Assessing Molecular Biomarkers and Subtypes of Colorectal Cancer in the Asir Region, Saudi Arabia: A Clinical Exploration
Keywords:
Colorectal Cancer, Molecular Subtypes, Biomarkers, Demographic Factors, Asir RegionAbstract
Aim: The study aims to investigate the prevalence of molecular subtypes and key biomarkers of colorectal cancer (CRC) in patients from the Asir region of Saudi Arabia. It also seeks to identify the most common molecular subtype and assess its association with demographic and clinical factors such as age, gender, tumor size, pathological diagnosis, and tumor grading.
Background: Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide, with its incidence influenced by genetic, molecular, and environmental factors. Understanding the distribution of molecular subtypes and biomarkers can aid in the development of targeted therapies and screening programs. This study focuses on the CRC landscape in the Asir region, a specific population in Saudi Arabia, where region-specific data on molecular subtypes remain limited.
Methods: A retrospective, observational, and analytical study was conducted at Asir Central Hospital, Abha, Saudi Arabia, spanning from January 2021 to December 2024. The study involved 187 Saudi colorectal cancer patients who received treatment at the hospital during this period. Clinical and demographic data, including patient age, gender, tumor characteristics, and molecular subtype classification, were extracted and analyzed to identify potential associations.
Results: The findings revealed a significant association between gender and the occurrence of malignant tumors (P = 0.028), with a higher prevalence in males compared to females. However, there was no statistically significant link between gender and the occurrence of polyps (P = 0.276). The data also indicated that 44.92% of colorectal cancer cases occurred in individuals aged over 50 years, highlighting an increased risk for this age group.
Conclusion: The study concludes that colorectal cancer is more prevalent in males, particularly in those aged over 50 years. The insights into the relationship between molecular subtypes and demographic factors may inform screening programs and early detection strategies. These findings can contribute to improved patient care and public health initiatives in the Asir region.
Downloads
References
Sung H, Ferlay J, Siegel RL, et al (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 71, 209-9.
Arnold M, Abnet CC, Neale RE, et al (2020). Global Burden of 5 Major Types of Gastrointestinal Cancer. Gastroenterology, 159, 335-49.e15.
Makhlouf NA, Abdel-Gawad M, Mahros AM, et al (2021). Colorectal cancer in Arab world: A systematic review. World J Gastrointest Oncol, 13, 1791-8.
Nasr Eldin Elwali et al (2023). Colorectal Cancer in Saudi Arabia: The Way Forward. Asian Pac J Cancer Prev, 24 (1), 13-19
Chaudhri E, Fathi W, Hussain F, Hashmi SK (2020). The Increasing Trends in Cases of the Most Common Cancers in Saudi Arabia. J Epidemiol Glob Health, 10, 258-2.
Ibrahim E1, Bin SB, Banjar L, Awadalla S, Abomelha MS (2008). Current and future cancer burden in Saudi Arabia: meeting the challenge. Hematol Oncol Stem Cell Ther, 1, 210-5.
Algabbani AM, Almubark R, Althumiri N, Alqahtani A, BinDhim N (2018). The prevalence of cigarette smoking in Saudi Arabia in 2018. Food Drug Regul Sci J, 1, 1-1
Nashar RM1, Almurshed KS (2008). colorectal cancer: a case control study of dietary factors, King Faisal specialist hospital and research center, Riyadh, Saudi Arabia. J Fam Commun Med, 15, 57- 4.
Azzeh FS, Alshammari EM, Alazzeh AY, et al (2017). Healthy dietary patterns decrease the risk of colorectal cancer in the Mecca Region, Saudi Arabia: a case-control study. BMC Public Health, 17, 1-8.
Alazzeh AY, Azzeh FS (2018). Active lifestyle patterns reduce the risk of colorectal cancer in the Mecca region, Saudi Arabia: a case–control study. Eur J Cancer Prev, 27, 438-2.
Al-Eid HS, Garcia AD (2014). Cancer incidence report. Saudi Arabia, 2010, 38-9.
AlSulaim L, AlOdhaybi G, AlSalamah M, et al (2021). Awareness and knowledge of colorectal cancer in Qassim region, Saudi Arabia. Asian Pac J Cancer Care, 6, 397-5
Al-Ahwal MS, Al-Ghamdi A (2005). Pattern of colorectal cancer at two hospitals in the western region of Saudi Arabia. Saudi J Gastroenterol, 11, 164-9.
