Incidence and clinicopathological features of colorectal cancer among multi-ethnic patients in Kuala Lumpur, Malaysia: a hospital-based retrospective analysis over two decades

Khairul Najmi Muhammad Nawawi; Norfilza M Mokhtar; Zhiqin Wong; Zairul Azwan Mohd Azman; Deborah Chia Hsin Chew; Rasyidah Rehir; Jocelyn Leong; Fuad Ismail; Isa Mohamed Rose; Yazmin Yaacob; Hamzaini Abdul Hamid; Ismail Sagap; Raja Affendi Raja Ali

doi:10.7717/peerj.12425

Incidence and clinicopathological features of colorectal cancer among multi-ethnic patients in Kuala Lumpur, Malaysia: a hospital-based retrospective analysis over two decades

PeerJ. 2021 Nov 8:9:e12425. doi: 10.7717/peerj.12425. eCollection 2021.

Authors

Khairul Najmi Muhammad Nawawi^#^{1

2}, Norfilza M Mokhtar^#^{2

3}, Zhiqin Wong^{1

2}, Zairul Azwan Mohd Azman^{2

4}, Deborah Chia Hsin Chew^{1

2}, Rasyidah Rehir¹, Jocelyn Leong¹, Fuad Ismail⁵, Isa Mohamed Rose⁶, Yazmin Yaacob⁷, Hamzaini Abdul Hamid^{2

7}, Ismail Sagap⁴, Raja Affendi Raja Ali^{1

2}

Affiliations

¹ Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.
² GUT Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.
³ Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.
⁴ Colorectal Unit, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.
⁵ Department of Oncology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.
⁶ Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.
⁷ Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.

^# Contributed equally.

Abstract

Background: The incidence rate of colorectal cancer (CRC) in Asian countries is increasing. Furthermore, recent studies have shown a concerning rise in the incidence of CRC among younger patients aged less than 50 years. This study aimed to analyze the incidence trends and clinicopathological features in patients with early-onset CRC (EOCRC) and later-onset CRC (at age ≥ 50 years).

Methods: A retrospective analysis was performed on 946 patients with CRC diagnosed from 1997 to 2017 at Universiti Kebangsaan Malaysia Medical Centre. The time trend was assessed by dividing the two decades into four 5-year periods. The mean age-standardized and age-specific incidence rates were calculated by using the 5-year cumulative population of Kuala Lumpur and World Health Organization standard population. The mean incidence was expressed per 100,000 person-years.

Results: After a stable (all age groups) CRC incidence rate during the first decade (3.00 per 100,000 and 3.85 per 100,000), it sharply increased to 6.12 per 100,000 in the 2008-2012 period before decreasing to 4.54 per 100,000 in the 2013-2017 period. The CRC incidence trend in later-onset CRC showed a decrease in the 2013-2017 period. Contrariwise, for age groups of 40-44 and 45-49 years, the trends showed an increase in the latter 15 years of the study period (40-44 years: 1.44 to 1.92 to 2.3 per 100,000; 45-49 years: 2.87 to 2.94 to 4.01 per 100,000). Malays' EOCRC incidence rate increased from 2008-2012 to 2013-2017 for both the age groups 40-44 years (1.46 to 2.89 per 100,000) and 45-49 years (2.73 to 6.51 per 100,000). Nearly one-fifth of EOCRC cases were diagnosed at an advanced stage (Dukes D: 19.9%), and the majority of them had rectal cancer (72.8%).

Conclusion: The incidence of EOCRC increased over the period 1997-2017; the patients were predominantly Malays, diagnosed at a later stage, and with cancer commonly localized in the rectal region. All the relevant stakeholders need to work on the management and prevention of CRC in Malaysia.

Keywords: Colorectal cancer; EOCRC; Early-onset; Incidence; Kuala Lumpur; Malaysia; Multi-ethnic.

Grants and funding

This study was funded by transdisciplinary research grant scheme from the Ministry of Higher Education, Malaysia (TRGS/2/2014/UKM/02/3) and by the Universiti Kebangsaan Malaysia research grant, Dana Impak Perdana (DIP/2020/014). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.