Epidemiological characteristics, prognostic factors, and survival of resectable colorectal cancer in a Moroccan population.

Abstract

Introduction: Colorectal cancer is one of the most common digestive cancers worldwide and constitutes a major public health problem in Morocco, a country where its incidence is increasing. The majority of patients are often diagnosed at an advanced stage, which sometimes compromises the prognosis. This study aims to describe the epidemiological, clinical, and histopathological profile of colorectal adenocarcinomas in Morocco and to identify prognostic factors influencing survival.

Materials and methods: We conducted a prospective, descriptive, and analytical multicenter study between February 2015 and February 2021, including 214 patients with histologically confirmed colorectal adenocarcinoma, followed up in three Moroccan university hospitals (Fez, Oujda, and Rabat). Clinical, pathological, and therapeutic data were collected from medical records. Overall survival was estimated using the Kaplan-Meier method, and prognostic factors were evaluated using multivariate analysis.

Results: The mean age of patients was 57 years (22-86 years), with a sex ratio of 1.02. Colonic forms accounted for 45.8% of cases, mostly located in the left colon, and rectal forms 33.2%, predominantly in the lower rectum. Significant complications were present in 21.5% of cases, primarily obstructions. Histologically, 52.3% of tumors were well differentiated, and 10.3% had a mucinous component. Curative resection was possible in 60.3% of cases. Overall survival was 82% at 1 year, 70.5% at 2 years, and 48.9% at 5 years. Factors associated with a poor prognosis were male gender, age <50 years, advanced tumor stage, the presence of a mucinous component, and the need for palliative treatment.

Discussion: Consistent with global research, our results emphasize the prevalence of late-stage diagnoses and the detrimental effect of tumor complications on survival. Due to delayed presentation and limited early detection, the five-year survival rate is still lower than in Western nations. Poorer outcomes are linked to a mucinous component and a younger age at diagnosis, highlighting the importance of early intervention and focused screening.

Conclusion: Colorectal cancer in Morocco is diagnosed late in nearly one-third of cases, with a major impact on survival. Management is based on a multidisciplinary approach integrating surgery, chemotherapy, and radiotherapy. The prognosis is significantly better for early-diagnosed forms undergoing surgery with R0 resection. Strengthening screening and improving access to care are essential to reduce CRC-related mortality in Morocco.