crossing96/oncoscreening huggingface dataset:
Learning curve for robot-assisted Mckeown esophagectomy in patients with thoracic esophageal cancer.	BACKGROUND: Robot-assisted minimally invasive esophagectomy (RAMIE) is an effective but technically demanding procedure. The learning curve of RAMIE has been studied to help guide training and to ensure its safe implementation. METHODS: We retrospectively analyzed the first 83 consecutive patients with thoracic esophageal cancer who underwent robot-assisted minimally invasive Mckeown esophagectomy (RAMIE-MK) between May 2021 and August 2023, all performed by a single surgeon. A cumulative sum (CUSUM) analysis was applied to generate the learning curve of RAMIE-MK, based on total operation time. RESULTS: The learning curve was divided into two phases based on the CUSUM analysis: Phase I, the initial learning phase (cases 1-27) and Phase II, the proficiency phase (cases 28-83). When comparing the proficiency phase with the initial phase, we observed a significant decreased trends in total operation time (329.6 ± 71.0 min vs 221.3 ± 33.5 min, P＜0.001). No significant differences were found in other clinicopathological characteristics. CONCLUSION: For a surgeon experienced in open and thoracolaparoscopic esophagectomy, and who also received systematic robot-assisted thoracic surgery training on animals, a total of 27 cases were required to gain technical proficiency in RAMIE-MK.	esophagus
Severe postoperative complications after minimally invasive esophagectomy reduce the long-term prognosis of well-immunonutrition patients with locally advanced esophageal squamous cell carcinoma.	BACKGROUND: While severe postoperative complications (SPCs) impact cancer prognosis, their effect on locally advanced esophageal squamous cell carcinoma (ESCC) patients with varying immunonutritional statuses after minimally invasive esophagectomy (MIE) is unclear. METHODS: This retrospective study analyzed 442 patients with locally advanced ESCC who underwent MIE, investigating the relationship between SPCs and survival based on preoperative immunonutritional status, determined by the prognostic nutritional index (PNI). Nomograms were developed for patients with preserved immunonutritional status using Cox regression, and their performance was assessed. RESULTS: Of the patients, 102 (23.1%) experienced SPCs after MIE. Five-year overall survival (OS) and disease-free survival (DFS) were significantly different between SPCs and non-SPCs groups (p < 0.001). In the preserved immunonutritional group, SPCs significantly reduced 5-year OS (p = 0.008) and DFS (p = 0.011), but not in the poor immunonutritional group (OS p = 0.152, DFS p = 0.098). Multivariate Cox regression identified SPCs as an independent risk factor for OS (HR = 1.653, p = 0.013) and DFS (HR = 1.476, p = 0.039). A nomogram for predicting OS and DFS in preserved immunonutritional patients demonstrated excellent performance. CONCLUSIONS: SPCs significantly affect prognosis in ESCC patients with preserved immunonutritional status after MIE. Nomograms based on SPCs can predict OS and DFS in these patients.	esophagus
RFC4 confers radioresistance of esophagus squamous cell carcinoma through regulating DNA damage response.	Radioresistance in esophageal squamous cell carcinoma (ESCC) is a critical factor leading to treatment failure and recurrence, yet its underlying molecular mechanisms remain unclear. This study aimed to investigate the role of replication factor C4 (RFC4) in ESCC radioresistance and to explore the underlying mechanisms. We utilized online bioinformatics tools to analyze the properties, functions, and prognostic significance of RFC4 in ESCC. We established cell lines with varying RFC4 expression levels and subjected them to radiation exposure. RFC4 expression was assessed using quantitative real-time polymerase chain reaction (qRT-PCR), immunohistochemistry, and immunoblotting. Cell proliferation was evaluated with MTT, 5-ethynyl-2'-deoxyuridine (EdU), and colony formation assays. Apoptosis and cell cycle distribution were analyzed by flow cytometry. Western blotting and immunofluorescence were used to study the impact of RFC4 on the DNA damage response in ESCC cells. A xenograft mouse model was employed to assess tumor growth in vivo. RFC4 expression was significantly upregulated in ESCC tissues and cells, particularly in radioresistant cases. Functional experiments revealed that RFC4 promotes cell proliferation, inhibits apoptosis, induces cell cycle arrest, and mitigates radiation-induced DNA damage responses. Mechanistically, RFC4-mediated radioresistance