Polyp Tissue LRG1 Protein Levels and Helicobacter pylori Infection as Independent Predictors for Colonic Polyp Recurrence.

OBJECTIVE: This prospective study was designed to investigate the independent predictive values of Helicobacter pylori (H. pylori) infection and tissue supernatant leucine-rich α-2-glycoprotein 1 (LRG1) levels for recurrence following endoscopic mucosal resection (EMR) of colonic polyps, and to construct a nomogram risk prediction model. METHODS: A prospective cohort study was conducted. A total of 256 patients with colonic polyps who underwent EMR between March 2020 and March 2023 were enrolled. Resected tissue specimens were collected intraoperatively and centrifuged to obtain supernatants. LRG1 levels in the supernatants were subsequently measured. H. pylori infection status was determined using the 13C-urea breath test. Patients were followed up every 3 months for 1 year postoperatively, and recurrence (including local recurrence and metachronous adenomas) was evaluated by colonoscopy. Based on follow-up results, patients were divided into recurrence and non-recurrence groups. Multivariable Cox proportional hazards regression analysis was performed to identify factors associated with recurrence. A nomogram prediction model was constructed and internally validated using bootstrap resampling. RESULTS: The recurrence and non-recurrence groups comprised 73 and 183 patients, respectively. Significant differences were observed between the two groups with respect to family history of colonic polyps, family history of colorectal cancer, polyp number, polyp diameter, histopathological type of polyps, tissue supernatant LRG1 levels, and H. pylori infection status (all p < 0.05). Multivariable Cox regression analysis demonstrated that elevated tissue supernatant LRG1 levels, H. pylori infection, family history of colorectal cancer, greater number of polyps, larger polyp diameter, and neoplastic polyp pathology were independent risk factors for postoperative recurrence. The nomogram model based on these factors was validated using bootstrap validation (B = 1000), yielding a C-index of 0.85. The calibration curve demonstrated good agreement between predicted and observed probabilities. CONCLUSION: This study investigated the independent predictive values of H. pylori infection and LRG1 levels. Elevated LRG1 levels and H. pylori infection are independent risk factors for recurrence after EMR of colonic polyps. The time-to-event nomogram model based on these risk factors demonstrated good discrimination and calibration, and could be used to predict the 1-year recurrence-free probability, providing a reference for clinical postoperative risk stratification and individualized follow-up strategies.