Cancer Management and Research (Feb 2022)
Prognostic Factors for Survival of Colorectal Adenocarcinoma Patients in Uganda
Abstract
Richard Wismayer,1– 3 Julius Kiwanuka,4 Henry Wabinga,3 Michael Odida3,5 1Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda; 2Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda; 3Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda; 4Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda; 5Department of Pathology, Faculty of Medicine, Gulu University, Gulu, UgandaCorrespondence: Richard Wismayer, Email [email protected]; [email protected]: 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.Methods: 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.Results: 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.Conclusion: 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.Keywords: colorectal cancer, mortality, overall survival, Uganda
