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Does Chemotherapy Help Patients With MSI-High Colon Cancer Live Longer?

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Adjuvant Chemotherapy and Survival in MSI-High Stages II and III Colon Cancer Impact of Histopathologic Risk Stratification. DOI- 10.1245s10434-025-18285-7

Some colon cancers have a feature called MSI-high (microsatellite instability-high). It means the cancer cells have trouble repairing DNA properly. This often leads to a better outcome, especially in early stages. But doctors have debated whether patients with MSI-high stage II colon cancer really need chemotherapy after surgery.

This new study looked at over 8,000 people with stage II or III MSI-high colon cancer to see who truly benefits from extra treatment.

Here’s what they found:

⦿ In low-risk stage II patients (those with fewer aggressive features), chemo did not improve survival. Most of these patients did well with surgery alone.

⦿ In high-risk stage II patients (with features like lymphovascular invasion, advanced tumor depth, or few lymph nodes examined), chemo cut the risk of death by more than half.

⦿ In stage III patients, chemo made a big difference, improving survival. But worryingly, 1 in 3 didn’t get chemo, even though guidelines recommend it.

Bottom line: If you have stage II MSI-high colon cancer, your doctor should look at the tumor’s risk features—not just the MSI status—when deciding about chemo. If you have stage III, chemo is likely to help, even if your cancer is MSI-high.

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