Survival Analysis and Prognostic Factors for Colorectal Cancer Patients in Malaysia

  • Published : 2016.07.01


Background: Cancer survival analysis is an essential indicator for effective early detection and improvements in cancer treatment. This study was undertaken to document colorectal cancer survival and associated prognostic factors in Malaysians. Materials and Methods: All data were retrieved from the National Cancer Patient Registry-Colorectal Cancer. Only cases with confirmed diagnosis through histology between the year 2008 and 2009 were included. Retrieved data include socio-demographic information, pathological features and treatment received. Survival curves were plotted using the Kaplan-Meier method. Univariate analysis of all variables was then made using the Log-rank test. All significant factors that influenced survival of patients were further analysed in a multivariate analysis using Cox' regression. Results: Total of 1,214 patients were included in the study. The overall 3- and 5-year survival rates were 59.1% and 48.7%, respectively. Patients with localized tumours had better prognosis compared to those with advanced stage cancer. In univariate analysis, staging at diagnosis (p<0.001), primary tumour size (p<0.001), involvement of lymph nodes (p<0.001) and treatment modalities (p=0.001) were found to be predictors of survival. None of the socio-demographic characteristics were found to exert any influence. In Cox regression analysis, staging at diagnosis (p<0.001), primary tumour size (p<0.001), involvement of lymph nodes (p<0.001) and treatment modalities (p<0.001) were determined as independent prognostic factors of survival after adjusted for age, gender and ethnicity. Conclusions: The overall survival rate for colorectal cancer patients in Malaysia is similar to those in other Asian countries, with staging at diagnosis, primary tumor size, involvement of lymph node and treatment modalities having significant effects. More efforts are needed to improve national survival rates in future.


  1. Akkoca AN, Yanik S, Ozdemir ZT, et al (2014). TNM and modified dukes staging along with the demographic characteristics of patients with colorectal carcinoma. Int J Clin Experimental Med, 7, 2828-5.
  2. Al-Ahwal MS, Shafik YH, Al-Ahwal HM (2013). First National survival data for colorectal cancer among Saudis between 1994 and 2004: What's next? BMC Public Health, 13, 73.
  3. Allemani C, Weir HK, Carreira H, et al (2015). Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 populationbased registries in 67 countries (CONCORD-2). Lancet, 385, 977-0.
  4. American Cancer Society. Global Cancer Facts & Figures 3rd Edition. Available: [2015 Sep 26]
  5. Chokshi RJ, Abdel-Misih S, Bloomston M (2010). Surgical management of colorectal cancer: a review of the literature. Indian J Sur, 71, 350-5.
  6. Du WB, Chia KS, Sankaranarayanan R, et al (2002). Populationbased survival analysis of colorectal cancer patients in Singapore, 1968-1992. Int J Cancer, 99, 460-5.
  7. Ferlay J, Soerjomataram I, Ervik M, et al (2012). GLOBOCAN 2012, cancer incidence and mortality worldwide: IARC Cancer Base No. 11._Lyon, France: international agency for research on cancer; 2013.
  8. Globocan (2012). Available: [2015 September 19].
  9. Greene FL, Balch CM, Fleming ID, et al (2003). AJCC Cancer Staging Handbook, Springer Science & Business Media. 491 .
  10. Harmy MY, Norwati D, Noor NM, Amry AR (2011). Knowledge and attitude of colorectal cancer screening among moderate risk patients in west Malaysia. Asian Pac J Cancer Prev, 12, 1957-0.
  11. Huerta S (2008). Recent advances in the molecular diagnosis and prognosis of colorectal cancer. Expert Review of Molecular Diagnostics, 8, 277-8.
  12. Hong YJ, Han HS, Jeong Y, et al (2014). Impact of hyperglycemia on survival and infection-related adverse events in patients with metastatic colorectal cancer who were receiving palliative chemotherapy. Cancer Res Treatment, 46, 288-96.
  13. Kong CK, Roslani AC, Law CW, Law SCD, Arumugam K (2010). Impact of socio-economic class on colorectal cancer patient outcomes in Kuala Lumpur and Kuching, Malaysia. Asian Pac J Cancer Prev, 11, 969-4.
  14. Lieu CH, Renfro LA, de Gramont A, et al. (2014). Association of age with survival in patients with metastatic colorectal cancer: analysis from the arcad clinical trials program. J Clin Oncol, 32, 2975-2.
  15. Mehrkhani F, Nasiri S, Donboli K, Meysami A, Hedayat A (2009). Prognostic factors in survival of colorectal cancer patients after surgery. Colorectal Disease, 11, 157-1.
  16. Mohamed YH, Daud N, Noor NM, Rahim AA (2012). Participation and barriers to colorectal cancer screening in Malaysia. Asian Pac J Cancer Prev, 13, 3983-7.
  17. Oberoi DV, Jiwa M, McManus A, Hodder R (2014). Colorectal cancer--applying a gender lens. Quality in Primary Care, 22, 71-9.
  18. Patel SS, Nelson R, Sanchez J, et al (2013). Elderly patients with colon cancer have unique tumor characteristics and poor survival. Cancer, 119, 739-7.
  19. Rashid MR, Aziz AF, Ahmad S, Shah SA, Sagap I (2009). Colorectal cancer patients in a tertiary referral centre in Malaysia: a five year follow-up review. Asian Pac J Cancer Prev, 10, 1163-6.
  20. Kumar S, Burney IA, Zahid KF, et al (2015). Colorectal cancer patient characteristics, treatment and survival in Oman--a single center study. Asian Pac J Cancer Prev, 16, 4853-8.
  21. Siddiqui AA, Spechler SJ, Huerta S, et al (2008). Elevated hba1c is an independent predictor of aggressive clinical behavior in patients with colorectal cancer: a case-control study. Digestive Diseases and Sci, 53, 2486-4.
  22. Sudsawat L, Maneechavakajorn J, Techatanol P (2010). Prognostic factors for survival in colorectal cancer patients. J Med Associat Thailand, 93, 1156-6.
  23. Teo MCC, Soo KC (2013). Cancer trends and incidences in Singapore. Japanese J Clin Oncol, 43, 219-4.
  24. Vaccaro CA, Im V, Rossi GL, et al (2009). Lymph node ratio as prognosis factor for colon cancer treated by colorectal surgeons. Diseases Colon Rectum, 52, 1244-0.
  25. Xu R, Zhou B, Fung PC, Li X (2006). Recent advances in the treatment of colon cancer. Histol Histopathol, 21, 867-2.