crossing96/oncoscreening huggingface dataset:
The Systemic Immune-inflammation Index (SII) Is an Independent Prognostic Factor for Patients With Recurrent Esophageal Cancer After Esophagectomy.	BACKGROUND/AIM: The systemic immune-inflammation index (SII) has been developed and reported to be a useful prognostic factor in various malignancies. The aim of the present study was to evaluate the clinical impact of the SII as a prognostic factor for esophageal cancer recurrence after esophagectomy. PATIENTS AND METHODS: We retrospectively reviewed the medical records and collected data from consecutive patients with recurrent EC who received any treatment after recurrence at Yokohama City University from 2005 to 2022. RESULTS: Ninety-four patients were included in this study. The median age was 69 years. The study included 83 men and 11 women. The median overall survival (OS) was 11.2 months. According to previous studies and 1- and 3-year OS rates, we set the cutoff value of the SII at 500 in the present study. Ninety-four patients were divided into an SSI-low group (n=36) and an SSI-high group (n=58). The 1- and 3-year OS rates were 84.9% and 44.7%, respectively, in the SSI-low group and 28.8% and 13.1%, respectively, in the SSI-high group. There were significant differences between the two groups (p<0.001). In the univariate and multivariate analyses, the SII was selected as an independent prognostic factor (hazard ratio=2.833, 95% confidence interval=1.555-5.161, p<0.001). The rate of first-line treatment introduction was 86.1% (31/36) in the SII-low group and 63.8% (37/58) in the SII-high group (p=0.019). In addition, the patients did not continue first-line chemotherapy because of disease progression, which was marginally significantly higher in the SII-high group than in the SII-low group. CONCLUSION: The SII was an independent prognostic factor. In addition, the SII affects the clinical course of treatment after recurrence. Therefore, physicians might have a chance to make better decisions for treatment and management of recurrent EC using the SII.	esophagus
Efficacy and safety of cisplatin + docetaxel + 5-FU + leucovorin + methotrexate and epirubicin combination chemotherapy for advanced esophageal cancer.	Esophageal cancer is a devastating disease. The cisplatin and 5-FU regimen is the most widely used concurrent chemoradiotherapy protocol for metastatic, unresectable advanced esophageal cancer in Asia. However, its effectiveness remains limited due to unsatisfactory outcomes. Therefore, we conducted a retrospective study to evaluate the efficacy and toxicity of Cisplatin + 5-FU combined with docetaxel, leucovorin, methotrexate, and epirubicin (CDFLME), a first-line multi-agent chemotherapy regimen used for the treatment of advanced esophageal cancer in Taiwan. We enrolled 94 patients in our study from January 2018 to June 2022. All patients were diagnosed with metastatic or unresectable advanced esophageal cancer. Among them, 81 patients received fluorouracil + cisplatin regimen serving as the control group, while 13 patients received the CDFLME combination regimen. Significant improvements were observed in the CDFLME group compared to the fluorouracil + cisplatin group in overall survival time, complete response rate, and disease control rate. No significant differences were noted in treatment-related deaths or grade 3-4 adverse events, except for grade 1-2 mucositis. Based on these findings, we conclude that the CDFLME regimen is a promising alternative treatment with relatively minor adverse events and is an effective protocol for patients with advanced esophageal cancer.	esophagus
Whole genome sequencing revealed esophageal squamous cell carcinoma related biomarkers.	Esophageal squamous cell carcinoma (ESCC) is among the most frequently diagnosed cancer types, and affected patients frequently experience poor prognostic outcomes and high mortality rates. Many genomic studies of ESCC have been performed in recent years, yet the mutational mechanisms driving ESCC and their clinical implications remain incompletely understood. In this study, paired tumor and normal tissue samples from 22 patients with ESCC were used for whole genome sequencing-based analyses of genome-wide mutational events. These comprehensive analyses enabled the detection and characterization of various mutation subtypes in ESCC including somatic single-nucleotide variants, small insertions and deletions, copy number variations, structural variations, and circular extrachromosomal DNA. Of identified genes harboring non-silent mutations, TP53, NOTCH1, CSMD3, EP300, and FAM135B were the most frequently mutated genes in this study and they were annotated in the COSMIC Cancer Gene Census. With the exception of aging-related signatures, an APOBEC-associated mutational signature was the dominant mutational feature detected in ESCC samples, suggesting that APOBEC-mediated cytidine deamination is likely a major driver of mutations in this cancer type. Notably, our study also detected circular extrachromosomal DNA (ecDNA) events in these ESCC patient samples. The oncogenes COX6C, PVT1, and MMP12 as well as the oncogenic long non-coding RNA AZIN1-AS1 which were detected in ecDNA regions in these analyses may be associated with worse disease-free survival in ESCC patients.	esophagus