in ESCC may involve the inactivation of the p53 signaling pathway. In animal studies, RFC4 knockdown, either alone or in combination with radiation therapy, effectively suppressed the growth of xenograft tumors. These findings highlight the potential of targeting RFC4 to overcome radioresistance by modulating the DNA damage response in ESCC, offering promising therapeutic avenues for patients with ESCC.NEW & NOTEWORTHY Our research indicates that replication factor C4 (RFC4) plays a role in conferring radioresistance to esophageal squamous cell carcinoma (ESCC) by bolstering DNA damage repair, primarily through the inhibition of the p53 signaling pathway. This finding positions RFC4 as a promising therapeutic target for combating radioresistance in ESCC, although further research is required to fully comprehend its intricate role in the disease.	esophagus
PHAX enhanced LIN28B-mediated PBX3 mRNA stability to promote esophageal cancer development.	The abnormal expression of PHAX was observed in esophageal cancer, however, its specific function and mechanism remain to be further elucidated. We demonstrated that PHAX, LIN28B, and PBX3 were upregulated in esophageal cancer, while TET2 was downregulated. Elevated PHAX correlated with adverse outcomes among esophageal cancer patients. PHAX or PBX3 knockdown not only inhibited esophageal cancer cell proliferation, and promoted apoptosis and autophagy in vitro, but it also repressed tumor growth and lung metastasis in mice. Mechanically, PHAX stabilized PBX3 mRNA through interacting with LIN28B. PBX3 directly bound to the TET2 promoter region and inhibited its expression. In conclusion, PHAX directly bound to LIN28B and enhanced LIN28B-mediated stabilization of PBX3 mRNA, leading to upregulation of PBX3. PBX3 then transcriptionally repressed TET2 expression to promote esophageal cancer cell proliferation, and suppress apoptosis and autophagy. Targeting this signaling cascade could represent a promising therapeutic strategy for esophageal cancer.	esophagus
Comparison of postoperative survival prognosis between early-onset and late-onset esophageal cancer: A Population-based study.	The prognosis of non-distant metastatic early-onset esophageal cancer (EC) patients undergoing surgical treatment remains unclear, this study aims to compare the prognosis of early-onset and late-onset EC. Information on non-distant metastatic EC patients who underwent surgical treatment and were initially diagnosed between 2004 and 2015 was collected from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was used to balance the baseline differences between early-onset and late-onset EC patients. Univariate and multivariate Cox regression analyses were used to calculate hazard ratio (HR) and 95% confidence interval (CI). The Kaplan-Meier method and log-rank test were used to compare the overall survival (OS) between the two groups of patients. Atotal of 5320 EC patients were included, with 571 in the early-onset group and 4749 in the late-onset group. Multivariate Cox regression analysis showed that early-onset EC patients had better OS (HR = 0.732, 95% CI: 0.655-0.819, p<0.001). Using PSM analysis at a 1:1 ratio, we matched 557 early-onset EC patients with 557 late-onset EC patients. After matching, the multivariate Cox regression model still showed a favorable prognosis for early-onset EC (HR = 0.728, 95% CI: 0.630-0.842, p<0.001). Additionally, subgroup analysis indicated that early-onset EC patients had better long-term prognosis. Non-distant metastatic early-onset EC patients undergoing surgical treatment demonstrated better OS outcomes, confirmed by regression analysis and subgroup analysis in the matched cohort.	esophagus
The short-term efficacy and safety of neoadjuvant Sintilimab combined with chemotherapy for resectable gastroesophageal junction adenocarcinoma.	INTRODUCTION: To explore whether neoadjuvant Sintilimab is suitable for patients with gastroesophageal junction (GEJ) adenocarcinoma, we designed this study to evaluate the short-term efficacy and safety of neoadjuvant Sintilimab in combination with chemotherapy for resectable GEJ adenocarcinoma. METHODS: We retrospectively collected data on patients with GEJ adenocarcinoma who underwent surgery after receiving neoadjuvant immunotherapy combined with chemotherapy at Jining First People's Hospital between October 2020 and October 2023. The primary endpoint was complete pathological response (pCR) rate; secondary endpoints: major pathological response (MPR) rate, neoadjuvant therapy-related adverse events (AES), the safety of surgery, Postoperative Complications, and