crossing96/oncoscreening huggingface dataset:
Primary Malignant Melanoma of the Oesophagus Treated With Immunotherapy: A Case Report and Scoping Review of the Literature.	PURPOSE: Primary malignant melanoma of the oesophagus is extremely rare. Given this, there is a paucity of evidence to guide treatment decisions. Traditionally, treatment has included standard modalities of surgery, chemotherapy, and/or radiotherapy. Immunotherapy has revolutionised the treatment of cutaneous melanoma; however, molecular studies have provided conflicting results regarding whether the underlying mechanisms driving melanoma response to immunotherapy are reproduced in mucosal and, more specifically, oesophageal melanomas. The evidence base for treatment decisions in primary malignant melanoma of the oesophagus remains limited due to the small number of reported cases, with only 374 cases reported in the world literature up to 2022. CASE REPORT AND LITERATURE REVIEW: We present the case of an 81-year-old Caucasian female patient, previously in good health aside from gastro-oesophageal reflux. The patient presented with dysphagia and proceeded to CT and endoscopy showing a large mid-to-distal oesophageal mass. Endoscopic biopsies revealed a poorly differentiated epithelioid malignancy, with immunohistochemical studies confirming melanoma. FDG-PET revealed metastatic deposits in the skeleton as well as mesenteric nodes. The patient was commenced on treatment with ipilimumab and nivolumab 18 days following diagnosis. Despite receiving only one cycle of immunotherapy, the patient demonstrated remarkable resolution of symptoms as well as complete resolution of PET-avidity of all local and metastatic disease and remains in remission 2 years following diagnosis. Scoping review of the literature identified just three case series and 18 case reports of patients with primary oesophageal melanoma treated with immunotherapy This case is now the third case reported in the literature of patients with oesophageal melanoma metastatic at diagnosis, who have entered long-term complete remission following sole treatment with immunotherapy and the only case to enter remission following a single cycle of treatment. CONCLUSION: We report our experience with one of the few reported cases of metastatic primary malignant melanoma of the oesophagus treated with immunotherapy, with encouraging results. We would encourage reporting of further cases in order to better understand the role of immunotherapy in oesophageal melanoma.	esophagus
A rare case report of esophageal neuroendocrine carcinoma mimicking a submucosal tumor: Diagnosis confirmed by endoscopic ultrasound-guided fine-needle aspiration.	Esophageal neuroendocrine carcinoma is an exceedingly rare and aggressive malignancy, accounting for less than 1% of all esophageal cancers. This case report presents a unique instance of esophageal neuroendocrine carcinoma that initially manifests as a submucosal tumor-like lesion, an atypical and under-recognized presentation that can mimic benign conditions such as leiomyomas or gastrointestinal stromal tumors. Conventional endoscopic biopsy, often the first-line diagnostic tool, failed to provide a definitive diagnosis due to the tumor's deep submucosal location and intact overlying mucosa. However, the utilization of endoscopic ultrasound-guided fine-needle aspiration proved instrumental in obtaining sufficient tissue for histopathological and immunohistochemical analyses, confirming the diagnosis of esophageal neuroendocrine carcinoma. This case underscores the critical role of endoscopic ultrasound-guided fine-needle aspiration in diagnosing rare esophageal malignancies that evade standard diagnostic approaches. Furthermore, it emphasizes the importance of considering esophageal neuroendocrine carcinoma in the differential diagnosis of unusual esophageal lesions, particularly when they exhibit unusual features or fail to respond to conventional management. Early and accurate diagnosis is essential for guiding appropriate therapeutic strategies and improving patient outcomes.	esophagus
