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Less Is More: Risk Factors and Survival Outcomes of Overtreatment for Early-Stage Colorectal Cancer.

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Title: Less Is More: Risk Factors and Survival Outcomes of Overtreatment for Early-Stage Colorectal Cancer.
Authors: Habib DRS; Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Shou M; Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Rogers JL; Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Sun K; Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Wang CC; Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Khan A; Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Source: Journal of surgical oncology [J Surg Oncol] 2025 Sep; Vol. 132 (3), pp. 427-436. Date of Electronic Publication: 2025 Jul 05.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: Wiley-Liss Country of Publication: United States NLM ID: 0222643 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1096-9098 (Electronic) Linking ISSN: 00224790 NLM ISO Abbreviation: J Surg Oncol Subsets: MEDLINE
Imprint Name(s): Publication: <2005-> : Hoboken, NJ : Wiley-Liss
Original Publication: New York, Plenum.
MeSH Terms: Colorectal Neoplasms*/mortality , Colorectal Neoplasms*/pathology , Colorectal Neoplasms*/surgery , Colorectal Neoplasms*/therapy , Overtreatment*/statistics & numerical data, United States/epidemiology ; Humans ; Female ; Male ; Middle Aged ; Aged ; Risk Factors ; Survival Rate ; Neoplasm Staging ; Follow-Up Studies ; Retrospective Studies ; Adult
Abstract: Background and Objectives: After cT1-2N0M0 colorectal cancer (CRC) definitive resection (colectomy/proctectomy) without pathologic upstaging, only observation is recommended given the lack of benefit from adjuvant treatment, which would constitute overtreatment. This study aims to determine risk factors and overall survival (OS) associated with overtreatment in early-stage CRC.
Methods: This National Cancer Database study included cT1-T2N0M0 CRC patients who underwent definitive resection between 2010 and 2020. Multivariable logistic regressions were performed to assess overtreatment risk factors. After propensity-matching, Kaplan-Meier survival analyses and multivariable Cox proportional-hazards analyses were performed to assess the association of overtreatment with OS.
Results: Of 22 875 colon cancer and 4198 rectal cancer cases, 144 (0.6%) and 82 (2.0%) were overtreated, respectively. Colon cancer overtreatment was associated with younger age (aOR = 0.96, 95% CI = 0.95-0.98), Black race (aOR = 1.94, 95% CI = 1.26-2.99), and pT2 vs. pT1 (aOR = 1.66, 95% CI = 1.19-2.33). Rectal cancer overtreatment was associated with pT2 (aOR = 2.58, 95% CI = 1.59-4.19), poor/undifferentiated grade (aOR = 2.61, 95% CI = 1.44-4.76), and high-risk histology (aOR = 3.20, 95% CI = 1.22-8.40). In the propensity-matched cohorts, overtreatment was associated with worse OS for colon (HR = 1.40, 95% CI = 1.01-1.93) but not rectal cancer (HR = 1.05, 95% CI = 0.66-1.68).
Conclusions: Patient and tumor characteristics predicted early-stage CRC overtreatment. Overtreatment was associated with worse OS for colon but not rectal cancer.
(© 2025 The Author(s). Journal of Surgical Oncology published by Wiley Periodicals LLC.)
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Grant Information: The authors received no specific funding for this work.
Contributed Indexing: Keywords: adjuvant therapy; colon cancer; overall survival; overtreatment; rectal cancer; surgery
Entry Date(s): Date Created: 20250705 Date Completed: 20250923 Latest Revision: 20250925
Update Code: 20260130
PubMed Central ID: PMC12455544
DOI: 10.1002/jso.70028
PMID: 40616596
Database: MEDLINE
Description
ISSN:1096-9098
DOI:10.1002/jso.70028