Survival Patterns in Early-onset Colorectal Cancer Receiving Adjuvant Capecitabine Based Therapy

Objective: The incidence of early-onset colorectal cancer (EOCRC) is increasing worldwide, yet optimal adjuvant treatment strategies remain unclear. This study evaluated survival outcomes and prognostic factors in EOCRC patients treated with adjuvant capecitabine-based chemotherapy. Material and Methods: This retrospective study included 51 patients aged younger than 50 years with high-risk stage II or stage III colorectal cancer who underwent curative surgery followed by capecitabine-based adjuvant therapy between 2017 and 2021. Overall survival (OS) and recurrence-free survival (RFS) were analyzed using Kaplan-Meier curves and Cox regression models. Results: The median follow-up was 32 months. Stage III patients had significantly poorer OS and RFS than those of Stage II patients (p<0.05). In multivariate analysis, recurrence was the only independent predictor of OS [hazard ratio (HR)=12.45, p=0.002]. For RFS, nodal status remained an independent prognostic factor (HR=0.032, p=0.006). Among stage II patients, the XELOX regimen was associated with a significantly different recurrence risk compared to capecitabine monotherapy (HR=14.87, p=0.038). Conclusion: In EOCRC, stage and nodal status are key prognostic determinants. Adjuvant therapy should be tailored to pathological risk rather than age alone, as XELOX may offer a recurrence benefit in selected stage II patients, whereas routine treatment intensification risks avoidable toxicity.