Strong association and effect of lifestyle and clinicopathological risk factors in colorectal cancer during treatment process: a study based on Kashmiri population

Abstract

Colorectal cancer (CRC) is one of the leading cancer worldwide and alarmingly rising in India. Various lifestyle, clinicopathological and genetic risk factors of CRC have been reported. Individuals with risk factors are more likely to host cancer and are subjected to screening programs. CRC is the fourth most cancer in males and third most in females of the Kashmiri population. This study aims to find out the association and effect of lifestyle risk factors (Smoking and Diet), clinicopathological risk factors (Age, Gender, Metastatic status and Tumor site) and outcome of CRC. This research is a case study that included 222 patients registered in the Shree Maharaja Hari Singh (SMHS) hospital and Sher-i-Kashmir Institute of Medical Sciences, Soura (SKIMS) hospital of Kashmir valley. The information relevant to the aim of study for all CRC patients including various behavioral variables, clinicopathological variables were gathered and reviewed from patient medical records (files), histopathology studies, as well as details collected from patients or guardians (as some critical patients were not able to speak themselves) through personal interviews. The collected data also included symptoms such as abdominal pain, constipation, on and off fever, bleeding and weight loss which were gathered from registered records as well as from patients themselves. This entire study was carried out by the willingness of the patients as they were prior informed about this study. The relevant data particularly included dietary factors, smoking factors, age, gender, tumor site and metastatic status. The outcome of CRC was categorized into three groups: Disease Progression (DP), Partial Response (PR) and Disease-Free (DF); the criteria used for categorizing outcome groups DP, PR and DF were as follows: (1) The patients were categorized as a DF based on clinical examination, i.e., history and physical examination, radiologically, i.e., based on CACT abdomen/MRI PET tests and biochemically, i.e., based on examination of Tumor markers like CEA levels. (2) The patients were kept in the PR category whose disease status was found Stagnant and who showed a decrease in the volume of the tumor arrived at, based on three diagnostic techniques such as clinical, radiological and biochemical examination reports. (3) The patients were under DP whose Increased CEA level showed tumor burden and prognosis and an increase in the volume of the tumor with spread to nearby organs. Smoking (p =0.001), age (p = 7.599e–07), metastatic (p = 2.2e–16) and diet (p = 4.508e–07) showed a highly significant association with CRC outcomes. However, no difference was observed in gender and tumor site. The outcome groups (DP, PR, DF) were also different in mean and showed statistical significance (p = 0.0022). In addition, family-wise comparison in outcome groups was observed statistically significant in between G3 and G1 (i.e., disease-free group and disease progression group) and in G3–G2 (i.e., disease-free group and partial response group). Furthermore, the main effect of chosen risk factors was high in the disease progression group but overall no strong association of effect was found. Risk factors of CRC act as a big impediment during the treatment process leading more patients to disease progression and poor differentiation. More awareness about risk factors is needed to provide a clear picture of the role of risk factors in the development and treatment of CRC.