Introduction

Colorectal Cancer (CRC) is the third most common cancer worldwide. Only scant data is known regarding specific ethnicities and minorities. The Arab population in Israel is about 20% of the population; the Arab population in Israel has unique historical, social, and cultural characteristics. The Arab society in Israel has undergone major and rapid changes in lifestyle in the last five decades, from agricultural to urban society, with changes in nutrition, a high rate of smoking among men, a low rate of physical activity, and a high rate of consanguinity, which affect the health of the population.

Aims & Methods

We aimed to investigate the general characteristic, comorbidities, and all cause-mortality of CRC among the Arab population compared to the Jewish population.
CRC patients, according to ICD-10 codes were retrospectively included between the years 1999 and 2021. Data regarding demographics, age at diagnosis, comorbidities, and mortality were collected. Data were retrieved using the MdClone platform from the largest Health Maintenance Organization, “Clalit” in Israel. The risk factors and comorbidities were compared between young patients (≤50 years) compared to the other patients.

Results

61,679 CRC patients were included in the present study, 4891 (7.9%) of Arab ethnicity and 56,788 of Jewish ethnicity. Age at diagnosis is significantly younger Among Arab (62.5±14 vs 70.8±13 years, p<0.001), with a higher males proportion of 51.3% vs 49.2%, p=0,005). 21.3% of the Arab CRC patients were diagnosed at age 50 or younger, compared to 8% of Jewish patients, p<0.001. Significant differences were found in family history of CRC and smoking (3.6% vs 6.2%, 34.9% vs 30%, respectively. Higher rates of diabetes mellitus and obesity were found among Arab patients (37.6% vs 27.5%, and 36% vs 21.4%, p<0.001), while lower rates of ischemic heart disease, hypertension and chronic kidney disease (9.7% vs 12.6%, 45.6% vs 53.7% and 8.1% vs 10.3%, p<0.001, respectively.
All-cause mortality was lower among patients of Arab ethnicity (49.6% vs 60.8%, p<0.001) with younger age at death (70.9±14.5 vs 79.8±11.8, p<0.001).

Conclusion

Disparities in risk factors, comorbidities, and all-cause mortality were found in different ethnic groups; special consideration is needed for specific ethnicities and minorities according to the colon cancer characteristics.

Introduction

Colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer death worldwide, with over 1.9 million new cases and 0.9 million deaths in 2020. CRC is a major health burden globally and in the Middle East. Lebanon has reported one of the highest CRC incidences in the region, but detailed trends over the past two decades are not well characterized. This study analyzes the evolution of CRC epidemiology in Lebanon from 2001 to 2024.

Aims & Methods

We conducted a retrospective analysis of CRC cases spanning 24 years, grouped into five intervals: 2001–2005, 2006–2010, 2011–2015, 2016–2019, and 2020–2024. Data were obtained from National Institute of Pathology registry. Variables included patient age, sex, tumor anatomic location, and stage at diagnosis (TNM). Incidence trends were evaluated using national registry. Descriptive statistics and interval comparisons were performed to identify temporal changes in CRC incidence and characteristics.

Results

The annual CRC incidence in Lebanon rose markedly over the study period. Age-standardized incidence rates increased from 16.3 per 100,000 (males) and 13.0 (females) in 2005 to 23.2 and 20.2 by 2016. By 2018, 1109 new CRC cases were diagnosed, making it the second most common cancer among Lebanese women and fourth in men. The median age at diagnosis shifted upward (early 60s in 2001–2005 to 67 years in 2020–2024), although a growing proportion of cases appeared in younger adults (notably the 40–49 age group). The male-to-female ratio remained approximately 1:1 throughout (52% male in early 2000s vs 50% by early 2020s), indicating near parity. Tumor location distribution showed a predominance of left-sided cancers across all periods, but with a modest proximal shift over time. More than 70% of tumors were distal (left colon or rectum) in the early 2000s, whereas by 2020–2024 about 35% were right-sided. Stage at diagnosis remained advanced in most patients, though there was a small improvement: 20% of cases were early stage (I–II) in 2001–2005 versus 25% by 2020–2024. Despite this trend, a majority of patients in the latest interval still presented with regional or metastatic disease.

