Objective: To evaluate one-year survival and identify mortality-associated factors in stage IV colorectal cancer patients in Indonesia. Patients and methods: A retrospective cohort study was conducted using medical records of 214 patients aged ≥18 years who were diagnosed with stage IV CRC at Cipto Mangunkusumo National General Hospital between January 2018 and May 2020. Variables analyzed included demographic characteristics, body mass index (BMI), and chemotherapy status. Survival analysis was performed using the Kaplan–Meier method and Cox proportional hazards model. Results: Key findings included a one-year mortality rate of 53.3% and a median survival of 9.0 months (IQR 3.0–12.0). Most patients were under 60 years old (66.8%), and 47% were underweight (BMI < 18.5 kg/m2). Multivariate analysis revealed that a BMI < 18.5 kg/m2 (HR: 1.49) and lack of chemotherapy (HR: 4.47) significantly predicted increased mortality. Multivariate analysis revealed that a BMI < 18.5 kg/m2 (HR: 1.49) and lack of chemotherapy (HR: 4.47) were independently associated with higher one-year mortality. However, the observed survival difference related to chemotherapy may be influenced by patient selection and baseline clinical condition. Conclusion: This study demonstrates poor one-year survival among stage IV colorectal cancer patients in Indonesia. Underweight status and non-receipt of chemotherapy were independently associated with higher mortality; however, chemotherapy status likely reflects underlying patient fitness and disease severity rather than a direct causal effect. These findings highlight the challenges of late presentation, poor nutritional status, and limited access to systemic therapy in resource-limited settings. Copyright © 2026 Wildan, Christabel, Rinaldi, Abdullah and Makmun.