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<p>We propose that there is a survival difference between late-stage II and early-stage III colorectal adenocarcinoma (CRC) that has not been addressed in the current AJCC guidelines. This study aimed to assess short-term and long-term outcomes in this population and identify prognostic factors that may influence survival. A study of a prospectively maintained database was conducted among patients with stage II or III colorectal cancer at two quaternary referral centres between January 2010 and December 2023. Data were analysed via univariate and multivariate survival models, as well as propensity score matching (PSM). A total of 1,933 patients were identified from the database. Early stage III (IIIA) patients, defined as early node-positive disease, received adjuvant chemotherapy more frequently than did late-stage stage II (IIB/C) patients, defined as T4N0 disease (<i>p</i> &lt; 0.001). Five-year overall survival and 5-year recurrence-free survival were significantly worse in stage IIB/C patients than in stage IIIA patients (<i>p</i> &lt; 0.001 for both). These significant differences between groups remained after both multivariate and PSM analyses, with weighted hazard ratios for IIB/C vs. IIIA and IIIB/C vs. IIIA of 3.020 (95% CI 2.060–4.427) and 3.456 (95% CI 1.824–6.549) for overall survival and 3.030 (95% CI 2.078–4.419) and 3.623 (95% CI 1.950–6.729) for relapse-free survival, respectively. The survival paradox between stage IIB/C and IIIA CRC patients persists even after accounting for high-risk factors and adjuvant chemotherapy. This finding potentially warrants a new assessment in the next iteration of the AJCC criteria and, in addition, a prospective investigation of optimised adjuvant strategies for stage IIB/C patients.</p>

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Propensity score matching reveals a survival paradox in prognostic outcomes for late-stage II and early-stage III colorectal cancer patients

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月5日

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  • Arthavan Surendran,
  • Simon Wilkins,
  • Mohammad Asghari-Jafarabadi,
  • John Paul Plazzer,
  • Raymond Yap,
  • Jeremy Shapiro,
  • Paul McMurrick

摘要

We propose that there is a survival difference between late-stage II and early-stage III colorectal adenocarcinoma (CRC) that has not been addressed in the current AJCC guidelines. This study aimed to assess short-term and long-term outcomes in this population and identify prognostic factors that may influence survival. A study of a prospectively maintained database was conducted among patients with stage II or III colorectal cancer at two quaternary referral centres between January 2010 and December 2023. Data were analysed via univariate and multivariate survival models, as well as propensity score matching (PSM). A total of 1,933 patients were identified from the database. Early stage III (IIIA) patients, defined as early node-positive disease, received adjuvant chemotherapy more frequently than did late-stage stage II (IIB/C) patients, defined as T4N0 disease (p < 0.001). Five-year overall survival and 5-year recurrence-free survival were significantly worse in stage IIB/C patients than in stage IIIA patients (p < 0.001 for both). These significant differences between groups remained after both multivariate and PSM analyses, with weighted hazard ratios for IIB/C vs. IIIA and IIIB/C vs. IIIA of 3.020 (95% CI 2.060–4.427) and 3.456 (95% CI 1.824–6.549) for overall survival and 3.030 (95% CI 2.078–4.419) and 3.623 (95% CI 1.950–6.729) for relapse-free survival, respectively. The survival paradox between stage IIB/C and IIIA CRC patients persists even after accounting for high-risk factors and adjuvant chemotherapy. This finding potentially warrants a new assessment in the next iteration of the AJCC criteria and, in addition, a prospective investigation of optimised adjuvant strategies for stage IIB/C patients.