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Risk factors for recurrence in elderly patients with stage II colorectal cancer: a multicenter retrospective study



Adjuvant chemotherapy for stage II colorectal cancer (CRC) is considered appropriate for patients with risk factors for recurrence, rather than for all patients uniformly. However, the risk factors for recurrence remain controversial, and there is limited information, especially for elderly patients. The Geriatric Nutritional Risk Index (GNRI) is widely used as a simple nutritional screening tool in the elderly and is associated with cancer prognosis and recurrence. This study aimed to investigate the risk factors for recurrence in the elderly with stage II CRC, focusing on the GNRI.


We enrolled 348 elderly patients (≥ 75 years) with stage II CRC who underwent curative resection at the Department of Surgery, Tottori University and our 10 affiliated institutions. The patients were divided into GNRIhigh (≥ 93.465) and GNRIlow (< 93.465) groups.


The GNRIlow group showed a significantly worse overall survival (OS), cancer-specific survival (CSS), and relapse-free survival (RFS) (P < 0.001, P < 0.001, and P < 0.001, respectively). In a multivariate analysis, GNRIlow (hazard ratio [HR]: 2.244, P < 0.001), pathologic T4 stage (HR: 1.658, P = 0.014), and moderate to severe lymphatic or venous invasion (HR: 1.460, P = 0.033) were independent factors affecting RFS. By using these three factors to score the risk of recurrence from 0 to 3 points, the prognosis was significantly stratified in terms of OS, CSS, and RFS (P < 0.001, P < 0.001, and P < 0.001, respectively). The recurrence rate for each score was as follows: 0 points, 9.8%; 1 point, 22.0%; 2 points, 37.3%; and 3 points, 61.9%.


GNRIlow, pathologic T4 stage, and moderate to severe lymphatic or venous invasion are high-risk factors for recurrence in the elderly with stage II CRC. The scoring system using these three factors appropriately predicted their recurrence and outcome.

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The number of elderly patients diagnosed with colorectal cancer (CRC) continues to increase with the aging of the population worldwide. In fact, approximately 40% of CRC patients are over 75 years [1]. However, because elderly patients are generally excluded from clinical trials, the recommended treatment for this population is more unclear than for non-elderly patients. In particular, elderly patients typically show poor tolerance to chemotherapy, and its administration might worsen their performance status (PS) [2]. In a previous retrospective study, the rate of adjuvant chemotherapy (AC) for patients with stage III CRC decreased dramatically with increasing age: 78% of patients aged 65–69 years, 74% of those aged 70–74, 58% of those aged 75–79 years, 34% of those aged 80–84 years, and 11% of those aged 85–89 years [3]. However, there is a considerable number of the elderly in a good general condition who may benefit from chemotherapy. An analysis of 5489 patients ≥ 75 years of age with resected stage III colon cancer reported a survival benefit of 5-fluorouracil-based AC [4].

The clinical efficacy of AC after curative resection in patients with stage II CRC remains controversial. Currently, guidelines recommend that AC for stage II CRC should be targeted to patients at high risk of recurrence rather than uniformly given to all patients [5,6,7,8]. The following variables have been proposed as high-risk factors for recurrence: pathologic T4 stage, perforation, poorly differentiated or undifferentiated adenocarcinoma, venous invasion, lymphatic invasion, and < 12 dissected lymph nodes [9, 10]. However, few studies have focused on risk factors for the recurrence of stage II CRC in elderly patients. Furthermore, most of these proposed risk factors represent only the progression of the tumor itself. Regarding AC for the elderly, it is advisable to identify high-risk factors specific to elderly patients.

In recent years, it has been reported that not only tumor-specific factors but also patient factors related to nutritional status influence survival outcomes in various cancers [11, 12]. The Geriatric Nutritional Risk Index (GNRI) was first reported as an elderly-specific nutritional assessment index to predict nutrition-related risks of morbidity and mortality for hospitalized elderly patients [13]. Recent reports have shown that the GNRI is closely associated with the prognosis of various malignant tumors, including CRC [14], gastric cancer [15], and pancreatic cancer [16]. Interestingly, a low GNRI is not only reported to indicate poor overall survival (OS) due to poor nutritional status but also poor cancer-specific survival (CSS) and relapse-free survival (RFS), which might reflect the state of cancer [16,17,18].

