The value of adjuvant chemotherapy in T2N0 gastric cancer (GC) remains controversial. The aim of this retrospective study is to define a high-risk subgroup of pathological T2N0 GC patients and examine the impact of adjuvant chemotherapy 2on overall survival (OS). A total of 225 patients underwent R0 resection for T2N0 gastric adenocarcinoma between 2002 and 2012 and 51/225 (22.7%) of these received adjuvant chemotherapy. Multivariate Cox regression identified tumor location in the Upper1/3 of the stomach (p<0.001), larger tumor diameter (p=0.013), lymphatic and/or blood vessel invasion (p=0.001), and perineural invasion (p<0.001) as independent risk factors associated with significantly decreased OS. There were 141 patients with at least one risk factor who were defined in the high-risk subgroup. After propensity score matching, there was a significant trend toward improved OS (p=0.042) with adjuvant chemotherapy in the high-risk subgroup. In conclusion, we identified a high-risk subgroup of T2N0 GC with at least one of the independent risk factor listed above, and we found that adjuvant chemotherapy significantly improved OS for this subgroup.