Postoperative Chemotherapy in Stage IIA Gastric Cancer: Not Always Necessary

The role of postoperative chemotherapy (POCT) in stage IIA gastric cancer remains controversial. In this population‐based Surveillance, Epidemiology, and End Results Program analysis of 2420 patients, long‐term outcomes were compared between those who received POCT ( n = 602) and those who did not ( n = 1818). Over a median follow‐up of 118 months, POCT was associated with improved overall survival and disease‐specific survival (DSS) in the unadjusted cohort. After propensity score matching, the overall survival benefit persisted ( p = 0.012), whereas the difference in DSS was no longer statistically significant ( p = 0.113). Exploratory subgroup analyses indicated that patients with intestinal‐type histology, non‐signet ring cell carcinoma, well to moderately differentiated tumors (grade I–II), or tumor size < 4 cm did not demonstrate a significant DSS benefit from POCT. These findings question the routine use of adjuvant chemotherapy in stage IIA disease and support a risk‐adapted approach in which POCT may be omitted in selected patients with favorable tumor biology.