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Background <p>The optimal use of adjuvant chemotherapy (ACT) in patients with impaired performance status (PS) has not been reliably determined, particularly regarding intensification of treatment with oxaliplatin (OX). In this study, we evaluated the clinical impact of ACT and OX in patients with Stage III colorectal cancer (CRC) and impaired PS.</p> Methods <p>The cohort of this multicenter retrospective study comprised 566 patients with Stage III CRC and PS ≥ 1 who had undergone curative resection. Propensity score matching was used to compare outcomes between ACT (+) and ACT (−) groups. Additionally, stabilized inverse probability of treatment weighting was performed to compare outcomes of fluoropyrimidine (FP) monotherapy and OX-based regimens. The primary endpoint was disease-free survival (DFS).</p> Results <p>After propensity score matching, ACT (+) was associated with significantly longer DFS than ACT (−) (HR 0.573, <i>P</i> = 0.003), with consistent findings for relapse-free survival, overall survival, and sensitivity analyses. Inverse probability of treatment weighting analyses showed that OX-based regimens did not achieve significantly longer DFS than did FP monotherapy (HR 1.143, <i>P</i> = 0.705). Exploratory subgroup analyses showed shorter DFS with OX in high-risk disease, but not in low-risk disease.</p> Conclusions <p>ACT was associated with improved survival, even in patients with impaired PS. In contrast, OX-based combination therapy did not demonstrate a statistically significant additional survival benefit over fluoropyrimidine monotherapy in this cohort. These findings suggest that treatment strategies for Stage III CRC with impaired PS should be individualized, with careful consideration of the patient’s condition rather than routinely intensifying treatment.</p>

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Clinical impact of adjuvant chemotherapy and regimen selection in Stage III colorectal cancer with impaired performance status: a multicenter cohort study

  • 期刊论文

  • 发表日期：

    2026年7月16日

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  • Takuki Yagyu,
  • Manabu Yamamoto,
  • Chihiro Uejima,
  • Akimitsu Tanio,
  • Yasuro Kurisu,
  • Shunsuke Shibata,
  • Akemi Iwamoto,
  • Takuji Naka,
  • Yusuke Kono,
  • Kyoichi Kihara,
  • Teruhisa Sakamoto,
  • Yoshiyuki Fujiwara

摘要

Background

The optimal use of adjuvant chemotherapy (ACT) in patients with impaired performance status (PS) has not been reliably determined, particularly regarding intensification of treatment with oxaliplatin (OX). In this study, we evaluated the clinical impact of ACT and OX in patients with Stage III colorectal cancer (CRC) and impaired PS.

Methods

The cohort of this multicenter retrospective study comprised 566 patients with Stage III CRC and PS ≥ 1 who had undergone curative resection. Propensity score matching was used to compare outcomes between ACT (+) and ACT (−) groups. Additionally, stabilized inverse probability of treatment weighting was performed to compare outcomes of fluoropyrimidine (FP) monotherapy and OX-based regimens. The primary endpoint was disease-free survival (DFS).

Results

After propensity score matching, ACT (+) was associated with significantly longer DFS than ACT (−) (HR 0.573, P = 0.003), with consistent findings for relapse-free survival, overall survival, and sensitivity analyses. Inverse probability of treatment weighting analyses showed that OX-based regimens did not achieve significantly longer DFS than did FP monotherapy (HR 1.143, P = 0.705). Exploratory subgroup analyses showed shorter DFS with OX in high-risk disease, but not in low-risk disease.

Conclusions

ACT was associated with improved survival, even in patients with impaired PS. In contrast, OX-based combination therapy did not demonstrate a statistically significant additional survival benefit over fluoropyrimidine monotherapy in this cohort. These findings suggest that treatment strategies for Stage III CRC with impaired PS should be individualized, with careful consideration of the patient’s condition rather than routinely intensifying treatment.