Epidemiological aspects of colorectal cancer in East Azerbaijan, Northwest Iran: five year survival analysis

Main Article Content

Ramin Barnous
Mohammad Hossein Somi
Zohreh Sanaat
Pooneh Jabbaripoor
Neda Dolatkhah
Roya Dolatkhah


Colorectal cancer (CRC) is the third most common cancer and the second leading cause of death from cancer in the world. Currently, CRC is the fourth most common cancer in men and the second common cancer in women of all ages in Iran. The aim of this study was to determine the epidemiologic profile of CRC along with CRC specific survival analysis.

This was an analytical cross-sectional study using the East Azerbaijan Population Based Cancer Registry database (EA-PBCR) as a source for data related to patients with a diagnosis of CRC. Colorectal cancer specific 1- to 5-year survival analysis and mortality rates were calculated. Log-rank test and Cox regression analysis was performed to test the equality of survival function and mortality hazard.

A total of 2,366 newly diagnosed CRCs were registered during 3 years, with a male: female ratio of 1.31. Overall survival rate was 49.8%. One- to 5-year survival rates were 96.21%, 56.94%, 48.62%, 47.88% and 46.76% respectively. At multivariate level, after adjusting for all variables, regression analysis showed that the hazard of mortality in stage IV cancers was 46.44 times higher than that in stage I cancers (HR=46.44, 95% CI: 14.86-145.14, p=0.000). However, differences in patients’ age group and sex and the subsite of cancer did not create any statistically significant variation between groups in regards to mortality hazards (p>0.05).

This study demonstrated that the stage and grade of CRC were important prognostic factors and that early screening and diagnosis of CRC were essential.

Article Details

How to Cite
Barnous, R. ., Somi, M. H. ., Sanaat, Z. ., Jabbaripoor, P. ., Dolatkhah, N. ., & Dolatkhah, R. (2021). Epidemiological aspects of colorectal cancer in East Azerbaijan, Northwest Iran: five year survival analysis. Universa Medicina, 40(3), 190–199. https://doi.org/10.18051/UnivMed.2021.v40.190-199
Original Articles


Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209-49. doi:10.3322/caac.21660.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424. doi: 10.3322/caac.21492.

International Agency for Research on Cancer. Islamic Republic of Iran. The global cancer observatory;2021.

Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut 2017;66:683-91. doi: 10.1136/gutjnl-2015-310912.

Hasanpour-Heidari S, Fazel A, Semnani S, et al. Temporal and geographical variations in colorectal cancer incidence in Northern Iran 2004-2013. Cancer Epidemiol 2019;59:143-7. doi:10.1016/j.canep.2019.02.003.

Roshandel G, Ghanbari-Motlagh A, Partovipour E, et al. Cancer incidence in Iran in 2014: results of the Iranian National Population-based Cancer Registry. Cancer Epidemiol 2019;61:50-8. doi:10.1016/j.canep.2019.05.009.

Somi MH, Dolatkhah R, Sepahi S, Belalzadeh M, Naghashi S, Asghari Jafarabadi M. A 12-year trend analysis of the incidence of gastrointestinal cancers in East Azerbaijan: last updated results of an ongoing population-based cancer registry. BMC Cancer 2019;19:782. doi:10.1186/s12885-019-6008-3.

Somi MH, Dolatkhah R, Sepahi S, et al. Cancer incidence in the East Azerbaijan province of Iran in 2015–2016: results of a population-based cancer registry. BMC Public Health 2018;18:1266. https://doi.org/10.1186/s12889-018-6119-9.

Maajani K, Khodadost M, Fattahi A, et al. Survival rate of colorectal cancer in Iran: A systematic review and meta-analysis. Asian Pac J Cancer Prev 2019;20:13-21. doi:10.31557/APJCP.2019.20.1.13.

Saadati HM, Khodamoradi F, Salehiniya H. Associated factors of survival rate and screening for colorectal cancer in Iran: a systematic review. J Gastrointest Cancer 2020;51:401-11. doi:10.1007/s12029-019-00275-0.

Tahmasbi B, Abedi G, Moosazadeh M, et al. Determining the survival rate of colorectal cancer in Iran: a systematic review and meta-analysis. Asian Pac J Cancer Prev 2018;19:3009-18. doi:10.31557/APJCP.2018.19.11.3009.

Dolatkhah R, Somi MH, Kermani IA, et al. Increased colorectal cancer incidence in Iran: a systematic review and meta-analysis. BMC Public Health 2015;15:997. doi:10.1186/s12889-015-2342-9.

Khanali J, Kolahi AA. National and subnational cancer incidence for 22 cancer groups, 2000 to 2016: a study based on cancer registration data of Iran. J Cancer Epidemiol 2021;2021:6676666. doi:10.1155/2021/6676666.