overall survival (OS). RESULTS: 24 eligible patients were enrolled in the study and achieved a pCR rate of 16.7%. The treatment-related AES was manageable. The median time interval between the end of neoadjuvant therapy and surgery was 35 days (28-81 days), R0 resection rate was 100%. The most common postoperative complications in the study were pneumonia (n = 11, 45.8%). Median follow-up was 13.5(interquartile range: 8.00, 25.50) months, Kaplan-Meier survival analysis showed median OS was not reached. CONCLUSIONS: It was safe and effective for resectable GEJ adenocarcinoma to undergo neoadjuvant Sintilimab combined with chemotherapy followed by surgery, and long-term efficacy needs to be confirmed by further follow-up.	esophagus
REsolution of Symptoms afTer Oesophago-gastric cancer REsection delphi (RESTOREd)-standardizing the definition, investigation and management of gastrointestinal symptoms and conditions after surgery.	BACKGROUND: Oesophago-gastric cancer surgery negatively affects quality of life with a high postoperative symptom burden. Several conditions that may be diagnosed and treated after surgery are recognised. However, consensus regarding their definition and management is lacking. This study aimed to develop consensus regarding the definition, investigation and management of the common symptoms and conditions, and triggers to consider disease recurrence, as a foundation for improving management and quality of life in these patients. METHOD: Modified two-round Delphi consensus study of a multidisciplinary expert panel. RESULTS: Eighty-six of 127 (67.7%) and 77 of 93 (82.8%) responses were received in rounds 1 and 2. Consensus was achieved in defining 26 symptoms. For 10 conditions (anastomotic stricture, acid reflux, non-acid reflux, biliary gastritis, delayed gastric emptying, dumping syndrome, exocrine pancreatic insufficiency, bile acid diarrhoea, small intestinal bacterial overgrowth and carbohydrate malabsorption), definitions, diagnostic criteria, first- and second-line investigation and first-line treatments were agreed. Consensus was not reached for third-line investigation of some conditions, or for second-, third- or fourth-line treatments for others. Twelve of 14 (85.7%) symptoms were agreed as triggers to consider cancer recurrence, during the early (<1 year) and late (>1 year) postoperative periods. CONCLUSION: Expert consensus regarding symptoms, conditions and triggers to consider investigation for recurrence after oesophago-gastric cancer surgery was achieved. This may allow standardization and timely diagnosis and treatment of postoperative conditions, reducing variation in care and optimizing patients' quality of life.	esophagus
Multiomics reveals tumor microenvironment remodeling in locally advanced gastric and gastroesophageal junction cancer following neoadjuvant immunotherapy and chemotherapy.	BACKGROUND: Perioperative chemotherapy is the standard of care for patients with locally advanced gastric and gastroesophageal junction cancer. Recent evidence demonstrated the addition of programmed cell death protein 1 (PD-1) inhibitors enhanced therapeutic efficacy. However, the mechanisms of response and resistance remain largely undefined. A detailed multiomic investigation is essential to elucidate these mechanisms. METHODS: We performed whole-exome sequencing, whole-transcriptome sequencing, multiplex immunofluorescence and single-cell RNA sequencing on matched pretreatment and post-treatment samples from 30 patients enrolled in an investigator-initiated Phase 2 clinical trial (NCT04908566). All patients received neoadjuvant PD-1 inhibitors in combination with chemotherapy. A major pathologic response (MPR) was defined as the presence of no more than 10% residual viable tumor cells following treatment. RESULTS: Before treatment, the positive ratio of CD3+T cells in both the tumor parenchyma and stroma was significantly higher in the non-MPR group compared with the MPR group (p=0.042 and p=0.013, respectively). Least absolute shrinkage and selection operator regression was employed for feature gene selection and 13 genes were ultimately used to construct a predictive model for identifying MPR after surgery. The model exhibited a perfect area under curve (AUC) of 1.000 (95% CI: 1.000 to 1.000, p<0.001). Post-treatment analysis revealed a significant increase in CD3+T cells, CD8+T cells and NK cells in the tumor stroma of MPR patients. In the tumor parenchyma, aside from a marked increase in CD8+T cells and NK cells, a notable reduction in macrophage was also observed (all p<0.05). Importantly, forkheadbox protein 