crossing96/oncoscreening huggingface dataset:
Closing the gap: endoscopic treatment of esophageal anastomotic leakage-a retrospective cohort study.	BACKGROUND: A variety of endoscopic techniques are available for the closure of esophageal defects, each offering distinct advantages. Endoscopic vacuum therapy (EVT) has emerged as a highly effective approach. Alternatively, fully covered self-expanding metal stents (SEMS) can be placed intraluminally until defect closure is achieved. For smaller defects, over-the-scope clips (OTSC®) provide a viable option. However, comparative data remain limited and reported closure rates vary widely across the literature. This study aimed to evaluate and compare closure rates of postoperative anastomotic leaks treated with EVT, SEMS, and OTSC® at two specialized centers in Germany. METHODS: This retrospective study included all patients treated endoscopically for anastomotic leakage at two tertiary gastroenterological centers between May 2007 and February 2023. The primary endpoint was successful endoscopic defect closure. Secondary endpoints included in-hospital mortality, need for revision surgery, duration of therapy, hospital stay length, time to treatment initiation, and procedure-related complications. RESULTS: A total of 59 patients (71% male, mean age 64 years) were included. In 94.9% of cases, surgery was performed for oncologic indications; 46% had received neoadjuvant therapy. The most common procedure was Ivor Lewis esophagectomy (89.8%). EVT was used in 24 patients, SEMS in 32, and OTSC® in 14. The overall closure rate was 78.0%. Patients with successful closure had a significantly lower ASA score (p = 0.039), smaller defects (≤ 1 cm: 57.8% vs. 15.4%, p = 0.007), lower in-hospital mortality (2.2% vs. 38.5%, p < 0.001), and reduced need for revision surgery (0% vs. 61.5%, p < 0.001). CONCLUSIONS: The success of endoscopic therapy is closely linked to patient health status and defect size. Notably, esophageal defects ≤ 1 cm can almost always be closed successfully using endoscopic methods.	esophagus
Impact of perioperative fluorouracil, leucovorin, oxaliplatin, and docetaxel delivery on postoperative survival in locally advanced oesophagogastric adenocarcinoma.	BACKGROUND: Perioperative fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) is the standard of care for locally advanced oesophagogastric adenocarcinoma (LA-OGA) in Western countries. However, completing treatment is challenging for patients, particularly in the postoperative setting. This study investigated the impact of adjuvant chemotherapy (ACT) administration and treatment completion on survival outcomes in patients receiving FLOT. METHODS: Charts of LA-OGA patients treated from 2017 to 2023 were retrospectively reviewed. Survival was analysed using Kaplan-Meier and restricted mean survival time (RMST) analyses, with propensity score matching (PSM) adjustments. Subgroup analyses were stratified by pathological nodal status and tumour regression grade (Mandard TRG). The primary endpoint was 3-year overall survival (OS). RESULTS: The study included 233 patients, among whom 62.4% completed the full perioperative FLOT regimen and 21% did not receive ACT. After PSM adjustment, 3-year OS for patients who completed and those who did not complete perioperative therapy was 69% and 57%, respectively (p = 0.09). The 3-year OS was 81% and 52% for patients who did and did not receive ACT, respectively (p = 0.01). In multivariate analysis, completion of perioperative FLOT was independently associated with improved OS (p = 0.04). Survival improvement with ACT was observed in the ypN-positive subgroup but not in the ypN-negative subgroup. CONCLUSIONS: Perioperative FLOT administration is recommended as the standard of care for LA-OGA. The survival impact of ACT might be influenced by pathological lymph node metastasis.	esophagus
Survival Prediction of Esophageal Cancer Using 3D CT Imaging: A Context-Aware Approach With Non-Local Feature Aggregation and Graph-Based Spatial Interaction.	Accurate prediction of survival rates in esophageal cancer (EC) is crucial for guiding personalized treatment decisions. Deep learning-based survival models have gained increasing attention due to their powerful ability to capture complex embeddings in medical data. However, the primary limitation of current frameworks for predicting survival lies in their lack of attention to the contextual interactions between tumor and lymph node regions, which are vital for survival predictions. In the current study, we aimed to develop an effective EC survival risk prediction using only 3D computed tomography (CT) images.The proposed model consists of two essential components: 1) non-local feature aggregation module(NFAM) that