Colorectal cancer in Arab world: A systematic review

Disease burden and projection of total and early-onset colorectal cancer in Gulf cooperation council countries from 1990 to 2019

BACKGROUND

Early-onset colorectal cancer (EO-CRC) incidence and prevalence trends in the rise in high income countries, such as the Gulf Cooperation Council (GCC) countries. The study aimed to offer an up-to-date assessment of the overall burden of CRC, and EO-CRC in GCC countries and project its incidence and mortality in 2030.

METHOD

The prevalence, incidence, mortality, years of life lived with disability (YLDs), and disability-adjusted life years (DALYs) of CRC were obtained from the Global Burden of Disease (GBD) Study 2019. The incidence and mortality of CRC, and EO-CRC up to 2030 were predicted.

RESULTS

All GCC countries showed a higher annual average percentage changes (AAPC) AAPC incidence rate for EO-CRC compared to CRC. In Saudi Arabia the number of CRC cases has increased from 1990 1484.57; (95 % UI 1987.98,1083.86) 11.4-fold-increase to 16991.83; (95 % UI 21754.79,12892.12) in 2019. In 2030, the total incidence cases of CRC for the six Gulf countries are expected to reach 13,339 thousand, primarily driven by Saudi Arabia with 7,910.19 cases. In 2030, the CRC mortality rate is projected to be 7,647 cases, with nearly 57 % of CRC mortality cases anticipated in Saudi Arabia.

CONCLUSION

This study sheds light on the alarming rise in CRC and EO-CRC across Gulf countries from 1990 to 2019, emphasizing Saudi Arabia's significant burden. It projects a concerning increase in CRC incidence and mortality by 2030, primarily in Saudi Arabia, and highlights the need for immediate public health interventions.

Age-period-cohort analysis of colorectal cancer mortality in Saudi Arabia from 1990 to 2019

OBJECTIVES

The current study aimed to describe and estimate the independent effects of age, period, and cohort on colorectal cancer (CRC) mortality in Saudi Arabia from 1990 to 2019.

STUDY DESIGN

This was an epidemiological study.

METHODS

Data were obtained from the Global Burden of Disease study 2019. Age-period-cohort modelling was used to compute the net drift, local drift, cross-sectional age curve, longitudinal age curve, and rate ratios (RRs) of period and cohort of CRC mortality in Saudi Arabia.

RESULTS

In 2019, there were 1629 (95% uncertainty interval [UI]: 1263 to 2045) CRC cancer deaths in Saudi Arabia, and the age-standardised mortality rate of CRC was 9.7 (95% UI: 7.8 to 11.6) per 100,000 population. For men, between 1990 and 2019, the total number of CRC deaths increased dramatically from 199 (95% UI: 130 to 286) in 2019 to 942 (95% UI: 725 to 1228). For the period effects, the relative risk (RR) of mortality rate for both sexes followed similar monotonic increase patterns throughout the study period.

CONCLUSIONS

Results from this study highlight a concerning increase in CRC mortality rates in Saudi Arabia from 1990 to 2019, particularly among individuals aged 30-50 years. While mortality rates for men were higher at the start of the study period, more favourable trends for men were seen in the later years of the study period, indicating evolving gender disparities. Establishing evidence-based national screening guidelines and adopting multi-level diagnostics, risk assessment, and population-wide screening, especially for younger populations, is crucial.

Cancer Incidence and Mortality Estimates in Arab Countries in 2018: A GLOBOCAN Data Analysis

BACKGROUND

Arab countries are projecting increase in cancer incidence and mortality; however, there are limited studies that compare the epidemiology of cancer in Arab countries compared with other parts of the world.

METHODS

We used the 2018 Global Cancer Observatory data to compare the age-standardized incidence and mortality estimates in Arab-speaking countries to the rest of the world.

RESULTS

Rates for incidence and mortality for all cancers in Arab countries were lower than the world's rates but the incidence rates of non-Hodgkin and Hodgkin lymphoma, bladder, breast, and liver cancers were higher. Arab countries generally had higher mortality-to-incidence ratio than the world's ratio. Incidence rates, even in age-specific groups, varied between subregions of Arab countries (the Levant, Arabian Gulf, and Arab African subregions), and Iraq and Egypt, suggesting some common and unique environmental factors and possible ethnic or genetic heritages.

