crossing96/oncoscreening huggingface dataset:
Recurrence rate of premalignant and early malignant lesions of the gastrointestinal tract following endoscopic submucosal dissection: a single-centre cohort.	AIM: Endoscopic submucosal dissection (ESD) has become a well-established treatment option for premalignant and early malignant lesions of the gastrointestinal tract. This study aimed to evaluate the recurrence rate following ESD in a single tertiary centre cohort of patients. METHODS: All consecutive patients who received ESD treatment for premalignant or early malignant lesions by a single endoscopist (AS) at Middlemore Hospital from 11 February 2019 to 6 October 2023 were included in this retrospective cohort study. The primary outcome was recurrence rate of premalignant and early malignant lesions of the gastrointestinal tract following ESD. Recurrence was defined as confirmed neoplasm on histopathology on first follow-up surveillance endoscopy. The target recurrence rate was less than or equal to 5%. Secondary outcome was recurrence stratified by location of the lesion, lesion size, en bloc resection status, R0 resection status and histopathological type of lesion. RESULTS: A total of 119 ESD procedures were completed during the study time frame, with 91 having a surveillance endoscopy with a median time of 231 days. Twenty-eight cases did not have surveillance endoscopy completed. Three (3.3%) had recurrence of disease, of which two were oesophageal squamous cell carcinoma and one was rectal sessile serrated adenoma. We were unable to ascertain any statistically significant associations with regard to our secondary outcome variables. CONCLUSION: This study supports the efficacy of ESD in our centre as a curative treatment modality for premalignant and early malignant gastrointestinal lesions, demonstrating a recurrence rate within the acceptable international benchmark.	esophagus
Cancer Burden on Piecemeal Endoscopic Resection of Early Adenocarcinoma in Barrett's Oesophagus Correlates With the Risk of Neoplastic Recurrence.	BACKGROUND AND STUDY AIMS: Endoscopic resection (ER) is curative for early-stage oesophageal adenocarcinoma (OAC) without high-risk features. Piecemeal endoscopic mucosal resection (pEMR) prevents assessment of lateral margins, complicating risk estimation for neoplastic recurrence. We investigated the risk factors for residual and recurrent OAC post-pEMR. METHODS: We performed a longitudinal study of two independent patient cohorts: the test cohort who underwent piecemeal or en-bloc ER (n = 140) and the validation cohort who underwent pEMR only (n = 89). Inclusion criteria were: OAC stage T1a or low-risk T1b, no lympho-vascular invasion, and R0 resection. The primary outcome was residual OAC at first post-ER endoscopy, and secondary outcomes were residual neoplasia (high-grade dysplasia and/or OAC), recurrence of neoplasia at any post-ER endoscopy, and remission of neoplasia, dysplasia and metaplasia at most recent endoscopy. RESULTS: In the test cohort, the incidence of neoplastic recurrence was higher in patients treated with pEMR (n = 54, 49%) versus en-bloc ER (n = 7, 23%) (p = 0.021). The percentage of pEMR specimens with OAC was an independent risk factor for residual OAC at the first post-pEMR endoscopy (OR for a 10% increase = 1.24, CI = 1.03-1.51, p = 0.025). A 50% cut-off of pEMR specimens with OAC was optimal to predict residual OAC (specificity = 0.68, sensitivity = 0.63). Rates of residual (p = 0.039) and recurrent (p = 0.0052) OAC were higher when > 50% of pEMR specimens were involved by OAC. In the validation cohort, recurrent OAC was also more frequent when cancer burden was > 50% (p = 0.013). CONCLUSIONS: High cancer burden on pEMR specimens correlates with the risk of residual OAC. Post-pEMR site check before endoscopic ablation is recommended if more than 50% of pEMR specimens show OAC.	esophagus
The relationship between examined lymph nodes and oncological outcome of proximal gastrectomy for Siewert II/III adenocarcinoma of the esophagogastric junction.	OBJECTIVE: The objective of this study was to summarize the oncological outcomes and long-term prognosis of patients with Siewert II/III adenocarcinoma of the esophagogastric junction (AEG) who underwent proximal gastrectomy (PG) at the China National Cancer Center (CNCC), with particular focus on the relationship between the number of examined lymph nodes (ELNs) and prognosis. METHODS: We retrospectively analyzed 242 patients with Siewert II/III AEG who underwent PG between 2017 and 2021 at the CNCC. Lymphadenectomy followed D1 + principles for early-stage and D2 for advanced-stage disease. Recurrence-free survival (RFS) and overall survival (OS) were assessed using Kaplan-Meier curves, and prognostic factors were identified through Cox regression. Restricted