{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T09:02:43Z","timestamp":1789635763383,"version":"4.0.0"},"reference-count":28,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Objectives: Colorectal adenomatous polyps are well-recognized precancerous lesions of colorectal cancer. Patients who undergo endoscopic polypectomy still face a high risk of polyp recurrence, and individualized risk stratification remains challenging in routine clinical practice. Dyslipidemia has been implicated in adenoma development, but its role in recurrence and the predictive value of machine learning tools are understudied in Chinese populations. This study aimed to identify independent risk factors for adenoma recurrence and compare the performance of eight machine learning prediction models. Methods: This single-center retrospective cohort study included 769 patients who underwent colonoscopic polypectomy and completed at least one surveillance colonoscopy. A non-random site-based split was used to derive a training cohort (n = 539, Endoscopy Center) and an independent internal test cohort (n = 230, Colorectal Center). Univariate and multivariate Cox proportional hazards regression were applied to identify independent predictors of recurrence. Eight machine learning models were constructed using the selected predictors, and their discriminative performance, calibration, and clinical net benefit were comprehensively evaluated. Results: Abnormal high-density lipoprotein cholesterol (HDL-C), higher baseline polyp count, and larger total polyp volume were independent risk factors for adenoma recurrence. In the training set, the gradient boosting machine (GBM) achieved the highest AUC of 0.874, followed by XGBoost (AUC = 0.866); in the test set, GBM and XGBoost maintained favorable discriminative performance with AUCs of 0.863 and 0.849, respectively. The two models delivered comparable clinical net benefit across clinically relevant probability thresholds. XGBoost demonstrated acceptable calibration (Hosmer-Lemeshow p = 0.065), whereas GBM showed statistically significant miscalibration (p = 0.043). Conclusions: Abnormal HDL-C and greater baseline polyp burden are independent predictors of earlier colorectal adenoma recurrence. Machine learning models, particularly gradient boosting algorithms, achieve favorable discriminative performance and may serve as complementary tools for post-polypectomy risk stratification, though further calibration optimization is warranted prior to clinical application.<\/jats:p>","DOI":"10.3390\/cancers18183012","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T08:03:17Z","timestamp":1789632197000},"page":"3012","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Machine Learning-Based Investigation of Factors Influencing Recurrence of Colorectal Adenomatous Polyps: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"18","author":[{"given":"Shenshen","family":"Wang","sequence":"first","affiliation":[{"name":"The Second Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing 210017, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3644-5333","authenticated-orcid":false,"given":"Xiaochun","family":"Zhang","sequence":"additional","affiliation":[{"name":"The Second Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing 210017, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Shuwen","family":"Zhang","sequence":"additional","affiliation":[{"name":"The First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing 210017, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"}]},{"given":"Qing","family":"Ren","sequence":"additional","affiliation":[{"name":"The Second Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing 210017, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Chao","family":"Jin","sequence":"additional","affiliation":[{"name":"The Second Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing 210017, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Yang","family":"Yang","sequence":"additional","affiliation":[{"name":"The Second Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing 210017, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA A Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4007","DOI":"10.3748\/wjg.v28.i29.4007","article-title":"Recurrence rates after endoscopic resection of large colorectal polyps: A systematic review and meta-analysis","volume":"28","author":"Rotermund","year":"2022","journal-title":"World J. Gastroenterol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1007\/s11606-021-07263-w","article-title":"An estimate of the US rate of overuse of screening colonoscopy: A systematic review","volume":"37","author":"Fraiman","year":"2022","journal-title":"J. Gen. Intern. Med."},{"key":"ref_4","first-page":"10","article-title":"Optimal colonoscopy surveillance interval period for the adenoma patients who had an adequate polypectomy at baseline colonoscopy","volume":"28","author":"Dong","year":"2019","journal-title":"Eur. J. Cancer Prev. Off. J. Eur. Cancer Prev. Organ. (ECP)"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.semcancer.2020.10.003","article-title":"Dietary fat, bile acid metabolism and colorectal cancer","volume":"73","author":"Ocvirk","year":"2021","journal-title":"Semin. Cancer Biol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1780","DOI":"10.1002\/ijc.32563","article-title":"The gut microbiota at the intersection of bile acids and intestinal carcinogenesis: An old story, yet mesmerizing","volume":"146","author":"Liu","year":"2020","journal-title":"Int. J. Cancer"},{"key":"ref_7","first-page":"e57511","article-title":"The relationship between serum lipids and the formation of colorectal polyps","volume":"16","author":"Sari","year":"2024","journal-title":"Cureus"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1097\/MCG.0000000000001678","article-title":"The relationship between colorectal polyps and serum lipid levels: A systematic review and meta-analysis","volume":"56","author":"Zhang","year":"2022","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"256","DOI":"10.21037\/jgo-21-933","article-title":"The predictive value of routine laboratory tests for colorectal polyps: A retrospective study","volume":"13","author":"Feng","year":"2022","journal-title":"J. Gastrointest. