crossing96/oncoscreening huggingface dataset:
Early versus late oral feeding regimens following esophagectomy: a propensity score-matched observational cohort.	BACKGROUND: The optimal time to resume oral intake after esophagectomy remains debated, with practices varying across centers. METHODS: This single-center, retrospective cohort study compared early and late oral feeding regimens after esophagectomy. Perioperative care was identical except for the feeding regimen. Early oral feeding began immediately post-surgery, while late oral feeding started on postoperative day 4 after swallow examination, with jejunostomy for early enteral tube feeding. Propensity score matching was used to reduce confounding. The primary outcome was overall survival. Secondary outcomes included complications, need for an alternative feeding route, hospital stay, readmission, and 90-day mortality. RESULTS: Between May 2017 and October 2023, 406 patients underwent an esophagectomy (312 transthoracic; 94 transhiatal). After matching, 139 patients were included in both the early and late oral feeding groups. Overall complication rates did not significantly differ (84.9% vs. 77.7%; P = 0.124), but the late oral feeding group had less severe complications (48.9% vs. 36.7%; P = 0.039). The late oral feeding group showed lower leakage rates in intrathoracic anastomosis (33.3% vs. 13.3%; P = 0.008), but no differences for cervical anastomosis. The late oral feeding group had a shorter median hospital stay (12 vs. 11 days, P = 0.008). No differences in overall survival rates were found (Kaplan-Meier: P = 0.604, Cox regression: HR: 1.020, 95% CI 0.729-1.427, P = 0.907). CONCLUSIONS: Early and late oral feeding showed similar survival rates, but late oral feeding was associated with fewer severe complications, lower anastomotic leakage, and shorter hospital stay. Therefore, despite no survival difference, late oral feeding with jejunal feeding may lead to better postoperative outcomes.	esophagus
Effect of Neoadjuvant Immunochemotherapy on Postoperative Pulmonary Complications for Locally Advanced Esophageal Cancer: A Propensity Score Matching Cohort Study.	PURPOSE: Neoadjuvant immunochemotherapy (NICT) has shown promise in improving the oncological outcomes of locally advanced esophageal cancer (LAEC). However, concerns remain regarding its potential to induce pulmonary side effects that may increase the risk of perioperative adverse events. This study aimed to compare the incidence of postoperative pulmonary complications (PPCs) in patients receiving NICT and those undergoing non-neoadjuvant therapy. PATIENTS AND METHODS: This retrospective cohort study included 274 patients with LAEC who received either NICT or non-neoadjuvant therapy followed by radical esophagectomy. Propensity score matching was used to balance patient characteristics between the two groups. The primary outcome was the incidence of PPCs within the first seven days postoperatively. Conditional logistic regression models were used to assess the association between NICT and PPCs. Sensitivity analysis using inverse probability of treatment weighting was conducted to validate the robustness of the findings. RESULTS: A total of 182 patients were included in the final analysis, with 91 patients in each group. The incidence of PPCs was significantly higher in the NICT group than in the control group (46.2% vs 26.4%, P = 0.009). Respiratory infections (37.4% vs 22.0%, P = 0.035) and pleural effusions (22.0% vs 9.9%, P = 0.043) were more frequent in the NICT group. New-onset arrhythmia was the most common cardiovascular complication, with tachycardia occurring in 24.2% of patients in the NICT group compared to 9.9% in the control group (P = 0.018). Conditional logistic regression analysis revealed a significant association between NICT and PPCs (OR = 5.648, 95% CI: 1.579-20.204, P = 0.008). Sensitivity analysis using IPTW further confirmed these results (OR = 2.893, 95% CI = 1.537-5.446, P = 0.001). CONCLUSION: Patients with locally advanced esophageal cancer who received at least two cycles of NICT had a significantly increased risk of developing postoperative pulmonary complications.	esophagus
