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Research Article
Survival of Colorectal Cancer Patients in Brunei Darussalam: Comparison between 2002-09 and 2010-17
Shirley Lee
Universiti Brunei Darussalam
Corresponding Author
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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 Brunei Darussalam in 2017, posing a major burden on society.
METHODS
This retrospective cohort study (n = 1,035 patients diagnosed with CRC in Brunei Darussalam from 1st January 2002 until 31st December 2017) aims to compare the overall survival rates of CRC patients (2002-2017), to compare survival rates between two study periods (2002-2009 and 2010-2017) and to identify prognostic factors of CRC. Kaplan-Meier estimator and log-rank tests were performed to analyse the overall survival rates of CRC patients. Multiple Cox regression was performed to determine the prognostic factors of CRC with adjusted hazard ratios (Adj. HRs) reported.
RESULTS
The 1-, 3- and 5-year survival rates of CRC patients are 78.6%, 62.5%, and 56.0% respectively from 2002-2017. The 1-, 3-, and 5-year survival rates of CRC patients for 2002-2009 are 82.2%, 69.6%, and 64.7%; 77.0%, 59.1%, and 51.3% for 2010-2017 respectively. A significant difference in CRC patients’ survival rate was observed between the two study periods, age groups, ethnic groups, cancer stages, and sites of cancer (p<0.001). The Adjusted Hazard Ratios (Adj. HRs) were significantly higher in the 2010-17 period (Adj. HR=1.78, p<0.001), older age group (>=60 years) (Adj. HR=1.93, p=0.005), distant cancer (Adj. HR=4.69, p<0.010), tumor at transverse colon and splenic flexure of colon (Adj. HR=2.44, p=0.009), and lower in the Chinese group (Adj. HR=0.63, p=0.003).
CONCLUSION
This study highlights the lower survival rates of CRC patients in 2010-2017, Malays, older patients, distant cancer, and tumors located at the latter half of the proximal colon (transverse colon), and predominantly LCRC (splenic flexure, descending colon, sigmoid colon, overlapping lesion colon and colon (NOS), as well as the rectosigmoid junction and rectum (NOS)). Age, ethnicity, cancer stage, and tumor location are significant prognostic factors for CRC. These findings underscore the importance of public health policies and programmes to enhance awareness on CRC from screening to developing strategies for early detection and management, to reduce CRC-associated mortality.
Keywords
Colorectal cancer, Survival rate, Survival tim, Prognosis, Brunei Darussalam, Cancer registry
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On 08 Jan, 2021
Reviewer #6 agreed
On 08 Jan, 2021
Reviewer #8 agreed
On 02 Jan, 2021
Reviewer #15 agreed
On 01 Jan, 2021
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On 01 Jan, 2021
Reviewer #9 agreed
On 01 Jan, 2021
Reviewer #14 agreed
On 01 Jan, 2021
Reviewer #11 agreed
On 01 Jan, 2021
Reviewer #10 agreed
On 01 Jan, 2021
Reviewer #13 agreed
On 01 Jan, 2021
Reviewer #4 agreed
On 01 Jan, 2021
Reviewer #2 agreed
On 01 Jan, 2021
Reviewer #1 agreed
On 01 Jan, 2021
Reviewer #16 agreed
On 01 Jan, 2021
Reviewer #12 agreed
On 01 Jan, 2021
Reviewers invited
Invitations sent on 31 Dec, 2020
Editor assigned
On 31 Dec, 2020
Editor invited
On 24 Dec, 2020
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On 24 Dec, 2020
First submitted
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This preprint is under consideration at BMC Cancer. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Survival of Colorectal Cancer Patients in Brunei Darussalam: Comparison between 2002-09 and 2010-17
Shirley Lee
Universiti Brunei Darussalam
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 29 Dec, 2020
No community comments so far
Review #2 received
Received 16 Jan, 2021
Review #1 received
Received 16 Jan, 2021
Review #3 received
Received 16 Jan, 2021
Reviewer #5 agreed
On 08 Jan, 2021
Reviewer #6 agreed
On 08 Jan, 2021
Reviewer #8 agreed
On 02 Jan, 2021
Reviewer #15 agreed
On 01 Jan, 2021
Reviewer #3 agreed
On 01 Jan, 2021
Reviewer #9 agreed
On 01 Jan, 2021
Reviewer #14 agreed
On 01 Jan, 2021
Reviewer #11 agreed
On 01 Jan, 2021
Reviewer #10 agreed
On 01 Jan, 2021
Reviewer #13 agreed
On 01 Jan, 2021
Reviewer #4 agreed
On 01 Jan, 2021
Reviewer #2 agreed
On 01 Jan, 2021
Reviewer #1 agreed
On 01 Jan, 2021
Reviewer #16 agreed
On 01 Jan, 2021
Reviewer #12 agreed
On 01 Jan, 2021
Reviewers invited
Invitations sent on 31 Dec, 2020
Editor assigned
On 31 Dec, 2020
Editor invited
On 24 Dec, 2020
Submission checks complete
On 24 Dec, 2020
First submitted
On 21 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Cancer Biology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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 Brunei Darussalam in 2017, posing a major burden on society.
METHODS
This retrospective cohort study (n = 1,035 patients diagnosed with CRC in Brunei Darussalam from 1st January 2002 until 31st December 2017) aims to compare the overall survival rates of CRC patients (2002-2017), to compare survival rates between two study periods (2002-2009 and 2010-2017) and to identify prognostic factors of CRC. Kaplan-Meier estimator and log-rank tests were performed to analyse the overall survival rates of CRC patients. Multiple Cox regression was performed to determine the prognostic factors of CRC with adjusted hazard ratios (Adj. HRs) reported.
RESULTS
The 1-, 3- and 5-year survival rates of CRC patients are 78.6%, 62.5%, and 56.0% respectively from 2002-2017. The 1-, 3-, and 5-year survival rates of CRC patients for 2002-2009 are 82.2%, 69.6%, and 64.7%; 77.0%, 59.1%, and 51.3% for 2010-2017 respectively. A significant difference in CRC patients’ survival rate was observed between the two study periods, age groups, ethnic groups, cancer stages, and sites of cancer (p<0.001). The Adjusted Hazard Ratios (Adj. HRs) were significantly higher in the 2010-17 period (Adj. HR=1.78, p<0.001), older age group (>=60 years) (Adj. HR=1.93, p=0.005), distant cancer (Adj. HR=4.69, p<0.010), tumor at transverse colon and splenic flexure of colon (Adj. HR=2.44, p=0.009), and lower in the Chinese group (Adj. HR=0.63, p=0.003).
CONCLUSION
This study highlights the lower survival rates of CRC patients in 2010-2017, Malays, older patients, distant cancer, and tumors located at the latter half of the proximal colon (transverse colon), and predominantly LCRC (splenic flexure, descending colon, sigmoid colon, overlapping lesion colon and colon (NOS), as well as the rectosigmoid junction and rectum (NOS)). Age, ethnicity, cancer stage, and tumor location are significant prognostic factors for CRC. These findings underscore the importance of public health policies and programmes to enhance awareness on CRC from screening to developing strategies for early detection and management, to reduce CRC-associated mortality.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6