Therefore, in the present study, we investigated the high-risk factors for recurrence in elderly patients with stage II CRC, focusing on the GNRI.



The present study included 348 elderly patients aged ≥ 75 years among a total of 713 patients with pathological stage II CRC who underwent radical surgery at the Department of Surgery, Tottori University and our 10 affiliated institutions from January 2007 to December 2017. The eighth edition of the Union for International Cancer Control Tumor, Node, Metastasis staging system was used to determine the clinicopathological characteristics [19]. The ninth edition of the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma by the Japan Society for Cancer of the Colon and Rectum was used to evaluate lymphatic invasion and venous invasion [20]. Preoperative data including serum albumin level, C-reactive protein, carcinoembryonic antigen, carbohydrate antigen 19–9, and body weight were measured within 1 month before surgery. Forty-one patients (11.8%) were treated with postoperative adjuvant chemotherapy (uracil/tegafur plus leucovorin, n = 15; capecitabine, n = 12; uracil/tegafur, n = 7; tegafur/gimeracil/oteracil potassium, n = 4; fluorouracil plus l-leucovorin, n = 1; capecitabine plus oxaliplatin, n = 1; fluorouracil/leucovorin plus oxaliplatin, n = 1). This study was approved by the Certified Review Board of Tottori University Hospital (18A052) and each institution, and the requirement for informed consent was waived.

Calculation of the GNRI

The GNRI is a simple index calculated using serum albumin levels (ALB), ideal body weight (IBW), and actual body weight (ABW), which are easily available. The formula for calculating the GNRI is as follows: GNRI = 1.487 × ALB (g/L) + 41.7 × ABW/IBW (kg) [13]. IBW was calculated as 22 × height2 (m).

Statistical analyses

The chi-squared test and Mann–Whitney U test were used to compare the clinicopathological characteristics. The area under the curve (AUC) was calculated by receiver operating characteristic (ROC) analysis. ROC analysis was also used to determine the Youden index for the GNRI. The Kaplan–Meier method was used to generate survival curves, and their differences were examined using the log-rank test. Multivariate analyses were performed using Cox’s proportional hazards model. P < 0.05 was considered significant. SPSS software (SPSS for Mac Version 25; IBM Corp., Armonk, NY, USA) was used for statistical analyses.


We first verified the usefulness of the GNRI in predicting recurrence in the elderly. ROC analysis for RFS showed that the GNRI was considered a useful factor in predicting recurrence (AUC = 0.631; P < 0.001; Fig. 1). We then divided patients into GNRIhigh (≥ 93.465; n = 147) and GNRIlow (< 93.465; n = 201) groups according to the optimal cutoff values determined by ROC analysis. The relationship between GNRI status and clinicopathological factors is shown in Table 1. In addition to body mass index (BMI) and ALB, which are required to calculate the GNRI, there were significant differences between the two groups in age, Eastern Cooperative Oncology Group (ECOG) PS, C-reactive protein, preoperative carcinoembryonic antigen, obstruction, pathologic T stage, and lymphatic invasion.

Fig. 1
figure 1

Receiver operating characteristic curves of GNRI for relapse-free survival. GNRI, geriatric nutritional risk index; AUC, area under the curve

Table 1 Relationship between GNRI status and clinicopathological factors in elderly patients with stage II colorectal cancer

The prognosis of the GNRIlow group was worse than that of the GNRIhigh group in terms of 5-year OS (54.6% vs. 78.6%, respectively; P < 0.001; Fig. 2a), 5-year CSS (78.3% vs. 93.2%, respectively; P < 0.001; Fig. 2b), and 5-year RFS (40.8% vs. 70.9%, respectively; P < 0.001; Fig. 2c).

Fig. 2
figure 2

Kaplan–Meier curves according to the GNRI for overall (a), cancer-specific (b), and relapse-free (c) survival. GNRI, geriatric nutritional risk index

In a multivariate analysis, GNRIlow (hazard ratio [HR]: 2.244, 95% confidence interval [CI]: 1.533–3.286, P < 0.001), pathologic T4 stage (HR: 1.658, 95% CI: 1.107–2.482, P = 0.014), and moderate to severe lymphatic or venous invasion (HR: 1.460, 95% CI: 1.031–2.068, P = 0.033) were independent and significant factors affecting RFS (Table 2).

