Gastric cancer (GC) has significant global mortality with high heterogeneity. A study of 226 GC samples from 121 patients integrated spatial transcriptomics and single-cell expression profiles, revealing extensive intratumour heterogeneity and spatially localised subgroups linked to specific immune environments and genetic drivers like SOX9. Two evolutionary trajectories, branched evolution and internal diaspora evolution, were identified, each associated with different molecular subtypes, clinical outcomes, and stromal neighbourhoods. Novel ecosystem states marked by increased GREM1 expression were highlighted. These findings from co-first author Dr Supriya Srivastava, a member of N2CR and the Singapore Gastric Cancer Consortium (SGCC), provide insights into how individual GC cellular ecosystems are shaped, resulting in personalised cancer cartographies for each patient.

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