Supoj Laiwattanapaisal¹

Objective: To evaluate overall survival (OS) and disease-free survival (DFS) in patients with colorectal adenocarcinoma (COAD) undergoing curative surgery and to identify independent prognostic factors.

Materials and Methods: The present study was a retrospective cohort study that included 221 patients with COAD who underwent curative resection by the same surgeon at Rayong Hospital, Thailand, between January 2012 and December 2021. Their demographic, clinical, and pathological characteristics were analyzed. Survival was examined using Kaplan-Meier analysis, and independent prognostic factors were identified using multivariate Cox regression.

Results: Among the patients studied, the mean follow-up duration was 66.6 months. The 5-year OS rate was 81.2%, and the 5-year DFS rate was 76.6%. By stage, the 5-year OS rate was 97.4% for patients in stage I, 91.4% for those in stage II, 65.9% for those in stage III, and 76.2% for those in stage IV. Multivariable analysis identified female (hazard ratio [HR] 2.39, 95% confidence interval [CI] 1.27 to 4.50, p=0.007), body mass index (BMI) of 25 kg/m² or more (HR 2.42, 95% CI 1.31 to 4.47, p=0.005), preoperative carcinoembryonic antigen (CEA) level of 5 ng/mL or more (HR 1.82, 95% CI 1.00 to 3.32, p=0.050), lymph node involvement (N1: HR 3.65, 95% CI 1.74 to 7.66, p=0.001; N2: HR 4.87, 95% CI 2.16 to 10.94, p<0.001), and having four high-risk pathological features (HR 79.7, 95% CI 7.62 to 833.57, p<0.001) as significantly associated with worse DFS.

Conclusion: Female, high BMI, nodal involvement, elevated preoperative CEA level, and multiple high-risk pathological features independently predict worse survival outcomes in patients with COAD. Therefore, these factors should be used to guide individualized follow-up and adjuvant therapy decisions.

Received 4 June 2025 | Revised 22 October 2025 | Accepted 22 October 2025

DOI: 10.35755/jmedassocthai.2025.12.961-973-03128