The efficacy of thoracic duct ligation for post-esophagectomy chylothorax in esophageal cancer: a nationwide inpatient cohort study.	BACKGROUND: Recently, thoracic duct embolization (TDE) has been increasingly adopted as a first-line minimally invasive therapy for post-esophagectomy chylothorax instead of thoracoscopic thoracic duct ligation (TTDL). However, the therapeutic efficacy and advantages of TDE over TTDL are still controversial. This study aimed to evaluate and compare the clinical and financial outcomes of TDE and TTDL for post-operative chylothorax after esophagectomy using a national database. METHODS: We retrieved data from patients with esophageal cancer who underwent TDE (n = 312) or TTDL (n = 167) for chylothorax after esophagectomy between April 2012 and March 2022 from the Diagnosis Procedure Combination database in Japan. We compared the success rate of the first intervention, length of post-interventional hospital stay, and total hospitalization cost between the TDE and TTDL groups using propensity score matching analysis. RESULTS: The success rate of the first intervention was significantly higher in the TTDL group than in the TDE group (odds ratio, 6.13; 95 % confidence interval [CI], 3.25 to 11.55). The length of post-interventional hospital stay was significantly shorter (regression coefficient, -14.8 days; 95 % CI, -26.7 to -2.9) and the total hospitalization cost was significantly lower in the TTDL group than in the TDE group (regression coefficient, -1,258,212 yen; 95 % CI, -2,082,407 to -434,017). CONCLUSIONS: This nationwide cohort study showed that TTDL was associated with a shorter length of post-interventional hospital stay, lower total hospitalization cost, and higher success rate of the first intervention than TDE for post-esophagectomy chylothorax.	esophagus
Development and validation of a prognostic model incorporating patient reported outcomes for advanced gastric and esophageal carcinoma (AGOC) using individual patient data from two AGITG randomized clinical trials.	BACKGROUND: We developed and validated a prognostic model incorporating readily accessible clinicopathological data and specific patient-reported outcomes (PROs). METHODS: We used data from two randomized trials comparing regorafenib to placebo: AGITG INTEGRATE IIa (n = 251) for model development and AGITG INTEGRATE (n = 152) for validation. Candidate variables were chosen from a systematic literature review and expert consultation. Significant prognostic factors in the multivariable model were identified using univariable Cox proportional hazards models with a p-value of < 0.1. Multivariable Cox proportional hazards models were developed using clinicopathological and PRO variables, with model selection refined using least absolute shrinkage and selection operator (LASSO). The model's discrimination and calibration were assessed using concordance indices (C-statistics) and calibration plots. RESULTS: Univariable analysis identified 9 clinicopathological variables and 4 PRO domains that were prognostic for overall survival: body mass index (BMI), ECOG performance status, number of metastatic sites, liver involvement, treatment with regorafenib, neutrophil-lymphocyte ratio (NLR), LDH, albumin, CA 19-9, appetite loss, constipation, fatigue, and pain. The initial multivariable model (M1) incorporated geographic region (Asia vs non-Asia), performance status, number of metastatic sites, treatment with regorafenib, NLR, BMI, LDH, CA 19-9, and albumin. The preferred multivariable model (M2), including the abovementioned variables plus the 4 PROs, demonstrated superior discriminative ability with higher C-statistic values than models without PROs. Plots supported the model's calibration. CONCLUSIONS: Incorporating PROs into prognostic models for AGOC improved the accuracy of survival predictions. Further research is needed to validate its use in routine clinical practice.	esophagus
Long-term outcomes of minimally invasive esophagectomy vs. open esophagectomy in older patients with esophageal squamous cell carcinoma: a propensity score matching analysis.	OBJECTIVE: Esophageal squamous cell carcinoma (ESCC) remains a significant health concern, particularly among older patients. While both minimally invasive esophagectomy (MIE) and open esophagectomy (OE) are established surgical types, there is ongoing debate about their comparative long-term outcomes in older patients. METHODS: This retrospective cohort study analyzed data from 469 patients with ESCC aged over 70 years who underwent esophagectomy between May 2016 and August 2021. Patients were divided into MIE and OE groups. Overall survival (OS), disease-free survival (DFS), and postoperative complications were evaluated. Propensity score matching was performed to minimize selection bias. Complications were assessed using the Clavien-Dindo classification system. RESULTS: Among 469 patients, 358 (76.33%) underwent MIE, while 111 (23.67%) underwent OE. After a median follow-up of 47.5 months, the MIE group had significantly better OS (median OS: 60.17 vs. 29.18 months, HR = 1.566, P = 0.002) and DFS (median DFS: 37.70 vs. 25.20 months, HR = 1.411, P = 0.010) compared to the OE group. After PSM, MIE remained associated with significantly improved OS (HR = 1.450, P = 0.039), while the difference in DFS was no longer significant (HR = 1.240, P = 0.201). The incidence of Clavien-Dindo grade III-IV complications was similar between groups. CONCLUSION: MIE is associated with better long-term survival outcomes compared to OE in older patients with ESCC, without increasing major postoperative complications. These findings support the consideration of MIE as a preferred surgical approach for older patients with ESCC to enhance survival and optimize postoperative recovery.	esophagus
