Adjuvant treatment of pathological stage III colorectal cancer: evaluation of different therapeutic regimens, toxicities and patient survival

Keywords

colorectal cancer - adjuvant treatment - therapeutic regimens - toxicities - patient survival

Introduction: The standard treatment for clinical stage III colon cancer is surgical treatment followed by adjuvant chemotherapy. There are several treatment regimens based on fluoropyrimidines and oxaliplatin and many patients are unable to complete adjuvant therapy.

Objective: evaluate the adjuvant treatment of patients, oncological journey, patients clinical profile, adverse events, treatment toxicities and estimate overall survival (OS) and progression-free survival (PSF) Method: retrospective, observational, unicentric study, with analysis of medical records of patients diagnosed with adenocarcinoma of the colon, rectosigmoid or proximal rectum treated with surgery and adjuvant chemotherapy.

Result: Between 2016 and 2021, 167 patients were evaluated with a median age at diagnosis of 59 years, most of them women (52%), median Charlson 3, 59% with low-risk tumors (74% T3 and 69% N1). Regarding the surgical journey, 49% of patients were treated with emergency surgery. The median time between diagnosis and surgery was 16 days and a median of 22 lymph nodes resected. All patients received adjuvant treatment. The median time to start adjuvant therapy was 10 weeks. The most used chemotherapy regimen was CAPOX (Capecitabine and Oxaliplatin) in 65% of cases. Between these patients, 10% discontinued and 73% completed adjuvant treatment. Among those who did not complete the treatment, 65% were due to toxicity and 10% due to disease progression. Among all patients, 24% required dose reduction, with the main toxicity being gastrointestinal (37%) and hematological (32%). Only 7.8% of patients were hospitalized because of treatment complications – the main cause was diarrhea (69%) and dehydration (23%). The median follow-up was 46 months. The 5-year overall survival rate was 81.2% and the 5-year progression-free survival rate was 68.1%. Multivariate Cox regression analysis showed that emergency surgery (HR1.81 [CI 0.95-4.43] - p 0.07) and high-risk (HR 1.57 [0.87-2.83] - p 0.01) had a significant impact in OS and PFS.

Conclusion: the most part of the population affected by stage III colorrectal adenocarcinoma in this study was young, healthy and had low-risk tumors. There was a high number of emergency surgeries, all of which underwent adjuvant surgery, but with a longer period until adjuvant treatment than recommended. Emergency surgery and high-risk factors had a greater impact on OS and PFS.

Corresponding author: Denize Bodnar (e-mail: [e-mail]).

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
06 May 2025