Clinicopathological Features and Outcomes of Metastatic Colorectal Cancers Treated at a Tertiary Care Hospital: A Bidirectional Observational Study.

Metastatic colorectal cancer (mCRC) remains a major contributor to cancer-related mortality worldwide. Real-world data from low- and middle-income countries remain limited. This bidirectional observational study included 60 patients with histologically confirmed mCRC treated at a tertiary care center between January 2019 and December 2025. Demographic, clinicopathological, molecular, treatment, and survival data were analyzed. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Cox proportional hazards regression was used to identify prognostic factors. The median age was 48.5 years, and 63.3% of patients were male. Extensive metastatic disease was present in 96.7% of patients. Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations were detected in 20.7% of patients, whereas microsatellite instability-high (MSI-high) status was identified in one patient. Median PFS and OS were 10.6 and 22.3 months, respectively. On multivariable analysis, peritoneal metastasis independently predicted inferior PFS [hazard ratio (HR) 4.45, 95% confidence interval (CI) 2.16-9.19; p < 0.001] and OS (HR 2.83, 95% CI 1.13-7.07; p = 0.026). Poorly differentiated histology independently predicted worse OS (HR 3.05, 95% CI 1.03-9.06; p = 0.045). This study highlights the substantial burden of advanced disease in Indian patients with colorectal cancer. Peritoneal metastasis and poor differentiation were associated with adverse outcomes. Improved early detection and wider access to targeted therapies may improve survival outcomes in resource-limited settings.