Impact of Artificial Intelligence on the Timing of Recurrent Laryngeal Nerve Recognition during Robot-Assisted Minimally Invasive Esophagectomy.	BACKGROUND: As a first step to prevent recurrent laryngeal nerve (RLN) palsy, we have developed an artificial intelligence (AI)-based anatomical recognition system for critical anatomical structures in robot-assisted minimally invasive esophagectomy (RAMIE). In the present study, we investigated whether AI would enable surgeons to rapidly recognize the RLN. PATIENTS AND METHODS: Five surgical videos of RAMIE were used to validate the AI. The confidence level (CL) was established as a new criterion to define how confidently surgeons recognize the RLN and stratified into three levels: CL0 is the level when looking for RLN candidates; CL1, after recognizing a candidate but before confirming it as the RLN; CL2, after confirming that the candidate is the RLN. Eight trainee surgeons watched the original and AI-enhanced videos with an interval of > 4 weeks, and they were instructed to declare the RLN's location at the start of CL1 and CL2. The time to CL1 and CL2 from the beginning of RLN lymph node dissection with and without AI were compared. RESULTS: In all cases, the average time to CL1 and CL2 of the right and left RLN recognition was reduced by using AI. Particularly, in the right RLN recognition, significant differences were found between the surgeons using and not using AI (CL1, 134 vs. 178 s, p < 0.001; CL2, 233 vs. 325 s, p < 0.001). CONCLUSIONS: This study demonstrated that AI would enable surgeons not only to rapidly identify the RLN but also to enhance their confidence in its identification.	esophagus
Rho GAPase protein 1 (RACGAP1) affects the proliferation and metastasis of esophageal squamous cell carcinoma cells by regulating signaling pathways: Thermal infrared medical image inspection.	This study aimed to investigate the effect of RACGAP1 on the proliferation and metastasis of esophageal squamous cell cancer cells by regulating the signaling pathway, and to evaluate the potential value of RACGAP1 in tumor diagnosis and treatment through thermal infrared medical examination. To investigate the expression level of RACGAP1 in esophageal squamous cell carcinoma and normal esophageal tissues by immunohistochemistry, and analyze the relationship between RACGAP1 expression and tumor stage, differentiation degree and prognosis of patients. The tumor cells with different expression levels of RACGAP1 were analyzed by thermal imaging with thermal infrared medical examination technique to evaluate the application value of RACGAP1 in tumor diagnosis. In vitro experiments showed that down-regulation of RACGAP1 inhibited the proliferation and migration of esophageal squamous cell cancer cells. Further molecular mechanism studies revealed that RACGAP1 affects cytoskeleton recombination and extracellular matrix degradation by regulating Rho/ROCK signaling pathway, thus promoting tumor cell proliferation and metastasis. The application of thermal infrared medical examination technology showed that tumor cells with high expression of RACGAP1 showed higher temperature in thermal imaging, suggesting that RACGAP1 may be a potential marker in thermal infrared medical examination.	esophagus
Radiotherapy as an organ-preserving alternative to surgery in patients with locally advanced esophageal squamous cell carcinoma achieving major pathologic response after induction immunochemotherapy.	With the advancement of immunotherapy, neoadjuvant immunochemotherapy has emerged as an effective approach for treating locally advanced esophageal squamous cell carcinoma (LA-ESCC). However, whether radiotherapy can serve as a reliable organ-preserving alternative following induction immunochemotherapy (IICT), and which patient subgroups benefit most, remains uncertain. In this retrospective study, 388 patients with LA-ESCC were analyzed, including 299 who underwent surgery and 89 who received radiotherapy after IICT. Responses to immunochemotherapy were classified as major pathologic response (MPR) or non-MPR based on pathologic examination for surgical patients and a previously developed MPR predictive model for radiotherapy patients. Survival outcomes were assessed using the Kaplan-Meier method, while prognostic factors were evaluated through Cox regression analyses. Propensity score matching (PSM) was used to minimize confounding factors. Surgery was associated with better progression-free survival (PFS) compared to radiotherapy (p = 0.002 before PSM; p = 0.017 after PSM), but no significant difference in overall survival (OS) was observed (p = 0.144 before PSM; p = 0.241 after PSM). Among MPR patients, radiotherapy achieved PFS and OS outcomes similar to surgery (PFS: p = 0.136; OS: p = 0.255) after PSM. Failure patterns differed, with local or regional recurrence being more common in the radiotherapy group, while distant metastasis was prevalent in surgery patients. Major postoperative complications occurred in 9.36% of surgery patients, and 11.2% of radiotherapy patients had grade 3-4 adverse events. These findings indicate that radiotherapy could be a safe and effective organ-preserving alternative for LA-ESCC patients, especially those achieving MPR, offering more personalized and less invasive treatment options while maintaining quality of life.	esophagus
Executive Summary of the American Radium Society Appropriate Use Criteria for the Use of Esophageal Stents in Patients With Esophageal Cancer: Systematic Review and Guidelines.	OBJECTIVES: Esophageal cancer (EC) often presents with dysphagia due to tumor obstruction. Esophageal stenting has the potential of palliating dysphagia, improving nutrition, preventing aspiration, and improving quality of life (QoL) but may be associated with risks. The present systematic review and guidelines are intended to assist treatment decision-making when considering stent placement in patients with EC based on the available evidence. METHODS: Using the population, intervention, comparator, outcome, timing and study design framework, the evidence was assessed using Cochrane and PRISMA 2020 methodology. Eligible studies included prospective phase II-III trials and retrospective analyses published between January 1, 2010 and December 3, 2024 in the Ovid Medline database. These references were assessed by American Radium Society (ARS) Appropriate Use Criteria (AUC) methodology. RAND-UCLA consensus methodology was used to rate the appropriateness of the use of stents. RESULTS: ARS AUC recommendations include (1) esophageal stenting is usually not appropriate in patients with early-stage EC in whom upfront surgery is planned; (2) esophageal stenting is usually not appropriate in patients with locally-advanced EC in whom neoadjuvant/perioperative therapy and esophagectomy or definitive chemoradiation is planned; (3) esophageal stenting may be appropriate in the setting of metastatic EC, especially in patients with short life expectancy with limited treatment options; (4) esophageal stenting is usually not appropriate for benign stricture following curative-intent therapy; (5) esophageal stenting is usually not appropriate for locally recurrent tumor in the setting of prior radiation; and (6) esophageal stenting is usually appropriate for management of tracheoesophageal fistula before curative-intent treatment. CONCLUSIONS: This ARS AUC summary provides guidelines for the use of esophageal stents in patients with EC provides based on available evidence.	esophagus
Body Subcutaneous Fat Change Predicts Chemoradiotherapy Response and Prognosis of Esophageal Cancer Patients: A Cohort Study.	BACKGROUND: Patients with esophageal cancer are prone to poor nutrition. Concurrent chemoradiation therapy (CCRT) may further influences body compositions including skeletal muscle (SM) and adipose tissue which are key indicators of nutritional status. This study aimed to evaluate whether body compositional change during CCRT could be a predictor of prognosis in esophageal cancer patients. METHODS: From 2006 to 2018, esophageal cancer patients who received CCRT as initial treatment were consecutively enrolled. We assessed body compositions, including subcutaneous fat (SCF), intramuscular fat (IMF), and SM mass by measuring the cross-sectional area (CSA) of the fourth thoracic vertebral body on computed tomography (CT) scan. The body compositional change was assessed by comparing baseline and post-CCRT CSA. The association of body compositions and their changes during CCRT with patient prognosis was analyzed. RESULTS: A total of 178 patients were enrolled with a mean baseline body mass index (BMI) of 22. After CCRT, there was a significant decrease in bodyweight (BW), SCF, IMF, and SM (P < 0.001). BMI and body compositions at baseline or post-CCRT were not significantly associated with patient prognosis. Patients with SCF loss during CCRT had significantly poorer CCRT response (OR 3.7, P < 0.001), shorter time to tumor progression (8.5 vs. 23.7 months, P = 0.011), and overall survival (13.7 vs. 25.9 months, P < 0.001) than patients with SCF gain/stable. IMF, SM, and BW change during CCRT did not correlate with CCRT response or survival. In multivariate Cox regression analysis, SCF change (HR 1.49, 95% CI: 1.03-2.14, P = 0.033) during CCRT was an independent predictor of survival after adjusting baseline BMI, cancer stage, treatment modality, and CCRT response. CONCLUSIONS: During the course of CCRT, SCF change is more sensitive than weight in assessing the nutritional status of esophageal cancer patients. SCF loss during CCRT is associated with worse CCRT response and survival in esophageal cancer patients.	esophagus
