{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:55:52Z","timestamp":1790916952499,"version":"4.1.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>9Objective<\/jats:title>\n                    <jats:p>\n                      To characterise age-related gradients in colorectal lesion severity and prespecified high-risk endoscopic features in a lesion-confirmed screening colonoscopy cohort and to evaluate an investigator-defined red-flag composite as an exploratory marker of advanced pathology.\n                      <jats:italic>Helicobacter pylori<\/jats:italic>\n                      was assessed as a secondary exposure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort included 291 participants with histologically confirmed lesions in four age groups (36\u201345, 46\u201355, 56\u201365 and 66\u201372 years). Logistic regression evaluated predictors of advanced neoplasia (high-grade dysplasia [HGD] or adenocarcinoma); adenocarcinoma-only and age \u00d7\n                      <jats:italic>H. pylori<\/jats:italic>\n                      interaction analyses were exploratory because events were sparse.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      With advancing age, body mass index,\n                      <jats:italic>H. pylori<\/jats:italic>\n                      positivity, adenoma, sessile serrated lesions, HGD, adenocarcinoma and high-risk endoscopic features increased, whereas hyperplastic polyps decreased (all P &amp;lt; 0.05). Age (per 10 years), male sex,\n                      <jats:italic>H. pylori<\/jats:italic>\n                      positivity, lesion size \u226510 mm, proximal location and JNET 2B\/3 pattern were independently associated with advanced neoplasia. Red-flag positivity (\u22652 of four features) increased from 5.2% to 32.7% and enriched for adenocarcinoma, although positive predictive values were imprecise and non-monotonic.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Colorectal lesion severity and high-risk endoscopic features showed an age-related gradient. The red-flag composite is an exploratory descriptive construct, not a validated predictive score.\n                      <jats:italic>H. pylori<\/jats:italic>\n                      findings, especially interaction analyses, are hypothesis-generating and require prospective validation.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1842525","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:41:59Z","timestamp":1790916119000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Age-stratified gradients of colorectal neoplasia and an exploratory endoscopic red-flag composite in a lesion-confirmed screening colonoscopy cohort"],"prefix":"10.3389","volume":"16","author":[{"given":"Lina","family":"Du","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Beijing Genertec Aerospace Hospital","place":["Beijing, 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