大腸直腸癌不論是在全世界或是在台灣，都是發生率和死亡率名列前茅的癌症，在台灣發生率更是年年上升，已高居癌症發生率第一位及死亡率第三位。大腸直腸癌的癌症形成過程大都是經由「腺瘤-癌序列」，因此早期發現腺瘤及研究相關的危險因子就是預防大腸直腸癌的重要課題。台灣現行的大腸直腸癌篩檢採用免疫生化法糞便潛血檢測，對偵測大腸腺瘤的敏感性僅不到三成。此外，肥胖和代謝症候群在亞洲地區也有逐年增加的趨勢，這也是大腸腺瘤發生的危險因子。而第二型環氧合酶(COX-2)已知在大腸直腸癌的形成過程早期就扮演重要角色，肥胖和代謝症候群也曾發現會增加COX-2所調節的發炎反應，且第二型環氧合酶抑制劑又可預防大腸癌及大腸腺瘤的發生，因此其與大腸腺瘤發生的危險因子，尤其是肥胖和代謝症候群的相關性，便值得做進一步的探討。本研究先回顧在健康檢查中心接受大腸鏡的受檢者，其單次免疫生化法糞便潛血檢測的表現，再分析造成糞便潛血陽性的相關因素，以及糞便潛血陰性但大腸鏡檢查卻發現腺瘤的相關風險因子。接下來收集健康檢查中心的篩檢性大腸鏡案例，以分析腺瘤發生的相關風險因子，並著重在代謝症候群及肥胖相關指標的分析，最後再分析腺瘤COX-2的表現是否與這些風險因子具有相關性。
本研究發現健康檢查中心在大腸鏡檢前，免疫生化法糞便潛血檢測對大腸腺瘤的敏感性只有17%，而對進階型腺瘤和高風險腺瘤的偵測敏感性則稍高，分別達到22.2%及30%。而在糞便潛血檢測結果為陰性者，有腺瘤者年齡較大、腰臀圍比較高且有較高比例患有糖尿病或高血壓。進一步分析接受在健康檢查中心接受篩檢性大腸鏡者，發現代謝症候群為已知亞太大腸直腸腫瘤篩檢評分系統(APCS)之外的腺瘤發生的獨立危險因子，且其中以高三酸甘油酯為最顯著的因素。而肥胖相關指標中，以雙能量X光吸收儀(DXA)所測得的軀幹/全身脂肪比(TTFR)為最顯著的指標，且TTFR高的人即使身體質量指數(BMI)、腰圍或腰臀圍比在正常範圍，仍有較高的風險發生大腸腺瘤。最後分析大腸腺瘤COX-2表現，並未發現與已知風險因子具有相關性，而僅與較大的腺瘤或進階型腺瘤有正相關。
總結，代謝症候群是篩檢性大腸鏡發現腺瘤的獨立危險因子，且TTFR比起一般的肥胖指標更能預測大腸腺瘤的發生，如何將這些因素應用在健康檢查受檢者或是一般民眾的大腸直腸腫瘤篩檢，有待進一步的大規模研究驗證。

Colorectal cancer is a leading cause of cancer occurrence and cancer associated mortality in Taiwan and in the world. The well-known adenoma-carcinoma sequence contributes to most colorectal cancinogenesis, and therefore early detection of colorectal adenoma (CRA) is important. The main screening method for colorectal neoplasm in Taiwan is fecal immunochemical test (FIT), however, the sensitivity for CRA is low. Therefore, the identification for risk factors for CRA occurrence is important. Among the important risk factors for CRA, obesity and metabolic syndrome are also growing problem in Asia. Besides, Cyclooxygenase-2 (COX-2), activated early in the colorectal carcinogenesis, can be inhibited by its inhibitor to prevent CRA. Since COX-2 mediated inflammation is observed in obesity and metabolic syndrome, the association of COX-2 expression on CRAs with known risk factors, especially obesity and metabolic syndrome, warrants more attention. In this study, we find the performance of FIT for CRA is still unsatisfied, and in addition to old age, increased waist-hip ratio (WHR), presence of hypertension or diabetes mellitus are risk factors for CRA occurrence even in FIT-negative population. We further investigate the risk factors with components of the well-validated Asia-Pacific Colorectal Screening (APCS) score, and find that metabolic syndrome is an independent risk factor for CRA, and hypertriglyceridemia is most important among the components of metabolic syndrome. We also find DXA determined trunk to total fat ratio (TTFR) is a better predictor for CRA　among parameters of obesity, and high TTFR is still a risk factor for CRA occurrence in population with normal body-mass index (BMI), normal waist circumference or normal WHR. The way to integrate these factors into screening of colorectal neoplasm warrants further large-scale study.

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