Prognostic Factors and Survival of Colorectal Cancer in Cameroun: A Retrospective Hospital-Based Study

Abstract

Background: Colorectal cancer represents a major health problem in the world today, the 3rd most common cancer and the 2nd in terms of mortality. Despite of the fact that the incidence rate remains the lowest in Africa, it is still a provider of a stronger lethality in most western countries. In Cameroon according to WHO 2018, 421 new cases (4.5% of all cancers) and 451 deaths (4.3% of all cancers) were registered. Objective: Determine the prognostics factors and the survival of patients suffering from colorectal cancer followed up in Douala. Patients and Method: This was a retrospective cohort study over a period from January 1st, 2009 to December 31st, 2018. All patients with histologically proven colorectal cancer, at the gastroenterological, oncological, anatomopathological, radiotherapy and surgery Department of Laquintinie and General Hospitals of Douala were included. The data collected were recorded and analyzed by SPSS version 25 and Excel 2016 statistical computer software. Survival was determined by the Kaplan Meier method and the search for prognostic factors was carried out using the Cox proportional hazards model. The significance level was p = 0.05. Results: The median survival was 43 months CI: [35,255 - 50,745]. Survival at 1 year, 2 years, 3 years, 4 years and 5 years was 79.6%, 61.5%, 46.3%, 22.6%, 12.2% respectively. In multivariate analysis, the low degree of differentiation (HR = 16.278, p = 0.007), the presence of synchronous metastases or stage IV patients (HR = 42.004; p = 0.011) were independent factors of poor prognosis while curative surgery (HR = 0.172; p = 0.001) was an independent factor of good prognosis. Conclusion: In our study, the median overall survival was 43 months and the survival at 1 year, 2 years, 3 years, 4 years and 5 years was respectively; 79.6%, 61.5%; 46.3%; 22.6%; 12.2%. The low degree of differentiation and the presence of synchronous metastases were factors of poor prognosis while curative surgery is a factor of good prognosis.