Gastrointestinal malignancies in Syria: An epidemiological analysis from the country’s main cancer center.

813 Background: Epidemiological data on gastrointestinal (GI) cancers in conflict-affected regions such as Syria are severely limited. Our study aims to fill in significant gaps in data by evaluating the demographics of Syrian patients diagnosed with new GI malignancies over a three-year period. Methods: This is a retrospective epidemiological study conducted at Al-Bairouni University Hospital – Syria’s national cancer center serving 60-70% of the country’s cancer patients. We included all patients diagnosed with GI malignancies (esophagogastric EG, hepatocellular HCC, biliary tract BTC, pancreatic PC, colorectal CRC cancers, and others) between Jan 2022 - Dec 2024. Data extracted from hospital records included sex, age at diagnosis, cancer stage, smoking status, and governorate of residence. Patients were grouped by disease group and year to assess annual trends. Institutional ethical approval was obtained to perform the study. Results: A total of 3,493 patients were diagnosed with GI cancers during the study period: 1,220 in 2022, 905 in 2023, and 1,368 in 2024 (Table 1). Across all years, a consistent male predominance was observed (60.1%). The average age at diagnosis was 59 years, 37.8% of patients were smokers, and 48.3% of all cases had advanced/metastatic disease at diagnosis. CRC (1,779) and EG (830) were the most common GI cancers. The highest patient loads originated from Damascus (17.6%) and Rural Damascus (17.5%), followed by central governorates such as Homs (9.7%) and Hama (9.3%). Notably, patients from more distant and underserved governorates such as Deir ez-Zor (7.0%), Aleppo (6.58%), and Al-Hasakeh (6.79%) accounted for a significant proportion of the GI cancers presenting to our center. Conclusions: To our knowledge, this study provides the first comprehensive multi-year dataset of GI cancers in Syria, with representation from all 14 governorates in the country. More than a third of our cohort were smokers and nearly half were diagnosed with advanced disease, demonstrating a need for public heath efforts to tackle tobacco use and improve screening & early detection. This dataset offers a foundation for future public health planning and research efforts in the region. Demographics of GI cancers diagnosed 2022-2024. Diagnosis 2022 Cases 2023 Cases 2024 Cases Total Cases Average Age Male Sex (%) Smokers (%) Advanced/Metastatic at diagnosis EG 311 217 302 830 56.1 519 (62.5%) 379 (45.7%) 370 (44.6%) HCC 88 46 61 195 59.2 134 (68.7%) 82 (42.1%) 116 (59.5%) BTC 34 43 54 131 58.4 69(52.7%) 40 (30.5%) 79 (60.3%) PC 118 122 160 400 58.4 249 (62.3%) 180 (45%) 247 (61.8%) CRC 620 444 715 1779 57.6 1008 (56.7%) 582 (32.7%) 805 (45.2%) Others (anal, small intestine, unknown primary) 49 33 76 158 55.5 75 (47.5%) 59 (37.3%) 69 (43.7%)