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Alfahed A. Molecular pathology of colorectal cancer: The Saudi situation in perspective. Saudi Med J 2023; 44:836-847. [PMID: 37717975 PMCID: PMC10505285 DOI: 10.15537/smj.2023.44.9.20230257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common cancers worldwide, and one of the most common causes of cancer deaths. In recent times, significant advancements have been made in elucidating the molecular alterations of the disease, and the results have been an improved understanding of CRC biology, as well as the discovery of biomarkers of diagnostic, prognostic, and therapeutic significance. In this review, an evaluation is carried out of the molecular pathology research of CRC emanating from Saudi Arabia. The verdict is that the data on the molecular alterations in CRC from Saudi patients is at best modest. This dearth of molecular pathology data is aptly reflected in the paucity of molecular markers recommended for testing by the Saudi National Cancer Centre guidelines for CRC management. Large scale multi-institutional and multiregional translational studies are required to generate molecular data that would inform diagnostic, prognostic, and risk-stratification guidelines for Saudi CRC patients.
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Affiliation(s)
- Abdulaziz Alfahed
- From the Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Kingdom of Saudi Arabia
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Clinicopathological Characteristics and Overall 5-Year Survival of Colorectal Cancer: A Retrospective Study. Med Sci (Basel) 2022; 10:medsci10030042. [PMID: 35997334 PMCID: PMC9396983 DOI: 10.3390/medsci10030042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 12/24/2022] Open
Abstract
Colorectal cancer (CRC) is the third leading cause of cancer-related death. We aimed to investigate the clinicopathological characteristics and 5-year survival in CRC. This retrospective study reviewed King Abdulaziz University Hospital records from 2009 to 2019. Tumor staging was performed using Dukes’ pathological classification. Additionally, we measured the frequency of qualitative data and performed the chi-square and Mann−Whitney U-tests. Kaplan−Meier analysis was performed to calculate overall survival. Of the 574 included patients (age (mean ± standard deviation), 55.51 ± 14.28 years), 43.2% were Saudis, and most were male (58.7%). The rectum was the most common location of CRC (30.8%); 33.1% of patients presented with abdominal pain. The dominant histological variant was mucinous adenocarcinoma (95.5%). Age at diagnosis was significantly associated with Dukes’ staging; 36.3% of individuals aged <50 years had Dukes’ D stage. The 5-year survival rate was 47.9%. Better survival was noted for those of Saudi nationality, those with Dukes’ A stage, and those who were overweight (51.6%, 56.3%, and 46.8%, respectively). Significantly better survival was seen in Saudi patients due to accessible healthcare and in overweight patients due to better treatment tolerance. The outcome of CRC was not related to sex or metformin use in patients with diabetes mellitus.
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Almuzzaini B, Alghamdi J, Alomani A, AlGhamdi S, Alsharm AA, Alshieban S, Sayed A, Alhejaily AG, Aljaser FS, Abudawood M, Almajed F, Samman A, Balwi MAA, Aziz MA. Identification of Novel Mutations in Colorectal Cancer Patients Using AmpliSeq Comprehensive Cancer Panel. J Pers Med 2021; 11:jpm11060535. [PMID: 34207827 PMCID: PMC8230213 DOI: 10.3390/jpm11060535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/25/2021] [Accepted: 05/30/2021] [Indexed: 02/07/2023] Open
Abstract
Biomarker discovery would be an important tool in advancing and utilizing the concept of precision and personalized medicine in the clinic. Discovery of novel variants in local population provides confident targets for developing biomarkers for personalized medicine. We identified the need to generate high-quality sequencing data from local colorectal cancer patients and understand the pattern of occurrence of variants. In this report, we used archived samples from Saudi Arabia and used the AmpliSeq comprehensive cancer panel to identify novel somatic variants. We report a comprehensive analysis of next-generation sequencing results with a coverage of >300X. We identified 466 novel variants which were previously unreported in COSMIC and ICGC databases. We analyzed the genes associated with these variants in terms of their frequency of occurrence, probable pathogenicity, and clinicopathological features. Among pathogenic somatic variants, 174 were identified for the first time in the large intestine. APC, RET, and EGFR genes were most frequently mutated. A higher number of variants were identified in the left colon. Occurrence of variants in ERBB2 was significantly correlated with those of EGFR and ATR genes. Network analyses of the identified genes provide functional perspective of the identified genes and suggest affected pathways and probable biomarker candidates. This report lays the ground work for biomarker discovery and identification of driver gene mutations in local population.
