Postoperative adjuvant chemotherapy in patients with stage II early onset colorectal cancer: exploration and discovery using real-world data and the SEER database
Background and aimThe incidence of early-onset colorectal cancer (EOCRC) is rising, yet intensive postoperative adjuvant chemotherapy (ACT) often results in overtreatment with minimal prognostic benefit. This study aims to assess the therapeutic necessity of ACT in stage II EOCRC patients and to ide...
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Frontiers Media S.A.
2025-05-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2025.1566569/full |
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| author | Shikun Cao Yihuan Qiao Lijun Wu Qi Chen Kai Tian Jipeng Li Chungen Xing |
| author_facet | Shikun Cao Yihuan Qiao Lijun Wu Qi Chen Kai Tian Jipeng Li Chungen Xing |
| author_sort | Shikun Cao |
| collection | DOAJ |
| description | Background and aimThe incidence of early-onset colorectal cancer (EOCRC) is rising, yet intensive postoperative adjuvant chemotherapy (ACT) often results in overtreatment with minimal prognostic benefit. This study aims to assess the therapeutic necessity of ACT in stage II EOCRC patients and to identify potential ACT candidates.MethodsA total of 296 non-ACT and 50 ACT patients with stage II EOCRC were included from Xijing Hospital (XJCRC), and 2067 non-ACT and 1163 ACT patients were enrolled from the Surveillance, Epidemiology, and End Results (SEER) cohort. To address selection bias and confounding, propensity score matching, inverse probability treatment weighting (IPTW), and multivariate Cox regression analyses were utilized. Survival curves and landmark analysis were employed to compare Overall Survival (OS) differences.ResultsSimilar OS were observed between ACT and non-ACT groups in both cohorts before and after adjustment for confounders. No significant survival differences were noted in dMMR (P = 0.48), pMMR (P = 0.07), and T3 (P = 0.83) subgroups. However, T4 stage patients receiving ACT demonstrated prolonged survival compared to non-ACT counterparts, particularly after three years (P = 0.007), as identified by landmark analysis.ConclusionsMost stage II EOCRC patients might yield limited benefits from postoperative ACT, with the sole exception of those at T4 stage, who could experience long-term clinical advantages.Clinical Trial Registrationhttps://clinicaltrials.gov/study/, identifier NCT06308354. |
| format | Article |
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| institution | DOAJ |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Oncology |
| spelling | doaj-art-ea93b4371a9a4bb6b5cf397790ec9c7f2025-08-20T03:21:47ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-05-011510.3389/fonc.2025.15665691566569Postoperative adjuvant chemotherapy in patients with stage II early onset colorectal cancer: exploration and discovery using real-world data and the SEER databaseShikun Cao0Yihuan Qiao1Lijun Wu2Qi Chen3Kai Tian4Jipeng Li5Chungen Xing6Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou Jiangsu, ChinaDepartment of Digestive Surgery, The First Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, ChinaDepartment of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou Jiangsu, ChinaDepartment of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou Jiangsu, ChinaDepartment of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou Jiangsu, ChinaDepartment of Digestive Surgery, The First Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, ChinaDepartment of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou Jiangsu, ChinaBackground and aimThe incidence of early-onset colorectal cancer (EOCRC) is rising, yet intensive postoperative adjuvant chemotherapy (ACT) often results in overtreatment with minimal prognostic benefit. This study aims to assess the therapeutic necessity of ACT in stage II EOCRC patients and to identify potential ACT candidates.MethodsA total of 296 non-ACT and 50 ACT patients with stage II EOCRC were included from Xijing Hospital (XJCRC), and 2067 non-ACT and 1163 ACT patients were enrolled from the Surveillance, Epidemiology, and End Results (SEER) cohort. To address selection bias and confounding, propensity score matching, inverse probability treatment weighting (IPTW), and multivariate Cox regression analyses were utilized. Survival curves and landmark analysis were employed to compare Overall Survival (OS) differences.ResultsSimilar OS were observed between ACT and non-ACT groups in both cohorts before and after adjustment for confounders. No significant survival differences were noted in dMMR (P = 0.48), pMMR (P = 0.07), and T3 (P = 0.83) subgroups. However, T4 stage patients receiving ACT demonstrated prolonged survival compared to non-ACT counterparts, particularly after three years (P = 0.007), as identified by landmark analysis.ConclusionsMost stage II EOCRC patients might yield limited benefits from postoperative ACT, with the sole exception of those at T4 stage, who could experience long-term clinical advantages.Clinical Trial Registrationhttps://clinicaltrials.gov/study/, identifier NCT06308354.https://www.frontiersin.org/articles/10.3389/fonc.2025.1566569/fullearly onset colorectal canceradjuvant chemotherapydeficient mismatch repairsurvivallandmark analysis |
| spellingShingle | Shikun Cao Yihuan Qiao Lijun Wu Qi Chen Kai Tian Jipeng Li Chungen Xing Postoperative adjuvant chemotherapy in patients with stage II early onset colorectal cancer: exploration and discovery using real-world data and the SEER database Frontiers in Oncology early onset colorectal cancer adjuvant chemotherapy deficient mismatch repair survival landmark analysis |
| title | Postoperative adjuvant chemotherapy in patients with stage II early onset colorectal cancer: exploration and discovery using real-world data and the SEER database |
| title_full | Postoperative adjuvant chemotherapy in patients with stage II early onset colorectal cancer: exploration and discovery using real-world data and the SEER database |
| title_fullStr | Postoperative adjuvant chemotherapy in patients with stage II early onset colorectal cancer: exploration and discovery using real-world data and the SEER database |
| title_full_unstemmed | Postoperative adjuvant chemotherapy in patients with stage II early onset colorectal cancer: exploration and discovery using real-world data and the SEER database |
| title_short | Postoperative adjuvant chemotherapy in patients with stage II early onset colorectal cancer: exploration and discovery using real-world data and the SEER database |
| title_sort | postoperative adjuvant chemotherapy in patients with stage ii early onset colorectal cancer exploration and discovery using real world data and the seer database |
| topic | early onset colorectal cancer adjuvant chemotherapy deficient mismatch repair survival landmark analysis |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2025.1566569/full |
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