CONCLUSIONS

There are essential scopes for improvements in Arab countries including better treatments to reduce the high mortality-to-incidence ratio, and supporting vaccination programs and antiviral treatments that would prevent the prevalent viral infection-related cancers. The high incidence of several cancers in younger Arabs suggests genetic factors and underlines the importance of genetic epidemiology studies.

IMPACT

This study is an essential reference to evaluate and monitor the progress of national cancer initiatives in Arab countries for surveillance and prevention programs and improving clinical management. The study also provides a comprehensive snapshot of cancers in a unique region that could shed light on the interplay of environmental, lifestyle, and genetic risk factors.

Design, Synthesis, In Vitro, and In Silico Studies of New N5-Substituted-pyrazolo[3,4-d]pyrimidinone Derivatives as Anticancer CDK2 Inhibitors

CDK2 is a key player in cell cycle processes. It has a crucial role in the progression of various cancers. Hepatocellular carcinoma (HCC) and colorectal cancer (CRC) are two common cancers that affect humans worldwide. The available therapeutic options suffer from many drawbacks including high toxicity and decreased specificity. Therefore, there is a need for more effective and safer therapeutic agents. A series of new pyrazolo[3,4-d]pyrimidine analogs was designed, synthesized, and evaluated as anticancer agents against the CRC and HCC cells, HCT116, and HepG2, respectively. Pyrazolo[3,4-d]pyrimidinone derivatives bearing N5-2-(4-halophenyl) acetamide substituents were identified as the most potent amongst evaluated compounds. Further evaluation of CDK2 kinase inhibition of two potential cytotoxic compounds 4a and 4b confirmed their CDK2 inhibitory activity. Compound 4a was more potent than the reference roscovitine regarding the CDK2 inhibitory activity (IC50 values: 0.21 and 0.25 µM, respectively). In silico molecular docking provided insights into the molecular interactions of compounds 4a and 4b with important amino acids within the ATP-binding site of CDK2 (Ile10, Leu83, and Leu134). Overall, compounds 4a and 4b were identified as interesting CDK2 inhibitors eliciting antiproliferative activity against the CRC and HCC cells, HCT116 and HepG2, respectively, for future further investigations and development.

Outcomes and appropriateness of colonoscopy referrals at King Khalid University Hospital, Saudi Arabia: An opportunity to expand the colonoscopy screening

OBJECTIVES

To examine the colonoscopy referrals in an open-access system and determine the outcome and factors associated with appropriate referral.

METHODS

A retrospective study of colonoscopy referrals used patients' medical records at King Khalid University Hospital, Riyadh, Saudi Arabia, during 2020-2022. Fisher's exact or Pearson's Chi-squared test were used for data analysis.

RESULTS

Out of 365 patients, 95.1% were referred from family medicine clinics with a mean age of 56.2±15.7 years. Men account for 53.2% of patients. The most common symptoms were change in bowel habits (35.6%), abdominal pain (30.4%), and anemia (20.1%). A family history of colorectal cancer was positive in 12.1%, while a personal history was positive in 4.4%. Most referrals (86.0%) were appropriate based on the American Society for Gastrointestinal Endoscopy (ASGE) guidelines. However, approximately 89.1% of patients aged ≥45 years had neoplasia and 40.0% had inflammatory bowel disease (p=0.019). The rank of the physicians (p=0.558) or the gender of the patients (p=0.665) did not influence the appropriateness. The inappropriate referrals were lower in patients with neoplasia (1.6%) than in patients with other lesions (p=0.002).

CONCLUSION

The colonoscopy referrals were appropriate. The incidence of neoplasia was higher among those aged ≥45. Low inappropriate referrals and a high neoplasia detection were found based on ASGE guidelines. Future research should involve prospective multicenter referrals from family physicians outside hospitals and investigate patients' hesitancy to proceed with colonoscopy and cost-effectiveness.

