Stroma AReactive Invasion Front Areas (SARIFA) is a negative prognostic factor for overall survival in non-intestinal gastric adenocarcinomas.

BACKGROUND

The Stroma AReactive Invasion Front Areas (SARIFA) is a novel histological phenomenon characterized by direct tumour cell-adipocyte interaction without intervening stroma or inflammatory cells and easily identifiable in routine haematoxylin-eosin-stained sections.

METHODS

This study evaluated the prognostic significance of SARIFA in a cohort consisting of 333 gastric cancer patients, including 171 intestinal and 162 non-intestinal adenocarcinoma cases. Associations between SARIFA and various well-known histopathological tumour parameters, including lymphovascular invasion, perineural invasion, tumour budding and poorly differentiated clusters (PDCs), were investigated and the prognostic value of these features for survival was determined.

RESULTS

SARIFA was more frequently observed in non-intestinal carcinomas but was significantly associated with lymphovascular and perineural invasion in both gastric cancer subtypes. Number of SARIFA foci showed a weak positive correlation with the number of tumour buds and PDCs. SARIFA was identified as an independent negative prognostic factor for overall survival in non-intestinal gastric cancers. According to time-dependent ROC curve analysis, quantification of SARIFA foci did not increase the prognostic accuracy beyond detecting their absence or presence in both gastric cancer subtypes. In addition, the lymph node ratio in both subcohorts and perineural invasion in intestinal adenocarcinomas were also found to be independent prognostic factors for overall survival.

CONCLUSION

SARIFA is a robust, easily assessable histological marker with independent prognostic value in non-intestinal gastric adenocarcinomas. Reliable histopathological markers for this group of tumours, characterized by their distinctive morphology and infiltration pattern, remain limited. Integration of SARIFA into routine diagnostics may enhance risk stratification.