Table 2 Univariate and multivariate analyses for relapse-free survival in elderly patients with stage II colorectal cancer

Previous reports have shown a relationship between the number of risk factors for recurrence and survival in patients with stage II CRC and suggested that AC is more beneficial for patients with multiple risk factors [21,22,23]. We considered that the adverse effects of AC should be carefully evaluated for elderly patients and that more accurate identification of high-risk patients was warranted. Therefore, we finally developed a scoring system (from 0 to 3 points) to predict recurrence using three independent factors obtained by multivariate analysis. As shown in Fig. 3, the proposed scoring system predicted the patient’s outcome in terms of OS (5-year OS rates, 78.6% vs. 65.3% vs. 53.7% vs. 34.5%, respectively; P < 0.001; Fig. 3a), CSS (5-year CSS rates, 94.3% vs. 88.0% vs. 75.6% vs. 44.7%, respectively; P < 0.001; Fig. 3b), and RFS (5-year RFS rates, 75.1% vs. 53.1% vs. 35.6% vs. 24.8%, respectively; P < 0.001; Fig. 3c). Regarding RFS, the survival curves for each score were generally evenly spaced. Furthermore, the recurrence rate for each score was as follows: 0 points, 9.8%; 1 point, 22.0%; 2 points, 37.3%; and 3 points, 61.9%.

Fig. 3
figure 3

Kaplan–Meier curves according to recurrence prediction scores for overall (a), cancer-specific (b), and relapse-free (c) survival


Our study showed that low GNRI level is a prognostic and high-risk factor for recurrence in elderly patients with stage II CRC and that the scoring system using the GNRI, pathologic T4 stage, and lymphatic/venous invasion could stratify patient outcomes in terms of OS, CSS, and RFS.

In recent years, not only the severity of tumor progression but also the patient’s poor nutritional condition have been considered to affect prognosis and recurrence. Several nutritional assessment tools, including the prognostic nutritional index [24], controlling nutritional status [25], and Glasgow prognostic score [26], have been reported as prognostic factors for patients with various cancers. Although these tools are inexpensive and objective, their clinical application is limited because of a lack of consensus in the elderly. In contrast, the GNRI was originally designed to assess nutritional risk for hospitalized elderly patients [13]. Furthermore, this index is calculated using ALB, height, and body weight, which are usually measured before surgery.

Hypoalbuminemia is a known indicator of malnutrition and is closely associated with systemic inflammation and poor immune responses. Tumor-induced systemic inflammation promotes tumorigenesis, invasion, and metastasis via inflammatory mediators, such as tumor necrosis factor-alpha, interleukin-6, and interleukin-10 [27, 28]. Additionally, nutritional deficiencies impair cell-mediated immunity and the function of cytokines and phagocytes, leading to an inadequate anti-tumor immune reaction [29]. Indeed, hypoalbuminemia has been reported as a prognostic factor for immune-checkpoint therapy (ICT) in lung cancer [30], and the Gustave Roussy Immune Score, which is used as a prognostic indicator for ICT, includes low albumin as one of its components [31]. In addition, lower ABW/IBW, which indicates lower BMI, reflects frailty and cachexia and is associated with poor prognosis in elderly patients with cancer [32]. Furthermore, BMI may also be related to tumor immunity. It has been reported that adipose tissue activates cytotoxic T-cells and reduces regulatory T-cells; therefore, a higher BMI leads to a greater effect of ICT [33, 34]. These findings support our results that a low GNRI reflects recurrence and poor prognosis in CRC.

Although nutritional status along with tumor-specific factors is considered important to evaluate patient outcomes, the risk factors for recurrence of stage II CRC reported to date are only related to tumor progression, and to the best of our knowledge, no reports have described nutritional assessment factors. In this study, pathologic T4 stage and lymphatic/venous invasion, which indicate advanced tumor progression, and a low GNRI, which indicates malnutrition, were identified as independent predictors of recurrence, suggesting that both tumor and patient’s nutritional factors have a significant impact on the outcome of elderly patients with stage II CRC.

