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World J Gastrointest Oncol. Feb 15, 2026; 18(2): 116336
Published online Feb 15, 2026. doi: 10.4251/wjgo.v18.i2.116336
Detection rate and risk factors of colorectal adenoma in high-altitude population: A cross-sectional study
Xiao-Lei Zhao, Wang-Yang Chen, Yi-Meng Liu, Suo-Lang Danzeng, Qu-Zhen Pingcuo, Zhen Yu, Hong-Da Chen, Yang-Jin Ciren, Dong Wu
Xiao-Lei Zhao, Wang-Yang Chen, Suo-Lang Danzeng, Qu-Zhen Pingcuo, Zhen Yu, Yang-Jin Ciren, Dong Wu, Department of Gastroenterology, The People's Hospital of Xizang Autonomous Region, Lhasa 850000, Xizang Autonomous Region, China
Xiao-Lei Zhao, Department of Gastroenterology, Peking University People's Hospital, Beijing 100044, China
Wang-Yang Chen, Dong Wu, Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
Yi-Meng Liu, Hangzhou International Innovation Institute, Hangzhou International Innovation Institute of Beihang University, Hangzhou 310000, Zhejiang Province, China
Hong-Da Chen, Center for Prevention and Early Intervention, National Infrastructures for Translational Medicine, Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
Co-first authors: Xiao-Lei Zhao and Wang-Yang Chen.
Co-corresponding authors: Yang-Jin Ciren and Dong Wu.
Author contributions: Zhao XL and Chen WY contribute equally to this study as co-first authors; Ciren YJ and Wu D contribute equally to this study as co-corresponding authors; Zhao XL was responsible for conceptualization, investigation, resources, supervision, project administration, funding acquisition, writing - review & editing; Chen WY was responsible for conceptualization, formal analysis, investigation, data curation, visualization, writing - original draft, writing - review & editing; Liu YM was responsible for software, formal analysis, visualization, writing - review & editing; Danzeng SL was responsible for investigation, writing - review & editing; Pingcuo QZ was responsible for investigation, writing - review & editing; Yu Z was responsible for investigation, writing - review & editing; Chen HD was responsible for conceptualization, methodology, supervision, writing - review & editing; Ciren YJ was responsible for investigation, resources, supervision, project administration, writing - review & editing; Wu D was responsible for conceptualization, resources, supervision, project administration, funding acquisition, writing - review & editing; all authors read, approved, and agreed to submit the final manuscript for publication.
Supported by the Scientific Research Development Funds of Peking University People’s Hospital, No. RDJP2022-15; the Xizang Autonomous Region Natural Science Foundation Group Medical Aid Project, No. XZ2024ZR-ZY012(Z); Clinical Research Excellence Program for Research-Oriented Wards, No. BRWEP2024W034010103; Science and Technology Projects of Xizang Autonomous Region, China, No. XZ202501JD0021 and No. XZ202501ZY0072; National Key Research and Development Program of China, No. 2024YFA0918504; and Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, No. 2022-I2M-1-003.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki. The study protocol was approved by the Ethics Committee of the People's Hospital of Xizang Autonomous Region (Approval No. ME-TBHP-24-KJ-050).
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong Wu, MD, PhD, Chief Physician, Professor, Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China. wudong@pumch.cn
Received: November 11, 2025
Revised: November 25, 2025
Accepted: December 11, 2025
Published online: February 15, 2026
Processing time: 86 Days and 19.5 Hours
Abstract
BACKGROUND

The epidemiology of colorectal cancer (CRC) varies significantly, with an increasing incidence in China. The Xizang Autonomous Region has the lowest CRC mortality nationally, offering a unique natural experiment to investigate carcinogenesis. As most CRCs develop via the adenoma-carcinoma sequence, characterizing the prevalence of its precursor lesion, colorectal adenoma (CRA), is essential for understanding this disparity.

AIM

To characterize the detection rates and risk factors for colorectal lesions in the high-altitude population of Xizang Autonomous Region.

METHODS

In this cross-sectional study, 1154 Tibetans undergoing high-definition colonoscopy were enrolled. Univariate and multivariate logistic regression were conducted to analyze the risk factors for CRA. Data were collected via questionnaire, and the China Sporadic Colorectal Cancer Risk Score and Asia-Pacific Colorectal Screening (APCS) score were calculated. A control group from low altitude was established using a 1:2 case-control matching protocol based on age, sex, body mass index (BMI), and first-degree family history of CRC, and detection rates were compared.

RESULTS

The detection rates in the Xizang Autonomous Region cohort were 7.7% for CRA (n = 89) and 1.6% for CRC (n = 18). Univariate analysis showed that CRA was associated with advanced age, male sex, higher BMI, and higher risk tiers on both the China and APCS scores. However, multivariate logistic regression confirmed only advanced age (OR = 1.035, 95%CI: 1.019-1.052, P < 0.001) and male sex (OR = 2.161, 95%CI: 1.337-3.492, P = 0.002) as independent risk factors. In the comparative analysis, the Xizang CRA detection rate was significantly lower than that in the matched Beijing cohort (7.7% vs 22.8%, P < 0.001). No significant difference was found in CRC detection rates (1.6% vs 1.3%, P = 0.626).

CONCLUSION

The prevalence of CRA in the high-altitude population was significantly lower. Advanced age and male sex remain independent risk factors for CRA in Xizang Autonomous Region.

Keywords: High altitude; Xizang Autonomous Region; Colorectal adenoma; Colorectal cancer; Detection rate

Core Tip: In this cross-sectional study of 1154 Tibetans, the colorectal adenoma (CRA) detection rate in the high-altitude Xizang Autonomous Region population was 7.7%. This was significantly lower than the 22.8% rate found in a rigorously matched low-altitude Beijing cohort. Advanced age and male sex were identified as the only independent risk factors for CRA in the Xizang Autonomous Region group.