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Racial Differences in the Phenotype of Colorectal Cancer: A Prospective Comparison Between Nigeria and South Africa

  • Surgery in Low and Middle Income Countries
  • Published:
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Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgements

The authors would like to acknowledge the dedicated surgical research team at OAUTHC for their help with data entry. The study was funded by the Global Cancer Disparities Initiative at the Memorial Sloan Kettering Cancer Center, with support from the Thompson Family Foundation. This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

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Authors and Affiliations

  1. Department of Surgery, College of Health Sciences, Obafemi Awolowo University Teaching Hospital Complex, PMB 5538, Ile-Ife, Osun State, Nigeria

    Olusegun I. Alatise, Patrick Ayodeji & Olalekan Olasehinde

  2. Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada

    Gregory C. Knapp

  3. Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Brendan Bebington

  4. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Gregory C. Knapp, Anna Dare, Jeremy Constable & T. Peter Kingham

Authors
  1. Olusegun I. Alatise
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  2. Gregory C. Knapp
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  3. Brendan Bebington
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  4. Patrick Ayodeji
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  5. Anna Dare
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  7. Olalekan Olasehinde
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  8. T. Peter Kingham
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Correspondence to Olusegun I. Alatise.

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A preliminary analysis of the data was presented in poster format at the African Organization for Research & Training in Cancer (AORTIC) conference in Maputo, Mozambique, November, 2019.

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Alatise, O.I., Knapp, G.C., Bebington, B. et al. Racial Differences in the Phenotype of Colorectal Cancer: A Prospective Comparison Between Nigeria and South Africa. World J Surg 46, 47–53 (2022). https://doi.org/10.1007/s00268-021-06304-z

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