3D-spatial interaction between cancer cells influences tumor behavior, making it essential to replicate tumor structures for predicting patient outcomes.

We collected data from three multicenter prospective studies to evaluate the ability to establish Patient-Derived Organoids (PDOs) from different biological samples and timepoints, correlating their characteristics and drug sensitivity with clinical outcomes.

From 184 patients (17 tumor types), 249 samples were collected: 149 (59.8%) from tumor tissue, 61 (24.5%) from peritoneal fluids, 39 (15.7%) from peripheral blood. Success rates for PDO establishment were 39.5%, 34.4%, and 25.6%, respectively. PDOs reproduced pathological and immunohistochemical patterns of source tumors, with pathogenic variants confirmed in 84% (21/25). In a series of 13 baseline and sequential PDOs from 9 patients undergoing treatment, responses to therapy mirrored patient responses during therapy.

PDOs preserve tumor features, reflect disease progression, and predict treatment responses, providing valuable models to complement molecular testing in precision medicine.