Modification of Pathological Nodal Classification for pT1b Esophageal Squamous Cell Carcinoma With Lymphovascular Invasion: Over 10-Year Experience.	BACKGROUND: Lymphovascular invasion (LVI) adversely affects the survival of pT1b esophageal squamous cell carcinoma (ESCC). It is hypothesized that a modified stage classification of pT1b ESCC based on LVI may facilitate multidisciplinary therapy in LVI-positive patients. AIMS: The study aims to investigate the impact of LVI on pathological nodal classification for pT1b ESCC. METHODS AND RESULTS: Surgically resected pT1b ESCC patients in Sun Yat-sen University Cancer Center between 2008 and 2018 were retrospectively reviewed. Tumor sections were re-assessed for LVI by gastrointestinal pathologists. The associations between patient survival and LVI were evaluated by the Log-rank method. A multivariate Cox regression model was applied to identify the impact of LVI on survival. Prognostic performance was assessed by Harrell's C-index. A total of 424 cases with the pT1b stage were included. The risk of LVI was significantly higher in patients with nodal positive status (p < 0.001) and larger tumor size (p = 0.033). The 5-year OS for LVI+ patients were 50.3% versus 78.0% for LVI- (p < 0.001). Multivariable analyses suggested that LVI (p = 0.021) and pN (p = 0.016) stages were two independent adverse prognostic factors in pT1b patients. When classifying LVI+ as an independent subgroup into the pN category, the modified pN staging system demonstrated a superior prognostic performance (p < 0.001). CONCLUSION: Tumors with LVI should be defined as a separate subclassification to accurately classify the prognostic category in pT1b patients. Further studies are required to investigate multidisciplinary therapies for LVI+ pT1b patients.	esophagus
Cross-Sectional Survey on Mediastinal Lymph Node Dissection in Lung and Esophageal Cancer: A Project of the Anatomy of the Border Consensus Meeting at the 37th Annual Meeting of the Japan Society for Endoscopic Surgery.	"INTRODUCTION: Although mediastinal lymph node dissection is performed in both lung and esophageal cancer surgeries, the underlying concepts and indications may differ between these fields. This study aimed to clarify these differences through a nationwide questionnaire survey initiated by the 37th Annual Meeting of the Japan Society for Endoscopic Surgery. METHODS: A joint task force from the lung and esophageal surgery divisions developed a questionnaire focusing on four key areas: (i) lymph node dissection around the left recurrent nerve, (ii) subcarinal lymph node dissection, (iii) pulmonary ligament lymph node dissection, and (iv) en bloc lymph node dissection. The survey was distributed to certified core institutions across Japan. RESULTS: The response rates were 50.4% for lung cancer institutions and 57.0% for esophageal cancer institutions. In the esophageal division, dissection of the aforementioned lymph nodes was routinely performed in most core institutions. In contrast, practices in the lung division varied widely, particularly depending on tumor location. The concept of ""sampling"" was rarely recognized in esophageal surgery but was partially accepted in lung surgery. Furthermore, there was no uniform definition of ""en bloc dissection"" across either field. CONCLUSION: This cross-sectional survey revealed notable conceptual differences between lung and esophageal cancer divisions regarding mediastinal lymph node dissection, despite targeting the same anatomical regions. Additionally, significant variability was observed even within the lung division. These findings indicate a lack of standardized consensus in Japan and highlight the need for ongoing cross-disciplinary dialog and consensus building."	esophagus
Involved-Field Irradiation Versus Elective Nodal Irradiation in Patients With Locally Advanced Esophageal Squamous Cell Carcinoma Treated With Neoadjuvant Chemoradiotherapy.	BACKGROUND: The method of lymph node (LN) irradiation for locally advanced esophageal squamous cell carcinoma (LA-ESCC) is still a topic of debate. We investigated the efficacy, toxicity, and rate of out-of-field LNs in irradiation across different target areas in patients with LA-ESCC undergoing neoadjuvant chemoradiotherapy (nCRT). METHODS: We retrospectively reviewed patient records from June 2017 to August 2022 and divided patients into elective nodal irradiation (ENI) and involved-field irradiation (IFI) groups. The differences in hematological and non-hematological toxicities of the out-of-field LNs were analyzed between the two groups. The log-rank test was used to evaluate the Kaplan-Meier curves for overall and progression-free survival. RESULTS: Among the 306 included patients, 202 (66.0%) received ENI and 104 (34.0%) received IFI. At the 3-year follow-up, the survival rate did not differ significantly between the groups (p > 0.05). Although the occurrence of radiation-induced pneumonia did not differ (p > 0.05), the incidence of radiation-induced esophagitis and the degree of leukopenia differed significantly (p < 0.05). While the average heart irradiation dose or heart V(20), V(30), and V(40) did not differ significantly (p > 0.05), we observed significant differences in the clinical target volume, average lung irradiation dose, and lung V(20), V(30), and V(40) (p < 0.05). Among all patients, 29 cases (9.5%) experienced out-of-field LNs with 26 (93.1%) in abdominal LNs, whereas only 3 cases (6.9%) with out-of-field LNs were in the upper esophagus. There was no statistical significance between out-of-field LNs and LN irradiation methods (p = 0.724). CONCLUSIONS: Under similar prognostic conditions, IFI resulted in mild toxicity compared to ENI. Therefore, for patients with ESCC undergoing nCRT, IFI is the preferred irradiation approach for the lymphatic drainage area.	esophagus
