Lymphocyte Count Predicts Adjuvant Chemotherapy Completion After Severe Postoperative Complications in Colorectal Cancer

Background/Aim: Postoperative complications can interfere with the continuation and completion of adjuvant chemotherapy (ACT) in stage III colorectal cancer. However, simple indicators for predicting treatment completion after severe postoperative complications remain unclear. This study evaluated whether total lymphocyte count (TLC) at ACT initiation predicts ACT completion and explored the association between ACT completion and recurrence-free survival. Patients and Methods: This retrospective multicenter study included 61 patients with pathological stage III colorectal cancer who developed severe postoperative complications, defined as Clavien-Dindo grade III-IV, and received ACT. The primary endpoint was ACT completion. Recurrence-free survival was evaluated as a secondary oncological outcome. Clinical factors, complication-related factors, treatment-related factors, and laboratory parameters at ACT initiation were compared according to completion status. Results: Among the 61 patients, 47 completed ACT and 14 did not. TLC at ACT initiation was significantly higher in the completion group. The area under the receiver operating characteristic curve of TLC for predicting ACT completion was 0.739. In multivariable logistic regression analysis, high TLC remained significantly associated with ACT completion [odds ratio 7.75, 95% confidence interval (CI)=1.90-31.63, p=0.004]. ACT completion was also associated with favorable recurrence-free survival (hazard ratio=0.387, 95%CI=0.155-0.968, p=0.042). Conclusion: TLC at ACT initiation may serve as a practical marker for predicting ACT completion in patients with stage III CRC who develop severe postoperative complications. ACT completion was associated with favorable recurrence-free survival and may reflect both adequate treatment exposure and postoperative recovery sufficient to tolerate ACT.