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Introduction <p>Obstruction in stage II colon cancer is a high-risk factor, but its definition remains unclear. The survival benefit of adjuvant chemotherapy (AC) in patients with partial obstruction has not been fully established. This study aimed to evaluate the oncologic implications of partial obstruction in stage IIA colon cancer and to examine whether AC was associated with improved survival.</p> Patients and methods <p>We retrospectively analyzed 214 patients with stage IIA colon cancer who underwent radical resection between January 2012 and December 2020. Partial obstruction was defined using endoscopic passability, adequacy of bowel preparation, and radiological bowel dilatation. Patients were grouped into surgery only (SO) (n = 108) and surgery plus AC (SC, n = 106). To reduce treatment-selection bias, 1:1 propensity score matching was performed, resulting in 53 matched pairs. Primary endpoints were overall survival (OS) and disease-free survival (DFS), estimated using Kaplan–Meier analyses and Cox proportional hazards models.</p> Results <p>Before matching, the SC group was younger and had higher rates of lymphatic, venous, and perineural invasion. In the matched cohort, 3-year disease-free survival was 92.1% in the SC group versus 81.4% in the SO group (log-rank p = 0.048), whereas 3-year OS was 98.1% versus 89.6%, respectively (p = 0.059). In multivariable Cox analysis of the matched cohort, adjuvant chemotherapy was not independently associated with improved OS (HR, 0.459; 95% CI 0.142–1.480; p = 0.193) or disease-free survival (HR, 0.492; 95% CI 0.206–1.174; p = 0.110). Most patients received capecitabine (72.6%), with a completion rate of 74.5%. A total of 10 grade 3–4 adverse events were recorded.</p> Conclusions <p>AC was associated with more favorable Kaplan–Meier survival patterns in the matched cohort, particularly for disease-free survival, but an independent survival advantage was not confirmed after multivariable adjustment. These findings support cautious, individualized decision-making and prospective validation using a reproducible definition of partial bowel obstruction.</p>

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Effect of adjuvant chemotherapy on survival in stage IIA colon cancer with partial bowel obstruction after propensity score matching

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月20日

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  • In Jun Yang,
  • Dong Ha Kim,
  • Kyung-Ha Lee,
  • Ji Yeon Kim

摘要

Introduction

Obstruction in stage II colon cancer is a high-risk factor, but its definition remains unclear. The survival benefit of adjuvant chemotherapy (AC) in patients with partial obstruction has not been fully established. This study aimed to evaluate the oncologic implications of partial obstruction in stage IIA colon cancer and to examine whether AC was associated with improved survival.

Patients and methods

We retrospectively analyzed 214 patients with stage IIA colon cancer who underwent radical resection between January 2012 and December 2020. Partial obstruction was defined using endoscopic passability, adequacy of bowel preparation, and radiological bowel dilatation. Patients were grouped into surgery only (SO) (n = 108) and surgery plus AC (SC, n = 106). To reduce treatment-selection bias, 1:1 propensity score matching was performed, resulting in 53 matched pairs. Primary endpoints were overall survival (OS) and disease-free survival (DFS), estimated using Kaplan–Meier analyses and Cox proportional hazards models.

Results

Before matching, the SC group was younger and had higher rates of lymphatic, venous, and perineural invasion. In the matched cohort, 3-year disease-free survival was 92.1% in the SC group versus 81.4% in the SO group (log-rank p = 0.048), whereas 3-year OS was 98.1% versus 89.6%, respectively (p = 0.059). In multivariable Cox analysis of the matched cohort, adjuvant chemotherapy was not independently associated with improved OS (HR, 0.459; 95% CI 0.142–1.480; p = 0.193) or disease-free survival (HR, 0.492; 95% CI 0.206–1.174; p = 0.110). Most patients received capecitabine (72.6%), with a completion rate of 74.5%. A total of 10 grade 3–4 adverse events were recorded.

Conclusions

AC was associated with more favorable Kaplan–Meier survival patterns in the matched cohort, particularly for disease-free survival, but an independent survival advantage was not confirmed after multivariable adjustment. These findings support cautious, individualized decision-making and prospective validation using a reproducible definition of partial bowel obstruction.