crossing96/oncoscreening huggingface dataset:
Association between traditional fermented milk (mursik) consumption and oesophageal carcinoma among patients presenting to two referral hospitals in Nandi County, Kenya: A case-control study.	BACKGROUND: Oesophageal carcinoma (OC) is a prominent cause of morbidity and mortality in low and middle-income countries yet little evidence exists about its contextual drivers. The objectives of this study were to assess the association between traditional fermented milk (FM) (mursik) consumption and OC independent of known socio-demographic and lifestyle risk factors as well as to quantify its population impact among patients presenting to two referral hospitals in Nandi County, Kenya. METHODS: A hospital-based case-control study was employed to assess the FM-OC relationship among patients presenting to Kapsabet Surgical Care Centre and Kapsabet County Referral Hospital in Nandi County, Kenya for care between 23rd November 2023 and 13th January 2024. All 33 cases meeting specific eligibility criteria were prospectively recruited whilst 131 controls were simple randomly sampled and frequency-matched to the cases by hospital and day of presentation. A logistic regression model was fitted to assess the FM-OC association while adjusting for potential confounders. Subsequently, a population attributable fraction (PAF) for the association (along with its confidence interval) was estimated. RESULTS: A strong association between FM and OC was noted; the odds of OC among frequent and infrequent consumers of FM being over nine (OR 9.1, 95% CI: 3.1-26.6) and three (OR 3.2, 95% CI: 1.1-9.2) times higher, respectively, than non-consumers. This association was not substantially confounded by the studied socio-demographic and lifestyle factors. The PAF estimate for this association was 65.2% (95% CI: 40.1-90.7). CONCLUSIONS: In this study setting, mursik consumption was strongly associated with OC independent of other risk factors. This association registered a high PAF suggesting that up to 65% of OC in the population could be prevented if mursik was not consumed. This finding calls for safe, community-owned alternatives for fermenting milk in order to mitigate the risk of OC in this population.	esophagus
Updated protocol of the POINT trial: a multicenter randomized controlled trial investigating effects of preoperative enteral immunonutrition for esophageal cancer patients treated with neoadjuvant chemoradiotherapy.	BACKGROUND: The Preoperative Immunonutrition Therapy (POINT) trial compares immunonutrition supplements with a regular diet for surgically resectable esophageal patients during neoadjuvant chemoradiotherapy. The last patient is expected to be included by the end of 2025. The purpose of this update is to present all amendments to the POINT trial protocol as approved by the Ethics Committee of Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital. DESIGN: The initial protocol of the POINT trial has been previously published ( https://doi.org/10.1186/s12885-022-09721-y ). In this ongoing, multicenter, open-labeled, randomized controlled trial, patients are randomly assigned to nutrition therapy group or control group with a 2:1 ratio. Patients in the nutrition therapy group received immune-enhanced enteral nutritional emulsion during the neoadjuvant chemoradiotherapy. Both groups receive neoadjuvant chemoradiotherapy with concurrent radiotherapy followed by minimally invasive esophagectomy. The primary outcome is the rate of nutrition and immune-related complications after surgery. UPDATE: Amendments to the participants include the addition of exclusion criteria and the specification of written informed consent. Amendments to the intervention include an extended window period from neoadjuvant chemoradiotherapy to surgery. Amendments to the outcome include two additional exploratory endpoints, which are minimal residual disease and differences in the distribution of gut microbiota and metabolomics before and after neoadjuvant chemoradiotherapy. An independent assessment committee has been established to perform ongoing safety surveillance outcome evaluation. CONCLUSION: These amendments do not affect the overall outcomes of the trial compared to the original protocol. The last patient is expected to be included by the end of 2025.	esophagus
Assessing dosimetric benefit from daily online adaptive radiation therapy for esophageal cancer.	