Clinicopathological predictors of five-year mortality in colorectalcancer patients in the Zenica-Doboj Canton, Bosnia and Herzegovina

Abstract

Aim: To identify the clinicopathological factors associated with five year mortality in patients with colorectal cancer (CRC) treated at Cantonal Hospital Zenica, Bosnia and Herzegovina.

Methods: A retrospective cohort of 64 consecutively operated CRC patients (2019 2024) was analysed. The base-line variables included age, sex, tumor stage, histology, metastatic burden, local infiltration, and comorbidities. Five year cumulative mortality was the primary outcome. Risk ratios (RR) with 95 % confidence intervals (CI) were calculated by two by two contingency analysis.
Results: The cohort comprised 26 women (40.6 %) and 38 men (59.4 %); their median age was 64 years (IQR 58.8–73.0). Eleven patients (17.2 %) died within five years. Mortality was strongly linked to tumor spread and cardiometabolic disease. Any distant metastasis conferred a fifteen fold increase in risk (9/15 vs 2/49; RR 14.7, 95 % CI 3.6–60.8, p < 0.001), and the involvement of two or more metastatic sites remained prognostic (RR 5.6, 95 % CI 1.9–16.9,
p = 0.014). Infiltration of more than two adjacent organs quadrupled mortality (RR 4.4, 95 % CI 1.7–11.6, p = 0.032). Hypertension was present in 10 of the 11 deaths, yielding an RR of 12.1 (95 % CI 1.6–88.8, p = 0.002).
Type 2 diabetes also increased risk (RR 3.5, 95 % CI 1.3–9.6, p = 0.040). Patients with three or more comorbid conditions had a nearly four times higher mortality (RR 3.9, 95 % CI 1.3–11.7, p = 0.027).
Conclusion: The five year death rate in this Bosnian Herzegovinian CRC cohort was driven chiefly by distant metastasis, extensive local invasion, and cardiometabolic comorbidities—especially hypertension and type 2 diabetes. Early detection of metastatic spread and proactive management of vascular risk factors may improve survival in similar settings.