Neoadjuvant Chemoimmunotherapy Combined With Node-Sparing Radiotherapy for Clinical T3N+ Locally Advanced Esophageal Squamous Cell Carcinoma: A Prospective Single-Arm, Phase II Study (CINSREC Trial).	INTRODUCTION: The promising therapeutic outcomes of neoadjuvant chemoimmunotherapy (NCIT) in locally advanced esophageal squamous cell carcinoma (ESCC) have been confirmed by multiple phase II clinical trials and are widely used in clinical practice. However, there are some cases, such as clinical T3N+ stage, that achieve poor tumor regression after receiving NCIT, reflecting the insufficient efficacy of NCIT for advanced T-type tumors. It may be necessary to add concurrent radiotherapy to further improve the local control effect of tumor, but it also means higher adverse events and immune suppression when irradiating tumor-draining lymph nodes. Nevertheless, node-sparing radiotherapy can enhance the effect of NCIT with fewer adverse effects, which has been applied to other solid tumors. The aim of this study was to evaluate the safety and efficacy of NCIT combined with node-sparing radiotherapy for clinical T3N+ locally advanced ESCC (CINSREC trial). METHODS: Forty eligible patients with pathologically confirmed ESCC of clinical T3N + M0 stage were allocated to receive neoadjuvant immunotherapy (tislelizumab, q3w × 2 cycles) plus chemotherapy (nad-paclitaxel + carboplatin, q3w × 2 cycles) and node-sparing radiotherapy (41.4 Gy/23 times) treatment. The primary end point of this study is the pathological complete response rate. The secondary end points include major pathological response rate, adverse events, 2-year overall survival, and disease-free survival. DISCUSSION: This is the first prospective clinical trial to investigate the safety and efficacy of NCIT combined with node-sparing radiotherapy for clinical T3N+ locally advanced ESCC. We hypothesize that this promising strategy can provide a better pCR rate and acceptable safety. TRIAL REGISTRATION: ClinicalTrial.gov: NCT06965829.	esophagus
Effect of Preoperative Selective Digestive Decontamination with Oral Gentamicin on Postoperative Infections after Esophagectomy.	OBJECTIVES: This study evaluated whether preoperative selective digestive decontamination (SDD) with oral gentamicin reduces the incidence of postoperative infections in patients undergoing oesophagectomy for oesophageal cancer. METHODS: We conducted a retrospective cohort study of 64 patients who underwent oesophagectomy for oesophageal cancer. The primary outcome was clinically diagnosed postoperative infection. To address potential confounding and small-sample bias, a prespecified 5-variable model was fitted using Firth's penalized logistic regression. Model performance was assessed by area under the receiver operating characteristic curve (AUC), Brier score, and bootstrap-corrected calibration. Secondary outcomes included inflammatory markers, fever characteristics, antibiotic use, and perioperative recovery indicators. RESULTS: Postoperative infections occurred in 4 of 27 (14.8%) patients in Group A and 12 of 37 (32.4%) in Group B (Fisher's exact P = .147). In the Firth model, preoperative oral gentamicin showed a non-significant trend towards lower infection risk (odds ratio [OR] 0.36, 95% confidence interval [CI], 0.09-1.28; P = .12). The model demonstrated acceptable discrimination (AUC 0.734) and good apparent calibration (Brier 0.144; calibration intercept 0, slope 1). Patients receiving gentamicin also had lower postoperative day 1 procalcitonin levels (median 0.14 vs 0.28 ng/mL; P = .009), while other inflammatory markers and recovery indicators were similar between groups. CONCLUSIONS: Preoperative oral gentamicin-based SDD was associated with a numerically lower risk of postoperative infection and lower early inflammatory biomarkers, although the association did not reach statistical significance. Given the small sample size and single-centre design, these findings are exploratory and should be interpreted with caution. Larger multicentre randomized trials are needed to validate these preliminary observations.	esophagus