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Affiliation(s)
- Bader Almuzzaini
- King Abdullah International Medical Research Center, Medical Genomics Research Department, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia;
- Correspondence: (B.A.); (M.A.A.); Tel.: +966-11-429-4533 (B.A.); +966-11-429-4582 (M.A.A.)
| | - Jahad Alghamdi
- King Abdullah International Medical Research Center, Saudi Biobank, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh 11481, Saudi Arabia; (J.A.); (A.S.)
| | - Alhanouf Alomani
- Department of Pathology, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13318, Saudi Arabia;
| | - Saleh AlGhamdi
- Clinical Research Department, Research Center, King Fahad Medical City, Riyadh 11564, Saudi Arabia;
| | - Abdullah A. Alsharm
- Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11564, Saudi Arabia;
| | - Saeed Alshieban
- King Abdul Aziz Medical City-National Guard Health Affairs (NGHA), King Abdullah International Medical Research Center, King Saud Bin Abdul Aziz University for Health Sciences (KSAU-HS), Riyadh 14611, Saudi Arabia;
| | - Ahood Sayed
- King Abdullah International Medical Research Center, Saudi Biobank, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh 11481, Saudi Arabia; (J.A.); (A.S.)
| | | | - Feda S. Aljaser
- Department of Clinical Laboratory Sciences, Chair of Medical and Molecular Genetics Research, College of Applied Medical Sciences, King Saud University Riyadh, Riyadh 11564, Saudi Arabia; (F.S.A.); (M.A.)
| | - Manal Abudawood
- Department of Clinical Laboratory Sciences, Chair of Medical and Molecular Genetics Research, College of Applied Medical Sciences, King Saud University Riyadh, Riyadh 11564, Saudi Arabia; (F.S.A.); (M.A.)
| | - Faisal Almajed
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh 11481, Saudi Arabia;
| | - Abdulhadi Samman
- Department of Pathology, Faculty of Medicine, University of Jeddah, Jeddah 23218, Saudi Arabia;
| | - Mohammed A. Al Balwi
- King Abdullah International Medical Research Center, Medical Genomics Research Department, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia;
| | - Mohammad Azhar Aziz
- King Abdullah International Medical Research Center, Colorectal Cancer Research Program, Department of Cellular Therapy and Cancer Research, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
- Correspondence: (B.A.); (M.A.A.); Tel.: +966-11-429-4533 (B.A.); +966-11-429-4582 (M.A.A.)
