Pathological Characteristics, Prognostic Determinants and the Outcome of Patients Diagnosed with Colorectal Adenocarcinoma at the University Teaching Hospital of Kigali

Abstract

Worldwide, colorectal cancer (CRC) is the second most diagnosed cancer in female and the third in men, arising from the epithelium of the colorectum. It is known that colorectal cancer is common in developed countries than in developing countries which may be due to inaccurate data on the existence of the disease in that region combined with embracing western lifestyle expressed by the current trend of changes in cultural, social, and lifestyle practices playing a major part in the etiology of CRC. The aim of this study was to document epidemiological, pathological characteristics, and prognostics determinants of patients diagnosed with CRC in Rwanda. The data from patients’ files and reviewed glass slides for 101 cases all from Kigali University Teaching Hospital (CHUK) were statistically analyzed and patient characteristics were described as mean and frequency accordingly. Comparisons were performed using chi square tests, Fisher’s exact test and odds ratio with 95% confidence interval (CI). Survival curves were plotted using the Kaplan–Meier method, and log-rank test was used to assess the statistical differences in the observed survival curves by each categorical variable. A P value < 0.05 was considered statistically significant. Statistical analyses were performed using Statistical Product and Service Solutions (SPSS), GraphPad Prism, and MedCalc, accordingly. Mean age of the participants was 54.26 years, the main symptom was rectal bleeding (46.5%), rectal adenocarcinoma NOS represented 40.6%, conventional adenocarcinoma was 60.4%, most tumors were of Grade II (54.5%), most common stage was pT3N0 (20.8%), resection margins were free at 71.3%, lympho-vascular invasion was 49.5% of cases, a high immune response was in 71.3% of cases and of 101cases, and 55.4% were still alive at the end of the data collection, with 29.3% of patients have overall survival of 5 years. Prognostic determinants also affect the outcome in this study and overall survival period was 3 years for CRC diagnosed in Rwanda.

Clinicopathological Characteristics and Mutational Landscape of APC, HOXB13, and KRAS among Rwandan Patients with Colorectal Cancer

“…In contrast to global data where CRC is reported to be more common in males than in females [9], in this study, we found that CRC was more common in females than in males (i.e., 63.0% versus 37.0%). Our findings also report a higher rate of female incidence than the 52.5% reported by Uwamariya et al [18] and the 52.2% reported by Fadelu et al [19].…”

“…They, therefore, immediately undergo resection to relieve the obstruction without undergoing colonoscopy. This speculation may be supported by the fact that Uwamariya et al [18] found that rectal cancer accounted for 40% of all CRC cases in a study conducted at the same institution as ours that used both biopsy and resection specimens.…”

“…CRC is underinvestigated in the Rwandan population. To our knowledge, only two papers [18,53] and one abstract [19] reporting on CRC in Rwanda have been published in international peer-reviewed journals within the last 10 years. In contrast to global data where CRC is reported to be more common in males than in females [9], in this study, we found that CRC was more common in females than in males (i.e., 63.0% versus 37.0%).…”

“…Despite the paucity of CRC research, the few published data show that, in contrast to other parts of the world where CRC is more frequent in males and/or in older patients [8,16,17], in Rwanda, females are more affected than males [18,19] and many Rwandan CRC patients are young [18,19]. Moreover, most patients are diagnosed with advanced disease, a high number of patients are lost to follow-up, and the overall survival of patients with CRC is poor [18,19]. These effects may be due to the low density of healthcare personnel, limited infrastructure and specialized care, lack of awareness of CRC among the Rwandan population, and the unavailability of screening programs [20].…”

Colorectal cancer disease profile and treatment patterns at an urban tertiary hospital in Rwanda

“…Among 74 patients, we found that the mean age at diagnosis was 54.6 years with a wide age range between 22 and 81. This finding is similar to previous findings at the BCCOE and Kigali University Teaching Hospital (KUTH) with reported mean age at presentation of 52.5 and 54.3 years, respectively [ 24 , 25 ]. The mean age of males at diagnosis was 56.6 years and the mean age of females at diagnosis was 51.4 years.…”