Risk factors for pathological upgrading pre- and post-endoscopic resection of colorectal adenoma: A retrospective study

doi:10.5528/wjtm.123433

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World Journal of Translational Medicine

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2220-6132

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Transl Med. Jul 28, 2026; 12(2): 123433
Published online Jul 28, 2026. doi: 10.5528/wjtm.123433

Risk factors for pathological upgrading pre- and post-endoscopic resection of colorectal adenoma: A retrospective study

Xu-Lin Zheng, Tao Chen, Yang Yu, Neng Wang, Biao Jiang, Yao Yao, Yun-Fei Zhao, Xin-Xin Yu, Chun-Lin Su

Xu-Lin Zheng, Tao Chen, Yang Yu, Neng Wang, Biao Jiang, Yao Yao, Chun-Lin Su, Department of Gastroenterology, Gastrointestinal Endoscopy Center, Suining Central Hospital, Suining 629000, Sichuan Province, China

Yun-Fei Zhao, Department of Pathology, Suining Central Hospital, Suining 629000, Sichuan Province, China

Xin-Xin Yu, Department of Respiratory and Critical Care Medicine, Suining Central Hospital, Suining 629000, Sichuan Province, China

Co-first authors: Xu-Lin Zheng and Tao Chen.

Co-corresponding authors: Xin-Xin Yu and Chun-Lin Su.

Author contributions: Zheng XL, Chen T, Yu XX and Su CL conceptualized and designed the research; Zheng XL applied for and obtained the funds for this research project; Zheng XL, Chen T, Su CL, and Zhao YF managed the clinical process; Zheng XL, Chen T, Yu Y, Wang N, Jiang B, Yao Y, and Yu XX collected clinical data; Zheng XL and Yu XX performed data analysis. Zheng XL wrote the first draft of the manuscript; Chen T, Yu XX, and Su CL revised the manuscript; and all the authors have read and approved the final manuscript. Zheng XL and Chen T were instrumental and responsible for data re-analysis and re-interpretation, figure plotting, comprehensive literature search, preparation and submission of the current version of the manuscript. Zheng XL and Chen T have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper. Yu XX and Su CL have played important and indispensable roles in the research design, data interpretation and manuscript preparation as the co-corresponding authors.

AI contribution statement: No artificial intelligence tools were employed in the preparation of this manuscript.

Supported by the Joint Growth Program for Early Gastrointestinal Cancer Physicians of China, Beijing Huaxia Cancer Prevention and Research Institute, No. GTCZ-2024-09.

Institutional review board statement: This study was approved by the Ethics Committee of Suining Central Hospital (approval No. KYLLKS20250132) and registered in the Medical Research Registration Information System (https://www.medicalresearch.org.cn/Registration No. MR-51-25-054893). All data were anonymized to protect patient privacy.

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.

Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available because of privacy or ethical restrictions.

Corresponding author: Chun-Lin Su, MD, Department of Gastroenterology, Gastrointestinal Endoscopy Center, Suining Central Hospital, No. 127 Desheng West Road, Chuanshan District, Suining 629000, Sichuan Province, China. 13408251310@163.com

Received: May 19, 2026
Revised: June 27, 2026
Accepted: July 2, 2026
Published online: July 28, 2026
Processing time: 71 Days and 17.5 Hours

Abstract

BACKGROUND

Colorectal adenoma (CRA) is a precancerous lesion of colorectal cancer. Pathological upgrading often occurs when comparing preoperative endoscopic biopsy results with postoperative pathological findings in certain adenomas.

AIM

To investigate the risk factors associated with pathological upgrading after endoscopic resection of CRAs.

METHODS

This retrospective study collected 200 cases of CRAs between January 2023 and December 2025. All adenomas underwent complete endoscopic resection and were divided into pathological upgrading and non-upgrading groups according to postoperative pathological findings. Baseline clinical data and endoscopic features of the adenomas were compared between the two groups to identify factors correlated with pathological upgrading.

RESULTS

Pathological upgrading was observed in 49 of the 200 included CRAs. No statistically significant differences were found between the two groups in age, gender, body mass index, smoking history, drinking history, diabetes history, personal tumor history, fasting blood glucose level, total cholesterol level, triglyceride level, platelet count, carcinoembryonic antigen level, and adenoma location. Significant intergroup differences were observed in hemoglobin level, adenoma diameter, Yamada classification, and mucosal hyperemia. Multivariate logistic regression analysis demonstrated that pathological upgrading incidence was significantly higher in adenomas with a diameter > 20 mm than in those ≤ 20 mm (odds ratio = 23.237, 95%CI: 5.868-92.018, P < 0.001). Adenoma diameter was an independent influencing factor for pathological upgrading of CRAs.

CONCLUSION

CRAs with a diameter > 20 mm are more susceptible to pathological upgrading and carry an elevated risk of undetected high-grade dysplasia or early carcinoma missed by preoperative biopsy.

Keywords: Colorectal adenoma; Colorectal cancer; Pathological upgrading; Endoscopic resection; Risk factor; Retrospective study

Core Tip: Colorectal adenomas (CRAs) are the predominant precancerous lesions of colorectal cancer. Assessing their pathological upgrading risk is critical for early diagnosis and intervention. In this retrospective study, pathological upgrading incidence was significantly higher in adenomas with a diameter > 20 mm than in those ≤ 20 mm. Adenoma diameter was an independent influencing factor for the pathological upgrading of CRAs. CRAs with a diameter > 20 mm are more susceptible to pathological upgrading and carry an elevated risk of undetected high-grade dysplasia or early carcinoma missed by preoperative biopsy. Early and complete endoscopic resection is recommended to prevent progression to colorectal cancer. These findings will enhance clinicians’ diagnostic capabilities and assist in formulating appropriate treatment strategies for CRAs.