There are several limitations to this study. First, it is a retrospective cohort study, and the number of cases is not large. Second, surgical techniques, such as the omission of extensive lymph node dissection in the elderly, are not standardized among institutions, which may introduce bias and affect the generalizability of the findings. Third, low GNRI values reflect malnutrition and poor general health; therefore, these patients may not necessarily tolerate chemotherapy. In fact, in our study, a low GNRI was strongly correlated with poor ECOG PS. Fourth, we performed this study with the definition of elderly patients as 75 years and older. Life expectancy has been increasing, and similar studies targeting patients over 80 years of age may be needed.


GNRIlow (< 93.465), pathologic T4 stage, and moderate to severe lymphatic or venous invasion are high-risk factors for recurrence in elderly patients with stage II CRC. The scoring system using these three factors appropriately predicted recurrence rates and outcomes, which may contribute to the decision of appropriate cases for AC.

Availability of data and materials

The datasets used and analyzed during the current study are not publicly available due to their containing information that could compromise the privacy of research participants but are available from the corresponding author on reasonable request.



Colorectal cancer


Performance status


Adjuvant chemotherapy


Geriatric Nutritional Risk Index


Overall survival


Cancer-specific survival


Relapse-free survival




Ideal body weight


Actual body weight


Area under the curve


Receiver operating characteristic


Body mass index


Eastern Cooperative Oncology Group


Hazard ratio


Confidence interval


Immune-checkpoint therapy


  1. van Steenbergen LN, Elferink MAG, Krijnen P, Lemmens V, Siesling S, Rutten HJT, Richel DJ, Karim-Kos HE, Coebergh JWW. Improved survival of colon cancer due to improved treatment and detection: a nationwide population-based study in The Netherlands 1989–2006. Ann Oncol. 2010;21(11):2206–12.

    Article  Google Scholar 

  2. Jensen SA, Vilmar A, Sørensen JB. Adjuvant chemotherapy in elderly patients (>or=75 yr) completely resected for colon cancer stage III compared to younger patients: toxicity and prognosis. Med Oncol. 2006;23(4):521–31.

    CAS  Article  Google Scholar 

  3. Schrag D, Cramer LD, Bach PB, Begg CB. Age and adjuvant chemotherapy use after surgery for stage III colon cancer. J Natl Cancer Inst. 2001;93(11):850–7.

    CAS  Article  Google Scholar 

  4. Sanoff HK, Carpenter WR, Stürmer T, Goldberg RM, Martin CF, Fine JP, McCleary NJ, Meyerhardt JA, Niland J, Kahn KL, et al. Effect of adjuvant chemotherapy on survival of patients with stage III colon cancer diagnosed after age 75 years. J Clin Oncol. 2012;30(21):2624–34.

    Article  Google Scholar 

  5. Figueredo A, Charette ML, Maroun J, Brouwers MC, Zuraw L. Adjuvant therapy for stage II colon cancer: a systematic review from the Cancer Care Ontario Program in evidence-based care’s gastrointestinal cancer disease site group. J Clin Oncol. 2004;22(16):3395–407.

    Article  Google Scholar 

  6. Matsuda C, Ishiguro M, Teramukai S, Kajiwara Y, Fujii S, Kinugasa Y, Nakamoto Y, Kotake M, Sakamoto Y, Kurachi K, et al. A randomised-controlled trial of 1-year adjuvant chemotherapy with oral tegafur-uracil versus surgery alone in stage II colon cancer: SACURA trial. Eur J Cancer. 2018;96:54–63.

    CAS  Article  Google Scholar 

  7. Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, Hasegawa K, Hotta K, Ishida H, Ishiguro M, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2020;25(1):1–42.

    Article  Google Scholar 

  8. Baxter NN, Kennedy EB, Bergsland E, Berlin J, George TJ, Gill S, Gold PJ, Hantel A, Jones L, Lieu C et. Al. Adjuvant Therapy for Stage II Colon Cancer: ASCO Guideline Update. J Clin Oncol. 2022:40(8):892–10.

  9. Benson AB 3rd, Schrag D, Somerfield MR, Cohen AM, Figueredo AT, Flynn PJ, Krzyzanowska MK, Maroun J, McAllister P, Van Cutsem E, et al. American society of clinical oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol. 2004;22(16):3408–19.