Bader T, Ismail A (2014). Higher prevalence of KRAS mutations in colorectal cancer in Saudi Arabia: Propensity for lung metastasis. Alexandria J Med, 50, 203-9.
Al-Shamsi HO, Jones J, Fahmawi Y, et al (2016) Molecular spectrum of KRAS, NRAS, BRAF, PIK3CA, TP53, and APC somatic gene mutations in Arab patients with colorectal cancer: determination of frequency and distribution pattern. J Gastrointest Oncol, 7, 882-2.
Andreyev HJ, Norman AR, Cunningham D, Oates JR, Clarke PA (1998). Kirsten ras mutations in patients with colorectal cancer: the multicenter “RASCAL” study. J Natl Cancer Inst, 90, 675-4.
Smith G, Carey FA, Beattie J, et al (2002). Mutations in APC, Kirsten-ras, and p53—alternative genetic pathways to colorectal cancer. Proc Natl Acad Sci U S A, 99, 9433-8.
Alsanea N, Abduljabbar AS, Alhomoud S, et al (2015). Colorectal cancer in Saudi Arabia: incidence, survival, demographics and implications for national policies. Ann Saudi Med, 35, 196-2.
Alyabsi M, Sabatin F, Ramadan M, Jazieh AR (2021). Colorectal cancer survival among Ministry of National Guard-Health Affairs (MNG-HA) population 2009–2017: retrospective study. BMC Cancer, 21, 1-1.
Siegel RL, Miller KD, Goding Sauer A, et al (2020). Colorectal cancer statistics, 2020. CA Cancer J Clin, 70, 145-4.
Khayyat YM, Ibrahim EM (2014). Public awareness of colon cancer screening among the general population: A study from the Western Region of Saudi Arabia. Qatar Med J, 1, 17–4.
Alaqel MA, Alshammari SA, Alahmari SM, et al (2021). Community knowledge and awareness of colorectal cancer and screening tools: Community-based survey of 1,912 residents of Riyadh. Ann Med Surg, 72, 103046.
Heavy PM, McKenna D, Rowland IR (2004). Colorectal cancer and the relationship between genes and the environment. Nutr Cancer, 48, 124–1.
Daca Alvarez M, Quintana, Terradas M, et al ( 2021). The inherited and familial component of early-onset colorectal cancer. Cells, 10, 710.
Sial SH, Catalano MF (2001). Gastrointestinal tract cancer in the elderly. Gastroenterol Clin North Am, 30, 565.
Triantafillidis JK, Nasioulas G, Kosmidis PA (2009). Colorectal cancer and inflammatory bowel disease: epidemiology, risk factors, mechanisms of carcinogenesis and prevention strategies. Anticancer Res, 29, 2727-7.
Baena R, Salinas P (2015). Diet and colorectal cancer. Maturitas, 80, 258-4.
Wu AH, Shibata D, Yu MC, Lai MY, Ross RK (1987). Alcohol, physical activity and other risk factors for colorectal cancer: a prospective study. Br J Cancer, 55, 687-4.
Frezza EE, Wachtel MS, Chiriva-Internati M (2006). Influence of obesity on the risk of developing colon cancer. Gut, 55, 285–91.
Botteri E, Iodice S, Bagnardi V, et al (2008). Smoking and colorectal cancer: a meta-analysis. JAMA, 300, 2765-8.
WHO. World Health Organization - Noncommunicable Diseases (Ncd) Country Profiles, 2018. Geneva, Switzerland: World Health Organization; (2018). Available at: https://www.who. int/nmh/countries/sau_en.pdf?ua=1.
Liu PH, Wu K, Ng K, et al (2019). Association of Obesity With Risk of Early-Onset Colorectal Cancer Among Women. JAMA Oncol, 5, 37–4.
Trinh A, Trumpi K, De Sousa E, Melo F, Wang X, de Jong JH, Fessler E, Kuppen PJ, Reimers MS, Swets M, Koopman M, Nagtegaal ID, Jansen M, Hooijer GK, Offerhaus GJ, Kranenburg O, Punt CJ, Medema JP, Markowetz F, Vermeulen L (2017) Practical and robust identification of molecular subtypes in colorectal cancer by immunohistochemistry. Clin Cancer Res 23(2):387–398.
