Impact of adjuvant chemotherapy on overall survival in early-onset stage II-III mucinous adenocarcinoma of the colon: A propensity-based analysis

Authors

• Usama Waqar, Emory University School of Medicine, Atlanta, Georgia, USA.
• Manali Rupji, Emory University School of Medicine, Atlanta, Georgia, USA.
• Musa Salar, Aga Khan UniversityFollow
• Hashim Salar, Aga Khan UniversityFollow
• Courtney L Devin, Emory University School of Medicine, Atlanta, USA
• Terrah J Paul Olson, Emory University School of Medicine, Atlanta, Georgia, USA.
• Yuan Liu, Emory University School of Medicine, Atlanta, Georgia, USA.
• Patrick Sullivan, Emory University School of Medicine, Atlanta, Georgia, USA.

Document Type

Article

Department

Medical College Pakistan

Abstract

Background: Incidence of early-onset colon cancer is rising. Younger patients often present with advanced disease and distinct molecular profiles. Mucinous adenocarcinoma (MAC) represents a biologically unique subtype that may demonstrate limited responsiveness to adjuvant chemotherapy (AC). This study evaluated association between AC and overall survival (OS) in patients with early-onset stage II and III MAC.
Methods: Patients aged < 50 years diagnosed with stage II-III MAC were identified from NCDB (2006-2020). Stage II was categorized as high- or low-risk, with high-risk defined by presence of ≥ 1 of: < 12 lymph nodes retrieved, lymphovascular/perineural invasion, poor differentiation, or pT4 disease. Stabilized inverse probability of treatment weighting, Kaplan-Meier analysis, and multivariable Cox regression were performed to assess the association between AC and OS.
Results: Among 3333 patients, 42.9% were stage II and 57.1% stage III. AC was administered to 70.1% of patients, including 41.3% with stage II and 91.7% with stage III disease. AC was not associated with improved OS in either high-risk or low-risk stage II subgroups but was significantly associated with improved OS in stage III disease (HR 0.71, 95% CI 0.54-0.93)
Conclusion: AC was associated with improved survival in stage III but not stage II early-onset MAC, including those with high-risk features

Comments

Volume, issue and pagination are not provided by author/publisher.

Publication (Name of Journal)

The Journal of Surgical Oncology

DOI

10.1007/s00428-026-04644-6

Recommended Citation

Waqar, U., Rupji, M., Salar, M., Salar, H., Devin, C., Olson, T. P., Liu, Y., Sullivan, P. (2026). Impact of adjuvant chemotherapy on overall survival in early-onset stage II-III mucinous adenocarcinoma of the colon: A propensity-based analysis. The Journal of Surgical Oncology.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_mc/705