Palmar fasciitis and polyarthritis syndrome with oesophageal carcinoma: a case report and review of the literature.	A 59-year-old male presented with a 1-year history of polyarthralgia and contracture. He was referred to our hospital from a local doctor, who diagnosed him with rheumatoid arthritis (RA); however, treatment with methotrexate and etanercept was ineffective. The patient also reported a 15-kg weight loss over the past year, and subsequent evaluation revealed oesophageal cancer. Contrast-enhanced magnetic resonance imaging (MRI) demonstrated enhancement around the digital muscles, and we diagnosed him with palmar fasciitis and polyarthritis syndrome (PFPAS). A rare paraneoplastic syndrome, PFPAS is characterised by hand flexion contracture, thickening of the palmar fascia, and symmetric polyarthritis. To the best of our knowledge, this is the first reported case associated with oesophageal squamous carcinoma. On T1-weighted MRI, the finger tendons typically exhibit high signal intensity, whereas contrast-enhanced imaging highlights fascial enhancement. Skin biopsy usually reveals fibroblast proliferation and monocyte invasion; however, its mechanism is unclear. The efficacy of corticosteroids, nonsteroidal anti-inflammatory drugs, and disease-modifying antirheumatic drugs is limited, whereas cancer resection may improve arthritis, though contractures are often irreversible. PFPAS may be misdiagnosed as RA due to symmetric digital synovitis, which may let the cancer progress and progression of contracture may lead to low performance status Because PFPAS often precedes initial diagnosis, recurrence, and progression of cancer, prompt cancer evaluation is essential in patients presenting with RA-like symptoms, contracture, or unexplained weight loss.	esophagus
A standardized health system approach to Ivor Lewis esophagectomy.	BACKGROUND: With the robotic approach to Ivor Lewis esophagectomy gaining popularity, concern has been raised regarding a learning curve resulting in increased complication rates. This study aimed to present the results of a standardized health system approach to Ivor Lewis esophagectomy and the transition to the robotic-assisted technique. METHODS: A retrospective review of our institutional database, along with individual patient chart review, was conducted. Patients who underwent Ivor Lewis esophagectomy at our institution from June 1, 2017, to July 7, 2023, were included. Preoperative patient characteristics and operative outcomes were recorded. The outcomes of the 60 most recent laparoscopic/thoracoscopic minimally invasive esophagectomies (MIEs) were compared with those of the first 60 robotic-assisted esophagectomies (RAMIEs). RESULTS: Over the study period, 145 patients were included for review. Of the Ivor Lewis esophagectomies, 5 were performed open, 80 were performed laparoscopic/thoracoscopic, and 60 were performed robotic assisted. The length of stay ranged from 5 to 84 days, with a median of 7 days. Leak from the esophagogastric anastomosis occurred in 5 cases (3.4%). Pulmonary complications occurred in 21 cases (14.5%). There were no 90-day mortality events. In the subset analysis, there was an increased mean operative time in the RAMIE group (443 vs 504 min [95% CI, -88.1 to -34.2]), but there were no significant differences in perioperative outcomes between the MIE and RAMIE groups. CONCLUSION: A standardized approach to perioperative management and operative technique can allow for low morbidity and mortality after Ivor Lewis esophagectomy and facilitate transitioning to a robotic-assisted technique without increasing complications.	esophagus
