crossing96/oncoscreening huggingface dataset:
Impact of readmission location on survival after oesophagectomy and gastrectomy.	BACKGROUND: Readmissions following oesophagogastric cancer surgery pose a substantial burden on healthcare systems and can adversely impact patient outcomes. While centralisation has improved postoperative mortality, concerns persist about the management of complex complications at peripheral hospitals. This study evaluates 90-day readmission rates following oesophagectomy and gastrectomy, distinguishing between index (hospital where primary surgery was performed) and non-index (peripheral hospital) readmissions. Secondary objectives include identifying risk factors for readmission and assessing the impact of readmission location on long-term survival. METHODS: A retrospective single-centre analysis was conducted on patients undergoing oesophagectomy or gastrectomy between 2011 and 2024. The primary outcome was unplanned readmission within 90 days of discharge. Multivariable logistic regression identified readmission risk factors. Survival analysis was conducted using Kaplan-Meier and Cox regression models. RESULTS: Of 881 patients (571 oesophagectomy, 310 gastrectomy), readmission rates were 26.1 % and 24.2 %, respectively. Risk factors for readmission included non-severe anastomotic leaks (OR 2.93; P = 0.004) and severe complications (OR 2.19; P = 0.003) for oesophagectomy, and prolonged hospital stay for gastrectomy (OR 1.04; P < 0.001). Protective factors included severe respiratory complications (OR 0.48; P = 0.024) and severe complications in gastrectomy patients (OR 0.33; P = 0.036). Index readmission was associated with improved survival on univariable analysis only. CONCLUSION: Complication-readmission patterns vary by procedure type. While the survival benefit of index readmission remains unclear, our results highlight the importance of structured postoperative care to mitigate postoperative morbidity. Further research should identify complications best managed at tertiary centres to guide targeted readmission pathways.	esophagus
Esophageal Lymphoepithelioma-like Carcinoma With a Remarkable Response to DCF Chemotherapy: A Case Report.	BACKGROUND/AIM: Esophageal lymphoepithelioma-like carcinoma (LELC) is an extremely rare malignancy with histological features resembling those of undifferentiated nasopharyngeal carcinoma. Owing to its rarity, no standard treatment protocol has been established. CASE REPORT: We report the case of a 76-year-old woman diagnosed with esophageal LELC. Routine upper gastrointestinal screening detected a submucosal tumor-like lesion. Histopathological examination revealed atypical cells with lymphocytic infiltration, leading to diagnosis of LELC. She underwent preoperative chemotherapy with DCF (docetaxel, cisplatin, and 5-fluorouracil), which resulted in significant tumor regression and decreased lymph node metastasis. A thoracoscopic subtotal esophagectomy with three-field lymph node dissection was performed. Histopathological analysis showed that while residual tumor cells were present in some lymph nodes, the primary site consisted entirely of scar tissue, with no viable cancer cells. The patient recovered without postoperative complications and has remained recurrence-free for 20 months. CONCLUSION: This case report demonstrates a remarkable response to DCF therapy for esophageal LELC, suggesting its potential as an effective preoperative treatment. Given the rarity of esophageal LELC, further case reports are essential to establish an optimal treatment strategy.	esophagus
Clinical outcomes of underwater endoscopic mucosal resection for esophageal subepithelial tumors.	Esophageal submucosal tumors are increasingly identified through routine upper endoscopy, often performed as part of health screenings. Although many of these lesions are benign, some have malignant potential, necessitating accurate diagnosis and appropriate resection. Underwater endoscopic mucosal resection (UEMR) has gained attention as a novel technique that enables mucosal resection without submucosal injection, offering advantages in terms of safety and efficacy. However, data regarding its use for esophageal submucosal tumors are limited. This retrospective single-center study included 31 patients who underwent UEMRs for esophageal submucosal tumors between 2020 and 2024. The inclusion criteria were lesions <15 mm in diameter, confined to the submucosal layer, as confirmed by endoscopic ultrasound. Clinical variables, including age, sex, lesion characteristics, procedural details, and histopathological