Comparison of risk factors and pathogenesis of serrated adenoma and conventional adenoma

Objective To compare the risk factors for serrated adenoma (SA) and conventional adenoma (CA), and to investigate the roles of cyclooxygenase-2 (COX-2) and phosphorylated signal transducer and activator of transcription 3 (p-STAT3) in their pathogenesis. Methods A retrospective study was conducted involving 105 participants, including 35 controls, 35 CA patients, and 35 SA patients. Demographic, clinical, endoscopic, and laboratory data were collected. Immunohistochemistry was used to detect COX-2 and p-STAT3 expression. Statistical analyses included ANOVA, chi-square test, Mann-Whitney U test, Spearman correlation, and multivariate logistic regression . Results No significant differences were found in gender, age, smoking history, hypertension, diabetes, hyperuricemia, or biliary disease among the three groups (P > 0.05). Significant differences were observed in body mass index, serum calcium, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and systemic immune-inflammation index (SII) (P < 0.05). The COX-2 positivity rate was significantly higher in the SA group (68.6%) than in the CA (28.6%) and control groups (2.9%) (P < 0.001). Both adenoma groups showed higher p-STAT3 positivity than controls (P = 0.005). Multivariate logistic regression confirmed COX-2 [Odds ratio (OR) = 80.232 for SA] and p-STAT3 (OR = 18.415 for SA) as independent risk factors for both adenoma types, with a more pronounced effect of COX-2 in SA. Conclusion Both COX-2 and p-STAT3 are involved in the development of colorectal adenomas. p-STAT3 activation is an early common event in adenoma formation, while COX-2 overexpression is a distinctive feature of the serrated pathway and a strong independent risk factor. These findings support the development of pathway-specific strategies for colorectal cancer risk assessment and chemoprevention.