integrates visual features from tumor and lymph nodes at both local and global scales, 2) graph-based spatial interaction module(GSIM) that explores the latent contextual interactions between tumors and lymph nodes.The experimental results demonstrate that our model achieves superior performance compared to state-of-the-art survival prediction methods, emphasizing its robust predictive capability. Moreover, we found that retaining lymph nodes with major axis [Formula: see text]mm yields the best predictive results (C-index: 0.725), offering valuable guidance on choosing prognostic factors for esophageal cancer.For EC survival prediction using solely 3D CT images, integrating lymph node information with tumor information helps to improve the predictive performance of deep learning models.Clinical impact: The American Joint Committee on Cancer (TNM) classification serves as the primary framework for risk stratification, prognostic evaluation, and therapeutic decision-making in oncology. Nevertheless, this prognostic tool has demonstrated limited predictive accuracy in assessing long-term survival for esophageal carcinoma patients undergoing multimodal therapeutic regimens. Notably, even among those categorized within identical staging parameters, significant outcome heterogeneity persists, with survival trajectories diverging substantially across clinically matched populations. Our model serves as a complementary tool to the TNM staging system. By stratifying patients into distinct risk categories, this approach enables accurate prognosis assessment and provides critical guidance for postoperative adjuvant therapy decisions (such as whether to administer adjuvant radiotherapy or chemotherapy), thereby facilitating personalized treatment recommendations.	esophagus
Perioperative Changes in Oral Function and Association With Oral Food Intake Status in Patients Undergoing Gastric and Oesophageal Cancer Surgery.	OBJECTIVES: Perioperative oral health care traditionally focuses on oral hygiene to prevent post-surgical infection, with limited attention to oral function. This study explores perioperative changes in oral function in association with oral food intake in patients receiving gastric or oesophageal cancer surgery. METHODS: Patients who underwent surgery for gastric or oesophageal cancer at a university hospital and visited its outpatient dental centre for perioperative oral health care were recruited from August 2018 to March 2021. Several oral function parameters (lip-tongue motor function, tongue pressure, occlusal force, oral dryness and dysphagia score) were measured 1 day before and 7 days after treatment. The patients were categorised into the oral intake (PO) and non-oral intake (NPO) groups based on oral food intake status at 7 days post-surgery, and perioperative changes in oral function were analysed using the Wilcoxon signed-rank test between the PO and NPO groups for both gastric and oesophageal cancers. RESULTS: Of the 298 gastric cancer patients and 71 oesophageal cancer patients analysed, 87% and 24% of patients, respectively, were capable of oral food intake at 7 days after surgery. In gastric cancer patients, oral hygiene, tongue pressure and dysphagia scores significantly worsened in the PO group. In contrast, oral hygiene, tongue pressure and dysphagia scores were all significantly worsened in the oesophageal cancer NPO group, but not in the PO group. Oral dryness and occlusal force did not change remarkably regardless of oral food intake status in these patients. CONCLUSIONS: This study uncovered a significant decrease in oral function in oesophageal cancer patients without postoperative oral food intake, suggesting a potential association between impaired oral motor function and delayed oral intake recovery. Accordingly, perioperative oral function management alongside oral hygiene care is advisable for early resumption of oral food intake.	esophagus
Efficacy of perioperative and neoadjuvant therapies in gastric and gastroesophageal junction adenocarcinoma: a network meta-analysis.	