Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2024; 16(11): 4424-4435
Published online Nov 15, 2024. doi: 10.4251/wjgo.v16.i11.4424
Endoscopic and pathological features of neoplastic transformation of gastric hyperplastic polyps: Retrospective study of 4010 cases
Dong-Xue Zhang, Zhan-Yue Niu, Ye Wang, Ming Zu, Ya-Han Wu, Yan-Yan Shi, He-Jun Zhang, Jing Zhang, Shi-Gang Ding
Dong-Xue Zhang, Zhan-Yue Niu, Ye Wang, Ming Zu, Ya-Han Wu, He-Jun Zhang, Jing Zhang, Shi-Gang Ding, Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
Yan-Yan Shi, Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
Co-corresponding authors: Jing Zhang and Shi-Gang Ding.
Author contributions: Ding SG and Zhang J designed the study; Zhang DX and Wu YH collected data; Shi YY provided guidance and assistance in data analysis; Zhang HJ verified pathological data; Niu ZY, Wang Y, and Zu M assisted in reading and clarifying endoscopy reports; Zhang DX organized and analyzed data, wrote the initial draft of the manuscript; Zhang J assisted in manuscript revision; Ding SG critically reviewed the manuscript and approved its final version; All authors read, approved, and agreed to submit the final manuscript for publication.
Institutional review board statement: This study was approved by the Peking University Third Hospital Medical Science Research Ethics Committee (No. M2023153).
Informed consent statement: Since this is a retrospective study, informed consent was not required from the patients.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The datasets used and/or analyzed during the present study are available from the corresponding author upon reasonable request.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shi-Gang Ding, MD, Chief, Professor, Department of Gastroenterology, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China. dingshigang222@163.com
Received: August 15, 2024
Revised: September 17, 2024
Accepted: September 29, 2024
Published online: November 15, 2024
Processing time: 70 Days and 15.3 Hours
Abstract
BACKGROUND

Hyperplastic polyps, which represent 30%-93% of all gastric epithelial polyps, are the second most common type of gastric polyps after fundic gland polyps. They were previously considered to have no risk of neoplastic transformation. Recently, an increasing number of cases of gastric hyperplastic polyps (GHPs) combined with neoplastic changes have been reported; however, the specific mechanism underlying their transformation has not been thoroughly explored.

AIM

To investigate the clinical, endoscopic, and pathological characteristics of the neoplastic transformation of GHPs and explore the risk factors.

METHODS

A retrospective analysis was performed on 4010 cases of GHPs diagnosed by gastroscopy and pathological examination at the hospital from 2005 to 2021. In total, 3874, 119, and 17 cases were in the group without intraepithelial neoplasia (IN), with low-grade IN, and with high-grade IN, respectively. The data analysis examined the association of endoscopic and pathological features with risk factors for neoplastic transformation. Factors with significant differences were entered into univariate logistic regression, followed by multivariate logistic regression analysis.

RESULTS

Univariate analysis revealed diameter, multiple polyp presence, redness, rough surface, lobulation, erosion, Yamada classification, location, and gastric mucosa were risk factors for neoplastic transformation. Multivariate analysis showed that age > 65 years [odds ratio (OR) = 1.789; 95% confidence interval (CI): 1.227-2.609; P = 0.003], male sex (OR = 1.680; 95%CI: 1.158-2.438; P = 0.006), multiple polyps (OR = 1.851; 95%CI: 1.230-2.784; P = 0.003), pedunculated or semi-pedunculated shape (OR = 2.722; 95%CI: 1.689-4.388; P < 0.001), and polyp diameter were significantly associated with GHPs that demonstrated neoplastic transformation. Compared with chronic superficial gastritis, autoimmune gastritis, atrophic gastritis, and gastritis with IN were independent risk factors for neoplastic transformation [(OR = 2.672; 95%CI: 1.559-4.579; P < 0.001), (OR = 1.876; 95%CI: 1.134-3.103; P = 0.014), and (OR = 5.299; 95%CI: 3.173–8.849; P < 0.001), respectively].

CONCLUSION

Male sex, age > 65 years, multiple polyps, pedunculated or semi-pedunculated shape, polyp size > 1 cm, and specific background gastric mucosa are key indicators for predicting neoplastic transformation of GHPs.

Keywords: Endoscopy; Gastric hyperplastic polyps; Neoplastic transformation; Pathology; Risk factors; Tumour

Core Tip: Our results show that larger diameter, the presence of multiple polyps, pedunculated or semi-pedunculated shape, and specific background gastric mucosa were risk factors for neoplastic transformation. Furthermore, age > 65 years and male sex were important indicators for predicting the risk of malignant transformation of gastric hyperplastic polyps. Our findings suggest that for polyps with the abovementioned endoscopic and pathological features, clinicians should be alert to the possibility of neoplastic transformation to improve the diagnosis rate of the neoplastic transformation of gastric hyperplastic polyps. Additionally, our study showed that Helicobacter pylori infection was not associated with the risk.