Abstract
This study examines the prognostic significance of tumor necrosis and dirty necrosis in gastric cancer. Tumor necrosis, often linked to rapid tumor growth and insufficient vascularization, is a known poor prognostic indicator in several cancer types. Dirty necrosis, a special form seen with neutrophils and necrotic debris, has prognostic value in cancers like colorectal carcinoma and renal cell carcinoma. The presence of tumor-associated neutrophils (TANs) and NETosis, a process where neutrophils release extracellular traps, also plays a role in tumor progression and prognosis. This study included 187 gastric cancer patients who underwent surgery at Eskisehir Osmangazi University. Dirty necrosis was present in 39.6% of cases, with significant associations found between dirty necrosis and tumor type, grade, lymph node stage, and TIL presence. The study demonstrated that dirty necrosis correlated with longer recurrence-free survival and overall survival. Additionally, patients with dirty necrosis and prominent TILs exhibited improved survival outcomes. The findings suggest that dirty necrosis, particularly when associated with TIL, may indicate a better prognosis in gastric cancer. This study highlights the importance of re-evaluating necrosis types in gastric cancer prognosis and treatment strategies. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1038/s41598-026-39605-1.