Integrating Microbiome Analysis, Metabolomics, Bioinformatics, and Histopathology to Elucidate the Protective Effects of Pomegranate Juice against Benzo-alpha-pyrene-Induced Colon Pathologies

Polycyclic aromatic hydrocarbons, e.g., benzo[a]pyrene (BaP), are common dietary pollutants with potential carcinogenic activity, while polyphenols are potential chemopreventive antioxidants. Although several health benefits are attributed to polyphenol-rich pomegranate, little is known about its interaction with BaP. This study integrates histochemical, microbiomic, and metabolomic approaches to investigate the protective effects of pomegranate juice from BaP-induced pathologies. To this end, 48 Sprague-Dawley rats received, for four weeks, either pomegranate, BaP, both, or neither (n = 12 rats per group). Whereas histochemical examination of the colon indicated tissue damage marked by mucin depletion in BaP-fed animals, which was partially restored by administration of pomegranate juice, the fecal microbiome and metabolome retained their resilience, except for key changes related to pomegranate and BaP biotransformation. Meanwhile, dramatic microbiome restructuring and metabolome shift were observed as a consequence of the elapsed time (age factor). Additionally, the analysis allowed a thorough examination of fecal microbiome-metabolome associations, which delineated six microbiome clusters (marked by a differential abundance of Lactobacillaceae and Prevotellaceae, Rumincococcaceae, and Erysipelotrichaceae) and two major metabolome clusters (a sugar- and amino-acids-dominated metabotype vs. a cluster of fatty acids and hydrocarbons), with sugar alcohols maintaining a unique signature. In conclusion, using paired comparisons to minimize inter-individual animal variations allowed the dissection of temporal vs. treatment-derived variations. Microbiome-metabolome association clusters may be further exploited for metabotype prediction and gut-health biomarker discovery.

Colorectal Cancer Screening in the Middle East: What, Why, Who, When, and How?

The incidence of colorectal cancer (CRC) in the Middle East is increasing, especially among those younger than 50 years. Risk factors including obesity, sedentary lifestyle, and dietary changes are associated with the epidemiologic shift and are a result of socioeconomic changes happening in the region. Worldwide, CRC screening is associated with decreased incidence and mortality of CRC, but screening uptake is still low in the Middle East because of cultural barriers and lack of awareness; in addition, most countries do not have national screening programs. Knowledge of CRC screening and participation rates vary among different countries, but overall they are low. Both primary and secondary prevention approaches are needed in the Middle East, and cost-effectiveness is important in choosing screening modalities. Although colonoscopy is considered the most robust screening method, stool-based testing may be an acceptable screening strategy in resource-limited settings, and focusing on high-risk individuals such as those with hereditary CRC might be the most cost-effective strategy. In addition to financial limitations in many countries in the Middle East, human displacement places an extra toll on cancer control strategies in the region.

Surgical outcomes and prognostic factors associated with emergency left colonic surgery

BACKGROUND

Mortality from emergency left-sided colorectal surgery can be substantial due to acuteness of the presentation and the urgent need to operate in the setting of a limited preparation in a morbid patient.

OBJECTIVES

Determine the 30-day postoperative outcomes and identify risk factors for complications and mortality following emergency colorectal operations.

DESIGN

Retrospective SETTINGS: Three tertiary hospitals in three countries.

PATIENTS AND METHODS

Factors that were studied included age, sex, ASA score, type and extent of the operation, and presence/absence of malignancy. Unadjusted 30-day patient outcomes examined were complications and mortality. Differences in proportions were assessed using the Pearson chi-square test while logistic regression analyses were carried out to evaluate the correlation between risk factors and outcomes.

MAIN OUTCOME MEASURES

30-day postoperative morbidity and mortality SAMPLE SIZE: 104 patients.

RESULTS

Among 104 patients, 70 (67.3%) were men, and 34 (32.7%) were women. The mean (SD) age was 57.2 (17.1) years. The most common indication for emergency colonic surgery was malignant obstruction in 33 (31.7%) patients. The postoperative complication rate was 24% (25/104), and the mortality rate was 12.5% (13/104) within 30 days of the operation. The ASA status (P=.02), presence of malignancy (P=.02), and the presence of complications (P=.004) were significantly related to mortality in the multivariable logistic regression analysis.

CONCLUSIONS

The 30-day mortality of emergency colorectal operations is greatly influenced by the presence of malignancy in the colon and physiological status at the time of the procedure.

