Trends in early onset colorectal cancer (EOCRC) in a South Asian cohort: data from a specialized tertiary care center in western Sri Lanka

Abstract

IntroductionEarly onset colorectal cancer [EOCRC] has significantly increased during the past decade globally. It is defined as cancers diagnosed in those aged 50 years or less. Most research on EORC are from western populations where the tumour biology and risk factors may differ from other regions. Evidence on EOCRC from the South Asian region is particularly scarce. This study presents the basic trends in presentation and overall survival [OS] pattern of EOCRC using data from a single specialized tertiary care institution over two decades. MethodsA total of 723 patients treated at the University surgical unit of the North Colombo teaching hospital from 1995 to 2020 were included in the analysis. Overall survival of the EOCRC was compared with that of the older population using Kaplan-Meier survival curves. Survival patterns over two time periods [pre-2010 vs post-2010] were also compared between the two populations. The stage at presentation, family history of colorectal or related cancers, tumour site, and tumour stage were also compared. ResultsThe proportion of EOCRC in this cohort has not shown a significant increase over the past two decades [2001-2010: 24% vs 2011-2020: 21%]. The advanced tumour stage at presentation and the presence of significant family history are also comparable. EOCRC cohort demonstrates a better OS for the entire study period [Median survival: < 50 years -not reached; >50 years -91 months; 95%CI -72-132; P<0.001]. However, this survival advantage is only observed during the pre-2010 period [Median survival: < 50 years -160 months; 95%CI -120 -not reached; >50 years -84 months; 95%CI -62-132; P=0.01] and becomes comparable in the 2010-2020 period [P=0.16]. OS of the EORC has not also improved over the two decades from 2001 to 2020 [P=0.51].

Quality improvement in colorectal cancer care; marching towards homegrown data

“…This phenomenon has been observed in other populations as well (31). Hemminki and colleagues analyzing data of 5 (32,33). An aging population is another challenge that the developing is faced with.…”