3 (FOXP3), the principal marker for regulatory T cells (Treg) cells, showed a significant decrease during treatment in MPR patients. FOXP3 expression in the non-MPR group was significantly higher than in the MPR group (p=0.0056) after treatment. Furthermore, single-cell RNA sequencing analysis confirmed that nearly all Treg cells were derived from the non-MPR group. CONCLUSIONS: Our study highlights the critical role of dynamic changes within the tumor immune microenvironment in predicting the efficacy of neoadjuvant combined immunochemotherapy. We examined the disparities between MPR/non-MPR groups, shedding light on potential mechanisms of immune response and suppression. In addition to bolstering cytotoxic immune responses, specifically targeting Treg cells may be crucial for enhancing treatment outcomes.	esophagus
Clinical characteristics and biomarkers of severe immune checkpoint inhibitor-related pneumonitis triggered by immunotherapy followed by radiation: a case report.	BACKGROUND: The advent of immune checkpoint inhibitors (ICIs) has revolutionized the treatment landscape for tumor patients, dramatically improving survival rate. However, patients treated with immunotherapy are inevitably at risk of immune-related adverse events (irAEs). Immune checkpoint inhibitor-related pneumonitis (ICI-P) is an important type of IrAEs with a potentially lethal risk, which should be given more attention. Diagnosis and timely treatment of ICI-P is challenging due to the lack of specificity of its clinical and radiological features. Besides, poor understanding of biological mechanisms of ICI-P has led to a lack of reliable biomarkers to identify patients at risk, limiting timely treatment and proper management of it. CASE PRESENTATION: We presented longitudinal clinical features and successful treatment experience in a metastatic esophageal squamous cell carcinoma (ESCC) patient treated with immunochemotherapy followed by palliative radiotherapy for cervical lymph nodes who developed severe pneumonitis outside of the radiation field ten days after completion of radiotherapy suggestive of ICI-P. In addition, analysis of circulating biomarkers demonstrated an increase in platelet-to-lymphocyte ratio (PLR) and platelet-to-monocyte ratio (PMR), as well as the levels of CD4(+)T and CD8(+)T cells that tracked with the progression of ICI-P, and then decreased with corticosteroid treatment. CONCLUSIONS: Our data highlight the imaging manifestations associated with ICI-related pulmonary toxicity and describe the dynamics of the corresponding circulating markers. Although our results reveal that dynamic monitoring of PLR and PMR as well as the levels of CD4(+)T and CD8(+)T cells may predict the risk of ICI-P, further investigations are needed to elucidate the underlying molecular and biological mechanisms for better management of ICI-P.	esophagus
Major pathologic response as a prognostic surrogate in esophageal squamous cell carcinoma patients receiving neoadjuvant chemotherapy/chemoimmunotherapy: A multi-center cohort study.	PURPOSE: To determine the prognostic and survival surrogate value of major pathologic response (MPR) in esophageal squamous cell carcinoma (ESCC) patients undergoing neoadjuvant chemotherapy/chemoimmunotherapy(nCT/nICT) and surgery. METHOD: A retrospective multi-center study cohort study enrolled 305 ESCC patients who underwent neoadjuvant chemotherapy/chemoimmunotherapy followed by esophagectomy. Endpoints included recurrence-free survival (RFS), locoregional recurrence-free survival(L-RFS), distant metastasis-free survival(D-MFS), and recurrence patterns. The Cox regression analysis and Harrell's C-index were used to analyze survival differences and surrogate endpoints. The Kaplan-Meier method was used for the subgroup analysis in two subgroups(the patients receiving nICT and patients receiving nCT) and the prognostic value analysis of adjuvant therapy in non-MPR and MPR patients. RESULT: Of the 305 patients, 105 achieved MPR, demonstrating a significantly improved RFS (P value < 0.001), L-RFS (P value < 0.001), and D-MFS (P value = 0.003). MPR was identified as an independent risk factor for RFS(HR:0.415, 95%CI:[0.227, 0.759], P value = 0.004) and demonstrated equal predictive capacity to be a surrogate of survival endpoints with T stage and N stage(Harrell's C-index: 0.613). In subgroup analysis, patients with MPR showed better survival outcomes in subgroups that received neoadjuvant chemoimmunotherapy (P value = 0.012) and neoadjuvant chemotherapy(P value < 0.001). Additionally, adjuvant therapy did not confer additional survival benefits to both MPR and non-MPR patients. Compared with patients who achieved MPR, non-MPR patients exhibited a higher recurrence rate, although the recurrence sites were similar between the two groups. CONCLUSION: MPR can serve as an independent prognostic factor and a surrogate of survival endpoints in ESCC patients undergoing nCT/nICT. Besides, as a potential indicator for postoperative management, MPR can provide reference basis and evidence support in clinical practice.	esophagus