    Article  Google Scholar 

  10. Schmoll HJ, Van Cutsem E, Stein A, Valentini V, Glimelius B, Haustermans K, Nordlinger B, van de Velde CJ, Balmana J, Regula J, et al. ESMO Consensus Guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann Oncol. 2012;23(10):2479–516.

    CAS  Article  Google Scholar 

  11. Yamamoto T, Kawada K, Obama K. Inflammation-related biomarkers for the prediction of prognosis in colorectal cancer patients. Int J Mol Sci. 2021;22(15):8002.

    CAS  Article  Google Scholar 

  12. Jiang Y, Xu D, Song H, Qiu B, Tian D, Li Z, Ji Y, Wang J. Inflammation and nutrition-based biomarkers in the prognosis of oesophageal cancer: a systematic review and meta-analysis. BMJ Open. 2021;11(9):e048324.

    Article  Google Scholar 

  13. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, Benazeth S, Cynober L, Aussel C. Geriatric nutritional risk index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82(4):777–83.

    CAS  Article  Google Scholar 

  14. Sasaki M, Miyoshi N, Fujino S, Ogino T, Takahashi H, Uemura M, Matsuda C, Yamamoto H, Mizushima T, Mori M, et al. The geriatric nutritional risk index predicts postoperative complications and prognosis in elderly patients with colorectal cancer after curative surgery. Sci Rep. 2020;10(1):10744.

    CAS  Article  Google Scholar 

  15. Hirahara N, Matsubara T, Fujii Y, Kaji S, Hyakudomi R, Yamamoto T, Uchida Y, Miyazaki Y, Ishitobi K, Kawabata Y, et al. Preoperative geriatric nutritional risk index is a useful prognostic indicator in elderly patients with gastric cancer. Oncotarget. 2020;11(24):2345–56.

    Article  Google Scholar 

  16. Sakamoto T, Yagyu T, Uchinaka E, Miyatani K, Hanaki T, Kihara K, Matsunaga T, Yamamoto M, Tokuyasu N, Honjo S, et al. The prognostic significance of combined geriatric nutritional risk index and psoas muscle volume in older patients with pancreatic cancer. BMC Cancer. 2021;21(1):342.

    Article  Google Scholar 

  17. Shoji F, Matsubara T, Kozuma Y, Haratake N, Akamine T, Takamori S, Katsura M, Toyokawa G, Okamoto T, Maehara Y. Preoperative geriatric nutritional risk index: a predictive and prognostic factor in patients with pathological stage I non-small cell lung cancer. Surg Oncol. 2017;26(4):483–8.

    Article  Google Scholar 

  18. Kanno H, Goto Y, Sasaki S, Fukutomi S, Hisaka T, Fujita F, Akagi Y, Okuda K. Geriatric nutritional risk index predicts prognosis in hepatocellular carcinoma after hepatectomy: a propensity score matching analysis. Sci Rep. 2021;11(1):9038.

    CAS  Article  Google Scholar 

  19. Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. Chichester : Wiley; 2017.

  20. Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal, appendiceal, and anal carcinoma: the 3d English edition [Secondary Publication]. J Anus Rectum Colon. 2019;3(4):175–95.

    Article  Google Scholar 

  21. Babcock BD, Aljehani MA, Jabo B, Choi AH, Morgan JW, Selleck MJ, Luca F, Raskin E, Reeves ME, Garberoglio CA, et al. High-risk stage II colon cancer: not all risks are created equal. Ann Surg Oncol. 2018;25(7):1980–5.

    Article  Google Scholar 

  22. Kim MK, Won DD, Park SM, Kim T, Kim SR, Oh ST, Sohn SK, Kang MY, Lee IK. Effect of adjuvant chemotherapy on stage II colon cancer: analysis of Korean National Data. Cancer Res Treat. 2018;50(4):1149–63.

    Article  Google Scholar 

  23. Lee Y, Park I, Cho H, Gwak G, Yang K, Bae BN. Effect of adjuvant chemotherapy on elderly stage II high-risk colorectal cancer patients. Ann Coloproctol. 2021;37(5):298–305.