findings, were reviewed. Outcomes included en bloc and pathological complete (R0) resection rates, complications, and recurrence during follow-up. Among the 31 patients (mean age: 57.0 ± 12.5 years; 61% male), the most common lesion location was the lower esophagus (45.2%). Most lesions measured 5 to 10 mm (51.6%). Histopathologic diagnoses included leiomyomas (38.7%), granular cell tumors (32.3%), inflammatory fibroid polyps, and other benign entities. All lesions were resected en bloc using UEMR, with a 100% R0 resection rate. No major complications, including bleeding or perforation, occurred. During a follow-up period of up to 37 months, no recurrence was observed, including in cases of granular cell tumors or adenoid cystic carcinomas. UEMR is a safe and effective technique for managing esophageal submucosal tumors, demonstrating high en bloc and R0 resection rates with no major complications. These findings support UEMR as a favorable option for the resection of small esophageal submucosal tumors, providing a rationale for further prospective studies comparing UEMR with conventional endoscopic mucosal resection, band ligation-assisted endoscopic mucosal resection, and endoscopic submucosal dissection.	esophagus
FOXP3 is a favourable prognostic indicator in oesophageal adenocarcinoma.	INTRODUCTION: Oesophageal Adenocarcinoma (OAC) is a cancer with poor prognosis although multimodal treatment has greatly improved clinical outcomes for certain patients. However, currently, there is no way to predict which patients will benefit from neoadjuvant regimens. The level of immune cell tumour infiltration has shown prognostic ability in other cancer types. This study aimed to define the immune landscape of OAC tumours and describe interactions with clinicopathological parameters. METHODS: Three micron sections from n = 135 treatment-naïve OAC biopsies were stained using multiplex immunofluorescence for immune markers CD8, CD3, FOXP3, HLA-DR, CD68 and CD163. Expression of the immune markers in the tumour and stroma compartments and other pathological markers such as tumour buds (TB), poorly differentiated clusters (PDCs) and the tumour stroma ratio (TSR) were quantified by digital pathology software and the ability of each marker to predict patient clinical outcomes was investigated. RESULTS: On log-rank analysis stromal expression of FOXP3, CD68 and CD163 and tumour expression of FOXP3 and CD163 were all associated with improved OS (Log-rank p = 0.003, p = 0.0009, p = 0.003, p = 0.015, p = 0.039). PDCs were associated with worse OS (p = 0.039). Multivariate analysis identified tumour expression of FOXP3 as an independent favourable prognostic factor for OS (HR = 0.398, 95 % CI: 0.178-0.887, p = 0.024). DISCUSSION/CONCLUSION: Stromal expression of CD68, CD163 and FOXP3 and tumour expression of FOXP3 and CD163 were associated with improved outcome while the presence of PDCs was associated with worse outcome. FOXP3 was found to be an independent favourable prognostic factor, highlighting the need to better understand the role of FOXP3 in OAC.	esophagus
Clinical application of Grunenwald incision in cervicothoracic junction surgery.	BACKGROUND: To evaluate the clinical efficacy of Grunenwald incision in cervicothoracic junction surgery. METHODS: A retrospective analysis was performed on 29 patients treated at the Fourth Hospital of Hebei Medical University, including 28 patients with cervicothoracic junction tumors (11cases of upper mediastinal tumors, 7 cases of superior sulcus tumors, 4 cases of thyroid tumors with upper mediastinal invasion, 4 cases of chest wall tumors, 2 cases of esophageal cancers with supraclavicular lymph node metastasis) and 1 patient with cervicothoracic junction penetrating trauma. Grunenwald incision or additional posterolateral thoracic incision, median sternal incision or neck collar incision were used in all patients. RESULTS: There was no perioperative death in the whole group. Complete tumor resection was achieved in 25 cases; palliative resection was performed in three cases, and one case underwent complete foreign body removal. The operation time ranged from 120 to 430 minutes, with an average of (231.90 ± 85.30) minutes. The intraoperative blood loss was between 100 and 1000 milliliters, with an average of (286.56 ± 192.90) milliliters. The postoperative hospital stay lasted 6 to 28 days, with an average of (13.14 ± 5.12) days. Follow-up periods spanned 6 to 142 months, with an average of (66.66 ± 46.96) months. During the follow-up period, six patients died. CONCLUSIONS: Grunenwald incision can provide good exposure of the structures near the cervicothoracic junction, preserve the integrity of the sternoclavicular joint, reduce shoulder deformity, and has advantages for patients with cervicothoracic junction tumor, high rib resection, and cervicothoracic junction trauma.	esophagus