cubic spline (RCS) modeling was applied to explore the dose-response relationship between ELNs and OS. RESULTS: Of the 242 patients, 163 (67.4%) did not achieve textbook outcome with ≥ 30 ELNs (TO-30LN) and had significantly worse survival (OS: HR = 1.85, 95% CI: 1.08-3.18; RFS: HR = 1.88, 95% CI: 1.06-3.34; both P < .05). Multivariable analysis identified pN + status and Clavien-Dindo grade ≥ II complications as independent adverse prognostic factors. RCS analysis revealed a nonlinear association between ELN count and OS in cT2-3 disease, with an optimal range of 28-53 nodes, whereas no survival benefit was observed in cT4 disease. CONCLUSION: For Siewert II/III AEG following PG, achieving TO-30LN improved survival. RCS analysis revealed an optimal ELN threshold in cT2-3 patients, but no benefit in cT4, indicating limited suitability of PG for this subgroup.	esophagus
Real-World Efficacy of Cadonilimab Plus Chemotherapy as Second-Line Therapy in Immunotherapy-Pretreated Advanced HER2 Negative Gastric or Gastroesophageal Junction Cancer.	BACKGROUND: Immunotherapy is now a cornerstone of first-line treatment for advanced gastric or gastroesophageal junction cancer (G/GEJC). However, optimal second-line options after progression on first-line immunotherapy are undefined. Given the established efficacy of cadonilimab in the first-line setting, this real-world study evaluated its combination with chemotherapy as a second-line treatment. METHODS: We conducted a single-center retrospective study of patients with advanced G/GEJC progressing after first-line immunotherapy. Patients received either cadonilimab plus chemotherapy (Cohort A, n=50) or chemotherapy alone (Cohort B, n=62) as second-line therapy between October 2022 and April 2025. The primary endpoint was overall survival (OS); secondary endpoints included progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and safety. RESULTS: Cohort A showed significantly improved outcomes. Median PFS was 4.9 months (95% CI: 3.9-6.0) in Cohort A vs 3.8 months (95% CI: 2.8-4.8) in Cohort B (p=0.024). Median OS was 10.3 months (95% CI: 8.8-11.8) vs 7.4 months (95% CI: 6.9-7.9), respectively (p=0.046). ORR was 34.0% vs 17.7% (p=0.048), and DCR was 74.0% vs 54.8% (p=0.036). Safety was comparable between cohorts, with no treatment-related deaths. CONCLUSION: Cadonilimab plus chemotherapy significantly improved efficacy outcomes versus chemotherapy alone in patients with advanced G/GEJC after first-line immunotherapy progression, with a manageable safety profile. This suggests cadonilimab based therapy is a promising second-line strategy. Further prospective randomized studies are needed to confirm these findings.	esophagus
FGFR2-IIIc isoform detection reveals prognostic prevalence and a functional link to mesenchymal transition in gastric and gastroesophageal junction cancer.	BACKGROUND: Fibroblast growth factor receptor 2 (FGFR2), a therapeutic target for advanced gastric and gastroesophageal junction cancers (GC/GEJCs), exists as two functionally distinct isoforms: FGFR2-IIIb and FGFR2-IIIc. We investigated the clinical significance of FGFR2 splice variant distribution in advanced GC/GEJCs and its implications for therapeutic targeting. PATIENTS AND METHODS: Whole-transcriptome sequencing was carried out on 235 patients with advanced GC/GEJCs enrolled in MONSTAR-SCREEN-2 (UMIN000043899). FGFR2-IIIc proportion was quantified using splice junction analysis, and its association with clinical outcomes was evaluated through survival analysis, comprehensive molecular profiling, and longitudinal assessment of treatment-induced isoform dynamics. RESULTS: Among 209 patients with detectable FGFR2 expression, high-proportion FGFR2-IIIc (>0.28) was associated with significantly shorter overall survival compared with low-proportion FGFR2-IIIc (median 9.59 versus 16.0 months, hazard ratio 2.08, 95% confidence interval 1.33-3.26, P < 0.001). Multivariable Cox regression confirmed FGFR2-IIIc proportion as an independent predictor of poor prognosis (P = 0.008), superior to total FGFR2 expression levels. Longitudinal analysis of 33 paired pre- and post-treatment samples revealed treatment-induced increases in FGFR2-IIIc proportion (P = 0.0085), suggesting adaptive isoform switching. Notably, all tumors with elevated FGFR2 expression exclusively belonged to the low-IIIc group, indicating that current FGFR2-targeted therapies primarily benefit patients with FGFR2-IIIb-dominant expression profiles. High-proportion FGFR2-IIIc was significantly associated with epithelial-to-mesenchymal transition and myogenesis pathway activation. Differential splicing analysis identified coordinated alternative splicing events in ESRP1-regulated targets, suggesting potential broader splicing dysregulation and providing mechanistic insights into the aggressive phenotype. CONCLUSIONS: FGFR2-IIIc proportion represents a clinically relevant prognostic biomarker in advanced GC/GEJCs. Treatment-induced isoform switching toward FGFR2-IIIc suggests a novel resistance mechanism requiring targeted therapeutic approaches. These findings underscore the importance of developing isoform-specific therapeutic strategies and implementing FGFR2-IIIc assessment in precision oncology approaches for GC/GEJCs.	esophagus
