A retrospective cohort study of 214 stage IV colorectal cancer patients aged ≥ 18 years at Cipto Mangunkusumo National General Hospital, Indonesia (January 2018–May 2020) evaluated 1-year survival. The one-year mortality rate was 53.3% and the median survival was 9.0 months (IQR 3.0–12.0). Most patients were younger than 60 years (66.8%) and 47% were underweight (BMI < 18.5 kg/m²). Multivariate analysis showed that BMI < 18.5 kg/m² (HR: 1.49) and absence of chemotherapy (HR: 4.47) were independently associated with higher mortality. The difference in survival associated with chemotherapy may be influenced by patient selection and baseline clinical status. The study points to poor one-year survival in these patients in a resource-limited setting.