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.canlet.2019.11.019","article-title":"Clostridium butyricum, a butyrate-producing probiotic, inhibits intestinal tumor development through modulating wnt signaling and gut microbiota","volume":"469","author":"Chen","year":"2020","journal-title":"Cancer Lett."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1007\/s10620-005-2464-5","article-title":"Prospective study of the association of serum triglyceride and glucose with colorectal cancer","volume":"50","author":"Tsushima","year":"2005","journal-title":"Dig. Dis. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"621","DOI":"10.26599\/1671-5411.2023.09.008","article-title":"2023 china guidelines for lipid management","volume":"20","author":"Li","year":"2023","journal-title":"J. Geriatr. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1007\/s00330-015-3829-6","article-title":"Accuracy and feasibility of estimated tumour volumetry in primary gastric gastrointestinal stromal tumours: Validation using semiautomated technique in 127 patients","volume":"26","author":"Tirumani","year":"2016","journal-title":"Eur. Radiol."},{"key":"ref_14","first-page":"635","article-title":"Plasma lipid levels and colorectal adenoma risk","volume":"26","author":"Coppola","year":"2015","journal-title":"Cancer Causes Control CCC"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Zhang, S., Deng, Z., Yao, C., Huang, P., Zhang, Y., Cao, S., and Li, X. (2017). At7867 inhibits human colorectal cancer cells via AKT-dependent and AKT-independent mechanisms. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0169585"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"117061","DOI":"10.1016\/j.bcp.2025.117061","article-title":"Exploring the anticancer potential of ergosterol and ergosta-5,22,25-triene-3-ol against colorectal cancer: Insights from experimental models and molecular mechanisms","volume":"240","author":"Taank","year":"2025","journal-title":"Biochem. Pharmacol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1038\/nrgastro.2017.119","article-title":"Bile acid-microbiota crosstalk in gastrointestinal inflammation and carcinogenesis","volume":"15","author":"Jia","year":"2018","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.jhep.2024.09.032","article-title":"Bile acid metabolism and signalling in liver disease","volume":"82","author":"Fuchs","year":"2025","journal-title":"J. Hepatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/s00394-008-0725-8","article-title":"Genotoxic effect of bile acids on human normal and tumour colon cells and protection by dietary antioxidants and butyrate","volume":"47","author":"Rosignoli","year":"2008","journal-title":"Eur. J. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1097\/01.cej.0000195708.72072.42","article-title":"Chronic but not acute conjugated linoleic acid treatment inhibits deoxycholic acid-induced protein kinase c and nuclear factor-kappab activation in human colorectal cancer cells","volume":"15","author":"Shah","year":"2006","journal-title":"Eur. J. Cancer Prev."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Sphyris, N., Hodder, M.C., and Sansom, O.J. (2021). Subversion of niche-signalling pathways in colorectal cancer: What makes and breaks the intestinal stem cell. Cancers, 13.","DOI":"10.3390\/cancers13051000"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1053\/j.gastro.2021.08.041","article-title":"High-fat diet promotes colorectal tumorigenesis through modulating gut microbiota and metabolites","volume":"162","author":"Yang","year":"2022","journal-title":"Gastroenterology"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Yoon, H., Shin, C.M., Park, Y.S., Kim, N., and Lee, D.H. (2022). Total polyp number may be more important than size and histology of polyps for prediction of metachronous high-risk colorectal neoplasms. BMC Gastroenterol., 22.","DOI":"10.1186\/s12876-022-02177-1"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.annepidem.2025.08.026","article-title":"Development of a web-based tool using machine learning algorithms to improve adherence to diagnostic colonoscopy among middle-aged and elderly adults in colorectal cancer screening program","volume":"109","author":"Yi","year":"2025","journal-title":"Ann. Epidemiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"102387","DOI":"10.3748\/wjg.v31.i11.102387","article-title":"Construction and validation of machine learning-based predictive model for colorectal polyp recurrence one year after endoscopic mucosal resection","volume":"31","author":"Shi","year":"2025","journal-title":"World J. Gastroenterol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1055\/a-1185-3109","article-title":"Post-polypectomy colonoscopy surveillance: European society of gastrointestinal endoscopy (esge) guideline-update 2020","volume":"52","author":"Hassan","year":"2020","journal-title":"Endoscopy"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"415","DOI":"10.14309\/ajg.0000000000000544","article-title":"Recommendations for follow-up after colonoscopy and polypectomy: A consensus update by the us multi-society task force on colorectal cancer","volume":"115","author":"Gupta","year":"2020","journal-title":"Am. J. Gastroenterol."},{"key":"ref_28","first-page":"1148","article-title":"Factors associated with recurrence of advanced colorectal adenoma after endoscopic resection","volume":"14","author":"Facciorusso","year":"2016","journal-title":"Clin. Gastroenterol. Hepatol. Off. Clin. Pract. J. Am. Gastroenterol. 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