Conclusion

CRC incidence in Lebanon has increased substantially over the past two decades, reaching levels comparable to Western countries. The patient profile has evolved to a slightly older median age, with hints of an increase in younger-onset cases, and the male-to-female incidence gap has virtually disappeared. Tumors remain predominantly left-sided, although the proportion of right-sided cancers has risen, likely reflecting an aging population. While there are signs of earlier diagnosis (more Stage I–II cases in recent years), most CRCs are still detected at late stages. These findings underscore the need for strengthened national CRC screening and public health strategies – including awareness campaigns and earlier screening initiation – to curb incidence and improve early detection in Lebanon.

Introduction

Risk factors for rectal neuroendocrine tumor (NET) has not been reported in a cohort setting, even if their association was reported in a cross sectional study. We investigated sex-specific risk factors of rectal NET in a population-based cohort.

Aims & Methods

This is a population-based cohort study. Cancer and NET-free individuals who underwent general health examination during 2010 at the Korean National Health Insurance Service were enrolled and followed through 2017. Many epidemiologic factors and lipid were evaluated. Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) determined by Cox regression analysis were used to investigate risk of NET.

Results

Rectal NET was newly detected in 2339 of 5.522 million individuals. In adjusted analysis, male sex (HR, 1.32; 95% CI, 1.17-1.48), current smoker (HR, 1.19), past smoker (HR,1.14), and obesity (HR, 1.462; 95% CI, 1.01-2.11 in BMI >=30) increased the risk of rectal NET. Frequent alcohol consumption increased the risk of rectal NET with dose dependent manner (HR, 1.36 in 1/week, 1.47 in 2-3/week, 1.54 in 4-5/week, 1.16 in >=6/week). In men, current smoker, past smoker, frequent alcohol consumption, and obesity (HR, 2.51; 95% CI, 1.41-4.45 in BMI >=30) increased the risk of NET. In women, past smoker (HR, 1.65), frequent drinker, and previous hysterectomy history (HR, 1.54; 95% CI, 1.16-2.03) increased the risk of rectal NET. Younger age was associated with rectal NET risk in both men and women.

Conclusion

Younger age, smoking, frequent alcohol consumption increased the risk of rectal NET in both men and women, whereas obesity markedly increased rectal NET in men but not in women. In women, previous hysterectomy history increased the risk of rectal NET.

Introduction

Colorectal cancer’s (CRC) incidence above 50 years old has been decreasing globally in the last decades, but its incidence in patients below 50 years old (early-onset colorectal cancer, EO-CRC) has been increasing, for reasons not yet fully understood.

Aims & Methods

A unicentric cohort study was conducted in a tertiary centre, including all patients admitted for a first diagnosis of CRC and evaluated by the Multidisciplinary Colorectal Cancer Group from 01.01.2017 until 31.12.2018. Patients with a previous diagnosis of a Hereditary Colorectal Cancer Syndrome were excluded.

Results

A total of 438 patients were included, 58.2% males, with a mean age at diagnosis of 67.7±11.1 years old. Mean follow-up time was 41.49 months. There were 25 EO-CRC patients (5.7%), 17 males (68%), mean age 43.1±6.0 years old.
Globally, 32.4% of the patients were current or past smokers, 18.5% had previous non-colorectal cancer, 7.5% and 3.4% were previously exposed to immunosuppressive drugs or abdominal/pelvic radiotherapy, respectively. The majority presented with normal(29.7%) to high Body Max Index (39.7%), median 25.6 (IQR:22.6-28.4) Kg/m². The most common CRC location was the rectum (42.9%) and 56.1% were stage I or II (AJCC 8^th edition).
In the univariate analysis, a significant association was found between EO-CRC and: smoking status (past or current smokers 52% in EO-CRC vs. 31.2% in older cases p=0.009); lymphovascular invasion (40.0% in EO-CRC vs. 17.4% in over 50, p=0.018) No significant differences were found for histological subtype (p=0.447), perineural invasion (p=0.474), or tumor stage at diagnosis, although a relevant proportion of the younger patients had metastatic disease at diagnosis (28.0% vs. 12.8%, p=0.064).
Immunohistochemistry for mismatch-repair proteins showed loss of expression of at least one protein in 1/18 EO-CRC patients and 22/179 of older patients (p=0.728).
From the EO-CRC patients, 16 were evaluated in the Familial Cancer Clinic and 14 underwent germline mutation analysis: 13 patients had inconclusive results, one of them presented a MUTYH heterozygote mutation and another was diagnosed with MUTYH-associated Polyposis (composed heterozygote mutation).

