Survival and its Predictors among Colorectal Cancer Patient at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2012-2016: A Retrospective Cohort Study.

Abstract

Abstract Background: Colorectal cancer (CRC) is the third most commonly diagnosed malignancy and the fourth leading cause of cancer death globally, and it is also the first and fourth diagnosed cause of cancer in males and females respectively, accounting for about 1.4 million new cases and almost 700,000 deaths in 2012 according to the latest global burden of cancer report. In Ethiopia, it represents the fourth cause of morbidity and mortality. Objective: To estimate survival time and identify its predictors among colorectal cancer patients treated at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, from 2012-2016. Methodology: A retrospective cohort study was conducted at Tikur Anbessa Specialized Hospital. Data was extracted from 161 colorectal cancer patient’s charts and telephone interviews were conducted to ascertain vital status of the patients. Finally, data was checked for completeness and consistency each day after data extraction, and entered into EpiData v.3.1, before being exported to SPSS v.23 for final analysis. Descriptive analyses such as median, range, interquartile range, life table and Kaplan Meier analysis were computed. The overall survival was estimated using the Kaplan-Meier product limit technique. Bivariate and multi variate Cox-regression analyses were used to determine predictors of survival time for colorectal cancer patients. Adjusted Hazard Ratios with 95%CI and p values < 0.05 were considered statistically significant. Result: The median age was 45 years with an interquartile range of 22 years, while the median duration of follow-up was 14 months with an interquartile range of 16 months. The median survival time was 21 months, and the overall survival rates were 71.9% and 34.7% at one year and five years, respectively. The predictors of overall survival of colorectal cancer were found to be: surgery (AHR 3.37, 95%CI:1.32-8.57), baseline carcino embryonic antigen levels>5ng/ml (AHR 2.01, 95%CI:1.14-3.57), mucinous/singent cell type (AHR 3.52, 95%CI:2.08-14.67), chemotherapy (AHR 0.52, 95%CI:0.27-0.98) and distant metastasis (AHR 2.8, 95%CI:1.32-3.94). Conclusion: We found that the overall 1 year & 5 years’ survival rate were 71.9% and 34.7%, respectively, with a median survival time of 21 months, and that mucinous /singent cell types, surgery, chemotherapy, distant metastasis and baseline CEA levels >5ng/ml were all strong predictors of colorectal cancer survival, indicating that these specific predictors are deserving of further attention. Key words: colorectal cancer, survival time, predictors, Tikur Anbessa Specialized Hospital, Ethiopia.