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Research Article
Colorectal Cancer in Iran: A Retrospective, Comparative Study of Early-onset and Late-onset Cases in north-eastern Iran based on the Iranian Hereditary Colorectal Cancer Registry
Saeid Eslami
Mashhad University of Medical Sciences
Corresponding Author
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Background: Generally, the incidence rate of colorectal cancer (CRC) is increasing among young patients (aged <49 years), while the reasons for the rising incidence are unclear. Indicative variables, such as tumour location, gender preference and genetic preponderance have not been followed up in a consistent manner. The current study was primarily conducted to improve the hereditary CRC screening programme by assessing the demographic and pathological characteristics of early-onset CRC compared to late-onset CRC in northeast Iran.
Methods: This retrospective study was carried out over a three-year follow-up period (2014-2017) and included 562 CRC patients in three Mashhad City hospital laboratories in north-eastern Iran. We applied comparative analysis of pathological and familial features together with information on the presence of genetic mismatch repair-deficiency in relation to final patient status (surviving versus deceased cases). Analyses using R studio software were performed on early-onset CRC (n=222) and late-onset CRC (n=340) groups produced by division at the age of 50 years.
Results: From an age-of-onset point of view, the distribution between the genders differed with females showing a higher proportion of early-onset CRC compared to men (56% vs. 44 %) , while the late-onset CRC disparity was less pronounced (48% vs. 52%). The mean age of all participants was 55.6 ± 14.8 years, while it was 40.3 ± 7.3 years for early-onset CRC and 65.1 ± 9.3 years for late-onset CRC. With respect to anatomical tumour location (distal, rectal, and proximal), the frequencies were 61%, 28% and 11%, respectively, but the variation did not reach statically significance. There was a dramatic difference with regard to the history of CRC in second-degree relatives (SDR) and that of the combination of first-degree relatives and SDR (p=0.001 and p=0.03, respectively). Expression of the MLH1 and PMS2 genes were significantly different between survivors and deceased, however this finding was not observed with regard to the MSH6 and the MSH2 genes.
Conclusion: The variation of demographic, pathological and genetic characteristics of CRC between early-onset and late-onset cancers of this kind emphasizes the need for a well-defined algorithm to identify high-risk patients.
Keywords
early-onset CRC, colon cancer, colorectal cancer, mismatch repair, cancer screening, registry
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This preprint is under consideration at BMC Cancer. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Colorectal Cancer in Iran: A Retrospective, Comparative Study of Early-onset and Late-onset Cases in north-eastern Iran based on the Iranian Hereditary Colorectal Cancer Registry
Saeid Eslami
Mashhad University of Medical Sciences
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 06 Jan, 2021
No community comments so far
Editor assigned
On 05 Jan, 2021
Editor invited
On 05 Jan, 2021
Submission checks complete
On 05 Jan, 2021
First submitted
On 28 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Cancer Biology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Generally, the incidence rate of colorectal cancer (CRC) is increasing among young patients (aged <49 years), while the reasons for the rising incidence are unclear. Indicative variables, such as tumour location, gender preference and genetic preponderance have not been followed up in a consistent manner. The current study was primarily conducted to improve the hereditary CRC screening programme by assessing the demographic and pathological characteristics of early-onset CRC compared to late-onset CRC in northeast Iran.
Methods: This retrospective study was carried out over a three-year follow-up period (2014-2017) and included 562 CRC patients in three Mashhad City hospital laboratories in north-eastern Iran. We applied comparative analysis of pathological and familial features together with information on the presence of genetic mismatch repair-deficiency in relation to final patient status (surviving versus deceased cases). Analyses using R studio software were performed on early-onset CRC (n=222) and late-onset CRC (n=340) groups produced by division at the age of 50 years.
Results: From an age-of-onset point of view, the distribution between the genders differed with females showing a higher proportion of early-onset CRC compared to men (56% vs. 44 %) , while the late-onset CRC disparity was less pronounced (48% vs. 52%). The mean age of all participants was 55.6 ± 14.8 years, while it was 40.3 ± 7.3 years for early-onset CRC and 65.1 ± 9.3 years for late-onset CRC. With respect to anatomical tumour location (distal, rectal, and proximal), the frequencies were 61%, 28% and 11%, respectively, but the variation did not reach statically significance. There was a dramatic difference with regard to the history of CRC in second-degree relatives (SDR) and that of the combination of first-degree relatives and SDR (p=0.001 and p=0.03, respectively). Expression of the MLH1 and PMS2 genes were significantly different between survivors and deceased, however this finding was not observed with regard to the MSH6 and the MSH2 genes.
Conclusion: The variation of demographic, pathological and genetic characteristics of CRC between early-onset and late-onset cancers of this kind emphasizes the need for a well-defined algorithm to identify high-risk patients.
Figure 1