Analysis of Risk Factors, Treatment Patterns, and Survival Outcomes After Emergency Presentation With Colorectal Cancer: A Prospective Multicenter Cohort Study in Nigeria.
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Aderibigbe Adeniyi S, Dare Anna J, Kalvin Hannah L, Olasehinde Olalekan, Wuraola Funmilola, Adisa Adewale, Omisore Adeleye Dorcas, Komolafe Akinwumi O, Omoyiola Oluwatosin Zainab, Okereke Chukwuma Eze, Katung Aba, Egberoungbe Adedeji, Ariyibi Olufemi, Olatoke Samuel Adegboyega, Adeyeye Ademola Adetoyese, Agodirin Sulaiman Olayide, Bojuwoye Matthew Olumuyiwa, Fayenuwo James Oluwaleke, Ademakinwa Oluwabusayomi Roseline, Osinowo Dapo, Lawal Abdul-Razak, Abdulkareem Fatimah B, Goldman Debra, Knapp Gregory, Murthy Shilpa, Kahn Rivka, Gonen Mithat, Kingham T Peter, Alatise Olusegun I, African Research Group in Oncology Colorectal Cancer Working Group
Аннотация
METHODS: Consecutive CRC patients presenting at six sites over 6 years were included. Risk factors for emergency presentation were evaluated using logistic regression methods. Overall survival (OS) was compared between emergent and elective patients using Kaplan-Meier methods and the log-rank test.
RESULTS: Of 535 patients, 30.7% presented emergently. Median age was 56 years, 55% were men, and 5.0% reported a cancer family history. Emergency patients had more proximal cancers (42.1% vs. 24.0%), Stage IV disease (61.6% vs. 40.2%; p < 0.001), lower household income (₦35 000/month vs. ₦50 000/month), lower education levels (p = 0.008) and accessed care with nonmotorized transport (50.6% vs. 37.2%; p = 0.005). Median OS was shorter in the emergency group (6.4 vs. 17.4 months; p < 0.001). Across clinical stages, emergency presentation was associated with worse OS (Stage IV median OS 4.8 vs. 9.4 months; p = 0.002). Surgery improved survival in both groups, although emergency patients had higher 30-day postoperative mortality (23.2% vs. 9.1%; p < 0.001).
CONCLUSIONS: Emergent Nigerian CRC patients have worse OS than elective patients. Cancer control efforts should focus on faster cancer detection, early presentation, diagnosis, and treatment.