Makmun D, Simadibrata M, Abdullah M, Syam AF, Shatri H, Fauzi A, Renaldi K, Maulahela H, Utari AP, Pribadi RR, Muzellina VN, Nursyirwan SA. Colorectal cancer patients in a tertiary hospital in Indonesia: Prevalence of the younger population and associated factors. World J Clin Cases 2021; 9(32): 9804-9814 [PMID: 34877319 DOI: 10.12998/wjcc.v9.i32.9804]
Corresponding Author of This Article
Dadang Makmun, FACG, MD, PhD, Attending Doctor, Professor, Division of Gastroenterology, Pancreatobiliary & Digestive Endoscopy, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo National General Hospital, Jl. Pangeran Diponegoro No. 71, Jakarta 10430, Indonesia. hdmakmun@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 16, 2021; 9(32): 9804-9814 Published online Nov 16, 2021. doi: 10.12998/wjcc.v9.i32.9804
Colorectal cancer patients in a tertiary hospital in Indonesia: Prevalence of the younger population and associated factors
Dadang Makmun, Marcellus Simadibrata, Murdani Abdullah, Ari F Syam, Hamzah Shatri, Achmad Fauzi, Kaka Renaldi, Hasan Maulahela, Amanda P Utari, Rabbinu R Pribadi, Virly N Muzellina, Saskia A Nursyirwan
Dadang Makmun, Marcellus Simadibrata, Murdani Abdullah, Ari F Syam, Achmad Fauzi, Kaka Renaldi, Hasan Maulahela, Amanda P Utari, Rabbinu R Pribadi, Virly N Muzellina, Saskia A Nursyirwan, Division of Gastroenterology, Pancreatobiliary & Digestive Endoscopy, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo National General Hospital, Jakarta 10430, Indonesia
Hamzah Shatri, Clinical Epidemiology Unit, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo National General Hospital, Jakarta 10430, Indonesia
Author contributions: Makmun D designed and performed the research, conducted the analysis, and wrote the manuscript; Simadibrata M supervised the report and provided clinical advice; Shatri H contributed to the statistical analysis; and Makmun D, Simadibrata M, Abdullah M, Syam AF, Fauzi A, Renaldi K, Maulahela H, Utari AP, Pribadi RR, Muzellina VN and Nursyirwan SA performed the colonoscopy examination and provided clinical advice.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Faculty of Medicine Universitas Indonesia (Protocol No. 19-06-0751).
Informed consent statement: As this was a retrospective study and only existing data from medical records were collected, patients were not required to give informed consent to the study. However, all patients agreed by written consent to the medical treatment provided in the healthcare setting.
Conflict-of-interest statement: The authors declare having no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dadang Makmun, FACG, MD, PhD, Attending Doctor, Professor, Division of Gastroenterology, Pancreatobiliary & Digestive Endoscopy, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo National General Hospital, Jl. Pangeran Diponegoro No. 71, Jakarta 10430, Indonesia. hdmakmun@yahoo.com
Received: June 21, 2021 Peer-review started: June 21, 2021 First decision: July 18, 2021 Revised: August 15, 2021 Accepted: September 22, 2021 Article in press: September 22, 2021 Published online: November 16, 2021 Processing time: 141 Days and 22.7 Hours
Abstract
BACKGROUND
An increasing trend in colorectal cancer (CRC) occurring at younger ages has been observed worldwide, even though incidence is declining in the general population. Most currently available guidelines still recommend CRC screening for older populations, despite an alarming rise in early-onset CRC incidence. Risk stratification is necessary to further determine the population most at risk for early-onset CRC. However, epidemiological data on related clinical characteristics and potential risk factors, especially in developing countries, have not been widely reported.
AIM
To investigate the prevalence, demographics, clinicopathologic features, and associated factors of young-onset CRC patients in a tertiary hospital in Indonesia.
METHODS
Patients undergoing colonoscopy examination between 2008 and 2019, yielding a diagnosis of CRC were identified from medical records. The subjects were classified into two groups according to their age at diagnosis, namely early-onset (18-49 years old) and late-onset (≥ 50-years-old). Demographic data, characteristics, and risk factors of both onset age groups were evaluated using the chi-square and Fisher’s exact test.
RESULTS
Among 495 CRC patients confirmed by histopathology, 205 (41.4%) were classified as early-onset and 290 (58.6%) as late-onset. Most subjects in the early-onset CRC group were male (53.7%), with 89.8% displaying adenocarcinoma histopathology. A majority (78%) of the early-onset CRC patients had left-sided tumors, with the rectum (41%) and rectosigmoid (17.6%) being the most common sites. Abdominal pain was the most frequent symptom in the early-onset CRC patients (55.6%), which was significantly higher than that in the late-onset CRC patients (43.8%, P < 0.05). Early-onset CRC cases were more likely to be underweight (34.6% vs 20.0%, P < 0.001) compared to late-onset CRC cases. The proportion of subjects with suspected hereditary nonpolyposis colorectal cancer (HNPCC) was also higher in the early-onset CRC group than in the late-onset age group (9.3% vs 4.1%, P < 0.05). However, no difference was observed in the parental or family histories of CRC cases.
CONCLUSION
Early-onset CRC patients were more likely to have abdominal pain, underweight status, and HNPCC suspicion than late-onset CRC patients.
Core Tip: This is the first study to evaluate clinicodemographics of early-onset colorectal cancer (CRC) patients and associated factors in Indonesia during a 12-year period from 2008-2019. We observed a slight increase in patients with early-onset CRC during the period of 2014-2019 compared to the period of 2008-2013. A larger proportion of patients with early-onset CRC were underweight, presented with abdominal pain, and suspected of suffering from hereditary nonpolyposis colorectal cancer.