Outcomes and predictive factors in post-surgical resection of sT4a esophageal cancer.	BACKGROUND: This study aimed to explore the prognostic outcomes and factors influencing survival in patients with sT4a esophageal cancer who have undergone surgical resection. This stage has been underreported in terms of comprehensive survival data and understanding of contributing factors. METHODS: A retrospective analysis was conducted on 139 patients with sT4a esophageal squamous cell carcinoma who underwent surgical treatment at a single institution between January 2013 and June 2020. Intraoperative T4a (sT4a) was defined according to the Japanese Esophageal Society (JES) criteria as tumor invasion into adjacent structures regarded surgically resectable at the time of operation, in contrast to pathological T4a (pT4a), which is determined histologically after resection. Overall survival (OS) and recurrence-free survival (RFS) were assessed using Kaplan-Meier curves, and multivariate Cox regression models were employed to identify key prognostic factors. RESULTS: Of the cohort, 95 (68.3%) patients experienced recurrence by the end of the follow-up period in July 2024. The five-year OS rate was 33.0%, with a median OS of 26 months. The five-year RFS was 31.7%, with a median RFS of 17 months. Key prognostic factors affecting survival and recurrence included preoperative treatment, azygos vein involvement, and specific recurrence patterns. The presence of azygos vein invasion emerged as a crucial predictor of increased recurrence risk and higher mortality. CONCLUSIONS: Surgical resection remains essential for managing sT4a esophageal cancer, while patient outcomes are heavily influenced by specific anatomical and pathological factors. The findings highlighted the importance of comprehensive preoperative evaluations and individualized treatment plans to enhance survival and quality of life in this high-risk patient group.	esophagus
The gastrin-releasing peptide receptor as a potential biomarker for squamous cell carcinoma.	The gastrin-releasing peptide receptor (GRPR) is expressed across multiple human cancer types, including head and neck tumors, and has also been detected in the oral mucosa of patients bearing head and neck neoplasms. This study aimed to evaluate GRPR expression in tumor samples obtained from patients with histopathologically confirmed squamous cell carcinomas of the head and neck and esophagus. GRPR protein expression was analyzed by immunohistochemistry in 80 tumor specimens and 10 cancer-free tissue samples. GRPR positivity was observed in 72.5% of tumors, whereas all healthy control samples were negative. Additionally, an expression threshold of 10% was sufficient to distinguish between positive and negative tumors (P < 0.0001). Overall survival for the cohort was 64.7%. GRPR expression tends to influence patient outcomes, with an expression level exceeding 50% correlating with worse survival (p = 0.031). GRPR is overexpressed in head and neck and esophageal squamous cell carcinoma, and higher expression was associated with worse survival, suggesting a promising role of GRPR as a new biomarker for early diagnosis and prognosis.	esophagus
Reassessing the Risk of Esophageal Cancer in Achalasia Post-Therapy: Findings From a Large United States Multi-Centre Retrospective Propensity-Matched Cohort Study.	BACKGROUND: Achalasia is associated with an increased risk of esophageal cancer; though reported incidence rates vary widely (0.4% to 9.2%) due to differences in demographics, follow-up duration, and diagnostic methods. This study evaluates the risk of esophageal cancer and Barrett's esophagus (BE) in achalasia using a large national database and a propensity-matched control cohort. METHODS: Achalasia patients were identified utilizing the TriNetX database based on International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes for diagnostic procedures and lower esophageal sphincter (LES) directed therapies, including Heller myotomy, peroral endoscopic myotomy, and pneumatic dilation. A matched control group of celiac disease patients was used. A 1-year lead time was applied to exclude secondary malignant achalasia. Outcomes included the incidence of esophageal cancer and BE, with subgroup analysis in patients following therapy. RESULTS: Among 7863 achalasia