Immune Microenvironment Dynamics and Resistance to Immunotherapy in Gastric and Gastroesophageal Junction Adenocarcinoma

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Immune checkpoint inhibitors are central to managing advanced gastric and gastroesophageal junction adenocarcinoma, but benefits vary widely among patients.
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Current biomarkers like PD-L1 and microsatellite instability do not fully explain the mechanisms of antitumor immunity in gastric cancer.
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Immunotherapy resistance is interpreted through a spatial immune-ecology lens, focusing on immune accessibility, competence, and suppression.
4

Gastric adenocarcinoma is classified into various subgroups with distinct immune contexts, affecting treatment responses and outcomes.
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Spatial features such as CD8+ infiltration and dendritic-cell proximity are complementary to established biomarkers but require further validation.

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