Aggressive progression in gastric/GEJ adenocarcinoma: linitis plastica (signet-ring diffu...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-GASTRIC-TRANSFORMATION-PROGRESSION`
Type	Red flag
Status	reviewed 2026-04-26 \| pending_clinical_signoff
Diseases	`DIS-GASTRIC`
Sources	`SRC-ESMO-GASTRIC-2024` `SRC-NCCN-GASTRIC-2025`

Red Flag Origin

Definition	Aggressive progression in gastric/GEJ adenocarcinoma: linitis plastica (signet-ring diffuse type with rigid stomach wall — historically poor prognosis), peritoneal carcinomatosis with malignant ascites, OR rapid progression on first cycle (clinical decline ≤4 weeks). Triggers MDT / early palliative-care / regimen-modification discussion.
Clinical direction	investigate
Category	transformation-progression

Trigger Logic

{
  "any_of": [
    {
      "finding": "linitis_plastica_pattern",
      "value": true
    },
    {
      "finding": "peritoneal_carcinomatosis_with_ascites",
      "value": true
    },
    {
      "finding": "rapid_decline_first_cycle",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

Linitis plastica + signet-ring biology — historically not benefited from anti-HER2 (FAST trial subgroup); CLDN18.2+ subset ~50% of diffuse-type gastric — emerging zolbetuximab benefit.

Used By

No reverse references found in the YAML corpus.