Overall Survival Following Radical Surgery and Postoperative Chemotherapy in Colorectal Cancer Patients Aged ≥70 Years: A Population-Based Retrospective Cohort Study

Background Colorectal cancer (CRC) predominantly affects the elderly, with a growing demand for evidence-based treatment strategies in this population. The influence of comorbidities and frailty on survival outcomes following postoperative chemotherapy in elderly CRC patients remains unclear. Method From the Korean National Health Insurance database, we analyzed 200,000 randomly sampled colorectal cancer patients (C18-20) diagnosed between 2009–2016. Patients under 20, those with inflammatory bowel disease, preoperative chemotherapy (except neoadjuvant chemoradiotherapy for rectal cancer), missing data, or death within 6 months post-surgery were excluded. Cox proportional hazards models estimated hazard ratios (HRs) for overall survival, adjusted for demographic factors. Subgroup and interaction analyses assessed effect modification by age, sex, and income. Incidence rates were reported per 1,000 person-years. Result Among 2,142 patients, 44.2% received postoperative chemotherapy. Chemotherapy recipients were younger and had lower overall mortality in the unadjusted analysis. However, after adjustment, postoperative chemotherapy was associated with an increased risk of mortality (adjusted hazard ratio [HR] 1.44, 95% CI: 1.10–1.87) in patients aged ≥ 70 years. The impact of chemotherapy on survival was more pronounced in younger patients. Comorbidity and frailty emerged as significant prognostic factors, potentially outweighing the benefits of adjuvant therapy in the elderly. Conclusion In elderly CRC patients, comorbidity and frailty may play a dominant role in determining overall survival, potentially exceeding the impact of tumor-directed treatments such as postoperative chemotherapy. These findings highlight the need for comprehensive geriatric assessment and individualized treatment planning in this population.