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. 2025 Feb 1;117(2):253-261.
doi: 10.1093/jnci/djae227.

Histopathological response to chemotherapy and survival of mucinous type gastric cancer

Irene A Caspers  1   2 , Astrid E Slagter  3 , Pauline A J Vissers  4   5 , Martha Lopez-Yurda  6 , Laurens V Beerepoot  7 , Jelle P Ruurda  8 , Grard A P Nieuwenhuijzen  9 , Suzanne S Gisbertz  10   11 , Mark I van Berge Henegouwen  10   11 , Henk H Hartgrink  12 , Danny Goudkade  13 , Liudmila L Kodach  14 , Johanna W van Sandick  15 , Marcel Verheij  3   16 , Rob H A Verhoeven  4   11   17 , Annemieke Cats  1 , Nicole C T van Grieken  2
Affiliations

Histopathological response to chemotherapy and survival of mucinous type gastric cancer

Irene A Caspers et al. J Natl Cancer Inst. .

Abstract

Background: Data on the clinicopathological characteristics of mucinous gastric cancer (muc-GC) are limited. This study compares the clinical outcome and response to chemotherapy between patients with resectable muc-GC, intestinal (int-GC), and diffuse (dif-GC) gastric cancer.

Methods: Patients from the D1/D2 study or the CRITICS trial were included in exploratory surgery-alone (SAtest) or chemotherapy test (CTtest) cohorts. Real-world data from the Netherlands Cancer Registry on patients treated between with surgery alone (SAvalidation) and receiving preoperative chemotherapy with or without postoperative treatment (CTvalidation) were used for validation. Histopathological subtypes were extracted from pathology reports filed in the Dutch Pathology Registry and correlated with tumor regression grade (TRG) and relative survival (RS).

Results: In the SAtest (n = 549) and SAvalidation (n = 8062) cohorts, muc-GC patients had a 5-year RS of 39% and 31%, similar to or slightly better than dif-GC (43% and 29%, P = .52 and P = .011), but worse than int-GC (55% and 42%, P = .11 and P < .001). In the CTtest (n = 651) and CTvalidation (n = 2889) cohorts, muc-GC showed favorable TRG (38% and 44% (near-) complete response) compared with int-GC (26% and 35%) and dif-GC (10% and 28%, P < .001 and P = .005). The 5-year RS in the CTtest and CTvalidation cohorts for muc-GC (53% and 48%) and int-GC (58% and 59%) was significantly better compared with dif-GC (35% and 38%, P = .004 and P < .001).

Conclusion: Recognizing and incorporating muc-GC into treatment decision-making of resectable GC can lead to more personalized and effective approaches, given its favorable response to preoperative chemotherapy in relation to int-GC and dif-GC and its favorable prognostic outcomes in relation to dif-GC.

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Conflict of interest statement

LVB received personal fees from Ipsen, Medtalks, BMS, Servier, and Travel Congress Management; MIvBH received consultancy fees from Viatris, Johnson & Johnson, Alesi Surgical, BBraun, Stryker, and Medtronic (paid to institute); GAPN received compensation for Clinical Immersions and Educational Meetings from Medtronic; RHAV received grants from BMS and consultancy fees from Daiichi-Sankyo (paid to institute). NCTVG received consultancy fees from BMS, Medtalks, Diaceutics, Astellas, and MSD. All remaining authors have declared no conflicts of interest.

Figures

Figure 1.
Figure 1.
Overview of patient cohorts. NCR = Netherlands Cancer Registry; PALGA = Dutch Pathology Registry; SA = surgery alone; CT = chemotherapy.
Figure 2.
Figure 2.
Distribution of histopathological subtypes per cohort. SA = surgery alone; CT = chemotherapy.
Figure 3.
Figure 3.
Relative survival in A) Surgery alone test cohort. B) Chemotherapy test cohort. GC = gastric cancer; RER = relative excess risks of death.
Figure 4.
Figure 4.
Relative survival in A) Surgery alone validation cohort. B) Chemotherapy validation cohort. C) Per-protocol perioperatively treated patients in the chemotherapy validation cohort. GC = gastric cancer; RER = relative excess risks of death.
Figure 5.
Figure 5.
Chemotherapy regimen administered in each histological subtype in the chemotherapy validation cohort. FLOT = 5-fluorouracil or capecitabine, oxaliplatin, and docetaxel; EOX = epirubicin, oxaliplatin or cisplatin, and capecitabine or 5-fluorouracil; CAP-/FOLFOX = capecitabine or 5-fluorouracil and oxaliplatin; Monotherapy: capecitabine or 5-fluorouracil.
See this image and copyright information in PMC

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