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

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.