{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T05:20:37Z","timestamp":1775539237712,"version":"3.50.1"},"reference-count":41,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T00:00:00Z","timestamp":1773446400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T00:00:00Z","timestamp":1773446400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2026,3,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The aberrant p16\n                      <jats:sup>INK4a<\/jats:sup>\n                      expression has been identified in gastric cancer (GC). However, the staining pattern of p16\n                      <jats:sup>INK4a<\/jats:sup>\n                      and its associations with clinical outcomes and immune contexture remains obscure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study involved two patient cohorts, the Zhongshan Hospital (ZSHS,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0443) and Samsung Medical Center (SMC,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a043) cohort. Patients were divided into p16\n                      <jats:sup>INK4a<\/jats:sup>\n                      loss, wild\u2010type (WT), and overexpression (OE) subgroups. The patient characteristics, overall survival (OS), response to adjuvant chemotherapy (ACT) and immune checkpoint inhibitor (ICI) treatment, as well as tumor immune contexture were investigated in each subgroup.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In ZSHS cohort, 90 of 443 (20.3%) patients with p16\n                      <jats:sup>INK4a<\/jats:sup>\n                      OE gastric cancer, who were characterized by advanced pT stage (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.011), higher Ki\u201067 (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.001), Rb loss (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.001), and CCNE1 OE incidence (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.001). Patients with p16\n                      <jats:sup>INK4a<\/jats:sup>\n                      OE tumors presented with poor OS (ZSHS: OE vs. WT,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.004; specific in MSI tumors,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.019), inferior responsiveness to ACT (OE vs. WT,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.011; specific in MSI tumors,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.024) and ICI (OE vs. WT,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.045; specific in programmed death\u2010ligand 1 CPS \u22651 and CIN tumors,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.027 and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.032, respectively), whereas patients with p16\n                      <jats:sup>INK4a<\/jats:sup>\n                      loss and WT gastric cancer exhibited comparable clinical outcomes (loss vs. WT: OS,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.424; ACT,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.834; ICI,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.223). Moreover, p16\n                      <jats:sup>INK4a<\/jats:sup>\n                      OE gastric cancer was associated with lower antitumor M1, neutrophils, and CD8\n                      <jats:sup>+<\/jats:sup>\n                      T cells infiltration and higher pro\u2010tumor TGF\u2010\u03b2, CD73, and IDO expression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This study identified a specific triple classification staining pattern of p16\n                      <jats:sup>INK4a<\/jats:sup>\n                      expression in GC, and demonstrated that p16\n                      <jats:sup>INK4a<\/jats:sup>\n                      OE was associated with poor clinical outcomes and evasive immune contexture.\n                    <\/jats:p>\n                  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