LIMITATIONS

The retrospective design and small sample size.

CONFLICT OF INTEREST

None.

The Insulin-like Growth Factor System and Colorectal Cancer

Insulin-like growth factors (IGFs) are peptides which exert mitogenic, endocrine and cytokine activities. Together with their receptors, binding proteins and associated molecules, they participate in numerous pathophysiological processes, including cancer development. Colorectal cancer (CRC) is a disease with high incidence and mortality rates worldwide, whose etiology usually represents a combination of the environmental and genetic factors. IGFs are most often increased in CRC, enabling excessive autocrine/paracrine stimulation of the cell growth. Overexpression or increased activation/accessibility of IGF receptors is a coinciding step which transmits IGF-related signals. A number of molecules and biochemical mechanisms exert modulatory effects shaping the final outcome of the IGF-stimulated processes, frequently leading to neoplastic transformation in the case of irreparable disbalance. The IGF system and related molecules and pathways which participate in the development of CRC are the focus of this review.

The associations between interleukin-17 single-nucleotide polymorphism and colorectal cancer susceptibility: a systematic review and meta-analysis

Background

Numerous case-control studies have reported associations between interleukin-17 (IL-17) polymorphisms and colorectal cancer; however, the results were inconsistent. The aim of this meta-analysis was to further clarify the effects of IL-17 polymorphisms on colorectal cancer susceptibility.

Materials and method

Relevant studies were extracted from the electronic databases PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and the Chinese Biomedical Literature Database (CMB) up to April 2021. The odds ratio and 95% confidence interval were used to estimate the strength of the associations.

Results

Ten articles including 2599 cases and 2845 controls were enrolled in our research after strict literature screening. Highly significant associations between the IL-17A rs2275913 polymorphism and increased colorectal cancer susceptibility were observed in all five gene models (allelic, dominant, recessive, homozygous, and heterozygous models), and subgroup analysis based on ethnicity revealed that these associations existed not only in the Asian population but also in the Caucasian population. However, the results showed no significantly elevated colorectal cancer risk correlated with the IL-17F rs763780 polymorphism, and a slightly lower colorectal cancer susceptibility for the Caucasian population was discovered in the recessive and homozygous models of this mutation.

Conclusion

The IL-17A rs2275913 polymorphism may be an independent risk factor contributing to colorectal cancer susceptibility, while the IL-17F rs763780 polymorphism may decrease susceptibility to colorectal cancer. Future studies with large-scale samples are warranted to identify these associations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12957-022-02586-2.

Ameliorative Potential of L-Alanyl L-Glutamine Dipeptide in Colon Cancer Patients Receiving Modified FOLFOX-6 Regarding the Incidence of Diarrhea, the Treatment Response, and Patients’ Survival: A Randomized Controlled Trial

Background and Objectives: Diarrhea induced by chemotherapy may represent a life-threatening adverse effect in cancer patients receiving chemotherapy. FOLFOX, an effective treatment for colon cancer, has been associated with diarrhea with high severity, particularly with higher doses. Management of diarrhea is crucial to increase the survival of cancer patients and to improve the quality of life. Glutamine is an abundant protein peptide found in blood and has a crucial role in boosting immunity, increasing protein anabolism, and decreasing the inflammatory effects of chemotherapy on the mucosal membranes, including diarrhea. This study aimed to provide evidence that parenteral L-alanyl L-glutamine dipeptide may have a positive influence on the incidence of diarrhea, treatment response, and the overall survival in colon cancer patients treated with modified FOLFOX-6 (mFOLFOX-6). Materials and Methods: Forty-four stage II and III colon cancer patients were included in this study where they were treated with the standard colon cancer chemotherapy mFOLFOX-6 and were randomly allocated into glutamine group and placebo group, each of 22 patients. Results: L-alanyl L-glutamine dipeptide was found to be significantly effective in decreasing the frequency and severity of diarrhea when compared to the placebo group, particularly after four and six cycles of mFOLFOX-6. There was no significant difference between the studied groups regarding to the overall survival. Conclusion: L-alanyl L-glutamine dipeptide can be considered as an add-on with chemotherapy to improve the quality of life and the overall survival of colon cancer patients.