Munkholm P (2003) The incidence and prevalence of colorectal cancer in inflammatory bowel disease. Aliment Pharmacol Ther 18:1–5.
Müller MF, Ibrahim AEK, Arends MJ (2016) Molecular pathological classification of colorectal cancer. Virchows Arch 469(2):125–134.
The Cancer Genome Atlas Network (326 collaborators) (2012) Comprehensive molecular characterization of human colon and rectal cancer. Nature 487(7407):330–
Poulogiannis G, Ichimura K, Hamoudi RA, Luo F, Leung SY, Yuen ST, Harrison DJ, Wyllie AH, Arends MJ (2010) Prognostic relevance of DNA copy number changes in colorectal cancer. J Pathol 220(3):338–347
Arends MJ (2013) Pathways of colorectal carcinogenesis. Appl Immunohistochem Mol Morphol 21(2):97–102.
Munkholm P (2003) The incidence and prevalence of colorectal cancer in inflammatory bowel disease. Aliment Pharmacol Ther 18:1–5.
Guinney J, Prager, G.W.; Taieb, J.; Fakih, M.; Ciardiello, F.; Van Cutsem, E.; Elez, E.; Cruz, F.M.; Wyrwicz, L.; Stroyakovskiy, D.; Pápai, Z.; et al. Trifluridine–Tipiracil and Bevacizumab in Refractory Metastatic Colorectal Cancer. N. Engl. J. Med. 2023, 388, 1657–1667.
Ros J, Vaghi C, Baraibar I, Saoudi González N, Rodríguez-Castells M, García A, Alcaraz A, Salva F, Tabernero J, Elez E. Targeting KRAS G12C Mutation in Colorectal Cancer, A Review: New Arrows in the Quiver. International Journal of Molecular Sciences. 2024; 25(6):3304.
Van de Haar, J.; Ma, X.; Ooft, S.N.; van der Helm, P.W.; Hoes, L.R.; Mainardi, S.; Pinato, D.J.; Sun, K.; Salvatore, L.; Tortora, G.; et al. Codon-Specific KRAS Mutations Predict Survival Benefit of Trifluridine/Tipiracil in Metastatic Colorectal Cancer. Nat. Med. 2023, 29, 605–614.
Hu J, Yan WY, Xie L, Cheng L, Yang M, Li L, Shi J, Liu BR, Qian XP. Coexistence of MSI with KRAS mutation is associated with worse prognosis in colorectal cancer. Medicine (Baltimore). 2016 Dec;95(50):e5649.
Cervantes A, Adam R, Roselló S, et al. Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and followup. Ann Oncol. 2023;34(1):10-32.
J. Taieb et al. (2023) Different prognostic values of KRAS exon 2 submutations and BRAF V600E mutation in microsatellite stable (MSS) and unstable (MSI) stage III colon cancer: an ACCENT/IDEA pooled analysis of seven trials Annals of Oncology 34 (11): 1025-1034
Abdulaziz Alfahed. Molecular pathology of colorectal cancer. Saudi Medical Journal September 2023, 44 (9) 836-847.
AlZaabi, A. (2022). Colorectal Cancer in the Arab World. In: Al-Shamsi, H.O., Abu-Gheida, I.H., Iqbal, F., Al-Awadhi, A. (eds) Cancer in the Arab World. Springer, Singapore.
Global Burden of Disease Cancer Collaboration. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol. 2019;5(12):1749–1768.
Lin, L., Li, Z., Yan, L. et al. Global, regional, and national cancer incidence and death for 29 cancer groups in 2019 and trends
Wang, K.S., Yu, G., Xu, C. et al. Accurate diagnosis of colorectal cancer based on histopathology images using artificial intelligence. BMC Med 19, 76 (2021). https://doi.org/10.1186/s12916-021-01942-5.
Sahin, Y., Durak, M.G., Mete, O. (2022). Biomarkers in Endocrine Organ Carcinomas. In: Sarioglu, S., Sagol, O., Aysal, A. (eds) Biomarkers in Carcinoma of Unknown Primary. Springer, Cham.
Published
How to Cite
License
Copyright (c) 2026 Saeed Mohammad Alnujami, Majed S Al Fayi, Abdullah M. Alshahrani, Irfan Ahmad, Mohammad Mahtab Alam, Adil Abdelrahim Mohammed Yousif, Hatem Mohammed A Asiri
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