Efficacy and safety of neoadjuvant FLOT treatment for resectable gastric/gastroesophageal junction adenocarcinoma in Turkish and German patients; a real-world data.	BACKGROUND: Perioperative FLOT is the current standard of treatment in resectable gastric adenocarcinoma(GC) and adenocarcinoma of gastroesophageal junction(GEJC). However, many ethnicities remain underrepresented in clinical trials or are not differentiated in subgroup analyses, making it unclear whether outcomes, especially major pathological response (mPR), vary across different populations. METHODS: Turkish(Tp) and German(Gp) patients with resectable GC/GEJC who received perioperative FLOT were evaluated retrospectively. The primary endpoint was mPR which was defined as pathological complete response or near-complete response. The secondary endpoints were disease-free survival(DFS), overall survival(OS), and safety. RESULTS: Forty-seven Tp and 55 Gp were included. While Tp had more GC(63.8% vs. 36.2%), GEJC was higher in Gp(41.8% vs. 58.2%)(p = 0.027). Tp had more node-positive diseases(91.5% vs. 63.6%, p = 0.005), and received more cycles of neoadjuvant FLOT(p < 0.001). The most commonly seen side effects were anemia in Tp, and neutropenia and neuropathy in Gp. R0 resection ratio was 87.2% in Tp and 92.7% in Gp. The ratio of mPR was higher in Gp (36% vs. 18.5%, p = 0.04) While German ethnicity and clinical node negativity was associated with better mPR in the univariate analysis, only clinical node negativity was associated with better mPR in the multivariate analysis [OR:3.951, 95% CI (1.168-13.365), p = 0.027]. There was no relation between mPR and other clinical factors including tumor location, histology and intensified neoadjuvant treatment (> 4 cycles of FLOT). Gp had longer DFS(53.22 vs. 21.42 months, p = 0.03) and OS(57.99 vs. 29.37 months, p = 0.05). However, mPR did not show any association with OS and DFS. Turkish ethnicity was related with worse OS and DFS in univariate analysis but not multivariate analysis. Multivariate analysis showed that intensified neoadjuvant treatment(> 4 cycles), signet-cell carcinoma, and higher pathological N-stage were independent risk factors for decreased OS. After adjusting for clinical node positivity and tumor location; intensified neoadjuvant treatment(> 4 cycles), and higher pathological N stage remained associated with worse OS. DISCUSSION: This bicentric study reveals that although ethnicity had limited prognostic impact, lymph node status remained the strongest determinant of outcome in perioperatively treated patients with GC/GEJC. Intensified treatment did not improve mPR and was associated with worse OS, while mPR itself was not independently linked to OS. Pathological nodal positivity and signet-ring cell carcinoma were the key predictors of poor survival. These findings highlight the importance of nodal risk stratification and tailored follow-up over therapy intensification.	esophagus
Real-world efficacy of PD-1 inhibitors in treating oesophageal squamous cell carcinoma (ESCAPE): protocol of a multicentre, real-world, observational, cohort study.	INTRODUCTION: Oesophageal cancer (EC) presents a substantial global health challenge, ranking eighth in incidence and sixth in cancer-related mortality. Oesophageal squamous cell carcinoma (ESCC) is the primary subtype and accounts for approximately 90% of cases in Asia. Despite treatment advances, the 5-year survival rate remains modest at 10%-30%. Immune checkpoint inhibitors, exemplified by KEYNOTE-590 and CheckMate 577 trials, have reshaped EC therapeutic landscapes. Our study addresses the critical gap in understanding the real-world impact of PD-1 (Programmed Death-1) inhibitors, conducting a multicentre, real-world, observational cohort analysis focused on ESCC. This research endeavours to provide practical insights into PD-1 treatment for EC, facilitating informed clinical decision-making and optimising patient outcomes in diverse healthcare settings. METHODS AND ANALYSIS: This multicentre study includes patients diagnosed with histopathologically confirmed ESCC who have consented to treatment with PD-1 inhibitors. It is structured into two distinct segments: Part A, characterised by its retrospective nature, and Part B, representing the prospective arm. Within both parts, four stratified cohorts are delineated, comprising Cohort 1 (preoperative