Introduction: Globally colorectal cancer
(CRC) is the third most common malignancy. The global incidence of colorectal
cancer (CRC) is projected to rise up to 60% in 2030. In Uganda and other
resource-deprived countries in Sub-Saharan Africa, colonoscopy is not easily
accessible for screening. Therefore, carcinoembryonic antigen (CEA) may have a
larger role as a marker for CRC development in these resource-limited settings.
The aim of this study was to investigate the incidence of positive CEA in CRC
tissue and compare it to clinicopathological features in Ugandan patients.
Methods: From 16th September 2019 to
16th September 2021, samples of colorectal biopsy specimens and resected
colorectal carcinoma specimens were obtained from patients in Masaka Regional
Referral Hospital, Mulago National Referral Hospital, Uganda Martyrs’ Hospital
Lubaga and Mengo Hospital. Participants were consecutively recruited from
hospitals in central Uganda between 2019-2021, with corresponding
formalin-fixed and paraffin-embedded (FFPE) tissue blocks that were included in
the CEA analysis. A Data Extraction Form was used to obtain data regarding age,
sex, stage, grade of colorectal cancer, and topography. Haematoxylin and eosin
sections from FFPE CRC blocks were prepared to establish the grade,
lymphovascular invasion (LVI), and histopathological subtype. The CEA molecular
marker was analysed using the ABC method for immunohistochemistry. The Pearson
chi-square test was used to assess the association between CEA expression and demographic
and histopathological variables. The correlation between the CEA biomarker and
grade was determined using Spearman’s rank correlation. A p-value of ≤0.05 was
considered statistically significant.
Results: The present study evaluated the
CRC tissue CEA and the correlation of the tissue staining intensity with the
grade, stage, LVI status, topography, and histopathological subtype of CRC. Out
of 118 participants, there were 67 male participants and 52 female participants
and the median age (SD) for all the participants was 59.9(15.3) years. Compared
to stage I, there were 31.4% of CRC tissues stained positively for CEA in stage
IV disease and this reached statistical significance (p=0.0101). There were
73.4% CRC tissues with grade II CRC that stained positively for CEA compared to
15.2% CRC tissues with grade I CRC (p=0.0000). There were more AC (85%)
participants that stained positively for CEA compared to MAC (5.8%) and SRCC
(9.2%) participants (p=0.0000). A positive correlation between tumour grade and
CEA expression was found (r=+0.2204) (p=0.0232).
Conclusions: In Uganda, increasing CEA
intensity in CRC tissues is associated with a poorer grade. High-grade CRC has
a higher incidence of lymph node metastasis and a higher CRC CEA tissue
expression. Therefore, in Uganda, there is a poorer prognosis for patients
expressing high levels of CEA in their colorectal cancer tissue. The number of
rectal cancer patients excluded due to neoadjuvant chemoradiotherapy was small
and therefore it is unlikely that selection bias was introduced. The effect of
neoadjuvant chemoradiotherapy on tissue CEA expression should be explored in
future studies.
Author (s) Details
Richard Wismayer
Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda,
Department of Surgery, Faculty of Health Sciences, Equator University for
Science and Technology, Masaka, Uganda, Department of Surgery, Faculty of
Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda,
Department of Pathology, School of Biomedical Sciences, College of Health
Sciences, Makerere University, Kampala, Uganda and Department of Surgery,
Mulago National Referral Hospital, Kampala, Uganda.
Julius Kiwanuka
Department of Epidemiology and Biostatistics, School of Public Health,
College of Health Sciences, Makerere University, Kampala, Uganda.
Josephat Jombwe
Department of Surgery, Mulago National Referral Hospital, Kampala, Uganda.
Emmanuel Elobu
Department of Surgery, Mulago National Referral Hospital, Kampala, Uganda.
Henry Wabinga
Department of Pathology, School of Biomedical Sciences, College of Health
Sciences, Makerere University, Kampala, Uganda.
Michael Odida
Department of Pathology, School of Biomedical Sciences, College of Health
Sciences, Makerere University, Kampala, Uganda and Department of Pathology,
Faculty of Medicine, Gulu University, Gulu, Uganda.
Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v9/2388
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