Clinical characteristics and treatment outcomes of colorectal cancer in a resource-restricted country.

Abstract

e15723 Background: Colorectal cancer is the second most common cancer in Jordan and remains the second common cancer-related deaths in both men and women. As projected by GLOBOCAN, colorectal cancer cases in Jordan are expected to double in the next 20 years. The Age-standardized mortality rate (ASMR) compared to the Age-standardized incidence rate (ASIR) is 8.7 to 16.5/100,000, which is higher than those in Western countries. National early detection and screening programs for colorectal cancer don’t exist, however, the feasibility of screening higher risk individuals is underway. This study aims to highlight epidemiological aspects and present data related to clinical presentation and treatment outcomes. Methods: We reviewed reports from the Jordan Cancer Registry (JCR) over the past 20 years on cancer incidence and distribution. Data on treatment outcomes was obtained from the King Hussein Cancer Center (KHCC) cancer registry. All consecutive patients treated since its establishment in 2006 and until August 2022 were enrolled. Results: During the study period, a total of 3,424 Jordanian patients with colorectal cancers were fully treated and included in the registry. Only a minority of the patients presented with early-stage disease; 132 (3.9%) with stage 1 and 589 (17.2%) with stage 2, while the majority presented with stage 3 (n=1,383, 40.4%) and stage 4 (1,131, 33.0%). After a median follow-up of 49 months, the 5-year overall survival (OS) for the whole group was 53.9% (95% CI, 52.0%-55.8%) and varied by disease stage; 87.7% (95% CI, 80.3%-93.5%) for stage 1, 84.7% (95% CI. 81.3%-87.9%) for stage 2, 69.9% (95% CI, 67.0%-72.8%) for stage 3 and only 14.5% (95% CI, 12.2%-16.9%) for patients with stage 4 disease, p<0.0001. The survival rates align with the international ones when compared stage by stage, however, the 5-year OS for all patients is around 10 percentage points lower than those reported from Western countries; 54% compared to 64% (Table-1). Conclusions: The incidence of colorectal cancer in Jordan is rising at an alarming rate, with a third of patients are diagnosed with stage 4 disease, contributing to significantly lower survival rates compared to Western countries. Immediate actions are required to address these challenges, including the potential implementation of early detection and screening programs for high-risk individuals. 5-year overall survival of colon, rectal and colorectal cancer. Stage Colorectal Colon Rectal KHCC (Jordan) England CDC SEER Localized Stage 1 87.7 90% 88.5% 91% 90% Stage 2 84.7 85% Regional Stage 3 69.9 65% 72.2% 73% 74% Distant Stage 4 14.5 10% 16.3% 13% 18% All stages combined 53.9 60% 64.4% 63% 67%