Shiraishi Takuya, Katayama Chika, Shibasaki Yuta, Komine Chika, Osone Katsuya, Okada Takuhisa, Sakai Makoto, Ogawa Hiroomi, Shirabe Ken, Saeki Hiroshi
Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi-shi, Gunma-ken, 371-8511, Japan.
Surg Today. 2025 Jun 17. doi: 10.1007/s00595-025-03072-4.
To investigate the impact of adjuvant chemotherapy on oncological outcomes in older and non-older patients with high-risk stage II colorectal cancer (CRC).
We retrospectively analyzed 247 patients diagnosed between January 2014 and August 2023. Clinicopathological factors, adjuvant chemotherapy, and the 3-year recurrence-free survival (3y-RFS) and overall survival (3y-OS) were analyzed. Older patients were defined as those ≥ 70 years old.
Of 247 patients, 154 (62.3%) were older. Adjuvant chemotherapy rates were significantly lower in older patients than in non-older ones (29.2% vs. 51.6%, p < 0.001). Side effects were the primary cause of discontinuation. The 3y-RFS improved with chemotherapy completion (non-older: 96.3% vs. 82.7%, p = 0.053; older: 100.0% vs. 83.7%. p = 0.028). Similarly, the 3y-OS also increased with chemotherapy completion (non-older: 100.0% vs. 91.9%, p = 0.475; older: 100.0% vs. 93.2%, p = 0.0139). A multivariate analysis identified obstruction (hazard ratio [HR], 4.153; p < 0.001), pT4 (HR, 3.891; p = 0.003), and adjuvant chemotherapy completion (HR, 0.046; p = 0.009) as independent RFS predictors.
Older patients were less likely to receive adjuvant chemotherapy than non-older ones primarily due to adverse effects. The completion of adjuvant chemotherapy notably improved the prognosis of high-risk stage II colorectal cancer. Patients with pT4 or obstruction have a poor prognosis, and the completion of adjuvant chemotherapy with appropriate management of adverse effects may improve the prognosis.
探讨辅助化疗对老年和非老年高危II期结直肠癌（CRC）患者肿瘤学结局的影响。
我们回顾性分析了2014年1月至2023年8月期间诊断的247例患者。分析了临床病理因素、辅助化疗以及3年无复发生存率（3y-RFS）和总生存率（3y-OS）。老年患者定义为年龄≥70岁的患者。
247例患者中，154例（62.3%）为老年患者。老年患者的辅助化疗率显著低于非老年患者（29.2%对51.6%，p<0.001）。副作用是停药的主要原因。完成化疗后3y-RFS有所改善（非老年患者：96.3%对82.7%，p=0.053；老年患者：100.0%对83.7%，p=0.028）。同样，完成化疗后3y-OS也有所提高（非老年患者：100.0%对91.9%，p=0.475；老年患者：100.0%对93.2%，p=0.0139）。多变量分析确定梗阻（风险比[HR]，4.153；p<0.001）、pT4（HR，3.891；p=0.003）和辅助化疗完成情况（HR，0.046；p=0.009）为独立的RFS预测因素。
老年患者接受辅助化疗的可能性低于非老年患者，主要原因是不良反应。辅助化疗的完成显著改善了高危II期结直肠癌的预后。pT4或梗阻患者预后较差，完成辅助化疗并适当处理不良反应可能改善预后。
