Colorectal cancer survival among Malaysia population: data from the Malaysian National Cancer Registry

Nor Asiah Muhamad; Nur Hasnah Ma'amor; Izzah Athirah Rosli; Fatin Norhasny Leman; Mohd Hatta Abdul Mutalip; Huan-Keat Chan; Siti Norbayah Yusof; Nor Saleha Ibrahim Tamin; Tahir Aris; Nai Ming Lai; Muhammad Radzi Abu Hassan

doi:10.3389/fonc.2023.1132417

Colorectal cancer survival among Malaysia population: data from the Malaysian National Cancer Registry

Front Oncol. 2023 Nov 29:13:1132417. doi: 10.3389/fonc.2023.1132417. eCollection 2023.

Affiliations

¹ Sector for Evidence-based Healthcare, National Institutes of Health, Ministry of Health, Setia Alam, Malaysia.
² Centre for Communicable Diseases Research, Institutes for Public Health, National Institute of Health, Ministry of Health, Setia Alam, Malaysia.
³ Clinical Research Centre, Sultanah Bahiyah Hospital, Ministry of Health, Alor Setar, Malaysia.
⁴ National Cancer Institute, Ministry of Health, Putrajaya, Malaysia.
⁵ Cancer Prevention and Control Unit, Non-communicable Disease Division, Ministry of Health, Putrajaya, Malaysia.
⁶ Institute for Medical Research, National Institutes of Health, Ministry of Health, Setia Alam, Malaysia.
⁷ School of Medicine, Taylor's University, Subang Jaya, Malaysia.
⁸ Office of the Director General Health, Ministry of Health, Putrajaya, Malaysia.

Abstract

Background: Colorectal cancer (CRC) is a major cause of cancer-related mortality worldwide. It is the second leading cause of cancer death in men and women in Malaysia and poses a major burden on society.

Aims: To determine the overall survival rate of patients diagnosed with CRC and factors contributing to survival.

Methods: Data were obtained from the Malaysia National Cancer Registry. All patients with CRC were identified, and a total of 15,515 patients were screened. A total of 5,675 CRC patients were included from January 1, 2012, to December 31, 2016. Sex, age groups, ethnic groups, stage at diagnosis, cancer sites, and status of treatment received were analysed. The Kaplan-Meier analysis was performed to estimate the 1-, 3-, and 5-year survival of CRC. The log-rank test was conducted to compare the survival between sex, age groups, ethnic groups, stage at diagnosis, cancer sites, and status of treatment received. Multiple Cox regression was conducted to determine the risk of CRC death.

Results: Of 5,675, a total of 2,055 had died, 3,534 were censored, and another 86 were still alive within 5 years of CRC diagnosis. The 1-, 3-, and 5-year survival rates were 68.5%, 34.7%, and 18.4%, respectively with a median survival time of 24 months. Significant differences in survival rates of CRC were observed between age groups (p < 0.001), ethnic groups (p < 0.001), stages at diagnosis (p < 0.001), treatment status (p = 0.003), and treatment modalities (p < 0.001). No significant difference was observed in survival rates of CRC between sex (p = 0.235) and cancer sites (p = 0.410). Those who were 80 years old and above were found to be at higher risk of CRC death compared to those below 80 years old (adjusted hazard ratio (HR): 1.24, 95% CI 1.14-1.36). The risk of CRC death was also found four times higher among those with stage IV compared to those with stage 0 (adjusted HR: 4.28, 95% CI 3.26-5.62).

Conclusion: In general, Malaysian patients with CRC had low survival rates. National health policies should focus on enhancing awareness of CRC, encouraging early screening, and developing strategies for early detection and management to reduce CRC-associated mortality.

Keywords: Malaysia; colorectal neoplasm; cumulative survival; hazard; survival time.