Dynamic landscape and regulation of m(5)C methylation in human tissues.	5-methylcytosine (m(5)C) is a prevalent RNA modification that has various impacts on mRNA fate. Here, we generated 30 single-base resolution RNA m(5)C methylomes and revealed the dynamic nature of m(5)C of heart, muscle, lung, esophagus, stomach, pancreas, colon, jejunum, and rectum from 7 adult human individuals using RNA-BisSeq. Based on clustering analysis, the heart and muscle formed one cluster, while the remaining tissues constituted another cluster. Intriguingly, we observed a discrepancy pattern between m(5)C levels and gene expression in these tissues when comparing the m(5)C methylome and transcriptome. Moreover, we identified differences in NSUN2-mediated m(5)C modifications between esophageal paracancerous tissues and healthy individual tissues. Notably, NSUN2 was found to interact with PLXNA1 mRNA, and silencing NSUN2 in esophageal squamous cell carcinoma (ESCC) cells resulted in the downregulation of PLXNA1 expression through an m(5)C-mediated mechanism. Overall, our study provides valuable insights into the m(5)C profile and the relationship between the methylome and transcriptome in human tissues, highlighting the potential role of m(5)C modification as an epitranscriptomic biomarker.	esophagus
Carcinoma of Esophagus.	Carcinoma of esophagus is one of the most common cancer worldwide, but its epidemiology is changing. Squamous cell carcinoma is declining in the East, but adenocarcinoma is rising in the West, probably related to the pandemic of obesity and changing lifestyle. Screening of esophageal cancer (both endoscopic and nonendoscopic methods) is recommended in patients suffering from long-term acid reflux symptoms associated with high-risk factors and surveillance in patients with Barrett's esophagus. Endoscopy with virtual chromoendoscopy, endoscopic ultrasound, and CT scan is essential for diagnosis and staging of the disease. Endoscopic therapy can be used to treat early diseases. Surgery remains a mainstay treatment. Multimodality treatment strategies involving combinations of chemotherapy, radiotherapy, and more recently immunotherapy and target therapies are gaining momentum.	esophagus
Dose to the left ventricle is associated to the risk of acute cardiac toxicity in patients with esophageal cancer undergoing trimodality treatment.	BACKGROUND AND OBJECTIVE: Esophageal cancer (EC) patients treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery (trimodality treatment) are at risk for developing cardiac toxicity (CarTox). The interaction between radiotherapy and surgery warrants specific CarTox prediction models in this population. MATERIALS AND METHODS: EC-patients treated with photon-based nCRT at UZ Leuven between 01-2015 and 12-2023 were eligible for inclusion. A subset scanned with a standardized imaging protocol was used to perform voxel-based analysis (VBA) comparing per-voxel dose to the heart between patients with versus without CarTox. Statistically significant voxels were matched with cardiac substructures. Relevant substructure dose metrics were included in subsequent logistic regression-based toxicity prediction modelling, with a temporal development/validation split. Final external validation was performed on a mixed photon and proton-treated cohort of MD Anderson Cancer Center. RESULTS: For VBA, 50 patients were used to identify a cluster of voxels located mainly in the left ventricle (LV) that was higher dosed in patients with adenocarcinoma who developed CarTox. Subsequent model development (n = 77) and validation (n = 29) identified a model containing age, the absolute volume of the LV that received at least 10 Gy (V10Gy) and the interaction term. Model performance, depicted by AUC, was 0.76 in the validation population. In external validation (n = 50) AUC reduced to 0.66. After recalibration, in agreement with recommended closed-loop testing procedure, good LV absolute V10Gy dependent model performance was observed in the calibration curve. DISCUSSION: Model-based identification of high-risk patients and minimizing their low to intermediate LV-dose may help reduce CarTox in EC-patients undergoing trimodality treatment.	esophagus
