ArticleVirchows Archiv : an international journal of pathology2026
Clinicopathologic and prognostic significance of FOLR1 expression in gastric adenocarcinoma and its association with PD-L1, HER2, MMR, and p53 status.
Article in Virchows Archiv : an international journal of pathology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Gastric adenocarcinoma carries high mortality despite modern multimodal therapy. Reliable biomarkers that refine prognosis and suggest therapeutic strategies are needed. We evaluated the clinicopathologic and prognostic significance of folate receptor-alpha (FOLR1) expression in a large single-institution cohort. We retrospectively analyzed 259 gastrectomy specimens (2016-2025). Immunohistochemistry included FOLR1 (H-score 0-300), HER2, PD-L1 (CPS; positive if ≥ 1), p53 status, and MMR proteins (MLH1/MSH2/MSH6/PMS2). The FOLR1 cut-off for recurrence-free survival (RFS) was derived by Receiver operating characteristic(ROC) analysis. Associations were tested with Chi-square or Fisher's exact tests and Spearman correlation; survival was assessed by Kaplan-Meier and Cox regression. ROC for RFS yielded an area under the curve (AUC) of 0.653 (95% CI 0.578-0.728; p < 0.001) and defined a FOLR1 H-score cut-off of 40; ROC for overall survival (OS) was not significant (AUC 0.528; p = 0.443). Using this threshold, FOLR1-high tumors (≥ 40; n = 48) showed significantly shorter RFS (mean 24.1 vs 266.6 months; log-rank p < 0.001) and shorter OS (mean 32.4 vs 53.9 months; p = 0.047) than FOLR1-low tumors. On univariate analysis, FOLR1-high predicted inferior RFS (HR 4.15; 95% CI 2.67-6.47; p < 0.001); in multivariate Cox modeling it remained an independent predictor (HR 1.99; 95% CI 1.15-3.45; p = 0.015). FOLR1-high status associated with advanced T stage (p = 0.045), vascular invasion (p < 0.001), higher M1 frequency (p < 0.001), and proximal location (p = 0.038). It correlated with PD-L1 positivity (p < 0.001; FOLR1 H-score vs PD-L1 CPS Spearman r = 0.286; p < 0.001), HER2 positivity (p < 0.001), and p53 mutant pattern (p < 0.001), and was inversely associated with MMR deficiency (p = 0.010). N-stage distribution was not different overall, although a linear trend toward higher nodal stage with FOLR1-high was observed (p = 0.013). No significant associations were found with Lauren or WHO subtype, histologic grade, lymphatic or perineural invasion, extracapsular extension, neoadjuvant therapy, age, or sex. High FOLR1 expression identifies a biologically aggressive subset of gastric adenocarcinoma with inferior RFS and independent prognostic value. Its concurrent association with PD-L1 and HER2, together with relative absence in dMMR tumors, supports biomarker-guided strategies that consider FOLR1 alongside HER2 and PD-L1, and provides a rationale to explore FOLR1-targeted therapies in selected patients.
Indexed as
Identifiers
41758267What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.