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This study evaluates the efficacy of adjuvant chemotherapy in improving outcomes for elderly patients with stage II and III colorectal cancer.

April 29, 2026Open Access

Impact of Adjuvant Chemotherapy on the Prognosis in Elderly Patients with Stage II and III Colorectal Cancer: A Retrospective Multicenter Study

Key Points

This study evaluates the efficacy of adjuvant chemotherapy in improving outcomes for elderly patients with stage II and III colorectal cancer.
Retrospective analysis of 1183 patients aged ≥ 70 years with colorectal cancer from 2012 to 2022.
Patients were divided into adjuvant chemotherapy (adCTx) groups: adCTx (+) and adCTx (-), further stratified into 5-FU monotherapy or combination therapy.
Multivariable Cox regression was employed to determine hazard ratios for overall survival (OS) and recurrence-free survival (RFS).
Patients receiving adjuvant chemotherapy showed a 5-year OS of 88.6% compared to 75.7% in the adCTx (-) group (P < 0.001).
Adjuvant chemotherapy was associated with improved OS (HR 0.33, 95% CI 0.23–0.48, P < 0.001) and RFS (HR 0.59, 95% CI 0.47–0.76, P < 0.001).
No significant differences in OS or RFS were observed between 5-FU monotherapy and combination therapy.

Abstract

Purpose: The objective of this retrospective multicenter study was to evaluate the efficacy of adjuvant chemotherapy (adCTx) following curative resection in patients aged ≥ 70 years with colorectal cancer (CRC) and to compare the outcomes of monotherapy versus combination chemotherapy. Methods: Data from 1183 patients with stage II or III CRC who underwent surgery at five Hallym University-affiliated hospitals in Korea between 2012 and 2022 were retrospectively analyzed. Patients were divided into two groups based on adjuvant chemotherapy status (adCTx (+) vs adCTx (-)). Those receiving adCTx were further stratified into 5-fluorouracil (5-FU) monotherapy or 5-FU plus oxaliplatin combination therapy. Multivariable Cox regression was used to estimate adjusted hazard ratios (HRs) for overall survival (OS) and recurrence-free survival (RFS). Results: Of the 1183 patients, 555 received adCTx and 628 did not. Patients in the adCTx (+) group showed significantly better 5-year OS (88.6% vs 75.7%, P < 0.001) and RFS (66.5% vs 58.6%, P < 0.001). In multivariable analysis, adCTx was independently associated with improved OS (HR 0.33, 95% CI 0.23– 0.48, P < 0.001) and RFS (HR 0.59, 95% CI 0.47– 0.76, P < 0.001). Among patients receiving chemotherapy, there was no significant difference in OS or RFS between monotherapy and combination therapy. In stage II patients with high-risk factors, adCTx (+) was associated with better OS (P = 0.002) and RFS (P = 0.006), but the number of agents did not provide additional benefit. Conclusion: In this study of patients aged ≥ 70 years with stage II or III CRC, adjuvant chemotherapy was associated with improved OS and RFS. No significant differences in oncologic outcomes were observed between monotherapy and combination therapy. These findings suggest a potential benefit of adjuvant chemotherapy in selected elderly patients; however, prospective randomized studies are needed to confirm these results. Keywords: colorectal cancer, elderly, adjuvant chemotherapy, combination therapy

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