    Article  Google Scholar 

  24. Tominaga T, Nagasaki T, Akiyoshi T, Fukunaga Y, Honma S, Nagaoka T, Matsui S, Minami H, Miyanari S, Yamaguchi T, et al. Prognostic nutritional index and postoperative outcomes in patients with colon cancer after laparoscopic surgery. Surg Today. 2020;50(12):1633–43.

    Article  Google Scholar 

  25. Kuroda D, Sawayama H, Kurashige J, Iwatsuki M, Eto T, Tokunaga R, Kitano Y, Yamamura K, Ouchi M, Nakamura K, et al. Controlling Nutritional Status (CONUT) score is a prognostic marker for gastric cancer patients after curative resection. Gastric Cancer. 2018;21(2):204–12.

    Article  Google Scholar 

  26. Li MX, Bi XY, Li ZY, Huang Z, Han Y, Zhou JG, Zhao JJ, Zhang YF, Zhao H, Cai JQ. Prognostic role of glasgow prognostic score in patients with hepatocellular carcinoma: a systematic review and meta-analysis. Medicine (Baltimore). 2015;94(49):e2133.

    CAS  Article  Google Scholar 

  27. Landskron G, De la Fuente M, Thuwajit P, Thuwajit C, Hermoso MA. Chronic inflammation and cytokines in the tumor microenvironment. J Immunol Res. 2014;2014:149185.

    Article  Google Scholar 

  28. Diakos CI, Charles KA, McMillan DC, Clarke SJ. Cancer-related inflammation and treatment effectiveness. Lancet Oncol. 2014;15(11):e493-503.

    Article  Google Scholar 

  29. Saunders J, Smith T, Stroud M. Malnutrition and undernutrition. Medicine. 2011;39(1):45–50.

    Article  Google Scholar 

  30. Guo Y, Wei L, Patel SH, Lopez G, Grogan M, Li M, Haddad T, Johns A, Ganesan LP, Yang Y. Serum Albumin: Early Prognostic Marker of Benefit for Immune Checkpoint Inhibitor Monotherapy But Not Chemoimmunotherapy. Clin Lung Cancer. 2022;S1525-7304(22):00008–0.

  31. Bigot F, Castanon E, Baldini C, Hollebecque A, Carmona A, Postel-Vinay S, Angevin E, Armand J-P, Ribrag V, Aspeslagh S. Prospective validation of a prognostic score for patients in immunotherapy phase I trials: the Gustave Roussy Immune Score (GRIm-Score). Eur J Cancer. 2017;84:212–8.

    CAS  Article  Google Scholar 

  32. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-156.

    CAS  Article  Google Scholar 

  33. Cortellini A, Bersanelli M, Buti S, Cannita K, Santini D, Perrone F, Giusti R, Tiseo M, Michiara M, Di Marino P, et al. A multicenter study of body mass index in cancer patients treated with anti-PD-1/PD-L1 immune checkpoint inhibitors: when overweight becomes favorable. J Immunother Cancer. 2019;7(1):57.

    Article  Google Scholar 

  34. Ichihara E, Harada D, Inoue K, Sato K, Hosokawa S, Kishino D, Watanabe K, Ochi N, Oda N, Hara N, et al. The impact of body mass index on the efficacy of anti-PD-1/PD-L1 antibodies in patients with non-small cell lung cancer. Lung Cancer. 2020;139:140–5.

    Article  Google Scholar 

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We thank Melissa Crawford, PhD, from Edanz ( for editing a draft of this manuscript.


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TY and MY participated in the design of the study, interpretation of data, analysis, and drafting the article. MY, AT, KH, KS, CU, KK, ST, YK, SS, TY, HN, SS, HS, TN, KS, and KK collected data. YF revised the article. All authors read and approved the final version of the article.

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Correspondence to Manabu Yamamoto.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional review board of ethics committee and national research committee with the 1964 Helsinki declaration and its later amendments. The Tottori University Hospital Ethics Committee approved this study (No. 18A052), and the need for informed consent was waived by the Tottori University Ethics Committee.

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Yagyu, T., Yamamoto, M., Tanio, A. et al. Risk factors for recurrence in elderly patients with stage II colorectal cancer: a multicenter retrospective study. BMC Cancer 22, 390 (2022).

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  • GNRI
  • Stage II CRC
  • Elderly patients