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Mulla N, Alshareef A, Syed AR, Al-Jahel M. Clinico-Pathological Study of K-ras Mutations in Colorectal Tumors: A Single-Center Retrospective Study of 51 Patients in Madinah, Saudi Arabia. Cureus 2020; 12:e9978. [PMID: 32983680 PMCID: PMC7511070 DOI: 10.7759/cureus.9978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Colorectal cancer (CRC) is one of the leading types of cancer worldwide and in Saudi Arabia. At the molecular level, CRC is very complicated and requires establishing comprehensive patient stratification models through identification of patients who will benefit or will not benefit from targeted therapy. We retrospectively investigated and analyzed the frequency of Kirsten-ras (K-ras) mutation and its correlation with patients' characteristics as weel as its association with clinicopathological features (i.e age, gender, clinical stage, anatomical site, histological subtype, degree of histological differentiation and metastatic site) in patients with CRC. Methods Medical records and paraffin-embedded tumor samples from 51 patients with histologically proven colorectal adenocarcinoma referred to Madinah center in Saudi Arabia were analyzed for the occurrence of rat sarcoma virus (RAS) mutations. Results RAS mutations occurred in 43% of the patients; 91% of these mutations were in K-ras. Seventy-five percent of these K-ras mutations were in codon 12, most commonly p.G12D. Codon 13 mutations occurred in 20% of tumors: all of these were p.G13D (100%). The percentage of K-ras mutations occurrence was higher in young patients (≤50) compared with the older patients (>50) (54.5% and 35%, respectively). Similarly, the percentage of K-ras mutations occurrence was higher in the right-sided tumors compared with the left-sided tumors (57.1% and 32.4%, respectively). Patients' characteristics and clinicopathological features were not significantly associated with K-ras mutations. Conclusions K-ras mutations are common among Saudi patients diagnosed with CRC in Madinah, especially pG12V and pG12D in codon 12. Further investigation would be required to establish correlation of K-ras mutations in larger cohorts.
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Affiliation(s)
- Nasser Mulla
- Department of Internal Medicine, College of Medicine, Taibah University, Madinah, SAU
| | - Abdulraheem Alshareef
- Department of Medical Laboratories Technology, College of Medicine, Taibah University, Madinah, SAU
| | - Abdul Rahman Syed
- Department of Pathology, King Fahad Hospital, Ministry of Health, Madinah, SAU
| | - Majid Al-Jahel
- Department of Oncology, King Fahad Hospital, Ministry of Health, Madinah, SAU
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Al-Ghafari AB, Balamash KS, Al Doghaither HA. Serum vitamin D receptor (VDR) levels as a potential diagnostic marker for colorectal cancer. Saudi J Biol Sci 2020; 27:827-832. [PMID: 32127758 PMCID: PMC7042625 DOI: 10.1016/j.sjbs.2020.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/29/2019] [Accepted: 01/06/2020] [Indexed: 01/17/2023] Open
Abstract
Colorectal cancer (CRC) is one of the leading causes of mortality and morbidity worldwide, and there has been a significant increase in the incidence of CRC in recent decades. Therefore, there is an urgent need to identify blood biomarkers that can be used for early diagnosis. It is not yet clear whether the level of vitamin D and its receptor, vitamin D receptor (VDR), in the blood are helpful factors in the diagnosis of CRC. Therefore, the study focuses on determining the VDR serum level’s contribution and other chemical parameters to the risk of CRC. A total of 189 Saudi participants (66 CRC patients and 123 control patients) aged 20–80 years old were enrolled in this case-control study. A serum sample was collected from each participant, and the levels of VDR and other bone profile tests were determined using ELISA or chemiluminescent assays. P values < 0.05 were considered statistically significant. The results showed a highly significant reduction in the levels of total vitamin D (P < 0.0001), VDR (P < 0.0001), vitamin D3 (P < 0.05), and calcium (P < 0.0001) in the serum of CRC patients compared to the controls. However, the alkaline phosphatase level was higher in CRC patients compared to the controls (P < 0.0001). None of the blood markers showed a significant correlation to the progression of CRC (P > 0.05). More investigation is needed to elucidate different physiological processes that can be affected by these blood biomarkers, therefore changing the carcinogenesis of CRC.