Ionic Liquid-Modified Leakage-Suppressed Catalytic Hairpin Assembly with Time-Resolved Fluorescence for Direct miRNA Detection in Serum: Application to Esophageal Cancer Screening.	Catalytic hairpin assembly (CHA) has emerged as a powerful enzyme-free nucleic acid amplification technique for point-of-care diagnostics, particularly in miRNA-based cancer screening. Despite its potential, clinical translation of CHA is hindered by two critical challenges: background leakage caused by spontaneous probe hybridization and serum matrix interference in fluorescence-based detection. This study presents an innovative solution by developing an ionic liquid-modified CHA system integrated with time-resolved fluorescence technology. Through systematic screening, 1,1,3,3-tetramethylguanidinium acetate was identified as the optimal ionic liquid that reduces leakage by 90% via DNA minor groove binding, without compromising catalytic efficiency. Although CHA can be performed directly in serum and other complex biological samples, background fluorescence originating from biological matrices (e.g., serum) frequently compromises the detection sensitivity and accuracy. In this research, we utilized a time-resolved fluorescence technology, which efficiently curbed serum autofluorescence, leading to a remarkable 1000-fold improvement in sensitivity compared to conventional fluorescence technology. This dual-optimized system was successfully applied to both high-throughput microarray analysis and rapid lateral flow strip detection. A clinical evaluation using 100 serum samples revealed excellent diagnostic accuracy for esophageal cancer, representing a significant improvement over conventional CHA methods in terms of clinical reliability and practical utility.	esophagus
Prognostic value of the ARISCAT score for postoperative pneumonia in patients with esophageal squamous cell carcinoma: a retrospective cohort study.	BACKGROUND: Postoperative pneumonia remains one of the most common and serious complications after esophagectomy for esophageal squamous cell carcinoma, significantly impairing recovery and survival outcomes. Accurate preoperative risk stratification is critical, yet no widely validated scoring system currently exists for ESCC-specific surgical cohorts. The ARISCAT score, a preoperative risk index developed to estimate pulmonary complication risk in general surgery, has not been previously assessed in ESCC patients. This study aimed to evaluate the prognostic value of the ARISCAT score and its integration with other perioperative indicators for predicting postoperative pneumonia. METHODS: This retrospective cohort study included 366 patients with histologically confirmed resectable ESCC who underwent curative thoraco-laparoscopic McKeown esophagectomy at a high-volume thoracic surgery center between January 2019 and December 2022. The ARISCAT score and other clinical parameters, including tumor length, length of hospital stay, PNI, and LMR, were collected preoperatively. Postoperative pneumonia was diagnosed based on radiologic, clinical, and laboratory criteria within 30 days after surgery. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of pneumonia. Restricted cubic spline modeling was used to assess non-linear associations. RESULTS: Postoperative pneumonia occurred in 99 of 366 patients (27.0%). Patients with pneumonia had significantly higher ARISCAT scores (59.6 ± 8.9 vs. 44.4 ± 7.6), longer tumor lengths (4.5 ± 0.7 cm vs. 3.8 ± 0.6 cm), and prolonged hospital stays (17.6 ± 2.8 vs. 13.6 ± 2.3 days), along with lower PNI and LMR values (all p < 0.001). In multivariate analysis, the ARISCAT score was independently associated with postoperative pneumonia (adjusted OR = 1.40, 95% CI 1.22-1.60, p < 0.001). Other independent predictors included tumor length (adjusted OR = 12.44), length of hospital stay (adjusted OR = 2.64), PNI (adjusted OR = 0.79), and LMR (adjusted OR = 0.18). RCS analysis revealed linear dose-response relationships for ARISCAT and tumor length, while LMR and hospital stay showed non-linear associations with pneumonia risk. No significant interaction effects were observed across subgroups. CONCLUSIONS: The ARISCAT score is an independent and robust predictor of postoperative pneumonia in ESCC patients undergoing McKeown esophagectomy. This study represents the first comprehensive evaluation of the ARISCAT score in an ESCC-specific surgical cohort, and uniquely demonstrates that its integration with inflammatory (LMR) and nutritional (PNI) markers significantly enhances preoperative risk stratification. These findings offer valuable clinical insights for personalized perioperative management.	esophagus
