Age-stratified gradients of colorectal neoplasia and an exploratory endoscopic red-flag composite in a lesion-confirmed screening colonoscopy cohort
6 affiliations
- 1Department of Gastroenterology, Beijing Genertec Aerospace Hospital , ,
- 2Department of Health Management, Beijing Genertec Aerospace Hospital , ,
- 3Department of Gastroenterology, Beijing Renhe Hospital , ,
- 4Department of Internal Medicine, Beijing Tongzhou District Maternal and Child Health Care Hospital , ,
- 5Department of General Practice, Beijing Daxing District Jiugong Hospital , ,
- 6Department of Gastroenterology, Xuanwu Hospital, Capital Medical University , ,
Abstract
9Objective: To characterise age-related gradients in colorectal lesion severity and prespecified high-risk endoscopic features in a lesion-confirmed screening colonoscopy cohort and to evaluate an investigator-defined red-flag composite as an exploratory marker of advanced pathology. Helicobacter pylori was assessed as a secondary exposure.
Methods: This retrospective cohort included 291 participants with histologically confirmed lesions in four age groups (36–45, 46–55, 56–65 and 66–72 years). Logistic regression evaluated predictors of advanced neoplasia (high-grade dysplasia [HGD] or adenocarcinoma); adenocarcinoma-only and age × H. pylori interaction analyses were exploratory because events were sparse.
Results: With advancing age, body mass index, H. pylori positivity, adenoma, sessile serrated lesions, HGD, adenocarcinoma and high-risk endoscopic features increased, whereas hyperplastic polyps decreased (all P < 0.05). Age (per 10 years), male sex, H. pylori positivity, lesion size ≥10 mm, proximal location and JNET 2B/3 pattern were independently associated with advanced neoplasia. Red-flag positivity (≥2 of four features) increased from 5.2% to 32.7% and enriched for adenocarcinoma, although positive predictive values were imprecise and non-monotonic.
Conclusions: Colorectal lesion severity and high-risk endoscopic features showed an age-related gradient. The red-flag composite is an exploratory descriptive construct, not a validated predictive score. H. pylori findings, especially interaction analyses, are hypothesis-generating and require prospective validation.
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BibTeX
@article{du2026agestratified,
title = {{Age-stratified gradients of colorectal neoplasia and an exploratory endoscopic red-flag composite in a lesion-confirmed screening colonoscopy cohort}},
author = {Lina Du and Jingzhi Su and Jihua Dai and Peipei Pu and Li Meng and Feiyan Zhao and Lili Pang and Sizhu Li and Yanxia Zhang and Xin Rong and Huihong Zhai and Sufang Shen},
journal = {Frontiers in oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1842525},
url = {https://europepmc.org/article/PMC/PMC13672195},
note = {CC BY},
}
RIS
TY - JOUR
TI - Age-stratified gradients of colorectal neoplasia and an exploratory endoscopic red-flag composite in a lesion-confirmed screening colonoscopy cohort
AU - Lina Du
AU - Jingzhi Su
AU - Jihua Dai
AU - Peipei Pu
AU - Li Meng
AU - Feiyan Zhao
AU - Lili Pang
AU - Sizhu Li
AU - Yanxia Zhang
AU - Xin Rong
AU - Huihong Zhai
AU - Sufang Shen
PY - 2026
DA - 2026/10/02
JO - Frontiers in oncology
DO - 10.3389/fonc.2026.1842525
UR - https://europepmc.org/article/PMC/PMC13672195
AB - 9Objective: To characterise age-related gradients in colorectal lesion severity and prespecified high-risk endoscopic features in a lesion-confirmed screening colonoscopy cohort and to evaluate an investigator-defined red-flag composite as an exploratory marker of advanced pathology. Helicobacter pylori was assessed as a secondary exposure. Methods: This retrospective cohort included 291 participants with histologically confirmed lesions in four age groups (36–45, 46–55, 56–65 and 66–72 years). Logistic regression evaluated predictors of advanced neoplasia (high-grade dysplasia [HGD] or adenocarcinoma); adenocarcinoma-only and age × H. pylori interaction analyses were exploratory because events were sparse. Results: With advancing age, body mass index, H. pylori positivity, adenoma, sessile serrated lesions, HGD, adenocarcinoma and high-risk endoscopic features increased, whereas hyperplastic polyps decreased (all P < 0.05). Age (per 10 years), male sex, H. pylori positivity, lesion size ≥10 mm, proximal location and JNET 2B/3 pattern were independently associated with advanced neoplasia. Red-flag positivity (≥2 of four features) increased from 5.2% to 32.7% and enriched for adenocarcinoma, although positive predictive values were imprecise and non-monotonic. Conclusions: Colorectal lesion severity and high-risk endoscopic features showed an age-related gradient. The red-flag composite is an exploratory descriptive construct, not a validated predictive score. H. pylori findings, especially interaction analyses, are hypothesis-generating and require prospective validation.
SN - 2234-943X
ER -