Retrospective single-center Rwanda cohort reports treatment gaps and survival estimates

A retrospective cohort study of 163 patients with colorectal cancer treated at Butaro Cancer Center of Excellence in northern Rwanda found substantial gaps in the use of surgery and radiotherapy, along with estimated median overall survival of 3.68 years. Most patients had localized disease, but only 74 of 163 patients, or 45%, underwent primary surgical resection. Among 94 patients whose rectal cancer was considered curable, 24 received radiotherapy, a rate of 25.5%. The investigators estimated median disease-free survival at 2.21 years among patients with localized disease.

The researchers included patients who presented to the tertiary cancer center between July 2012 and June 2018 and collected data on their clinical characteristics, diagnostic workup, treatment and survival through August 2023. The cohort had a median age of 53 years, and 86 participants, or 53%, were female. Rectal cancer accounted for 127 cases, or 78% of the cohort, while 98 patients, representing 60%, had localized disease. Overall, 111 patients received chemotherapy. These figures describe the patients treated and recorded at one Rwandan cancer center rather than all people with colorectal cancer in Rwanda or the wider sub-Saharan African region.

Treatment use differed by tumor location among patients treated with curative intent. Primary surgical resection was performed in 20 colon cancer cases, corresponding to 91% of that subgroup, compared with 38 rectal cancer cases, or 40% of that subgroup. The rectal cancer group also had limited exposure to radiotherapy: 24 of 94 patients with curable rectal cancer received it. The results therefore identify shortfalls across several treatment modalities, particularly in surgical and radiation treatment, but they do not establish that any specific treatment or pattern of care caused the observed survival outcomes. The study’s authors described multidisciplinary colorectal cancer management in Rwanda as a challenge resembling that encountered in other low-resource settings.

The investigators estimated survival using the Kaplan–Meier method. For the entire cohort, median overall survival was 3.68 years. For patients with localized disease, median disease-free survival was 2.21 years. Exploratory multivariable analyses examined associations between patient or disease characteristics and survival. In the adjusted overall-survival analysis, male patients had a hazard ratio of 1.84 relative to female patients, with p=0.007. Patients with metastatic disease had an adjusted hazard ratio of 1.92 relative to patients without metastatic disease, with p=0.004. Neither disease location nor age was associated with overall survival in that analysis. For disease-free survival, rectal cancer was associated with a higher adjusted hazard than colon cancer, with a hazard ratio of 2.35 and p=0.047.

These findings come from a retrospective, observational cohort at a single cancer center, making them descriptive and association-based rather than evidence of causal effects. The design cannot determine whether sex, disease stage, tumor location, age or treatment use produced the survival differences observed. It also limits how broadly the results can be applied, because the cohort represents patients who reached Butaro Cancer Center of Excellence and for whom information was available in the records reviewed. The survival estimates are based on a defined clinical cohort and follow-up extending to August 2023, while the treatment percentages document care received rather than measures of population-wide access. Within those constraints, the study provides a detailed account of colorectal cancer management and outcomes in a setting where the authors said the disease remains understudied in sub-Saharan Africa.

Subject of Research: Clinical characteristics, treatment gaps and survival outcomes in a retrospective colorectal cancer cohort at a tertiary center in Rwanda

Article Title: Patient characteristics and outcomes of colorectal cancer at a cancer hospital in Rwanda: results from a retrospective cohort

Article References: Mugabo, F., Pain, D., Rugengamanzi, E., Carrion, J., Nsabimana, V., Sebahungu, F., Kapesa, L., Ruhangaza, D., Shulman, L. N., Slater, S., & Fadelu, T. (2026). Patient characteristics and outcomes of colorectal cancer at a cancer hospital in Rwanda: results from a retrospective cohort. BMC Cancer. https://doi.org/10.1186/s12885-026-16799-1

Image Credits: AI Generated

DOI: 10.1186/s12885-026-16799-1

Keywords: colorectal cancer, Rwanda, retrospective cohort, overall survival, disease-free survival, cancer surgery, radiotherapy, chemotherapy, Butaro Cancer Center, sub-Saharan Africa, Patient, characteristics