Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2023; 29(18): 2836-2849
Published online May 14, 2023. doi: 10.3748/wjg.v29.i18.2836
Endoscopic and pathological characteristics of de novo colorectal cancer: Retrospective cohort study
Shi-Yang Li, Mei-Qi Yang, Yi-Ming Liu, Ming-Jun Sun, Hui-Jing Zhang
Shi-Yang Li, Mei-Qi Yang, Yi-Ming Liu, Ming-Jun Sun, Hui-Jing Zhang, Department of Endoscopy, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Author contributions: Zhang HJ had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis; Zhang HJ, Li SY, and Yang MQ were responsible for protocol/project development; Li SY, Yang MQ, and Zhang HJ performed data analysis; Li SY, Yang MQ, Liu YM, and Sun MJ performed data collection or management; Yang MQ and Zhang HJ were responsible for manuscript writing/editing; Li SY and Yang MQ, these two authors, contributed equally to this work.
Supported by Natural Science Foundation of Liaoning Province, China, No. 2022-YGJC-71.
Institutional review board statement: The study was reviewed and approved by the Research Ethics Committee of the First Affiliated Hospital of China Medical University Institutional Review Board, No. [2021]2021-68-2.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Participants gave informed consent for data sharing.
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.
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:
Corresponding author: Hui-Jing Zhang, MD, Professor, Department of Endoscopy, The First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang 110001, Liaoning Province, China.
Received: March 28, 2023
Peer-review started: March 28, 2023
First decision: April 10, 2023
Revised: April 14, 2023
Accepted: April 19, 2023
Article in press: April 19, 2023
Published online: May 14, 2023

Endoscopy has rapidly developed in recent years and has enabled further investigation into the origin and features of intestinal tumors. The small size and concealed position of these tumors make it difficult to distinguish them from nonneoplastic polyps and carcinoma in adenoma (CIA). The invasive depth and metastatic potential determine the operation regimen, which in turn affects the overall survival and distant prognosis. The previous studies have confirmed the malignant features and clinicopathological features of de novo colorectal cancer (CRC).


To provide assistance for diagnosis and treatment, but the lack of a summary of endoscopic features and assessment of risk factors that differ from the CIA prompted us to conduct this retrospective study.


In total, 167 patients with small-sized CRCs diagnosed by endoscopy were reviewed. The patients diagnosed as advanced CRCs and other malignant cancers or chronic diseases that could affect distant outcomes were excluded. After screening, 63 cases were excluded, including 33 de novo and 30 CIA cases. Patient information, including their follow-up information, was obtained from an electronic His-system. The characteristics between two group and risk factors for invasion depth were analyzed with SPSS 25.0 software.


Nearly half of the de novo CRCs were smaller than 1 cm (n = 16, 48.5%) and the majority were located in the distal colon (n = 26, 78.8%). The IIc type was the most common macroscopic type of de novo CRC. In a Pearson analysis, the differential degree, Sano, JNET, and Kudo types, surrounding mucosa, and chicken skin mucosa (CSM) were correlated with the invasion depth (P < 0.001). CSM was a significant risk factor for deep invasion and disturbed judgment of endoscopic ultrasound. A high degree of tumor budding and tumor-infiltrating lymphocytes are accompanied by malignancy. Finally, de novo CRCs have worse outcomes than CIA CRCs.


This is the first comprehensive study to analyze the features of de novo CRCs to distinguish them from nonneoplastic polyps. It is also the first study paying attention to CSM invasive depth measurement. This study emphasizes the high metastatic potential of de novo CRCs and highlights the need for more research on this tumor type.

Keywords: De novo colorectal cancer, Carcinoma in adenoma, Endoscopic features, Clinical characteristics, Pathological features

Core Tip:De novo colorectal cancer (CRC) is a specific tumor with a small lesion. Many different features of de novo CRCs exist to distinguish them from non-neoplastic polyps. Moreover, the study highlights that de novo CRCs have special endoscopic and pathological features that distinguish them from traditional adenocarcinomas. Different pit pattern types indicate various tumor types; for example, the III-type pit pattern often occurs in tubular adenomas. For CRCs, invasion depth evaluation is a vital issue. Computed tomography imaging and endoscopic ultrasound are used for judging invasive depth. Besides, chicken skin mucosa may also be a risk factor.