Cancer Survival by Stage at Diagnosis in Kuwait: A Population-Based Study.

OBJECTIVE: To examine the distribution of stage at diagnosis for 12 cancers in Kuwait, to estimate stage-specific net survival at 1 and 5 years after diagnosis, and to assess differences in stage-specific survival between Kuwait and the United States. MATERIAL AND METHODS: Data were obtained from the Kuwait Cancer Registry, for Kuwaiti patients diagnosed during 2000-2013, with follow-up to 31 December 2015. The distribution of Surveillance Epidemiology and End Results (SEER) Summary Stage for 12 malignancies was examined. We estimated net survival by stage up to 5 years after diagnosis, controlling for background mortality with life tables of all-cause mortality in the general population by single year of age, sex, and calendar period. Survival estimates were age-standardised using the International Cancer Survival Standard (ICSS) weights. RESULTS: Only 14.2% of patients were diagnosed at a localised stage and 38.9% at the regional stage. The proportion of patients with known stage was 88.9% during 2000-2004 but fell to 59.4% during 2010-2013. During 2005-2009, 1- and 5-year survival for colon, rectal, breast, cervical, and prostate cancer was about 90% or higher for patients diagnosed at the localised stage. During 2004-2009, the proportion of patients diagnosed at a localised stage was lower in Kuwait than in the US for colon, breast, and lung cancer. Age-standardised 5-year net survival for all stages combined was lower in Kuwait than the US for colon, lung, and breast cancer, but stage-specific survival was similar. CONCLUSION: Since stage-specific survival is similar in Kuwait and the US, late stage at diagnosis is likely to be a major contributing factor to the overall lower survival in Kuwait than in the US. Increasing public awareness of cancer risk factors and symptoms and investment in early detection will be vital to reduce the proportion of patients diagnosed at a late stage and to improve survival.

c-MET overexpression as a prognostic biomarker in colorectal adenocarcinoma.

BACKGROUND: There is a need for informative molecular markers that provide prognostic information over and above that given by conventional pathologic parameters. This study examined the expression and potential prognostic value of c-MET in colorectal adenocarcinoma. MATERIAL AND METHODS: Two-hundred and thirty cases were evaluable after tissue microarray construction and evaluated for c-MET expression by immunohistochemistry. The results were correlated with standard clinicopathologic prognostic factors. Cases were followed up for 5 years. RESULTS: c-MET was highly expressed in 138 of 230 cases (60%). In normal tissues a negative or weak reaction was observed. Significantly higher c-MET expression was found in the metastatic group (p=0.04). No significant association was found in relation to age, sex, tumor site, tumor size, histological type, or tumor grade (p > 0.05). The 5-year disease free survival for patients with low levels of expression was significantly higher than that for patients with high levels (64% versus 45%, p=0.04). CONCLUSION: c-MET seems to be a valuable biomarker in colorectal adenocarcinoma; overexpression is a useful prognostic indicator for metastasis and patient outcome. KEYWORDS: c-MET, prognosis, colorectal adenocarcinoma, tissue microarray.

Medullary carcinoma of the breast: ten year clinical experience of the Kuwait cancer control centre.

BACKGROUND: Medullary carcinomas of the breast account for fewer than 7% of all invasive breast cancers. Some investigators include medullary carcinomas in the favourable histologic subtype, despite its aggressive histologic appearance. However, others fail to confirm its favourable prognosis. METHODS: This was a retrospective analysis of sixty-one (61) cases of breast cancer cases diagnosed with Medullary Carcinoma, presenting to the Kuwait Cancer Control Center between 1995 and 2005. RESULTS: Median survival time was 122 months and the seven-year disease free survival was 82%. Overall survival rate was not assessed as no cases died during the study period. No cases were metastatic from the start and only eight cases developed metastases, local recurrence or contralateral breast primary. 68.8% of the cases were Stage I or IIA (i.e. no lymph node affection). CONCLUSION: There is no overt favourable prognosis of medullary carcinoma when compared to invasive ductal carcinoma. Prognosis is more related to stage than histologic subtyping. The majority of cases were negative estrogen and progesterone receptor status and node negative.

Reliability of the Kuwait Cancer Registry: a comparison between breast cancer data collected by clinical oncologists and registry staff.

AIM: The quality of cancer registration is of great importance and the present study was conducted to assess the reliability of Kuwait Cancer Registry data on breast cancer. METHODS: Data from the clinical records extracted by a group of clinical oncologists for another study on 1,235 breast cancer cases diagnosed between 1999 and 2004 were used to audit the data held on these individuals by the Kuwait Cancer Registry (KCR). Only 902 cases met the eligibility criteria. Main measures were sex, nationality, laterality, morphology, stage of disease at time of admission to the center, type of treatment and status at last follow up (alive or dead). RESULTS: Full or high agreement between registry data and clinical oncologists collected data was recorded for sex, nationality and laterality. The rate of agreement for treatment with chemotherapy and status at last follow up was near perfect. Substantial agreement was also noted for morphology, tumor grade, TNM staging, surgical, radiotherapy and hormonal treatment. The majority of minor differences in morphology disagreements occurred when a more specific description was stated by registry staff, while major disagreement occurred due to difference in the codes used. CONCLUSIONS: The accuracy of the KCR data seems to be comparable to that found in reviews of other cancer registries. Stage was the hardest variable for the registry to collect accurate information on. KCR data could be improved by improving the quality of information provided to the registry.

Cancer in Kuwait: magnitude of the problem.

UNLABELLED: Cancer registry data obtained from the Kuwait Cancer Registry at Kuwait Cancer Control Center (KCCC) of Ministry of Health, State of Kuwait. The data covers the years 1974 to 2007. AIM OF THIS STUDY: was to estimate the magnitude of the cancer problem in Kuwait over the period 1974-2007. MATERIALS AND METHODS: Age-adjusted incidence rates (ASR) with standard error (er) and 95% confidence intervals (95% CI) of age-standardized rates were estimated. Statistical significance was assessed by examining the standardized rate ratio (SRR). RESULTS: It was noted that by following the Cancer registry data there was a trend of increase in adjusted rates among both males and females. Looking into specific cancers it was noticed that comparing the ASR of colorectal cancer among Kuwaiti males, it increased by about 5 folds over the last 33 years and ranked the 1st most frequent site on the years 2003-2007. Prostate cancer incidence increased by 3 folds (14.5 cases /100,000 populations) and ranked the 4th most frequent site among Kuwaiti males. The incidence of Non Hodgkin's Lymphoma (NHL) and leukemia had increased by 1.5 to 2 folds over the same time period. The rise of lung cancer incidence declined to similar rates compared to that observed in the early 70s and 80s. For Kuwaiti females breast cancer had the highest incidence among Kuwaiti population (15 cases /100,000 populations), it increased by 3 folds (50 cases /100,000 populations) over the last 33 years. The incidence of colorectal cancer increased by about 4 folds; (13 cases /100,000 populations). NHL and leukemia increased by 2-2.5 folds over the same studied duration. Meanwhile Thyroid cancer increased by one fold. CONCLUSION AND RECOMMENDATIONS: Some of the differences in cancer rates over the last 33 years are likely to be attributable to the variation in exposure to specific etiologic factors that are caused by differences in lifestyle and habits, such as dietary, physical activity and obesity. Further research with a view to understanding these changes in cancer incidence is warranted. The need for an interventional prevention programs that vigorously involve, diet, anti-smoking and physical activity among both sexes.