Background/Objectives: Advanced gastric cancer usually has an unfavorable prognosis. Stroma AReactive Invasion Front Area (SARIFA) is a newly recognized biomarker of aggressiveness, easily recognized as five tumor cells in direct contact with adipocytes in perigastric, submucosal, and perivascular adipose tissue. We investigated this phenomenon and correlated it with other pathohistological variables.Material and Methods: The sample includes 102 Croatian patients with locally advanced gastric cancer, who underwent total gastrectomy/lymphadenectomy between 2012–2018 and in 2023 at University Hospital Split, Croatia, and had pathological stage pT3 or pT4. Representative histological specimens were analyzed for SARIFA, and results were compared with other variables and overall survival. External validation and gene expression analysis of CD36 and FABP4 were performed using the TCGA-STAD cohort.Results: SARIFA was significantly associated with positive pN status (p= 0.009) and perineural invasion (p= 0.043). Patients with SARIFA had a more than fivefold increased risk of nodal involvement (OR = 6.35; 95% CI: 1.35–29.84;p= 0.019). Lymphovascular invasion (LVI) was associated with nodal disease (OR = 4.39; 95% CI: 1.194–16.143;p= 0.026), and SARIFA was marginally associated (OR = 4.886; 95% CI: 0.985–24.241;p= 0.052). Patients who had both LVI and SARIFA had a higher proportion of affected lymph nodes (p= 0.009). SARIFA status did not significantly affect overall survival. Gene expression analysis showed a significant increase in CD36 expression, while FABP4 expression was elevated but not statistically significant, in SARIFA-positive cases.Conclusions: SARIFA could be used as a marker for invasiveness and further investigated due to its predictive potential.
背景/目的：进展期胃癌通常预后不良。间质反应性浸润前沿区（SARIFA）是一种新近被识别的肿瘤侵袭性生物标志物，其定义为在胃周、黏膜下层及血管周围脂肪组织中，至少五个肿瘤细胞与脂肪细胞直接接触的现象。本研究旨在探讨该现象并分析其与其他病理组织学变量的相关性。 材料与方法：样本包括102例克罗地亚局部进展期胃癌患者，这些患者于2012年至2018年及2023年间在克罗地亚斯普利特大学医院接受全胃切除术/淋巴结清扫术，病理分期为pT3或pT4。对代表性组织学标本进行SARIFA评估，并将结果与其他变量及总生存期进行比较。利用TCGA-STAD队列进行外部验证及CD36和FABP4基因表达分析。 结果：SARIFA与阳性pN状态（p=0.009）和神经侵犯（p=0.043）显著相关。SARIFA阳性患者淋巴结转移风险增加五倍以上（OR=6.35；95% CI：1.35–29.84；p=0.019）。淋巴血管侵犯（LVI）与淋巴结转移相关（OR=4.39；95% CI：1.194–16.143；p=0.026），而SARIFA呈边缘性相关（OR=4.886；95% CI：0.985–24.241；p=0.052）。同时存在LVI和SARIFA的患者受累淋巴结比例更高（p=0.009）。SARIFA状态对总生存期无显著影响。基因表达分析显示，在SARIFA阳性病例中CD36表达显著升高，FABP4表达虽有升高但未达统计学显著性。 结论：SARIFA可作为肿瘤侵袭性的标志物，因其预测潜力值得进一步深入研究。
SARIFA Is Associated with Lymph Node Metastases in PT3 and PT4 Gastric Cancers
肿瘤(癌症)患者之家