patients (mean age 58.0, 51.9% female), the esophageal cancer risk was significantly higher than control (risk ratio 2.87, 95% CI: 1.56-5.27, p < 0.001). The absolute risk was low, with 40 cases (0.51%) over a mean follow-up of 3.18 years. BE risk was also higher in achalasia (risk ratio 1.54, 95% CI: 1.24-1.90, p < 0.001), with 220 cases (2.80%). Subgroup analysis revealed no significant difference in BE risk between POEM and Heller myotomy (risk ratio 1.0, 95% CI: 0.42-2.40, p > 0.99). DISCUSSION: The elevated cancer risk in achalasia over a short follow-up period warrants reconsideration of current endoscopic surveillance guidelines, despite the low absolute risk of esophageal cancer and BE.	esophagus
Modified Minimally Invasive Ivor-Lewis Esophagectomy with Trans-Hiatal Esophageal Transection.	BACKGROUND: Totally minimally invasive Ivor-Lewis esophagectomy (ILMIE) is a particularly challenging procedure. Despite recent improvements, technical difficulties, mainly in creating intrathoracic anastomosis, still account for a high rate of anastomotic leaks. We present a modified ILMIE technique, with a transhiatal esophageal transection during the laparoscopic stage, aimed at facilitating the thoracoscopic approach and overcoming some of its pitfalls. METHODS: Twenty-four consecutive patients with Siewert I and Siewert II esophago-gastric junction tumors with a 8 cm maximum involvement of distal esophagus were included in the study and underwent modified ILMIE with transhiatal esophageal transection and transabdominal (Pfannestiel) specimen extraction. A frozen section examination of specimen margin was obtained while repositioning the patients for thoracoscopic access in prone position. An end-to-side mechanical anastomosis, reinforced by a 3-0 running suture, was performed. RESULTS: There were no major intraoperative complications. Eleven patients (45.8%) had a Clavien-Dindo grade higher than 2 postoperative complication, including one (4.2%) type II anastomotic leak. The mean number of harvested lymph nodes was 31.5 ± 17.2 and we recorded 1 R1 resection (4.2%). Disease free survival rate at 1 year, irrespective of the pathologic stage, was 67%. CONCLUSIONS: Modified ILMIE seems to be a safe alternative to the traditional technique. Transabdominal specimen extraction allows a reduced minithoracotomy, a better thoracoscopic workspace and early availability of a frozen section for examination. Larger series are needed to assess possible benefits on postoperative and oncological outcomes.	esophagus
Adjuvant immunotherapy in esophageal squamous cell carcinoma after radiotherapy: retrospective multicentric survival analysis.	BACKGROUND: Immunotherapy improves survival with manageable toxicity in esophageal cancer as neoadjuvant, first-line, or second-line therapy. However, its adjuvant role in esophageal squamous cell carcinoma (ESCC) remains uncertain. This study evaluates whether adjuvant immunotherapy enhances survival in ESCC. METHODS: We conducted a multicentric propensity-score matching analysis in patients with unresected ESCC who underwent radiotherapy between January 2015 and December 2024. Kaplan-Meier analysis was employed to generate survival curves, with comparisons made via the log-rank test. Univariate and multivariate-analyses employed Cox regression models. RESULTS: A total of 207 patients were enrolled. Among them, 60 patients received immunotherapy, while 147 did not receive adjuvant immunotherapy. The median overall survival (OS) was 42 months in the immunotherapy group, compared with 22.0 months in the non-immunotherapy group (HR, 0.55; 96.4%CI, 0.32 to 0.93). The median progression-free survival (PFS) was 26 months in the adjuvant immunotherapy group versus 17 months in the non-adjuvant group, showing a statistically significant difference (HR, 0.58; 95%CI, 0.36 to 0.95). After propensity score matching, the results remained consistent with the overall cohort. Compared with the non-adjuvant group, adjuvant immunotherapy significantly improved both PFS (HR, 0.49; 95%CI, 0.27 to 0.89) and OS (HR, 0.50; 95%CI, 0.29 to 0.85). Eastern Cooperative Oncology Group performance-status score, tumor stage, and maximum tumor thickness are independent prognostic factors in univariate-analyses. In multivariate-analyses, no significant prognostic factors were identified. CONCLUSIONS: Patients with unresected ESCC who received adjuvant immunotherapy following radiotherapy demonstrated significantly longer OS and PFS compared to those who did not receive adjuvant immunotherapy.	esophagus
