The efficacy of XELOX and FOLFOX adjuvant chemotherapy in stage III colorectal cancer patients with low preoperative serum albumin levels

The incidence of advanced stage colorectal cancer (CRC) patients is increasing. Adjuvant chemotherapy [5-fluorouracil/leucovorin plus oxaliplatin (FOLOX) or capecitabine plus oxaliplatin (XELOX) is the standard treatment for patients with stage III CRC following surgery, with the objective of avoiding tumor recurrence and metastasis. However, the selection of an optimal treatment regimen is still necessary when managing elderly CRC patients. Seventy-five CRC elderly patients (aged ≥ 60 years) with stage III CRC who presented at the cancer center of Changhua Show Chwan Memorial Hospital from 2007-2014 were enrolled in this study. Sixty patients received FOLFOX and XELOX adjuvant chemotherapy. The remaining 15 did not. The overall survival (OS) and relapse-free survival (RFS) of the two groups [those who received adjuvant chemotherapy (XELOX and FOLOX) and those who did not] was analyzed using the Kaplan-Meier estimator and the Cox regression method. Longer periods of OS and RFS were found in patients in the FOLFOX or XELOX adjuvant chemotherapy regimen group compared with those in the non-adjuvant chemotherapy group. Five-year survival of 36.8% (OS) and 41.6% (RFS) was reported in the XELOX group and 58.0% (OS) and 90.0% (RFS) in the FOLFOX group, respectively, using the Kaplan-Meier estimator. Following Cox regression, it was revealed that the adjusted hazard ratio relating to non-adjuvant chemotherapy was 0.302 (a range of 0.130-0.703) and 0.437 (a range of 0.202-0.943) for the XELOX, and 0.112 (a range of 0.0140.913) and 0.124 (a range of 0.015-1.016) for the FOLFOX, adjuvant chemotherapy regimen groups, for OS and RFS, respectively. In addition, CRC patients with low preoperative serum albumin levels (≤ 3.5 g/dl) experienced inferior OS compared to those with high preoperative serum albumin levels (≥ 3.5 g/dl). Better clinical outcomes were found in patients with low preoperative serum albumin levels in the FOLFOX and XELOX adjuvant chemotherapy groups, compared to those with similar levels who did not receive adjuvant chemotherapy. Conversely, preoperative serum albumin levels of ≥ 3.5 g/dl in the elderly was an indication that chemotherapy was not warranted. Thus, it was determined on conclusion of the study that chemotherapy treatment for CRC was only indicated in the elderly when preoperative serum albumin levels of ≥ 3.5 g/dl were recorded.