Stop Canceling Surgery for Esophageal Cancer: An Analysis of Treatment Related Mortality in 60 000 Patients.	BACKGROUND AND METHODS: Surgical esophagectomy is falsely regarded as contributing little survival in resectable, early-stage disease in favor of nonsurgical treatment with definitive chemoradiation (dCR). We examine surgery in treatment by evaluating large-scale trends in mortality. The SEER database was queried for esophageal cancer patients from 2004 to 2020. Total of 59 754; 19 806 squamous and 34 484 adenocarcinoma. The primary outcome was the hazard ratio for overall survival defined as time from diagnosis-to-death. Differences between patients were assessed using χ(2) tests for categorical variables and t-tests for continuous variables. Difference in survival by histology was assessed using Kaplan-Meier curves and Cox Proportional Hazards models. RESULTS: A total of 47 170 (78.9%) did not undergo surgery and 12 584 (21.1%) received surgery. The hazard ratio for patients undergoing dCR for SCC was 1.929. The hazard ratio for treatment with dCR compared to chemoradiation-followed-by-surgery (CRS) was 2.151 and for adenocarcinoma 2.386. Further analyses highlight groups under similar clinical conditions; including multivariate analysis, T-Stage, overall stage, surgical era, and surgery refusal. In every category, the risk of mortality was higher in dCR compared to CRS. CONCLUSIONS: Surgery combined with chemoradiation, and/or surgery alone, confers a significant survival benefit over dCR in resectable patients. DISCUSSION: Surgery should be considered early in medically fit patients with operable disease.	esophagus
Neoadjuvant chemoimmunotherapy cycles in locally advanced Esophageal squamous cell carcinoma: a retrospective comparison of three versus two cycles.	Esophageal squamous cell carcinoma is a major global health challenge in its locally advanced stages. Neoadjuvant chemoimmunotherapy aims to downstage tumors before surgery, but the optimal number of cycles remains uncertain. We performed a single-institution retrospective study of 208 consecutive patients with resectable, locally advanced esophageal squamous cell carcinoma treated between March 2020 and April 2024. Patients received either two (n = 84) or three (n = 124) cycles of platinum-based chemotherapy plus a programmed death-1 inhibitor, followed by esophagectomy without planned radiotherapy. Primary outcomes were pathologic complete response and disease-free survival; safety and clinical-to-pathologic downstaging were prespecified secondary end points. Three cycles yielded higher objective response (75.0% vs. 60.7%) and a higher pathologic complete response of the primary tumor (27.4% vs. 11.9%) than two cycles. Disease-free survival favored three cycles (hazard ratio, 0.52). Treatment-related adverse events occurred more often with three cycles, driven mainly by bone-marrow suppression (32.3% vs. 11.9%) but were generally manageable and compatible with timely surgery. Overall survival did not differ within the current median follow-up of 21 months. This retrospective analysis suggests that three cycles of neoadjuvant chemoimmunotherapy may provide greater tumor response and improved disease-free survival compared with two cycles in operable esophageal squamous cell carcinoma, with acceptable toxicity. However, neoadjuvant chemoradiation-which typically achieves higher pathologic complete response rates-remains the standard of care. Longer follow-up and prospective, stratified trials are needed to validate these findings and to define the role of a radiation-free strategy in appropriately selected patients.	esophagus
Subvisual imaging signals as biomarkers of impending lung metastasis: A multicenter pan-cancer study.	STUDY AIM: Early detection of distant metastases is crucial, but current imaging detects them only when radiographically visible. This study reported subvisual chest CT signals could serve as early biomarkers for impending lung metastasis before radiological visibility. METHODS: This multicenter study enrolled breast, colorectal, and esophageal cancer patients from four hospitals, with at least three follow-up chest CT scans per patient. Signaling features were extracted from 3D lung regions of interest (ROIs). Using Multi-TimePoint Modeling approach, we analyzed features across time points to develop machine learning models, with performance evaluated by the area under the curve. A predefined cutoff classified patients as Signal-Positive or Signal-Negative, and the actual lung metastasis risk was compared between these groups. The lead time that spanned from first Signal-Positivity to metastasis, and the impact of CT scan count and interval on model performance were explored. RESULTS: This study analyzed 10,280 follow-up chest CT scans from 2148 cancer patients. Signal-Positive patients showed significantly higher actual lung metastasis risk than Signal-Negative patients: 57.14 % vs 5.77 % (breast, adjusted p < 0.0001), 66.67 % vs 6.25 % (colorectal, adjusted p = 0.0361), and 50.00 % vs 12.50 % (esophageal, adjusted p = 0.0480). The lead times were 0.84 years (breast), 1.41 years (colorectal), and 0.83 years (esophageal). At least two CT scans within 1.5 years (breast/colorectal cancer) or 0.5 years (esophageal cancer) are recommended for model application. CONCLUSION: Subvisual chest CT signals serve as biomarkers for impending lung metastasis detection across cancers. This non-invasive approach dynamically identifies high-risk patients, enabling possible early intervention.	esophagus
