Ramli Siti Ramizah, Azhar Zahir Izuan, Raman Sukumaran, Yusof Siti Norbayah, Mohamad Mariam
Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia.
National Cancer Registry Department, National Cancer Institute, Ministry of Health, Putrajaya, Malaysia.
Cancer Causes Control. 2025 Apr;36(4):389-397. doi: 10.1007/s10552-024-01945-6. Epub 2024 Dec 9.
Large geographical variations in colorectal cancer (CRC) survival rates have been reported across regions. Poorer survival rates were mainly found in socioeconomically deprived areas, highly dense areas, and areas lacking healthcare accessibility. The objective of this study was to identify, compare, and contrast the spatial patterns of 5-year CRC-specific survival rates and identify high-priority areas by districts in Malaysia.
This retrospective cohort study utilized secondary data from the National Cancer Registry. CRC patients (ICD10 C18-21) diagnosed between 2013 and 2018 were selected. Patient addresses were geocoded into districts and states via geospatial data from the National Geospatial Centre, whereas district population density data were gathered from the Population Census of Malaysia. Kaplan‒Meier survival analysis and log-rank test were conducted to determine and compare the 5-year CRC-specific survival rates, and the spatial distribution of CRC survival by district was determined via ArcGIS software.
A total of 18,513 CRC patients were registered from 143 districts, with 10,819 deaths occurring during follow-up. The national 5-year CRC-specific survival rate was 42%, with median survival time of 36 months (95% CI: 34.46, 37.54). The eastern region (Kelantan, Terengganu, and Pahang) had the lowest survival (38.0%). Among the 143 districts, eighty-one (56.6%) reported survival rates below the national average while thirty-six (25.2%) were identified as high-priority districts.
The differences in CRC survival rates were evident according to geographical location. Area-based targeted interventions to improve CRC detection, management, and access to healthcare are imperative to address cancer survival disparities and help effectively allocate resources.
据报道，不同地区的结直肠癌（CRC）生存率存在很大的地理差异。生存率较低的情况主要出现在社会经济贫困地区、人口高度密集地区以及缺乏医疗可及性的地区。本研究的目的是识别、比较和对比马来西亚各地区5年结直肠癌特异性生存率的空间模式，并按地区确定高优先级区域。
这项回顾性队列研究使用了国家癌症登记处的二手数据。选取了2013年至2018年期间诊断为CRC的患者（ICD10 C18 - 21）。通过国家地理空间中心的地理空间数据将患者地址地理编码到地区和州，而地区人口密度数据则从马来西亚人口普查中收集。进行Kaplan - Meier生存分析和对数秩检验以确定和比较5年结直肠癌特异性生存率，并通过ArcGIS软件确定CRC生存率按地区的空间分布。
共从143个地区登记了18,513例CRC患者，随访期间有10,819例死亡。全国5年结直肠癌特异性生存率为42%，中位生存时间为36个月（95% CI：34.46，37.54）。东部地区（吉兰丹州、登嘉楼州和彭亨州）的生存率最低（38.0%）。在143个地区中，有81个（56.6%）报告的生存率低于全国平均水平，而36个（25.2%）被确定为高优先级地区。
结直肠癌生存率因地理位置而异。基于地区的针对性干预措施对于改善CRC检测、管理和医疗可及性至关重要，以解决癌症生存差异问题并帮助有效分配资源。