Conclusion

Colorectal cancer showed distinctive features in the younger population, with a higher prevalence of lymphovascular invasion and, possibly, a higher incidence of metastatic disease at diagnosis. Smoking had a significant association with CRC, especially in this younger population. Whether this means there is a biological difference is not yet clear. More evidence is needed in order to clarify EO-CRC aetiology and to develop screening and improve management strategies.

References

Siegel RL, Jakubowski CD, Fedewa SA, Davis A, Azad NS. Colorectal Cancer in the Young: Epidemiology, Prevention, Management. Am Soc Clin Oncol Educ Book. 2020 Mar;40:1-14. doi: 10.1200/EDBK_279901. PMID: 32315236

Introduction

Colorectal cancer (CRC) is one of the most common digestive tract malignant tumors, and its incidence rate and mortality rate rank third among all malignant tumors. The IMMUNOGLOBULIN SUPERFAMILY DOMAINS genes has been reported to be hypermethylated in human colorectal cancer (CRC) cell lines and primary tumor tissues, .On the other hand High mobility group genes are characteristically present at high levels in a variety of human cancers including colorectal, ovarian, breast, lung, and pancreatic cancer.

Aims & Methods

The aim of the work to evaluate the gene expression of both leucine-rich repeats and immunoglobulin-like domains 1 (LRIG1) (as an example of immunoglobulin sperfamily domains and High mobility group AT-hook 2 (HMGA2) as an example of high mobility group as diagnostic and prognostic markers in cases of colorectal cancer.
In this study forty-five patients pathologically approved with colorectal cancer were prospectively analyzed for LRIG1 and HMGA2 genes expression at tissue level. SYBR Green Real-Time RT-PCR technique was used for gene expression analyses and β-actin gene was considered as a reference gene for data normalization. Additionally, appropriate statistical analyses were used to assess the expression of LRIG1 and HMGA2 in diseased and adjacent healthy tissues.

Results

HMGA2 mRNA gene expression was over-expressed in CRC tissue than normal tissue ( median fold change and median Log² ratio are [9.3(0.2, 100.4) and 3.1(-2.6, 6.7), respectively]with positive correlation between HMGA2 and poor differentiation ,more advanced stage and lymph node metastasis(p> 0.05) but not with distant metastasis (p >0.05) , The expression of LRIG1 mRNA gene in tumor tissue was low expressed in colorectal tumor tissues (Median fold change and median Log2 ratio are [0.29(0.01, 4.14) and -1.8(-6.1, 2.1), respectively but no correlation of the LRIG1 gene with the the stage, Differentiation and metastasis of the CRC (P >0.05). There is no correlation of both genes neither with tumor biomarkers (CA19-9, CEA) nor with laboratory findings (WBCs, Hemoglobin, Platelet, INR, Albumin, Creatinine) P>0.5%). The overall survival showed no significant association with any genetic expression of both genes (P >0.05).

Conclusion

LRIG1 low expression may be considered for diagnosis but not valuable as prognostic marker in colorectal cancer patients. However, HMGA2 overexpression may be valuable as both diagnostic and prognostic markers in CRC.

Disclosure

No conflict of interest to be disclosed