated distinct LST clinicopathological characteristics in different populations. This study evaluated clinicopathological characteristics of LST in a Chinese population.MethodsA total of 259 Chinese LST patients with 289 lesions were recruited for endoscopic and clinicopathological analyses.ResultsAmong these 289 lesions, 185 were granular type (LST-G), whereas 104 were non-granular type (LST-NG). LST-G lesions were further classified into homogeneous G-type and nodular mixed G-type, while LST-NG lesions were further classified into flat elevated NG-type and pseudo-depressed NG-type. Clinically, these four LST subtypes showed distinct clinicopathological characteristics, e.g., lesion size, location, or histopathological features (high-grade intraepithelial neoplasia and submucosal carcinoma). The nodular mixed G-type showed larger tumor size and higher incidence of high-grade intraepithelial neoplasia compared to the other three subtypes, while pseudo-depressed NG-type lesions showed the highest incidence of submucosal carcinoma. Noticeably, no diffidence was detected between the lesions of homogeneous G-type and flat elevated NG-type with regard to the histopathological features. Histology of the malignancy potential was associated with nodular mixed G-type [OR = 2.41, 95% CI (1.09–5.29); P = 0.029], flat elevated NG-type [OR = 3.49, 95% CI (1.41–8.22); P = 0.007], Diameter ≥30 mm [OR = 2.56, 95% CI (1.20–5.20); P = 0.009], Villous adenoma [OR = 2.76, 95% CI (1.01–7.58); P = 0.048] and serrated adenoma [OR = 6.99, 95% CI (1.81–26.98); P = 0.005].ConclusionChinese LSTs can be divided into four different subtypes, which show distinct clinicopathological characteristics. Morphology, size and pathological characteristics are all independent predictors of advanced histology.
Highlights
Colorectal cancer is one of most common neoplasms in the world, i.e., it is the second most common cancer diagnosed in women and the third most common in men, accounting for one fourth of worldwide cancer deaths in 2008 [1,2]
Recent studies have indicated that Laterally spreading tumor (LST) represents 17.2% of advanced colorectal neoplasia [14] and that LST lesions may develop high-grade intraepithelial neoplasia (HIGN) with an incidence rate ranging from 20.9% to 33.8% [15,16]
LSTs can be treated with endoscopic resection or surgery to eliminate the late stage of colorectal cancer [10]
Summary
Colorectal cancer is one of most common neoplasms in the world, i.e., it is the second most common cancer diagnosed in women and the third most common in men, accounting for one fourth of worldwide cancer deaths in 2008 [1,2]. Spreading tumor (LST) of the colorectum is a large and relatively flat neoplastic lesion, which typically extends laterally rather than vertically along the colonic wall [9,10,11] and belongs to the class nonpolypoid colorectal neoplasia. Recent studies have indicated that LSTs represents 17.2% of advanced colorectal neoplasia [14] and that LST lesions may develop high-grade intraepithelial neoplasia (HIGN) with an incidence rate ranging from 20.9% to 33.8% [15,16]. The use of colonoscopy for LST diagnosis is crucial to effectively prevent colorectal cancer. LSTs can be treated with endoscopic resection (such as endoscopic mucosal resection, piecemeal endoscopic mucosal resection, or endoscopic submucosal dissection) or surgery to eliminate the late stage of colorectal cancer [10]. Spreading tumor (LST) is a colorectal pre-cancerous lesion. This study evaluated clinicopathological characteristics of LST in a Chinese population
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