title: A comparison of colorectal cancer in Nigerian and North American patients: is the cancer biology different?
abstract: BACKGROUND
  Of the 24 million people predicted to have cancer by 2050, 70% will live in low- and middle-income countries (LMIC). As a result, cancer care is becoming a priority for health care systems in West Africa. This study compares the presentation and pattern of spread of colorectal cancer (CRC) observed in a hospital in West Africa with that of a North American referral center.
  
  
  METHODS
  Data on all adults presenting with CRC at a hospital in Nigerian patients (West Africa; 1990-2011) and all adults with stages III or IV CRC at a specialty hospital in (New York City, New York, North America; 2005-2011) were examined retrospectively. Demographic data, stage of disease, site of metastasis, and survival were compared.
  
  
  RESULTS
  There were 160 patients identified in West Africa and 1,947 patients identified in North America. Nigerian patients were younger (52 vs 59 years; P < .01) and presented with a later stage of disease (58% stage IV vs 47%; P < .01). Site of disease presentation was different between West African and North American patients (P < .01); 2.2% of West African patients presented with liver metastases only compared with 48.1% of North American patients. Conversely, 61.3% of patients in West Africa presented with peritoneal metastases only compared with 5.4% in North America. Overall survival stratified by stage at presentation (III/IV) showed worse prognosis for patients in either stage subgroup in Nigeria than North America.
  
  
  CONCLUSIONS
  We found differences in the presentation, metastatic pattern, and outcomes of CRC in Nigerian (West Africa) when compared with New York City (North America). Late detection and differential tumor biology may drive the differences observed between the sites. Future studies on early CRC detection and on tumor biology in LMIC will be critical for understanding and treating CRC in this region.
authors: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors: Saurabh
authors: S
authors: Saluja
authors: Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria.
authors: Olusegun I
authors: OI
authors: Alatise
authors: Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria.
authors: Adisa
authors: A
authors: Adewale
authors: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors: Justine
authors: J
authors: Misholy
authors: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
authors: Joanne
authors: J
authors: Chou
authors: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
authors: Mithat
authors: M
authors: Gonen
authors: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors: Martin
authors: M
authors: Weiser
authors: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: kinghamt@mskcc.org.
authors: T Peter
authors: TP
authors: Kingham
mesh_terms: D000328:Adult; D000368:Aged; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009519:New York City / Q000453:epidemiology; D009549:Nigeria / Q000453:epidemiology; D010534:Peritoneal Neoplasms / Q000556:secondary; D011379:Prognosis; D012189:Retrospective Studies