BACKGROUND: Optimal treatment for resectable gastric and gastroesophageal junction (GEJ) adenocarcinoma remains unclear due to limited head-to-head comparisons among chemotherapy and chemoradiation regimens. This network meta-analysis aimed to determine the relative efficacy of available multimodality treatment regimens in these patients. METHODS: MEDLINE, EMBASE, Scopus, Web of Science, and CENTRAL were searched till September 20, 2024. Phase 3 randomized trials evaluating perioperative/neoadjuvant systemic therapy ± radiation in resectable gastric/GEJ adenocarcinoma were included. Primary outcomes were disease-free survival (DFS) and overall survival (OS). Frequentist network meta-analysis was conducted to compare hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Fifteen trials (8072 patients) were analyzed. pFLOT (perioperative fluorouracil, leucovorin, oxaliplatin, and docetaxel) ranked highest for DFS in the overall population (P-score 91%), achieving significant improvements compared to surgery alone (HR 0.48, 95% CI, 0.38-0.60) and nCROSS (neoadjuvant paclitaxel, carboplatin, and radiotherapy) (0.67, 0.56-0.81). For OS, nPLF + nCRT(EP) (neoadjuvant cisplatin, leucovorin, and fluorouracil for induction, followed by etoposide, cisplatin, and radiotherapy) (P-score 90%) and pFLOT (P-score 87%) were the top regimens. pFLOT significantly outperformed surgery alone (0.57, 0.45-0.72) and nCROSS (0.73, 0.60-0.89). Based on the limited data available, adding neoadjuvant chemoradiation to pFLOT provided no additional OS (1.14, 0.76-1.72) or DFS (1.22, 0.83-1.82) benefit. Similarly, adding pembrolizumab to perioperative chemotherapy (cisplatin and fluorouracil/capecitabine) was not superior to pFLOT (DFS: 1.10, 0.71-1.69; OS: 1.09, 0.69-1.72). CONCLUSIONS: pFLOT demonstrated superior efficacy in resectable gastric/GEJ adenocarcinoma, outperforming surgery alone, nCROSS, and alternative perioperative regimens. The additive role of immunotherapy requires further investigation to optimize patient selection and outcomes.	esophagus
Tumor Microvessels with Specific Morphology as a Prognostic Factor in Esophageal Squamous Cell Carcinoma.	BACKGROUND: Angiogenesis is essential for tumor progression. Microvessel density (MVD) is a widely used histological method to assess angiogenesis using immunostained sections, but its prognostic significance in esophageal cancer remains controversial. Recently, the evaluation of microvascular architecture has gained importance as a method to assess tumor aggressiveness. The present study aimed to identify the histological characteristics of tumor microvessels that are associated with the aggressiveness of esophageal squamous cell carcinoma. PATIENTS AND METHODS: A total of 108 esophageal squamous cell carcinoma tissues were immunohistochemically stained with blood vessel markers and angiogenesis-related markers, including CD31, alpha smooth muscle actin, vascular endothelial growth factor A (VEGF-A), CD206, and D2-40. MVD, microvessel pericyte coverage index (MPI), and tumor vascular morphology were evaluated by microscopy. RESULTS: MVD was significantly associated with patient outcomes, whereas neither MPI nor VEGF-A expression throughout the tumor showed a significant correlation. In addition, the presence of blood vessels encircling clusters of tumor cells, termed C-shaped microvessels, and excessively branching microvessels, termed X-shaped microvessels, was significantly associated with poor prognosis. These vessel types were also correlated with clinicopathological parameters, including deeper invasion of the primary tumor, presence of lymph node metastasis, advanced pathological stage, and distant metastasis. Focal VEGF-A immunoexpression in tumor cells was higher in areas containing C-shaped or X-shaped microvessels compared with areas lacking these vessel morphologies. CONCLUSIONS: The data suggest that tumor microvessels with specific morphologies (C-shaped and X-shaped microvessels) may serve as a promising prognostic factor in esophageal squamous cell carcinoma.	esophagus
Adjuvant treatment efficacy in esophageal adenocarcinoma patients receiving neoadjuvant therapy and esophagectomy.	The application of adjuvant therapy following neoadjuvant treatment and subsequent esophagectomy remains a subject of debate due to the limited availability of comprehensive studies. This study aims to evaluate the role of adjuvant therapy in patients with esophageal adenocarcinoma (EAC) who have undergone neoadjuvant therapy and esophagectomy, thereby offering evidence-based guidance for clinical decision-making. Patients diagnosed with EAC and treated with neoadjuvant therapy followed by surgical intervention were enrolled in our study. The data for patients in the training cohort were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. To validate the findings, new patient cohorts were utilized. A total of 3,445 patients with EAC were identified from the SEER database based on the established eligibility criteria. The analysis revealed no significant differences between the adjuvant therapy group and the non-adjuvant therapy group in terms of 5-year overall survival, with rates of 35.7% and 37.2%, respectively (p=0.920), nor in 5-year cancer-specific survival, with rates of 39.5% and 43.2%, respectively (p=0.520). Additionally, 130 patients were identified from the Affiliated Jinling Hospital of Nanjing University's Medical School. In this cohort, findings indicated that patients receiving adjuvant therapy demonstrated improved overall survival compared to those not receiving such therapy (p=0.031). Leveraging the SEER database, our study demonstrated that adjuvant therapy did not confer a survival advantage for patients with EAC following neoadjuvant therapy and surgery. In contrast, data analysis from the Affiliated Jinling Hospital, Medical School of Nanjing University in China, indicated that EAC patients might indeed benefit from adjuvant therapy after undergoing neoadjuvant treatment and esophagectomy.	esophagus