Young C, Wood HM, Seshadri RA, et al. The colorectal cancer-associated faecal microbiome of developing countries resembles that of developed countries. Genome Med 2021;13:27. doi:10.1186/s13073-021-00844-8.

Roshandel G, Ghanbari-Motlagh A, Partovipour E, et al. Cancer incidence in Iran in 2014: results of the Iranian national population-based cancer registry. Cancer Epidemiol 2019;61:50-8. doi: 10.1016/j.canep.2019.05.009.

Fitzmaurice C, Abate D, Abbasi N, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the Global Burden of Disease study. JAMA Oncol 2019;5:1749-68. doi:10.1001/jamaoncol.2019.2996.

Cheung KS, Chen L, Seto WK, Leung WK. Epidemiology, characteristics, and survival of post-colonoscopy colorectal cancer in Asia: A population-based study. J Gastroenterol Hepatol 2019;34:1545-53. doi:10.1111/jgh.14674.

Li X, Zhou Y, Luo Z, et al. The impact of screening on the survival of colorectal cancer in Shanghai, China: a population based study. BMC Public Health 2019;19:1016. doi:10.1186/s12889-019-7318-8.

American Cancer Society. Survival rates for colorectal cancer. Atlanta: American Cancer Society;2021.

Kassim SA, Tang W, Abbas M, et al. Clinicopathologic and epidemiological characteristics of prognostic factors in post-surgical survival of colorectal cancer patients in Jiangsu Province, China. Cancer Epidemiol 2019;62:101565. doi:10.1016/j.canep.2019.07.004.

Almansoori A, Alzaabi M, Alketbi L. Colorectal cancer screening in ambulatory healthcare service clinics in Abu Dhabi, United Arab Emirates in 2015-2016. BMC Cancer 2021;21:897. doi:10.1186/s12885-021-08623-9.

Hassan MRA, Suan MA, Soelar SA, Mohammed NS, Ismail I, Ahmad F. Survival analysis and prognostic factors for colorectal cancer patients in Malaysia. Asian Pac J Cancer Prev 2016;17:3575-81.

Rasouli MA, Moradi G, Roshani D, Nikkhoo B, Ghaderi E, Ghaytasi B. Prognostic factors and survival of colorectal cancer in Kurdistan province, Iran: a population-based study (2009-2014). Medicine (Baltimore) 2017;96:e5941. doi:10.1097/MD.0000000000005941.

Vasudevan S, Mehta A. Clinical characteristics and survival profile of young versus old colorectal cancer patients at a tertiary cancer center in North India over a period of 5 years. Indian J Cancer 2020. doi:10.4103/ijc.IJC_246_19.

Hu S, Li S, Teng D, et al. Analysis of risk factors and prognosis of 253 lymph node metastasis in colorectal cancer patients. BMC Surg 2021;21:280. doi:10.1186/s12893-021-01276-2.

Destri GL, Barchitta M, Pesce A, et al. Predictive value of the number of harvested lymph nodes and cut-off for lymph node ratio in the prognosis of stage II and III colorectal cancer patients. J Invest Surg 2019;32:1-7. doi:10.1080/08941939.2017.1369605.

Li Q, Wang G, Luo J, Li B, Chen W. Clinicopathological factors associated with synchronous distant metastasis and prognosis of stage T1 colorectal cancer patients. Sci Rep 2021;11:8722. doi:10.1038/s41598-021-87929-x.

Borumandnia N, Doosti H, Jalali A, et al. Nomogram to predict the overall survival of colorectal cancer patients: a multicenter national study. Int J Environ Res Public Health 2021;18: 7734. doi:10.3390/ijerph18157734.

Madadizadeh F, Ghanbarnejad A, Ghavami V, Bandamiri MZ, Mohammadianpanah M. Applying additive hazards models for analyzing survival in patients with colorectal cancer in Fars Province, Southern Iran. Asian Pac J Cancer Prev 2017;18:1077-83. doi:10.22034/APJCP.2017.18.4.1077.

Hosseini SV, Rezaianzadeh A, Rahimikazerooni S, et al. Prognostic factors of rectal cancer in Southern Iran. J Gastrointest Cancer 2020. doi:10.1007/s12029-020-00553-2.

Jalaeikhoo H, Khajeh-Mehrizi A, Zokaasadi M, et al. Sixteen years of experience with the treatment of advanced colorectal cancer in Iran; a report from three institutions. Middle East J Dig Dis 2018;10:160-8. doi:10.15171/mejdd.2018.105.

Moamer S, Baghestani A, Pourhoseingholi MA, Hajizadeh N, Ahmadi F, Norouzinia M. Evaluation of prognostic factors effect on survival time in patients with colorectal cancer, based on Weibull Competing-Risks Model. Gastroenterol Hepatol Bed Bench 2017;10:54-9.