Predictors of Disease Outcomes in a Cohort of Syrian Colon Cancer Patients: Cohort Study

Background: Colon cancer ranks fourth in terms of incidence and cancer-related mortality in Syria, with the number of recorded cases likely to increase annually. Disease prognosis can be predicted based on a combination of genetic and non-genetic factors. Non-genetic factors (demographic and clinical) are particularly important in resource-limited countries due to their feasibility for detection, collection, and analysis without additional costs. This study aimed to evaluate a number of clinical and demographic factors and their association with disease outcomes in a cohort of Syrian colon cancer patients attending Al-Bairouni University Hospital in Damascus.

Study Design and Methods: Our cohort study included colon cancer patients attending the Digestive Tumors Unit at Al-Bairouni University Hospital. Interviews were conducted with patients to fill out a questionnaire designed to collect clinical and demographic data and relevant information. Data were supplemented by reviewing medical records. Patients were followed up for 20 months, during which their medical records were periodically reviewed. Data were statistically analyzed using GraphPad Prism 10.1.0.

Results: The study cohort included 82 colon cancer patients, with a mean age (±SD) of the study cohort was 54 years (±10.3), with males comprising 53%. Thirty-one patients (37.8%) were diagnosed at ages ≤50, with one-third (n=10) being ≤40 years old at diagnosis. Fifty-nine patients (72%) reported a family history of cancer among first, second, and third-degree relatives, and 27 patients (32.5%) reported a family history of colon cancer. Twenty-four percent and 44% of patients were diagnosed at advanced stages III and IV, respectively, with a mortality percentage of 58% in these stages, approximately five-folds compared to 12% in patients at stages I and II (p=0.001). The median overall survival was 70 months for patients at stages I and II compared to 32 months for patients at stages III and IV (p=0.001). Fifteen patients (18.3%) experienced thrombotic or hemorrhagic vascular events, of whom 12 patients (80%) died, compared to a mortality percentage of 41% in the group of patients who did not develop similar events (p=0.009). The median overall survival for patients with thrombotic or hemorrhagic events was 32 months compared to 50 months for the group that did not experience any bleeding or thrombosis until the last follow-up point (p=0.039).

Conclusions: The study cohort had a mean age comparable to that of Arab populations and relatively lower than Western populations. Diagnosis at advanced stages and the development of thrombotic or hemorrhagic events were both associated with poor prognosis, represented by decreased median overall survival and increased mortality.