Risk Factors for Dysphagia after Oesophagectomy in Oesophageal Cancer Patients: A Systematic Review and Meta-analysis.	BACKGROUND: The high incidence of dysphagia in patients after oesophageal cancer surgery significantly impacts prognosis and rehabilitation. We aimed to summarize the risk factors for dysphagia in patients with oesophageal cancer through a meta-analysis and systematic review. METHODS: We comprehensively searched the PubMed, EBASE, Web of Science, and Cochrane databases to retrieve articles published up to August 2024 for research on dysphagia after oesophagectomy patients. Relevant data were extracted and evaluated using fixed-effects or random-effects models to aggregate the effect sizes. RESULTS: The final review included sixteen studies. The meta-analyses, revealed that seven factors were significantly associated with the onset of dysphagia. The pooled age showed an odds ratio (OR) of 1.06 (95% confidence interval [CI] 1.02-1.1) in univariate analysis and 1.07 (95% CI 1.05-1.09) in multivariate analysis. Body mass index demonstrated an OR of 0.96 (95% CI 0.92-0.99), and tumour location showed an OR of 2.61 (95% CI 1.01-6.77). Sarcopenia demonstrated an OR of 1.69 (95% CI 1.23-2.32) in univariate analysis and 3.42 (95% CI 1.76-6.66) in multivariate analysis. Recurrent laryngeal nerve palsy demonstrated an OR of 3.03 (95% CI 2.18-4.2) in univariate analysis and 3.63 (95% CI 2.46-5.35) in multivariate analysis. Prognostic Nutritional Index demonstrated an OR of 1.21 (95% CI 1.02-1.43), and maximum anterior displacement of the hyoid showed a standardized mean difference of - 0.74 (95% CI -1.17 to -0.31). CONCLUSIONS: Our meta-analysis results demonstrated that age, body mass index, sarcopenia, tumour location, prognostic nutritional index, maximum anterior displacement of the hyoid, and recurrent laryngeal nerve palsy were associated with dysphagia and revealed multiple clinicopathological factors that correlate with dysphagia in patients undergoing oesophagectomy.	esophagus
Cervical Incision-Free Technique for R0 Resection in Cervicothoracic Esophageal Carcinoma: A Novel Approach of the Chai's Supra-Thoracic Apex Technique.	Purpose: Esophageal squamous cell carcinoma (ESCC) located at the cervicothoracic junction (CTJ-ESCC), approximately 18-21 cm from the incisors, poses unique surgical difficulties given its proximity to the trachea and recurrent laryngeal nerves. This investigation evaluated a new approach that avoids cervical incisions by combining the EGIARADMT™ curvilinear stapling method with OrVil™-based three-dimensional suspension anastomosis (TriSAS) to achieve R0 resection. Methods: A retrospective analysis was performed on 11 consecutive cases of CTJ-ESCC treated between February 2019 and March 2024, with follow-up data available until February 2025. Results: All patients underwent R0 resection without cervical incisions, achieving a proximal margin of 1-4 cm. The median operative time was 350 minutes (range: 275-605) with a blood loss of 100 mL (range: 20-700). Lymphadenectomy resulted in a median of 21 nodes (range: 9-38) being retrieved. The median duration of hospitalization was 49 days (range: 42-67). There were no occurrences of anastomotic leaks, strictures, or recurrent laryngeal nerve injuries. Transient gastric stasis was observed in 18.2% of cases and resolved with conservative management. One postoperative mortality was attributed to pulmonary infection. The median overall and disease-free survival were 25 months. Conclusion: Integrating EGIARADMT curvilinear stapling with OrVil-TriSAS anastomosis enables cervical incision-free R0 resection for CTJ-ESCC, achieving precise oncologic control with functional preservation. Adjuvant therapy may further improve survival despite clear margins.	esophagus