[Neuroendocrine carcinoma with significantly vacuolar nucleus at the esophagogastric junction: A case report].	Neoplasms characterized by the expression of markers of neuroendocrine differentiation in neoplastic cells are defined as neuroendocrine neoplasms. A case of neuroendocrine carcinomas (NECs) with a small amount of papillary adenocarcinoma and significantly vacuolar nucleus at the esophagogastric junction was reported in this article. A 77-year-old male had dysphagia for one week. Endoscopy revealed early-stage esophagogastric junction carcinoma, and biopsy was diagnosed as poorly differentiated carcinoma. Endoscopic submucosal dissection was performed. Histologically, the papillary adenocarcinoma progresses from typically branching papillary structures (well-differentiated) to hyperplasia of the lining epithelium of the papilla to form a cribriform structure (moderately differentiated), to solid area lacking papillary structures (poorly differentiated). There was a continuous process, and during this process, the vacuoles in the nuclei of tumor cells showed progressive changes from mild to obvious and finally to significant vacuoles. The tumor was mainly composed of solid areas (about 95%), with single cell, large cell, round or oval to irregular nuclei, and significantly vacuolar nuclei, nuclei with larger vacuoles appeared in a loop, a few thin weakly basophilic or weakly eosinophilic fine particles could be seen in the vacuoles, and the vacuoles had rough edges. The nucleus chromatin at the outer edge of the vacuoles was fine particles, and mitosis was common (20-30/mm(2)), atypical mitosis could be seen, and nucleoli could be seen easily, the cytoplasm was weakly eosinophilic, and the boundaries of cells were unclear. The cells were arranged in a nested, trabecular, or diffuse sheet shape, with some arranged in a glandular tube shape. Tumor thrombus was found in the vein of submucosa; the interstitial tissue rich in capillaries within the tumor was accompanied by a large number of neutrophil infiltration. Immunohistochemical staining showed that the solid area of the tumor was positive for synaptophysin (Syn) and chromogranin A (CgA), while papillary adenocarcinoma was negative. Mucin 5AC (MUC5AC) was diffusely positive in papillary adenocarcinoma, while the proportion of positive cells in the solid area of the tumor was about 10% to 15%. In a word, this case showed the extreme situation of the vacuolar nuclear characteristics of NECs, extremely rare, in a sense, this case expanded the boundary of the morphological spectrum of NECs. Understanding the extreme vacuolar features of this nucleus is helpful to make a correct pathological diagnosis.	esophagus
Oesophageal cancer and its associated factors among patients attending surgical and oncology clinics at Garissa County Referral Hospital, Kenya: a case-control study.	BACKGROUND: Oesophageal cancer (EC) is a common cause of cancer mortality. Evidence on the burden, risk factors and treatment outcomes is limited in low-income and middle-income countries. This study aimed to describe the features of EC cases and determine associated factors among patients attending surgical and oncology clinics in Garissa County Referral Hospital (GCRH). METHODS: We conducted a case-control study in which cases were patients with EC and positive histological confirmation and controls were patients admitted to GCRH for other diseases. Data on exposures were extracted from patient files. Data on tobacco and alcohol use were based on current or past use as documented in the records; hot tea intake referred to habitual consumption. Mixed-effect logistic regression model was used to determine EC-associated factors. RESULTS: 141 cases and 282 controls were recruited. Of the 141 cases, 59 (42%) had cancer in the lower third of the oesophagus, whereas 72 (51%) and 10 (7%) had cancers in the middle and upper thirds, respectively. EC was associated with tobacco use (adjusted OR (AOR), 21.02, 95% CI 5.41 to 81.69), consumption of hot tea (AOR 59.87, 95% CI 5.45 to 657.35), chewing khat (miraa, AOR 9.94, 95% CI 3.59 to 27.52), gastro-oesophageal reflux disease (GERD) (AOR 54.12, 95% CI 24.48 to 119.62), gastritis (AOR 17.89, 95% CI 2.94 to 108.989) and peptic ulcer disease (PUD) (AOR 69.31, 95% CI 14.09 to 340.9). Among the case group, 95 (65%) had surgery or gastrostomy tube placement as treatments for EC. CONCLUSION: The study findings highlight modifiable risk factors for EC, including tobacco use, hot tea consumption, chewing miraa, GERD, gastritis and PUD. Targeted screening of high-risk patients may improve early detection and outcomes.	esophagus