ArticleInternational journal of clinical oncology2026
Clinical impact of adjuvant chemotherapy and regimen selection in Stage III colorectal cancer with impaired performance status: a multicenter cohort study.
Article in International journal of clinical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe 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.
methodsThe 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).
resultsAfter 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.
conclusionsACT 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.
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