Distal esophageal acid exposure and poor esophageal clearance correlate with probability of progression in Barrett's esophagus as determined by the tissue systems pathology test.	BACKGROUND: The risk of progression from non-dysplastic Barrett's esophagus (NDBE) to high grade dysplasia or esophageal adenocarcinoma (HGD/EAC) is low but variable. Biomarker assays can aid with risk stratification to optimize surveillance for NDBE. The role of diagnostic esophageal testing in prognosticating progression is unclear. The aim of this study was to evaluate whether esophageal physiology parameters correlate with a validated biomarker for BE risk progression. METHODS: Patients with NDBE, including histology confirmed intestinal metaplasia < 1 cm, had their pathology specimen analyzed using a validated tissue systems pathology test with 9 biomarkers (TSP-9). This assay uses immunohistochemistry and digital pathology analysis to provide a 5-year risk of progression to HGD/EAC. These patients also underwent esophageal pH-monitoring and high-resolution impedance manometry (HRIM). Correlation analyses were performed between TSP-9 risk percent and esophageal testing. RESULTS: A total of 59 patients [52.5% male; mean (SD) age 59 (14)] were included (40 NDBE, 19 < 1 cm IM) between 2021 and 2023. The median (IQR) TSP-9 value for 5-year risk of progression was low at 2.0% (2.0-3.0%). There were 8 (13.6%) statistical outliers with higher risk ranging from 5.0 to 10.0%. Risk of progression in the entire cohort was directly correlated with physiology testing parameters including DeMeester score (R = 0.30), acid exposure time (AET) (R = 0.34), duration of longest reflux episode on pH-monitoring (R = 0.30), and % incomplete bolus clearance on HRIM (R = 0.35) (p < 0.05 for all). In a subgroup of 19 patients with < 1 cm IM, risk of progression had a stronger correlation with DeMeester score (R = 0.65), AET (R = 0.67), supine AET (R = 0.70), number of reflux episodes on pH-monitoring (R = 0.50) and % incomplete bolus clearance on HRIM (R = 0.68) (p < 0.05 for all). CONCLUSION: There was a direct correlation between 5-year risk of progression to HGD/EAC using TSP-9 and distal esophageal acid exposure and poor esophageal clearance among patients with NDBE that was even stronger in those with < 1 cm of IM. These findings suggest that esophageal physiology testing may have value in predicting risk progression in BE.	esophagus
Toripalimab in Esophageal Cancer: A Systematic Review and Meta-Analysis.	BACKGROUND: Esophageal cancer (EC) remains a highly aggressive malignancy with a poor prognosis despite advancements in treatment. Toripalimab, a PD-1 inhibitor, has demonstrated the potential to improve clinical outcomes. This systematic review and meta-analysis assess the efficacy and safety of Toripalimab in EC. METHODS: Following PRISMA 2020 guidelines, we conducted a systematic review and meta-analysis, searching PubMed, Embase, Scopus, ScienceDirect, and Google Scholar up to January 2025. Eligible studies evaluated Toripalimab in esophageal cancer, including randomized controlled trials and non-randomized controlled trials. Primary outcomes included overall survival (OS), progression-free survival (PFS), and objective response rate (ORR), while safety outcomes assessed treatment-related adverse events. Data were synthesized using random-effects models, with heterogeneity evaluated via Cochrane's Q and I(2) statistics. RESULTS: The pooled analysis included six studies involving 678 patients. Toripalimab demonstrated promising efficacy, with a Complete Response (CR) rate of 33%, Partial Response (PR) rate of 36%, pathological complete response (pCR) rate of 30%, and major pathological response (MPR) rate of 46%. The R0 resection rate was 87%, while OS and PFS rates were reported at 78% and 50%, respectively. Anemia (56%), alopecia (54%), leukopenia (54%), and fatigue (30%) were the most frequently reported adverse effects. Other common adverse effects included nausea (29%), constipation (18%), and vomiting (20%). CONCLUSIONS: Toripalimab demonstrates significant potential in treating esophageal cancer, with favorable response rates and survival outcomes. However, the high incidence of adverse effects highlights the need for supportive care and ongoing research. While based on limited sample sizes and single-arm studies that may introduce bias and affect generalizability in this review, we provide valuable preliminary insights into toripalimab's potential, highlighting the need for larger randomized trials to build on these findings.	esophagus
Intraoperative Complications During Esophagectomy.	An esophagectomy is a high-risk procedure with considerable potential peri-operative morbidity and mortality. The procedure, regardless of approach, demands high-technical precision and careful, coordinated management among a multidisciplinary team throughout the peri-operative course. While rare, intra-operative complications and catastrophes, such as major bleeding or airway injuries, may occur. The ability to readily recognize and intervene is critical to a successful outcome.	esophagus