Colorectal Cancer Liver Metastasis Trends in the Kingdom of Saudi Arabia

Background/Aim:To elucidate colorectal cancer (CRC) disease patterns, demographics, characteristics, stage at presentation, metastases, and survival rates of patients, particularly those with liver metastases, at our center as the first report from the Kingdom of Saudi Arabia.Results:427 cases of CRC with a mean age at diagnosis of 55.47 ± 12.85 years, out of which 96% were resected. Stage II was predominant at presentation, followed by both stage III and IV, with the remainder being stage I. One hundred patients had distant metastases, of which the liver was the only location in 54 patients. Mean survival was 3.0 years. Overall survival rates for CRC patients with liver metastases who underwent resection were 30% at 2 years and 17% at 5 years, and the mean survival rate was 1.4 years.Conclusions:Both the mean survival rate of our CRC patients with resectable liver metastases and the 5-year survival rate of these patients are lower than global averages. This discrepancy is likely due to late diagnoses rather than more aggressive disease.Key Words: Colon cancer, metastasis, Saudi Arabia, survivalColorectal cancer (CRC) is considered to be the third most common malignancy worldwide.[1] It affects roughly 30–50 people per 100,000 individuals in the USA and Europe,[2] and roughly half of these patients develop metastases during the course of the disease.[3,4] The liver is the predominant site of metastasis in CRC, and 25% of patients present with metastases at the time of diagnosis (synchronous).[4,5,6] Throughout the course of the disease, in particular after resection of the primary tumor, approximately half of all CRC patients develop liver metastases.[4,5,6] CRC rates are markedly lower in Africa and the Middle East, occurring at an estimated rate of 3–11 per 100,000 individuals.[7] Specifically, in the Kingdom of Saudi Arabia (KSA), the incidence of CRC is increasing from 6.6 per 100,000 individuals in 2003[8] to over 12 per 100,000 individuals in 2008.[9]In a recent meta-analysis by Kanakas et al., the global 3 and 5-year mean survival rates of CRC were estimated to be 57.6 and 40.3%, respectively;[10] however, 5-year survival rates in the USA are estimated to be greater than 65%.[11] In comparison, the 5-year survival rate of CRC in the KSA is reported to be 44.6%.[12] Survival rates have improved tremendously for CRC due to early detection, application of total mesorectal excision, and addition of radiochemotherapy.[13,14] With respect to CRC patients with liver metastases, the estimated global mean 5-year survival is 38%, although this number varies dramatically from region to region.[10] Survival improvement for metastatic CRC is majorly due to the aggressive surgical approach in resecting all metastasis and the addition of effective systemic chemotherapy.[15] Despite increasing data pertaining to CRC incidence and survival in the KSA, information relating to the leading cause of death from this disease, namely liver metastasis, is currently scarce.[16] Therefore, the aim of this study is to elucidate CRC disease pattern and survival rates, particularly of patients with liver metastases, in the KSA population and to compare these figures to the global averages.