Tailoring treatment for esophageal cancer: a retrospective comparison of chemoradiation with and without esophagectomy.	BACKGROUND: Locally advanced esophageal cancer remains a significant therapeutic challenge, with the optimal treatment strategy still debate. While previous studies suggest that concurrent chemoradiation therapy (CCRT) can improve survival, the role of esophagectomy following CCRT in patients with partial or no response has not been well-characterized, particularly in resource-limited settings. This study aimed to evaluate the survival benefit of esophagectomy following CCRT, with particular focus on non-complete responders (non-CR). METHODS: We conducted a retrospective cohort study of 132 patients with locally advanced esophageal cancer treated at Maharaj Nakorn Chiang Mai Hospital between 2013 and 2022. Patients were categorized based on initial treatment into preoperative CCRT or definitive CCRT groups. Overall survival (OS) and progression-free survival (PFS) were compared using multivariable Cox regression. A secondary analysis stratified patients into three groups by clinical response and surgical status: CR without surgery, non-CR with surgery, and non-CR without surgery. To reduce baseline imbalances and selection bias, inverse probability of treatment weighting (IPTW) was applied in the non-CR subgroup initially intended for preoperative CCRT. RESULTS: Baseline characteristics were balanced except for tumor location. Median follow-up was 1.23 years (IQR: 0.64-2.50). Overall, 1-/2-year PFS was 27.97%/17.80%, while OS was 60.47%/37.33%. Median survival did not differ between preoperative versus definitive CCRT (1.20 vs. 1.52 years, p = 0.346). However, in the surgical-status analysis, patients undergoing post-CCRT esophagectomy showed significantly improved PFS and OS versus non-surgical non-CR patients (PFS HR: 2.89, p < 0.001; OS HR: 2.97, p = 0.001). Notably, surgical non-CR patients achieved OS comparable to CR patients without esophagectomy (HR: 1.12, p = 0.812). To minimize selection bias, we conducted an IPTW-adjusted analysis in the subgroup of non-CR patients initially assigned to preoperative CCRT. After IPTW, the survival benefit of surgery remained significant, with improved PFS (HR: 3.75; 95% CI: 1.40-10.08; p = 0.009) and OS (HR: 2.74; 95% CI: 1.57-4.77; p < 0.001) compared to CCRT alone. CONCLUSION: Esophagectomy after CCRT provides survival benefits equivalent to achieving CR with CCRT alone, particularly for non-CR patients. These results advocate for surgical integration as a salvage strategy for incomplete responders in locally advanced esophageal cancer.	esophagus
The association between pathological complete response and prognosis of gastric or adenocarcinoma of esophagogastric junction cancer following neoadjuvant chemotherapy: A meta-analysis.	"OBJECTIVE: To evaluate the prognostic value of pathological complete response (pCR) in patients with gastric cancer (GC) and adenocarcinoma of the esophagogastric junction (AEG) after neoadjuvant chemotherapy (NACT). METHODS: PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from inception to August 2024. The primary outcome was assessed by overall survival (OS), with progression-free survival (PFS) and disease-free survival (DFS) as secondary outcomes. Hazard ratios (HR) and 95 % confidence intervals (CI) were calculated. We analyzed OS, PFS, and DFS across different tumor regression grade (TRG) systems and performed a subgroup analysis, categorizing studies into pCR (Mandard 1/Becker 1a/the Japanese Gastric Cancer Association (JCGC) 3/the College of American Pathologists (CAP) 0) and major pathological response (MPR) (Mandard 1-2/Becker 1a-1b/JCGC 2-3/CAP 0-1). RESULTS: Twenty-five studies (20,503 patients) were included. Achieving pCR significantly correlated with improved survival across all TRG systems: Mandard system (PFS: HR = 0.38, 95 % CI: 0.21-0.68, p = 0.001; DFS: HR = 0.31, 95 % CI: 0.21-0.48, p < 0.001), Becker system (OS: HR = 0.63, 95 % CI: 0.43-0.93, p = 0.005; PFS: HR = 0.42, 95 % CI: 0.21-0.85, p = 0.015; DFS: HR = 0.34, 95 % CI: 0.21-0.57, p < 0.001). Significant associations were also observed for JCGC and CAP systems. Subgroup analysis revealed a strong survival benefit from achieving pCR in the ""pCR"" subgroup, but no significant correlation in the ""MPR"" subgroup. CONCLUSIONS: This meta-analysis indicated that pCR is closely associated with improved survival outcomes in GC and AEG patients following NACT, particularly under the Becker system, which is the most widely used system today. However, the prediction of survival may vary among various TRG systems."	esophagus