Page 38 - SRPSKO DRUŠTVO ISTRAŽIVAČA RAKA

ORIGINAL ARTICLES

Manuscript received on: Apr 3, 2025. 616.345-006(479.11)”2003/2016”
Manuscript revised on: Apr 30, 2025.
Manuscript accepted on: May 6, 2025.

Trends in pathology in colorectal cancer patients in Serbia 2003-2016

Velimir Markovic , Marina Anastasov3, Mina Krnjajic1, Sandra Dragicevic3, Aleksandra Djikic Rom1, Katarina Eric1,
1,2
Marko Miladinov1, Ivan Dimitrijevic , Goran Barisic , Jovana Despotovic , Aleksandra Nikolic 3
3
1,2
1,2
1Clinic for Digestive Surgery, University Clinical Center of Serbia, Belgrade, Serbia
2Faculty of Medicine, University of Belgrade, Belgrade, Serbia
3Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
Correspondence: Aleksandra Nikolic; e-mail: nikolic@imgge.bg.ac.rs; phone: +381 11 3976658

Abstract
Colorectal cancer (CRC) is a leading cause of morbidity and mortality worldwide, with varying trends in tumor pathology
depending on geographic and demographic factors. The aim of this study was to describe trends in tumor pathology
in Serbian patients with colorectal cancer (CRC) over a 14-year period, from 2003 to 2016. The study included patients
referred from local units to the tertiary center for CRC treatment during the entire observation period, as well as
patients diagnosed within the national screening program during the last four years. Resections were performed in
2462 patients (1465 men, 60% and 997 women, 40%) with an average age of 62±12 years, and the incidence was
equally distributed between genders. Rectal tumors were noted in 54% of patients, while in 46% of patients tumors
were found in the colon (32% in the left and 14% in the right colon). The majority of patients were in an advanced stage
of the disease, with only 12% of cases with Dukes A stadium. Patients with early-onset disease represented between
11% and 22% of all cases per year. Among early-onset patients, women were significantly overrepresented (P=0.013),
patients were diagnosed at significantly later stages (P=0.033), tumors were significantly less differentiated (P=0.001)
and tumors of the right colon were overrepresented (P<0.001). A group of patients who underwent neoadjuvant
chemoradiotherapy consisted of 235 men and 88 women with an average age of 60±12 years. Within this group, 20%
of patients had a good response, 37% a moderate response, and 43% a poor response. The study has provided valuable
insight into trends in tumor pathology in Serbian CRC patients and confirmed the beneficial effects of the introduction
of the national screening program.

Introduction
In spite of the therapeutic advancements, CRC remains a heavy burden for the world health systems. It is the third
most deadly and fourth most commonly diagnosed cancer in the world (1). The incidence of this disease has increased
substantially during the last four decades mainly due to primary preventable factors, and the incidence is expected to
continue increasing during the next decades mainly due to further aging of the population (2). There is a specifically
alarming rise in incidence of early-onset CRC, which differs in epidemiological, clinical, pathological, and molecular
features from late-onset disease (3). The incidence and mortality of this disease among the individuals younger than
50 has risen by about 2% and 1.3% annually, respectively (4). Although these rates are considerably lower than in older
adults, a disturbing pattern is beginning to emerge considering aggressive features and worse outcomes in early-onset
disease.
During the last two decades, management of colorectal cancer (CRC) has significantly advanced. Improved surgical
approaches and introduction of a watch-and-wait strategy after neoadjuvant chemoradiotherapy (nCRT) resulted in
better outcomes for patients (5). Incorporation of molecular data in the clinical management of patients will allow
further advancement towards precision medicine. New classifications of CRC are emerging, based on molecular
parameters: combinations of gene expression patterns, chromosomal alterations, gene mutations and epigenetic

23