A cohort of 19 esophageal cancer patients treated at our institution were analyzed to assess the clinical feasibility and dosimetric benefit from daily adaptive radiation therapy (ART). An Ethos-planning template was developed to generate the initial ethos reference plan and daily adaptive plans using 9-field IMRT for reduced on-treatment optimization time. The template included relevant OAR goals and used an institutionally validated esophagus RapidPlan model. Clinical planning margins were used. Ethos-generated plans were validated against the clinically-approved plans which used 2-arc VMAT. Weekly on-treatment CBCT images were used to simulate doses from daily nonadaptive and adaptive techniques using the Ethos 2.0 Emulator. Timing data was recorded for each fraction. Dose metrics from institutional guidelines were compared between standard-of-care (SOC) and adaptive plans using a Wilcoxon signed rank test; these included mean dose for heart, lungs and liver, lungs V20Gy, and max dose for heart, spinal canal, and stomach. All Ethos template-generated plans were found equivalent to clinical plans. The daily adaptive workflow required 14.1 ± 6.8 min. Dosimetric improvements were variable by patient. Some patients experienced large metric reductions while others saw very minor benefits if any. For a sub cohort of patients that received high benefit, statistically significant (p < 0.05) reductions in the lung mean, lung V20, heart mean, and heart V30 and V40 were observed. From these results we conclude that Ethos ART is feasible in terms of plan quality and on-treatment time for esophageal cancer. ART can produce significant normal tissue dose reductions; however, not all patients benefited equally. Thus, identifying high-benefit patients prior to treatment is necessary. Preliminary modeling results suggest this can be done prospectively, but these models are internally validated and require larger datasets to fully develop.	esophagus
TOPAS-based 4D Monte Carlo simulation of transit dose in esophageal HDR brachytherapy: a phantom study.	Objective.Intraluminal high-dose-rate (HDR) brachytherapy is a well-established treatment modality for esophageal cancer, where a radioactive source moves through a catheter to deliver dose at discrete dwell positions. However, during the source's transit phase non-negligible dose may be delivered to surrounding healthy tissues. This study utilizes the time-dependent (4D) Monte Carlo (MC) simulation approach to quantify the transit dose to organs at risks (OARs) during esophageal brachytherapy using the TOPAS tool.Approach.A simplified yet anatomically representative male anthropomorphic phantom was modeled in TOPAS, incorporating key anatomical structures including the esophagus, trachea, spinal cord, pharynx, and other OARs. The motion of an Ir-192 HDR source was dynamically simulated through a brachytherapy catheter, with source acceleration and deceleration explicitly modeled to reflect clinical delivery. Focusing on a 6 cm tumor in the upper esophagus, absorbed doses were calculated under varying conditions: constant versus variable source speeds and differing numbers of dwell points, to evaluate the dosimetric impact of source motion.Main results.Compared to static simulations that neglect source movement, the inclusion of realistic source motion led to a substantial increase in dose to the tumor itself, up to 31%. Transit dose to OARs along the catheter path and those adjacent to the esophagus, such as the pre-pharyngeal region and pharynx, reached up to 11.7% of the tumor dose under variable speed profiles. These results reveal significant underestimation in static dose calculations, highlighting the importance of accounting for source motion.Significance.This study underscores the dosimetric importance of accounting for source transit in HDR brachytherapy and demonstrates the value of TOPAS's time-feature for conducting 4D MC simulations of realistic source motion. The findings indicate that transit dose can contribute substantially to overall dose distributions and should be considered in treatment planning, particularly for tumors situated in anatomically complex or radiosensitive regions.	esophagus
Impact of intraoperative fluid therapy on postoperative complications following robotic-assisted minimally invasive esophagectomy (RAMIE).	BACKGROUND: Robotic-assisted minimally invasive esophagectomy (RAMIE) has become an increasingly adopted approach for the treatment of esophageal cancer. However, the impact of intraoperative fluid therapy on postoperative outcomes remains poorly defined. Whereas fluid overload has been linked to pulmonary and anastomotic complications, restrictive strategies may impair tissue perfusion and organ function. This study investigates the association between intraoperative fluid balance and postoperative morbidity in patients undergoing RAMIE. METHODS: We conducted a retrospective single-center cohort study including 254 consecutive patients who underwent elective RAMIE between 2019 and 2024. Intraoperative fluid balance was calculated in mL/kg/h and analyzed as a continuous variable. Primary endpoints included pulmonary complications, anastomotic leakage, postoperative atrial fibrillation (POAF), and acute kidney injury (AKI). Secondary endpoints comprised ICU length of stay (LOS), postoperative delirium, delayed gastric emptying (DGE), and complication severity according to the Clavien-Dindo classification. Multivariable regression models were adjusted for age, sex, BMI, and ASA status. RESULTS: Pulmonary complications (23.2%) were significantly associated with higher intraoperative fluid volumes (mean: 5.2 vs. 4.4 ml/kg/h; p = 0.027; OR: 1.24, 95% CI: 1.05-1.46). Anastomotic leakage (18.5%) exhibited an inverted U-shaped relationship, with the highest risk at fluid levels of 4.7-8.1 ml/kg/h). POAF (16.1%) and AKI (5.5%) were not significantly associated with fluid volume in multivariable