Effects of s-ketamine combined with sevoflurane anesthesia on postoperative cellular immune function and inflammatory response in radical esophageal cancer surgery: A double-blind randomized trial.	BACKGROUND: Immunosuppression and inflammation are associated with postoperative rehabilitation and tumor prognosis. This study aimed to explore the effects of s-ketamine combined with sevoflurane anesthesia on postoperative cellular immune function and inflammatory responses in patients undergoing radical esophagectomy. METHODS: Fifty adult patients scheduled for radical esophagectomy were randomly divided into a control group receiving routine anesthesia (C) and an experimental group receiving s-ketamine combined with sevoflurane anesthesia (E). All patients were maintained under general anesthesia with sevoflurane and remifentanil and received patient-controlled intravenous analgesia postoperatively. In addition, the patients of group E received continuous intravenous infusion of 0.2 mg·kg-1·h-1 s-ketamine intraoperatively and 1 mg/kg s-ketamine in the patient-controlled intravenous analgesia for postoperative analgesia. Blood samples for lymphocyte subsets and inflammatory cytokines were collected preoperatively and on postoperative days (POD) 3 and 7. The primary outcome was the percentage of CD3+ lymphocytes on POD 7. Secondary outcomes included the percentages of other lymphocyte subsets (CD4+, CD8+, natural killer, and B cells); levels of inflammatory cytokines: C-reactive protein, serum amyloid A, interleukin-6, interleukin-10, and tumor necrosis factor-alpha-α; remedial analgesic consumption within 48 hours; incidence of postoperative adverse events; unplanned intensive care unit transfers; and postoperative length of stay. RESULTS: A total of 48 patients completed this analysis. The percentage of CD3+ lymphocytes changed significantly over time (P < .001), but no significant differences were found between the groups or in group × time interactions. Both groups showed significantly elevated C-reactive protein and serum amyloid A levels on POD 3 and 7 compared to baseline (P < .05). Group E had a significantly shorter postoperative length of stay compared to group C (P < .05). No significant differences were found between the groups regarding remedial analgesic consumption within 48 hours, incidence of postoperative adverse events, and unplanned intensive care unit transfers. CONCLUSION: S-ketamine combined with sevoflurane anesthesia did not significantly affect postoperative cellular immune function in patients undergoing radical esophageal cancer surgery.	esophagus
Evaluating the Role of an Objective Lower Gastrointestinal Assessment as Part of ERAS Pathway Following hRAMIE.	BACKGROUND: Postoperative esophagram is commonly employed following hybrid robotic-assisted minimally invasive esophagectomy (hRAMIE) to assess proper gastric conduit emptying. However, we hypothesize that the passage of enteric contents through the entire gastrointestinal tract is equally critical for patient recovery. This study aims to assess the utility of lower gastrointestinal contrast studies-such as jejunostomy tube imaging and abdominal X-rays-as part of the enhanced recovery after surgery (ERAS) pathway following hRAMIE for esophageal cancer. METHODS: This retrospective study evaluated 139 patients who underwent hRAMIE between September 2018 and November 2024, following completion of neoadjuvant chemoradiotherapy for esophageal cancer. Inclusion criteria consisted of patients with confirmed stage T2 or higher esophageal cancer who had completed chemoradiotherapy. Exclusion criteria included patients requiring emergency surgery or those with metastatic disease. All patients received a routine postoperative Day 2 esophagram in addition to a lower gastrointestinal assessment. The primary outcomes were length of hospital stay, time to nasogastric tube removal, return of bowel function, time to initiation of oral intake, and time to initiation of jejunostomy tube feeds. RESULTS: Patients with normal postoperative esophagrams demonstrated a significantly shorter time to first oral intake, reduced hospital length of stay, and quicker removal of the nasogastric tube. In contrast, lower gastrointestinal radiography, including jejunostomy contrast studies and abdominal X-rays, did not significantly impact early postoperative outcomes, with the exception of a prolonged time to first oral intake in patients with abnormal lower gastrointestinal findings. CONCLUSION: The inclusion of radiographic jejunostomy contrast studies did not significantly affect key postoperative outcomes, such as length of stay, time to nasogastric tube removal, return of bowel function, or initiation of jejunostomy tube feeds. However, abnormal lower gastrointestinal studies were associated with delayed oral intake. Based on these findings, we do not recommend including lower gastrointestinal studies in routine incorporation into institutional ERAS protocols for esophagectomy.	esophagus