neoadjuvant/conversion therapy), Cohort 2 (postoperative adjuvant therapy), Cohort 3 (first-line therapy for advanced ESCC) and Cohort 4 (≥2 lines of therapy for advanced ESCC). The primary endpoint is the objective response rate in diverse treatment cohorts. Secondary endpoints include pathologic complete response rate, disease-free survival, progression-free survival, overall survival, adverse events, immune-related adverse events, quality of life and the intricacies of immunotherapy patterns and hyperprogression. Furthermore, exploratory endpoints scrutinise potentially predictive biomarkers, as well as the clinical and genomic characteristics inherent to ESCC patients if possible. The study endeavours to enrol 417 participants, subject to a comprehensive 5-year follow-up period.We will collect and analyse real-world data from Chinese ESCC patients treated with PD-1 inhibitors to observe and describe the efficacy and safety of PD-1 inhibitors in Chinese patients with ESCC at various treatment stages. ETHICS AND DISSEMINATION: Ethical approval was provided by the Ethics Committee for Medical Research and New Medical Technology of Sichuan Cancer Hospital, China (Approval No. SCCHEC-02-2023-096). Each participating hospital has applied for research permission from the Institutional Review Board of its unit. We will disseminate the results through peer-reviewed journals and academic conferences. TRIAL REGISTRATION NUMBER: ChiCTR2300078657.	esophagus
Sparing lymphocytes during preoperative adjuvant radiotherapy for oesophageal squamous cell carcinoma (SPARE): protocol for an open-label, randomised controlled trial.	INTRODUCTION: Oesophageal squamous cell carcinoma (ESCC) ranks among the most aggressive malignancies and carries a poor prognosis. Lymphocytes play a key role in combating infections and suppressing tumourigenesis. Many studies have established a close association between lymphocyte depletion and adverse therapeutic outcomes in oesophageal cancer. Nevertheless, high-quality data validating the clinical efficacy and safety of lymphocyte-sparing thoracic radiotherapy regimens for ESCC remain scarce. MATERIALS AND METHODS: This prospective, open-label, randomised controlled trial aims to determine whether lympho-nTRT-ESO reduces the incidence of acute grade 3-4 lymphopaenia in patients with ESCC undergoing neoadjuvant chemoradiotherapy (nCRT), compared with conventional thoracic radiotherapy (RT). A total of 212 participants will be enrolled and randomly allocated in a 1:1 ratio to either the lymphocyte-sparing RT (RT) group or the conventional RT group. All patients will receive standardised nCRT, which will deliver a total dose of 41.4 Gy in 23 fractions. For the lymphocyte-sparing RT group, RT planning prioritises the planning target volume (PTV) coverage and conventional organ-at-risk (OAR) constraints while applying dose constraints to lymphocyte-related OARs (LOARs). These LOARs include the T1-T12 vertebral bodies, ribs, spleen and major cardiovascular structures (heart and large blood vessels), with optimisation performed only after PTV coverage and standard OAR constraints are satisfied. ETHICS AND DISSEMINATION: This trial was approved by the Ethics Committee of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine (RJ 2024-210) on 11 July 2024 and registered on ClinicalTrials.gov (NCT06596954) before participant recruitment. All participants should provide written informed consent to be eligible. We planed to publish the primary and secondary results of this study in scientific peer-reviewed journals and present at radiation oncology conferences. TRIAL REGISTRATION NUMBER: NCT06596954.	esophagus
Preoperative prediction of lymph node metastasis in adenocarcinoma of esophagogastric junction using CT texture analysis combined with machine learning.	This study aims to construct a noninvasive preoperative prediction model for lymph node metastasis in adenocarcinoma of esophagogastric junction (AEG) using computed tomography (CT) texture characterization and machine learning. We analyzed clinical and imaging data from 57 patients with preoperative CT enhancement scans and pathologically confirmed AEG. Lesions were delineated, and texture features were extracted from arterial phase and venous phase CT images using 3D-Slicer software. Features were normalized, downscaled, and screened using correlation analysis and the least absolute shrinkage and selection operator algorithm. The lymph node metastasis prediction model employed machine learning algorithms (random forest, logistic regression, decision tree [DT], and support vector machine), with performance validated using receiver operating characteristic curves. In the arterial phase, the random forest model excelled in precision (0.86) and positive predictive value (0.86). The DT model exhibited