analysis. POAF showed no significant association with intraoperative fluid volume in adjusted models. Predicted probabilities illustrated a fivefold increase in pulmonary risk across the 0 to 10 ml/kg/h range, whereas POAF declined steadily over this interval. Postoperative delirium showed a trend toward association with fluid volume (OR: 1.34; p = 0.056), while DGE, ICU-LOS, and major complications demonstrated no significant associations. Subgroup analyses suggested stronger associations between fluid volume and pulmonary complications in elderly patients, and a more pronounced POAF risk in males, indicating potential effect modification by age and sex. CONCLUSION: Intraoperative fluid volume during RAMIE is variably associatiated with postoperative outcomes. While higher volumes are linked to increased pulmonary morbidity, lower volumes may predispose patients to arrhythmias. Anastomotic complications appear to peak at moderate fluid levels. These findings challenge binary fluid strategies and support a more individualized, risk-adapted approach to intraoperative fluid management in esophageal surgery.	esophagus
Health care professionals' perceptions of machine learning based clinical decision support systems for oesophageal cancer management.	Oesophageal cancer (OC) causes significant morbidity and mortality. Multiple treatment regimens are available, and multidisciplinary team (MDT) decisions over which to offer are complex, multi-faceted and subject to logistical constraints and human factors. A machine learning (ML) model-based clinical decision support system (CDSS) for OC has been developed, trained on historical treatment decisions. However, clinician trust in such systems is not yet established. This study surveyed clinicians in OC MDTs in the UK and Ireland to investigate which clinical and sociodemographic factors influence conscious decision-making in OC, comparing their relative subjective importance to those derived from the ML model (reflecting previous real-world practice). It also sought to explore clinicians' views on the potential use of artificial intelligence-based CDSSs in OC. There was agreement between clinicians and the model in many of the most influential factors in decision making, although age and gender had greater influence on the model than their conscious importance to clinicians would support. Clinicians identified a wide range of additional clinical and holistic factors outside the current model which factor into their decision-making, including further investigations, symptoms, nutrition and social factors. The prospect of utilising an ML CDSS in future received generally positive feedback, although opinions varied widely. However, barriers to implementation were identified, including concerns around perceived clinician superiority over ML CDSSs, patient individuality, transparency and safeguarding, the need for evidence, and additional input requirements. As ML CDSSs are increasingly offered in practice, clinicians' reservations must be addressed and their need for transparency and evidence met.	esophagus
Judicious use of critical care resources by predicting the need for routine ICU admission following esophagectomy.	With advances made in the care for esophagectomy patients, the need for routine postoperative intensive care unit (ICU) admission needs reassessment. We developed a preoperative prediction model to distinguish patients requiring routine ICU admission from those who can be cared for in a post-anesthesia care unit (PACU). This retrospective cohort study included consecutive adults undergoing elective esophagectomy between January 2011 and June 2021 in the UMC Utrecht. Firth's corrected multivariable logistic regression was used for model development and internal validation using bootstrapping was performed to obtain optimism-corrected performance metrics. Among the 619 patients included, 380 (61%) received critical care support beyond the first morning following surgery: 83 (13%) were on invasive mechanical ventilation and 338 (55%) needed cardiovascular support (with 174 [28%] receiving only low-dose norepinephrine). Predictors retained in the final model included age, diabetes mellitus, hemoglobin level, kidney function, forced expiratory volume in 1 second, tumor stadium, type of neoadjuvant therapy and surgical approach. Discrimination was acceptable (adjusted c-statistic 0.67, 95% CI 0.62-0.71) with good calibration (O:E ratio 1.00). Using the model, approximately 50% of ICU beds could be conserved, at the cost of misallocating 22% of patients to a PACU (with only 12% of PACU-allocated patients requiring mechanical ventilation). Between one- and two-thirds of elective esophagectomy patients do not need routine ICU admission, depending on whether hemodynamic support can be provided in another high-dependency unit. Our model can help rationalize perioperative patient allocation and reduce ICU bed claims by roughly half.	esophagus