Perioperative systemic therapy as a part of comprehensive multimodal treatment in esophageal and gastric cancer - new treatment guidelines.	Esophageal and gastric cancer are diseases with a serious prognosis. While the incidence of gastric cancer is decreasing, the incidence of the gastroesophageal junction and esophageal cancer is increasing. Men are affected more often than women. Despite some progress in the last 10 years, cancer-specific mortality is very high, reaching 70%. The prognosis is mainly determined by the stage, histology, general condition and comorbidities. The treatment approach is curative for early and localized stages, requir-ing comprehensive care already during neoadjuvant therapy. Nutritional support is an essential part of preoperative preparation, and centres specializing in esophagogastric surgery are increasingly adopting the concept of prehabilitation. The main treatment modalities are endoscopy, surgery, systemic therapy and radiotherapy. In locally ad-vanced squamous cell carcinoma, neoadjuvant chemoradiotherapy followed by post-operative immunotherapy is the standard of care, if pathological complete remission has not been achieved. Definitive chemoradiotherapy is an alternative in patients with comorbidities. For adenocarcinoma, perioperative FLOT chemotherapy is the first choice and has shown better results than chemoradiotherapy. Chemoradiotherapy has its place in patients who would not tolerate FLOT or when trying to achieve a higher response rate. According to phase II studies, patients with MSI-high tumours could be treated with neoadjuvant immunotherapy, alone or in combination with chemotherapy; this approach has led to a pathological complete remission rate of approximately 60% and is a promising organ-preserving approach. For HER2-positive tumours, preoperative systemic therapy with trastuzumab may be considered as it demonstrates a significantly higher number of pathological complete remissions and offers the possibility of achiev-ing a higher R0 resection rate. In oligometastatic disease, surgical management of the primary tumour and metastases may be considered in individual cases in patients who respond to systemic therapy. However, an impact on overall survival has only been documented in patients with retroperitoneal involvement and no peritoneal metastases.	esophagus
Characteristics and Risk Factors for Postoperative Bleeding Following Endoscopic Resection of Esophageal Squamous Neoplasms.	BACKGROUND: Reports on postoperative bleeding after esophageal endoscopic resection are limited. AIMS: This study aimed to identify the clinical characteristics and risk factors for postoperative bleeding following endoscopic resection of esophageal neoplasms. METHODS: This single-center, retrospective study included consecutive patients who underwent endoscopic resection for esophageal squamous cell carcinoma or squamous intraepithelial neoplasm between January 2018 and December 2022. We investigated the incidence, timing, severity, and risk factors for postoperative bleeding. RESULTS: Of 1288 patients, 1062 (82%) underwent endoscopic submucosal dissection, and 226 (18%) underwent endoscopic mucosal resection. Postoperative bleeding occurred in seven (0.5%) patients (95% confidence interval [CI] 0.2-1.1%; median postoperative day 8 [range, 4-17 days]). In these seven patients, hemoglobin concentration decreased by a median of 3.0 g/dL (range, 1.6-6.8 g/dL). Antithrombotic agent use, resection wound circumference, and specimen size were significantly associated with postoperative bleeding (P < 0.001, P = 0.002, and P = 0.024, respectively). Among 43 patients who received direct oral anticoagulants (DOACs), postoperative bleeding occurred in four (9%) patients (95% CI 2.6-22.1%). DOACs were significantly associated with postoperative bleeding even after propensity score matching (4/40 [10%] vs. 0/80 [0%], respectively; P = 0.011). CONCLUSIONS: The overall bleeding rate following esophageal endoscopic resection was 0.5%, with a delayed onset, leading to anemia. DOACs emerged as the most significant risk factor for postoperative bleeding.	esophagus