Oral microbial profile polymorphisms predict early Siewert II adenocarcinoma of esophagogastric junction.	BACKGROUND: Dysbiosis of the oral microbiota has been shown to be associated with the development of esophageal and gastric cancer. Nevertheless, little research explores how oral microbiota might contribute to the occurrence and progression of adenocarcinoma of the esophagogastric junction (AEG). METHOD: 16 S rRNA V3-V4 amplicon sequencing was performed on 106 oral microbiota samples from 55 AEG patients and 51 controls. To determine key microbial indicators, Linear Discriminant Analysis Effect Size (LEfSe) analysis, Random Forest model, and species composition heatmaps were utilised. Spearman correlation analysis assessed the relationship between oral microbiota and clinicopathological variables. PICRUSt2 was employed to predict microbial functions and investigate the association with KEGG metabolic pathways. RESULTS: A total of 584 oral genera and 647 oral species were observed in AEG and controls, excluding unidentified species. The abundance of 24 oral genera significantly increased in AEG patients, with Neisseria, Streptococcus, Rothia, Gemella, and Capnocytophaga being the five most abundant. Lefse, RF model and Species composition heatmap identified that genera enriched in the AEG group including Streptococcus, Neisseria, Rothia, Gemella, and genera depleted including Prevotella, Veillonella, Centipeda, Nanosynbacter were determined as biological markers to distinguish AEG from healthy controls. The genera with decreased abundance in AEG patients showed a positive association with WBC levels, neutrophil levels, and CA724 levels in the Mantel correlation test. PICRUSt analysis revealed significant differences in the abundance of 12 KEGG pathways. Carbohydrate metabolism, drug resistance, infectious diseases, lipid metabolism, nucleotide metabolism, and membrane transport pathways were positively correlated with genera enriched in the AEG group such as Streptococcus and Rothia, while negatively correlated with depleted genera like Prevotella. CONCLUSION: Our research may suggest that dysbiosis of the oral microbiota and alterations in the KEGG metabolic pathway are linked to the development of AEG. In the future, we will conduct comprehensive verification through animal experiments and large-scale multicentre studies.	esophagus
Assessing Risk of Progression in Barrett's Esophagus Using a Mass-Spectrometry-Based Proteomic Panel.	INTRODUCTION: Esophageal adenocarcinoma (EAC) is an aggressive cancer with poor prognosis. Barrett's esophagus (BE) is a critical precursor of EAC. Patients with BE undergo endoscopic surveillance to monitor disease progression although only a small fraction develop EAC. These procedures are invasive and have limited accuracy in predicting BE progression. We evaluated the utility of an 8-protein mass spectrometry panel in predicting progression in patients with BE. METHODS: Eighty untreated controls and 20 cases were selected from our institutional tissue registry. Quantitative mass-spectrometry was performed on microdissected tissue sections. Data were split into 80% training and 20% test sets. We used Least Absolute Shrinkage and Selection Operator-regularized regression to train a logistic classifier on training data. Classifier performance was evaluated in test data. RESULTS: Ninety-two samples had sufficient tissue for mass spectrometry analysis (18 progressors, 74 nonprogressors). The multivariable regression model produced a sensitivity of 100% and a specificity of 39% in the overall cohort, with AUCs of 0.75 and 0.89 in the overall and test cohorts, respectively. Cox proportional hazards time-to-progression (TTP) showed a hazard ratio of 66.1 (95% CI 7.79-561, P = 0.00012) for the model prediction. DISCUSSION: The promising performance of the model generated here suggests that the test may aid in selecting patients most likely to benefit from active BE surveillance. Moreover, the association of this model's prediction with time-to-progression may offer decision support for management of patients likely to progress quickly. These results support continued development of this proteomic panel as a risk stratification tool for patients with BE.	esophagus