Wismayer Richard, Kiwanuka Julius, Wabinga Henry, Odida Michael
Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda.
Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda.
Cancer Manag Res. 2022 Feb 28;14:875-893. doi: 10.2147/CMAR.S354360. eCollection 2022.
In Uganda, similar to other countries in East Africa, the incidence of colorectal cancer (CRC) has been steadily increasing. This increase in incidence is accompanied by a poor prognosis. There is limited knowledge on factors responsible for the poor outcome of patients with CRC in Uganda. Cancer survival analysis is one way of determining some of these prognostic factors. The aim of this study was to determine prognostic factors associated with CRC survival in Ugandan patients.
This was a retroprospective cohort study involving patients with linked data in the Kampala cancer registry and medical records from hospitals in Uganda. Participants with a diagnosis of colorectal adenocarcinoma between 1st January 2008 and 31st December 2018 were included. Variables included patients' demographic data, grade, stage and location of CRC, data on whether a patient was operated on, type of operation, treatment modalities and date of diagnosis. Our outcome variable was time to death after diagnosis. We computed and compared survival using the Log rank test and used Cox proportional hazards regression to determine factors associated with survival.
A total of 247 patients were included in the study with a mean (SD) age of 53.3 (15.7) years and a female: male ratio of 1.14:1. The proportions of patients surviving at 1, 2 and 3 years were 65.2% (95% CI: 58.8-70.9), 42.0% (95% CI:35.6-48.3) and 33.3% (95% CI:27.3-39.4) respectively. In multivariate analysis, factors associated with increased mortality included clinical stage II (aHR = 2.44, 95% CI: 1.10-5.41, p=0.028), stage III (aHR=2.65, 95% CI: 1.31-5.39, p=0.007) and stage IV (aHR=5.47, 95% CI: 2.40-12.48, p<0.001). Curative surgery alone (aHR=0.63, 95% CI: 0.39-1.01, p=0.057) and curative surgery with chemotherapy (aHR=0.53, 95% CI: 0.32-0.88, p=0.015) were associated with a better survival.
The survival rate among CRC patients in Uganda is low. Advanced stage CRC accelerates mortality, while surgery alone or in combination with chemotherapy improves survival. Implementation of national screening programmes for early diagnosis of CRC and increasing surgery and oncology infrastructure is recommended to improve the CRC survival rate in the Ugandan population.
在乌干达，与东非其他国家类似，结直肠癌（CRC）的发病率一直在稳步上升。发病率的上升伴随着预后不良。关于乌干达CRC患者预后不良的相关因素，人们了解有限。癌症生存分析是确定其中一些预后因素的一种方法。本研究的目的是确定乌干达CRC患者生存的预后因素。
这是一项回顾性队列研究，涉及坎帕拉癌症登记处的关联数据患者以及乌干达医院的病历。纳入了2008年1月1日至2018年12月31日期间诊断为结直肠腺癌的患者。变量包括患者的人口统计学数据、CRC的分级、分期和位置、患者是否接受手术的数据、手术类型、治疗方式和诊断日期。我们的结局变量是诊断后至死亡的时间。我们使用对数秩检验计算并比较生存率，并使用Cox比例风险回归来确定与生存相关的因素。
共有247名患者纳入研究，平均（标准差）年龄为53.3（15.7）岁，女性与男性比例为1.14:1。1年、2年和3年存活患者的比例分别为65.2%（95%置信区间：58.8 - 70.9）、42.0%（95%置信区间：35.6 - 48.3）和33.3%（95%置信区间：27.3 - 39.4）。在多变量分析中，与死亡率增加相关的因素包括临床II期（调整后风险比[aHR]=2.44，95%置信区间：1.10 - 5.41，p = 0.028）、III期（aHR = 2.65，95%置信区间：1.31 - 5.39，p = 0.007）和IV期（aHR = 5.47，95%置信区间：2.40 - 12.48，p < 0.001）。单纯根治性手术（aHR = 0.63，95%置信区间：0.39 - 1.01，p = 0.057）和根治性手术联合化疗（aHR = 0.53，95%置信区间：0.32 - 0.88，p = 0.015）与更好的生存相关。
乌干达CRC患者的生存率较低。晚期CRC会加速死亡，而单纯手术或手术联合化疗可提高生存率。建议实施全国CRC早期诊断筛查计划，并增加手术和肿瘤学基础设施，以提高乌干达人群的CRC生存率。
