Introduction Comparison of rectal cancer characteristics in Pakistani Americans and native Pakistanis remains poorly investigated, as migrant studies have predominantly concentrated on East and Southeast Asian groups. This research aims to compare clinicopathological characteristics between the two groups. We hypothesize that significant differences will exist between these cohorts, mediated by gene-environment interactions.

Methods This was a retrospective cohort study utilizing two multi-institutional databases to identify adult patients with rectal cancer: the National Cancer Database in the U.S (2018–2022) and the Rectal Cancer Surgery and Epidemiology Study in Pakistan (2020–2021). Non-Hispanic Whites (NHWs) were included as a reference population for comparative analysis. Clinicopathological characteristics were compared using Wilcoxon rank-sum and chi-square tests.

Results A total of 523 Pakistani Americans and 608 native Pakistanis were included in the study. The median age at diagnosis was 57 years in Pakistani Americans (IQR 48-68), 42 years (IQR 33-54) in native Pakistanis and 63 years in NHWs (IQR 54-73) (p < 0.001). Native Pakistanis presented with early-stage disease less often than Pakistani Americans and NHWs (5.3%, 25.1%, and 20.5%, respectively; p < 0.001) and had markedly higher rates of signet cell carcinoma (20.1%, 0.6%, and 0.4%, respectively; p < 0.001) and poorly differentiated tumors (29.0%, 10.4%, and 11.4%, respectively; p < 0.001).

Conclusions This study found that Native Pakistanis with rectal cancer presented at a younger age and with more aggressive tumor characteristics compared to both Pakistani Americans and NHWs. Notably, Pakistani Americans displayed a distinct clinical profile, intermediate between both groups.

The authors have declared no competing interest.

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper

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The study was reviewed by the Institutional Review Board (IRB) at Vanderbilt University Medical Center, which determined that the research was exempt from full review because it utilized de-identified data from the National Cancer Database (NCDB) and Rectal Cancer Surgery and Epidemiology Study (ReCESS)

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Disclosures: None

Funding: None.

The data that support the findings of this study are available on request from the corresponding author, AK. The data are not publicly available due to license restrictions of the NCDB and ReCESS databases.