Epidemiology, access to treatments and clinical outcomes of colorectal cancer in Brazil: a 16-year longitudinal analysis evaluating more than 240,000 patients

Keywords

colorectal cancer - epidemiology - survival

Introduction: Colorectal cancer (CRC) is a global health issue. The incidence rate of the disease is strictly linked to the human development index (HDI). Nevertheless, epidemiology, access to treatments and clinical outcomes of CRC is scarcely described in low- and middle-income countries, such as Brazil.

Objectives: Evaluate the epidemiology, access to treatments and clinical outcomes of CRC in Brazil Methods: Data from CRC patients registered in the national databases of the Brazilian Unified Health System - SUS (Mortality Information Systems— SIM, Outpatient Information System—SIA/SUS, and Hospital Information System—SIH/SUS) from 1999 to 2015 were obtained. These databases include information from the 26 Brazilian states and the Federal District.

Results: A total of 242.465 new cases of colorectal cancer were documented, of which 68,7% were colon cancer and 31,3% rectal cancer. The median age at diagnosis was 58 years. 50,1% were male. Staging information was available for 130.450 patients: 3,2% stage I, 26,9% stage II, 40,4% stage III, and 29,5% stage IV. The first treatment modality was surgery in 63,8%, chemotherapy in 30,6%, and radiotherapy in 5,6% of patients. 76,7% of patients received treatment within 60 days of diagnosis (median 53 days). The longest waiting time for the start of treatment was observed in the northern region (median 68 days), followed by the southeast (median: 59 days), northeast (median: 49 days), central-west (median: 44 days) and southern (median: 40 days) (p<0.05). Mortality in this cohort was 39%. Overall survival at 1-year, 2-years, 5-years and 10-years was 70%, 66%, 59% and 51% respectively. Colon cancer, male sex, African American ethnic background, and age over 50 years were associated with worse survival.

Conclusion: This is the largest Brazilian cohort study of CRC patients with sociodemographic data so far. In agreement with international literature, the majority of patients were diagnosed at later stages. Mortality rate around 40% is in line with SEER data. Colon cancer, male sex, African American ethnic background, and age over 50 years were associated with worse survival. Screening programs must be strengthened throughout the country.

Corresponding author: Thais de Melo Passarini (e-mail: [e-mail]).

 

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Artikel online veröffentlicht:
06. Mai 2025