Factors Affecting Survival of Patients with Synchronous Metastatic Colorectal Cancer in a Tertiary Hospital in Indonesia: A Retrospective Study

Yasjudan Rastrama Putra; Susanna Hilda Hutajulu; Susanti Susanti; Didik Setyo Heriyanto; Naomi Yoshuantari; Adeodatus Yuda Handaya; Bambang Purwanto Utomo; Ericko Ekaputra; Mohammad Ilyas; Mardiah Suci Hardianti; Kartika Widayati Taroeno-Hariadi; Ibnu Purwanto; Johan Kurnianda

doi:10.31557/apjcc.2023.8.4.721-727

Authors

Yasjudan Rastrama Putra Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital Yogyakarta, Indonesia.
Susanna Hilda Hutajulu Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital Yogyakarta, Indonesia.
Susanti Susanti Molecular Pathology Research Group, Academic Unit of Translational Medical Science, School of Medicine, Queen’s Medical Centre, University of Nottingham, Nottingham, United Kingdom. Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Indonesia.
Didik Setyo Heriyanto Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
Naomi Yoshuantari Department of Anatomical Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital Yogyakarta, Indonesia.
Adeodatus Yuda Handaya Division of Digestive Surgeon, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital Yogyakarta, Indonesia.
Bambang Purwanto Utomo Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia.
Ericko Ekaputra Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia.
Mohammad Ilyas Molecular Pathology Research Group, Academic Unit of Translational Medical Science, School of Medicine, Queen’s Medical Centre, University of Nottingham, Nottingham, United Kingdom.
Mardiah Suci Hardianti Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital Yogyakarta, Indonesia.
Kartika Widayati Taroeno-Hariadi Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital Yogyakarta, Indonesia.
Ibnu Purwanto Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada
Johan Kurnianda Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital Yogyakarta, Indonesia.

DOI:

https://doi.org/10.31557/apjcc.2023.8.4.721-727

Keywords:

carcinoembryonic antigen, colorectal neoplasms, metastases , neoplasm grading, physical functional performance

Abstract

Background and Objective: Despite colorectal cancer (CRC) being one of the most frequent cancers in Indonesia, limited data exists regarding the survival and prognostic factors of Indonesian metastatic CRC patients. This study aimed to investigate the survival outcome and factors influencing local CRC patients presenting with a metastatic stage at diagnosis.

Materials and Methods: A retrospective cohort study was conducted using data from 441 cases of synchronous metastatic CRC treated between January 2016 and December 2019 at Dr. Sardjito Hospital, Yogyakarta, Indonesia. Secondary data were collected from the CRC clinical registry database. Demographic, clinicopathological, and treatment data were collected. Survival status was obtained from the registry database and communication with patients or their families. Kaplan-Meier curves were used to estimate overall survival (OS). The Cox proportional hazards regression model was applied to analyze potential factors affecting survival.

Results: The median follow-up in the study was 17 months. The median overall survival was 13 months. Two-year overall survival was 37%, and the estimated 5-year overall survival was 16.1%. Multivariate Cox analysis identified poor performance status (HR 2.639, 95% CI 1.438-4.842, p = 0.002), elevated carcinoembryonic antigen (CEA) (HR 2.795, 95% CI 1.509-5.176, p = 0.001), and higher histological grade (HR 2.019, 95% CI 1.112-3.667, p = 0.021) as factors associated with poorer overall survival.

Conclusion: Based on the findings, poor performance status, high CEA levels, and higher histological grade were associated with unfavorable overall survival among patients with synchronous metastatic colorectal cancer in Yogyakarta, Indonesia.