Kaplan-Meier analysis showed that socioeconomic status, serum CEA, postoperative complications, HADS-anxiety status, HADS-depression status, and SCNS-SF34 score were significantly associated with early initiation (< 4 weeks) and delayed initiation (≥ 8 weeks) of adjuvant chemotherapy. Here, CEACAM5 is linked to major depressive disorder.