Impact of adjuvant chemotherapy on survival outcomes in older and non-older patients with high-risk stage II colorectal cancer.

PURPOSE

To investigate the impact of adjuvant chemotherapy on oncological outcomes in older and non-older patients with high-risk stage II colorectal cancer (CRC).

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.