📖 ABSTRACT/OVERVIEW
The tumour microenvironment (TME) of gastric cancer, encompassing tumour-infiltrating lymphocytes, cancer-associated fibroblasts, and cytokine milieu, critically modulates disease progression and treatment response. Nigerian gastric cancer patients are often diagnosed at advanced stages, yet TME characterization in this population is nonexistent. This study characterizes the TME of gastric cancer in Nigerian patients and examines its association with pathological stage, lymph node involvement, and overall survival. Eighty paraffin-embedded gastric cancer specimens from patients managed at teaching hospitals in Kano (North West) and Lagos (South West) were analyzed. Immunohistochemical markers including CD3, CD8, CD68, PD-L1, and alpha-SMA were quantified by digital image analysis. Genomic profiling for EBV positivity and microsatellite instability (MSI) was performed using in-situ hybridization and multiplex PCR. High CD8-positive tumour-infiltrating lymphocyte density was significantly associated with improved 3-year overall survival (HR 0.41, p=0.003). PD-L1 positivity was identified in 34% of cases and correlated with poor differentiation. MSI-high status was present in 12% and was associated with more favorable prognosis. EBV-positive tumours constituted 9% of cases. These findings provide original molecular data on Nigerian gastric cancer and recommend PD-L1 and MSI testing as pretreatment biomarkers. Development of immunotherapy access protocols in Nigeria is urgently recommended. Keywords: gastric cancer, tumour microenvironment, PD-L1, MSI, immunohistochemistry
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