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Affiliation(s)
- Ayat B Al-Ghafari
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, P.O.Box 80200, Jeddah 21589, Saudi Arabia.,Experimental Biochemistry Unit, King Fahd Medical Research Center, King Abdulaziz University, P.O. Box 3270, Jeddah, 22252 Saudi Arabia.,Cancer and Mutagenesis Unit, King Fahd Medical Research Center, King Abdulaziz University, P.O. Box 3270, Jeddah, 22252 Saudi Arabia
| | - Khadijah S Balamash
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, P.O.Box 80200, Jeddah 21589, Saudi Arabia
| | - Huda A Al Doghaither
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, P.O.Box 80200, Jeddah 21589, Saudi Arabia
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Colorectal cancer in Saudi Arabia as the proof-of-principle model for implementing strategies of predictive, preventive, and personalized medicine in healthcare. EPMA J 2019; 11:119-131. [PMID: 32140189 DOI: 10.1007/s13167-019-00186-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/14/2019] [Indexed: 12/24/2022]
Abstract
Colorectal cancer (CRC) is the most commonly diagnosed cancer among Saudi males and ranks third in females with up to 73% of cases diagnosed at late stage. This review provides an analysis of CRC situation in the Kingdom of Saudi Arabia (KSA) from healthcare perspective. A PUBMED (1986-2018) search was done to identify publications focusing on CRC in KSA. Due to reports of increased CRC incidence among young age group (< 50), and given the young population of KSA, the disease may burden the national healthcare system in the next decades. Environmental factors attributed to increasing incidence rates of CRC include red meat consumption, sedentary lifestyle, and increased calorie intake. Despite substantial investment in healthcare, attention to predictive diagnostics and targeted prevention is lacking. There is a need to develop national screening guidelines based on evidence that supports a reduction in incidence and mortality of CRC when screening is implemented. Future approaches are discussed based on multi-level diagnostics, risk assessment, and population screening programs focused on the needs of young populations that among others present the contents of the advanced approach by predictive, preventive, and personalized medicine. Recommendations are provided that could help to develop policies at regional and national levels. Countries with demographics and lifestyle similar to KSA may gain insights from this review to shape their policies and procedures.
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Affiliation(s)
- Mohammad Azhar Aziz
- Colorectal Cancer Research Program, King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affair, Riyadh, KSA,Address for correspondence: Dr. Mohammad Azhar Aziz, King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affair, PO Box 3660, Riyadh 11426, KSA. E-mail:
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Almadi MA, Alghamdi F. The gap between knowledge and undergoing colorectal cancer screening using the Health Belief Model: A national survey. Saudi J Gastroenterol 2019; 25:27-39. [PMID: 30618441 PMCID: PMC6373220 DOI: 10.4103/sjg.sjg_455_18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/AIMS Colorectal cancer (CRC) is a public health issue, and before the initiation of a national cancer screening program, there is a need to examine the acceptance of the public to undergo CRC screening and explore potential barriers. MATERIALS AND METHODS A nationwide survey was conducted using an electronic platform to collect demographic variables and using the Health Belief Model to assess attitudes and behavior of participants as well as the knowledge about and intent to undergo CRC screening. At the end of the survey, participants from Riyadh were invited to get screened for CRC. RESULTS Responses from 5720 individuals covering all the 13 jurisdictions of Saudi Arabia were collected. Males represented 71.53% of the respondents; the mean age was 43.28 years and 15.24% had already undergone CRC screening using various methods, mostly colonoscopy (72.73%). The mean knowledge score was 11.05 (standard deviation 4.4, range 1-23), with no difference between genders, jurisdictions of the Kingdom, between those who expressed interest in screening and those who did not, and between those who accepted the invitation to undergo CRC screening and those who did not. Participants displayed positive attitudes toward both CRC screening and colonoscopy as a screening tool, and 73% expressed willingness to undergo screening. On multivariate analysis, male gender was the only factor associated with a higher probability of accepting screening, whereas neither knowledge nor willingness to undergo screening predicted accepting the invitation to screening. CONCLUSION Although the majority of participants were willing to undergo screening, no significant correlation between knowledge and willingness to undergo screening were predictors of screening uptake. Other areas that could be targeted in the promotion of CRC screening uptake to bridge the gap between "knowing" and "doing" should be explored.
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Affiliation(s)
- Majid A. Almadi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia,Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada,Address for correspondence: Dr. Majid A. Almadi, Division of Gastroenterology, King Khalid University Hospital, King Saud University, P.O. Box 2925 (59), Riyadh 11461, Saudi Arabia. E-mail:
| | - Faisal Alghamdi
- Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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