Survival and Its Predictors among Colo-Rectal Cancer Patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2012-2016: Hospital-Based Retrospective Cohort Study

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Colorectal cancer (CRC) is the 3rd and 4th leading cause of morbidity and mortality worldwide. Without a national CRC screening program, it is the 4th leading cause of morbidity and mortality in Ethiopia. Furthermore, there is limited evidence on the predictors of survival of CRC patients. We estimated survival time and identified predictors for colorectal cancer.
We conducted a hospital-based retrospective cohort study. We used the American Joint Committee of Cancer 7th Edition for staging. We recruited a total of 161 biopsy-proven CRC patients who started treatment between January 2012 to December 2016 in Tikur Anbessa Specialized Hospital were included. Kaplan-Meier product-limit technique and Cox’s regression analysis used to determine predictors of survival and estimate survival time. We presented findings using adjusted hazard ratios (AHR) with 95 %CI.
We found that 47.8% (77/161) were stage IV followed by stage II 35.4% (57/161), with 96% adenocarcinoma (156/161) histologic type. The median age was 45 years with an interquartile range of 22 years. The median survival time was 21 months, with overall five-year and one-year survival rates of 34.7% and 71.9%.We found that colorectal surgery (AHR =3.37, 95%CI:1.32-8.57), carcinoembryonic antigen (CEA) levels >5ng/ml (AHR=2.01, 95%CI: 1.14-3.57), muci- nous/singent cell carcinoma vs. adenocarcinoma (AHR=3.52, 95%CI:2.08-14.67), and distant metastasis (AHR=2.8, 95%CI:1.32-3.94) predicted death, while chemotherapy (AHR= 0.52, 95%CI: 0.27-0.98) predicted survival.
The survival rate of CRC patients decreased with increased duration of disease. Chemotherapy improved survival, while histologic type, surgery, distant metastasis, and elevated baseline CEA levels were all strong predictors of CRC death. Early screening and diagnosis of CRC patients, with rapid initiation of chemotherapy, will prolong the patient survival.

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