Histological Response and Prognostic Factors in Gastric Adenocarcinoma Treated With Fluorouracil, Leucovorin, Oxaliplatin, and Docetaxel (FLOT) Chemotherapy: A Retrospective Single-Center Study

TL;DR

This study finds that tumor biology, not chemotherapy regimen, is a key factor in predicting response to treatment in gastric cancer patients.

Contribution

The study provides real-world evidence that tumor biology is more important than chemotherapy regimen in determining histological response in gastric cancer.

Findings

No significant difference in histological response between FLOT and non-FLOT chemotherapy regimens.

Poor differentiation and advanced tumor stage are linked to worse tumor regression in FLOT-treated patients.

Poor histological response correlates with higher recurrence rates and shorter survival.

Abstract

Background: Neoadjuvant chemotherapy is widely used in the management of resectable gastric adenocarcinoma and is considered an important component of multimodal treatment. This study provides real-world evidence on histological response patterns following fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) chemotherapy, suggesting that tumor biology may play a more relevant role than regimen selection in determining pathological response.

Methods: We conducted a retrospective study including 104 patients who underwent curative surgery for gastric adenocarcinoma between January 2015 and December 2024. Patients were divided into two groups according to the neoadjuvant chemotherapy regimen: FLOT or other protocols. Tumor regression was evaluated by the Becker criteria. Clinicopathological variables were analyzed to identify predictors of histological response.

Results: Of the 104 patients, 68 received the FLOT regimen, while 36 received alternative regimens. There was no statistically significant difference in the Becker regression between the FLOT and non-FLOT groups (p = 0.08). Within the FLOT cohort, factors associated with poorer tumor regression included poor differentiation, advanced T stage, nodal metastasis, lymphatic and perineural invasion (all p<0.05). Poorer histological response correlated with higher recurrence rates and shorter disease-free survival.

Conclusions: The type of neoadjuvant chemotherapy did not significantly influence Becker regression in this cohort. Tumor biology and pathological staging remain key determinants of response. These findings reinforce the importance of individualized treatment strategies and suggest a role for biomarkers to guide therapeutic decisions in gastric cancer.

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