Purpose To investigate the role of adenoma in the carcinogenesis of colorectal carcinoma. Methods 290 cases of patient with colorectal adenoma and adenoma canceration or colorectal carcinoma accompanying with adenoma were derived directly from total colonoscopy. Collectively, 300 adenomas with low -grade intraepithelial neoplasia( LGIN ) , 96 adenomas with high-grade intraepithelial neoplasia( HGIN ), 36 adenoma cancerations, and 9 colorectal carcinoma focis were detected and the distribution of these colorectal lesions in colorectum were evaluated. Results Both adenoma with HGIN and invasive carcinoma foci migrate markedly towards distant location of colon in comparison with adenoma with LGIN ( P ＜ 0. 01 ). Adenoma with HGIN exhibits much higher incidence in the distal colon than in the proximal colon ( P ＜ 0. 03 ). Adenoma with HGIN exhihits much higher incidence in the rectum than adenoma with LGIN ( P ＜ 0. 02 ). The average age of patients suffering from either adenoma with LGIN, or adenoma with HGIN , colorectal adenoma canceration, or colorectal carcinoma accompanying with adenoma were 58. 2, 59. 2 and 63. 7 years old respectively. The median as well as the interquartile range of foci sizes of each of the three groups in the order mentioned above were 0. 8 cm and 0. 4 cm, 1. 5 cm and 1. 45 cm, 4 cm and 2. 0 cm respectively. By spearman rank correlation analysis, there were positive correlation between the groups of adenoma of both low and HGIN with rs = 0. 826 ( P ＜0. 05 ) and between the groups of denoma of HGIN and colorectal adenoma canceration, or colorectal carcinoma accompanying with adenoma with rs = 0. 970 ( P ＜ 0. 01 ). For adenomas measuring larger than 1 cm,the incidence of adenoma with HGIN higher than that with low-grade intraepithelial neoplasia ( P ＜ 0. 001 ). Tubulovillous adenoma exhibits higher incidence of HGIN than tubular adenoma ( P ＜ 0. 001 ), villous adenoma exhibits much higher incidence of canceration than tubulovillous adenoma ( P ＜ 0. 02 ) , suggesting that adenoma with HGIN possesses malignant potential falling in between that of adenoma with LGIN and invasive colorectal carcinoma. Conclusion The different distribution of adenomas with different grades of intraepithelial neoplasia( dysplasia ) in colorectum indicates that adenomas with different grades of intraepithelial neoplasia ( dysplasia ) may possess different malignant potentials towards the development of colorectal carcinoma. And this phenomenon is more likely to resemble the intraepithelial neoplasia( dysplasia )-carcinoma sequence in development.%目的 探讨腺瘤在结直肠癌发生中的作用.方法 收集经全结肠镜检查的290例腺瘤和腺瘤癌变或伴发腺瘤的结直肠癌病例,检测检出的300枚低级别上皮内瘤变(low-grade intraepithelial neoplasia,LGIN)腺瘤、96枚高级别上皮内瘤变(high-grade intraepithelial neoplasia,HGIN)腺瘤、36枚腺瘤癌变和9个结直肠癌灶在结直肠的分布.结果 与LGIN腺瘤相比,HGIN腺瘤和浸润癌灶由近端部位向远端部位迁移(P<0.01);与近端结肠相比,HGIN腺瘤数目在远端结肠增加(P<0.03);与LGIN腺瘤相比,HGIN腺瘤数目在直肠增加(P<0.02).LGIN腺瘤、HGIN腺瘤、腺瘤癌变或伴发腺瘤的结直肠癌患者平均年龄分别为58.2、59.2和63.7岁;病变的中位数大小和四分位数间距分别是0.8、0.4、1.5、1.45、4、2 cm;秩相关分析rs值分别为0.826,P<0.05;0.970,P<0.01.直径＞1.0 cm组中,与LGIN腺瘤相比,HGIN腺瘤的发生率增加(P<0.001);与管状腺瘤相比,HGIN腺瘤的数目在管状绒毛状腺瘤中增加(P<0.001);与管状绒毛状腺瘤相比,腺瘤癌变的数目在绒毛状腺瘤中增加(P<0.02).表明HGIN腺瘤所具有的恶性潜能介于LGIN腺瘤和浸润癌之间.结论 不同上皮内瘤变(异型增生)腺瘤在结直肠呈不同分布,提示:不同上皮内瘤变(异型增生)腺瘤对结直肠癌的发生呈现不同的恶性潜能.这一现象更像是发展中的上皮内瘤变(异型增生)-癌序列.
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