the best negative predictive value (0.86), while the logistic regression model demonstrated the highest area under the curve (AUC; 0.78) and specificity (1.0). During the venous phase, the DT model excelled in precision (0.72), F1 score (0.76), and recall (0.80), whereas the support vector machine model had the highest AUC (0.75). Differences in AUCs between models in both phases were not statistically significant per DeLong's test, indicating comparable performance. Each model displayed strengths across various metrics, with the DT model showing consistent performance across arterial and venous phases, emphasizing accuracy and specificity. The CT texture-based machine learning model effectively predicts lymph node metastasis noninvasively in AEG patients, demonstrating robust predictive efficacy.	esophagus
The impact of immunotherapy on the prognosis of small cell carcinoma of the esophagus: a propensity score-matched analysis of a retrospective study.	OBJECTIVE: Small cell carcinoma of the esophagus (SCCE) is a rare neuroendocrine malignancy with no standardized treatment regimen. This study aims to evaluate the impact of immunotherapy on the prognostic survival outcomes of patients with SCCE. METHODS: A retrospective analysis was conducted on 83 SCCE patients treated at the Provincial Hospital of Shandong First Medical University and the Cancer Hospital of Shandong First Medical University from January 2020 to June 2024. Propensity score matching (PSM) was applied to minimize potential biases between patients who received combination immunotherapy and those who did not. Survival outcomes, including overall survival (OS) and progression-free survival (PFS), were assessed using the Kaplan-Meier method, while univariate and multivariate analyses were performed using the Cox proportional hazards model. RESULTS: Among the 83 patients included, 33 received combination immunotherapy and 50 did not. Prior to PSM, clinicopathological comparisons revealed that tumor size was significantly larger in the non-immunotherapy group (P = 0.032), and the immunotherapy group had more advanced N stages (P = 0.015). After 1:1 PSM, 20 matched pairs were analyzed. The immunotherapy group demonstrated a significantly longer OS compared to the non-immunotherapy group (22 months vs. 13 months, P = 0.0165), though PFS differences were not statistically significant (9 months vs. 7 months, P > 0.05). Univariate and multivariate analyses identified treatment methods (P=0.039) as independent prognostic factors for OS. Survival rate analysis showed that patients in the immunotherapy group achieved superior six-month (97.0% vs. 83.7%), one-year (78.9% vs. 56.5%), and two-year (22.1% vs. 10.4%) survival rates compared to the non-immunotherapy group. CONCLUSIONS: This study demonstrates that combination immunotherapy significantly improves overall survival in SCCE patients and represents an effective treatment strategy for this rare malignancy.	esophagus
Screening telomere-related genes to predict prognosis, immunotherapy response, and drug sensitivity in esophageal cancer using a machine learning approach.	BACKGROUND: Esophageal cancer (EC) is a common malignancy with poor prognosis. Telomeres, composed of repetitive DNA sequences and shelterin complexes, play important roles in tumor biology. However, the prognostic value of telomere-related genes (TRGs) in EC remains unclear. METHODS: TRGs were obtained from TelNet, and transcriptomic and clinical data were collected from The Cancer Genome Atlas (TCGA). Prognostic TRGs were identified using multivariate Cox regression analysis, Least Absolute Shrinkage and Selection Operator (LASSO), Random Forest (RF), and Support Vector Machine (SVM) algorithms to construct a risk model. Model performance was evaluated by Kaplan-Meier(K-M) and Receiver Operating Characteristic (ROC) analyses, and a nomogram integrating clinical variables was developed. Somatic mutations, immune infiltration, immunotherapy response, and drug sensitivity were compared between high- and low-risk groups. In addition, functional assays were performed to verify the biological role of the key gene PTGES3. RESULTS: Six TRGs significantly associated with prognosis were identified to establish a risk model. High-risk patients had worse survival, higher TP53 and TTN mutation rates, altered immune infiltration, poorer predicted immunotherapy response, and distinct drug sensitivity profiles. Knockdown of PTGES3 significantly suppressed EC cell migration, invasion, and clonogenic ability, supporting its oncogenic role. CONCLUSION: A TRGs-based prognostic model effectively predicts survival in EC and reveals associations with somatic mutations, immune infiltration, and drug sensitivity. Functional validation of PTGES3 further supports its potential as a therapeutic target.	esophagus