# Clinical Pathological Features and Carcinogenic Risk Factors of Colorectal Lateral Spreading Tumors With Skirt Features

## TL;DR

This study examines the features and cancer risk factors of colorectal tumors with a specific 'skirt' appearance, finding they are more common in older women and larger rectal lesions.

## Contribution

The study identifies rectal location, lesion size, and age as key predictors of skirt features and cancer risk in colorectal lateral spreading tumors.

## Key findings

- LSTs with skirt features were more common in the rectum and had larger sizes (≥ 20 mm).
- Rectal lesions and lesion diameters ≥ 20 mm were independent predictors of skirt presence.
- Age ≥ 60 years was an independent risk factor for carcinogenesis in LSTs with a skirt.

## Abstract

Objective: This study aims to investigate the clinical pathological features of colorectal lateral spreading tumors (LSTs) with skirt features and the associated carcinogenic risk factors.

Methods: A total of 390 cases of colorectal LSTs, treated via endoscopy at the Digestive Endoscopy Center of the 900th Hospital of the People's Liberation Army Joint Logistics Support Force between January 2021 and August 2023, were included. The cases were categorized into a skirt group (30 cases) and a group without a skirt (360 cases) based on the presence of skirt features. The clinical pathological characteristics, including age, gender, endoscopic features (lesion diameter, location, morphology), and histological types, were compared between the two groups. Additionally, the risk factors for carcinogenesis in LSTs with a skirt were analyzed.

Results: Among the 390 LSTs cases, 30 (7.69%) exhibited skirt features, with 23 lesions located in the rectum (76.67%) and 26 lesions having a diameter of ≥ 20 mm (86.67%). Histological classification revealed 10 cases (33.33%) of adenomas with low-grade intraepithelial neoplasia (LGIN), 9 cases (30.00%) of adenomas with high-GIN (HGIN), and 11 cases (36.67%) of carcinoma. The proportions of female patients, rectal lesions, lesions with a diameter of ≥ 20 mm, mixed nodular lesions, and those classified as carcinoma were significantly higher in LSTs with a skirt group compared to LSTs without a skirt group. Rectal lesions (p=0.001, OR = 8.588, 95% CI: 2.428–30.379) and lesion diameters ≥ 20 mm (p=0.008, OR = 4.538, 95% CI: 1.477–13.940) were identified as independent predictors of skirt presence in colorectal LSTs. Age ≥ 60 years (p=0.002, OR = 22.667, 95% CI: 3.140–163.629) was found to be an independent risk factor for carcinogenesis in LSTs with a skirt.

Conclusion: Compared with LSTs without a skirt, the results indicated that LSTs with a skirt are more commonly found in female patients, predominantly has a diameter of ≥ 20 mm, typically presents as a mixed nodular type, is frequently located in the rectum, and is often classified as carcinoma. The presence of rectal lesions and lesion diameter ≥ 20 mm increases the likelihood of skirt features in LSTs. Furthermore, advanced age (≥ 60 years) may elevate the risk of carcinogenesis in LSTs with a skirt, necessitating thorough preoperative assessments and complete resection during endoscopic removal of such lesions.