Department of Surgery, College of Health Sciences, Obafemi Awolowo University Teaching Hospital Complex, PMB 5538, Ile-Ife, Osun State, Nigeria.
Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada.
World J Surg. 2022 Jan;46(1):47-53. doi: 10.1007/s00268-021-06304-z. Epub 2021 Sep 5.
There are significant differences in the phenotype of CRC by race in the U.S. A similar CRC phenotype-race relationship also appears to exist in South Africa (SA). However, there is a paucity of comparative data on the presentation and survival of CRC in sub-Saharan African by country of origin or race. This study compares clinicopathologic variables between CRC patients in Nigeria and SA.
From a prospective CRC database, consecutive patients diagnosed between September, 2013 and October, 2018 from the African Research Group for Oncology in South West Nigeria were compared to consecutive patients diagnosed from January, 2016 to October, 2018 from the Colorectal Cancer in South Africa database. Patients with histologically confirmed adenocarcinoma were included. Patients were excluded if they had in-situ disease or no histological diagnosis. Clinical outcomes were calculated from the date of presentation. National census categories were used to define self-reported race in SA.
The mean age at presentation in Nigeria (n = 347) was 54.1 years (SD 15.5) compared to 56.8 (SD 13.7) in SA (n = 534). The median age among Black SA (BSA) patients was significantly lower than the median age among White SA (WSA) patients (55 vs. 63, p < 0.001). Right-sided colon cancer was more common in Nigerian (27.4%) and BSA (21.2%) patients compared to WSA patients (15.2%, p < 0.001). Nigerian (39.1%) and BSA (16.7%) patients were also more likely to present with mucinous histology than WSA patients (4.9%, p < 0.001). There was a significant difference in the stage-at-presentation between the cohorts, with a large burden of stage IV disease in the Nigerian cohort (52.6%). Adjusting for stage-at-presentation, there was a significant difference in the median overall survival between country and racial cohorts.
There are significant differences in the phenotype of CRC between Nigeria and SA. Nigerian and BSA patients, appear to share characteristics that are different than those of WSA patients. Larger series with tissue banking and next-generation sequencing are needed to better delineate these observed differences.
在美国，不同种族的结直肠癌（CRC）表型存在显著差异。南非（SA）似乎也存在类似的 CRC 表型-种族关系。然而，关于撒哈拉以南非洲国家或种族起源的 CRC 表现和生存的比较数据很少。本研究比较了来自尼日利亚和南非的 CRC 患者的临床病理变量。
从一个前瞻性 CRC 数据库中，比较了 2013 年 9 月至 2018 年 10 月期间在尼日利亚西南非洲肿瘤研究组连续诊断的患者与 2016 年 1 月至 2018 年 10 月期间在南非结直肠癌数据库中连续诊断的患者。纳入组织学证实为腺癌的患者。如果患者有原位疾病或无组织学诊断，则将其排除在外。临床结果从就诊日期开始计算。南非使用全国人口普查类别来定义自我报告的种族。
尼日利亚（n=347）的中位年龄为 54.1 岁（标准差 15.5），南非（n=534）的中位年龄为 56.8 岁（标准差 13.7）。南非黑人（BSA）患者的中位年龄明显低于南非白人（WSA）患者（55 岁与 63 岁，p<0.001）。右半结肠癌在尼日利亚（27.4%）和 BSA（21.2%）患者中比 WSA 患者（15.2%，p<0.001）更常见。尼日利亚（39.1%）和 BSA（16.7%）患者的黏液组织学也比 WSA 患者（4.9%，p<0.001）更常见。两个队列之间的分期存在显著差异，尼日利亚队列中 IV 期疾病的负担很大（52.6%）。调整分期后，国家和种族队列之间的中位总生存期存在显著差异。
尼日利亚和南非的 CRC 表型存在显著差异。尼日利亚和 BSA 患者的特征似乎与 WSA 患者不同。需要更大的系列研究，包括组织库和下一代测序，以更好地描绘这些观察到的差异。
