We radiographically evaluated the response of primary lesions to chemotherapy in 101 patients with inoperable advanced gastric cancer. The median survival time in the 50 responders (49.5%) was 379 days, as compared with only 210 days in the 51 non-responders (50.1%) (p<0. 001). Morphologic changes of the gastric mucosa were assessed endoscopically. Among the changes observed, we focused on regenerative mucosa and its relation to response and survival. Regenerative mucosa was seen in 56 (55%) of the 101 patients. The regenerative mucosa was examined endoscopically and classified into four patterns: flat, radial, granular and cobble-stone. Biopsy specimens were taken from the regenerative mucosa and examined histopathologically. The response to chemotherapy was found to be closely associated with the incidence of regenerative mucosa. In particular, a flat or radial pattern significantly correlated with a positive response to treatment (p=0.004) and was associated with significantly longer survival than granular or cobblestone pattern or no regenerative mucosa (p<0.001). Flat or radial pattern was also associated with low tumor-positive rate of biopsy specimens. We conclude that endoscopic evaluation of regenerative mucosa in patients with inoperable advanced gastric cancer who receive chemotherapy can provide useful information in the assessment of response and prognosis.

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