Cost-effective analysis of sugemalimab plus chemotherapy as first-line treatment for advanced gastric or gastroesophageal junction adenocarcinoma with PD-L1 CPS ≥5.	BACKGROUND: Results from the GEMSTONE-303 trial indicate that compared with placebo plus capecitabine and oxaliplatin (PLA-CAP), sugemalimab plus capecitabine and oxaliplatin (SUG-CAP) as first-line therapy provides clinical benefits for patients with advanced gastric or gastroesophageal junction (G/GEJ) adenocarcinoma with programmed cell death ligand 1 (PD-L1) combined positive score (CPS) ≥5. However, the addition of sugemalimab increases medical costs. This study aimed to assess the cost-effectiveness of SUG-CAP vs. PLA-CAP for the first-line treatment of advanced G/GEJ adenocarcinoma with PD-L1 CPS ≥5 from the perspective of China's healthcare system. METHODS: A Markov model with three health states was developed to compare the cost-effectiveness of SUG-CAP and PLA-CAP. Clinical data were obtained from the GEMSTONE-303 trial, drug costs were determined based on national bidding prices, and other costs and utility values were obtained from published literature. Outcomes included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analysis was used to verify the robustness of the model. RESULTS: The SUG-CAP incurred costs of $70,673.28 and gained 1.28 QALYs. In the PLA-CAP, the effectiveness was 1.00 QALYs at a cost of $11,241.52. Compared with PLA-CAP, SUG-CAP yielded an increase of 0.28 QALYs at an incremental cost of $59,431.76. The ICER for SUG-CAP vs. PLA-CAP was $217,686.71 per QALY, which exceeds the preset willingness-to-pay (WTP) threshold of $41,511 per QALY, with a 0% probability of being cost-effective. The parameters that significantly affected the model were the cost of sugemalimab, progression-free survival (PFS) utility, and discount rate. CONCLUSION: From the perspective of China's healthcare system, SUG-CAP as first-line therapy for advanced G/GEJ adenocarcinoma with PD-L1 CPS ≥5 is not cost-effective compared with chemotherapy alone.	esophagus
The impact of early nutritional care intervention on gastrointestinal function, immune function and nutritional indicators in patients after radical surgery for esophageal cancer: A single-center, observational study.	This study aims to evaluate whether initiating naso-jejunal enteral nutrition within 24 hours after radical esophagectomy shortens the time to first bowel sound, first oral intake, and first defecation. It also investigates whether it improves early postoperative nutritional markers without adversely affecting albumin levels, and whether it enhances cellular immunity, thereby mediating the impact of protein intake on gastrointestinal recovery. A total of 90 patients undergoing radical esophageal cancer surgery at The Fourth Hospital of Hebei Medical University from January 2019 to June 2021 were randomly divided into 2 groups: intervention (n = 45) and control (n = 45). The control group received routine postoperative care, while the intervention group received early nutritional therapy combined with comprehensive nursing interventions. Key indicators, including gastrointestinal function recovery, nutritional status (transferrin, prealbumin, and albumin levels), immune function (CD4+, CD8+, and CD4+/CD8 + ratios), and complications, were monitored and analyzed. Quantitative analysis demonstrated that the intervention shortened mean time to first bowel sound by 1.26 days (2.07 ± 0.77 vs 3.33 ± 0.98 days), to first oral intake by 1.28 days (2.76 ± 0.79 vs 4.04 ± 0.74 days) and to first defecation by 1.54 days (3.24 ± 0.74 vs 4.78 ± 0.60 days); all P < .001. Post-care transferrin rose by 1.42 g/L (33.28 ± 4.31 vs 31.86 ± 3.38 g/L) and pre-albumin by 0.76 mg/dL (46.30 ± 4.16 vs 45.54 ± 4.17 mg/dL), while albumin remained unchanged (P = .865). CD4 + counts increased by 4.16 %, CD8 + counts decreased by 4.63 %, and the CD4+/CD8 + ratio improved by 0.22 (2.00 ± 0.26 vs 1.78 ± 0.16, P = .004). The CD4+/CD8 + ratio mediated 9.1 % of the effect of protein intake on defecation time. The incidence of complications was lower in the intervention group (P < .05). Early enteral nutritional support combined with comprehensive nursing interventions significantly improves quantifiable clinical, nutritional, and immune outcomes, accelerating gastrointestinal recovery and underscoring the value of integrating targeted nutritional support into postoperative care.	esophagus
Predictive role of geriatric nutritional risk index for postoperative complications in operated esophageal cancer patients: a meta-analysis.	PURPOSE: To determine the association between preoperative geriatric nutritional risk index (GNRI) and postoperative complications in surgical esophageal cancer patients. METHODS: PubMed, Web of Science EMBASE and CNKI databases were searched from inception up to December 16, 2024. Primary outcome was the overall complication. Secondary outcomes included the postoperative pulmonary complication (PPC), anastomotic leakage, chylothorax, vocal code paresis, pneumonia, arrhythmia, incision infection, gastrointestinal complication, respiratory failure and heart failure. Odds ratios (ORs) and 95% confidence intervals (CIs) were combined. RESULTS: Eight eligible studies were included with 1,689 cases. Pooled results demonstrated that lower GNRI was significantly related to increased risk of overall complication (OR = 2.56, 95% CI: 1.85-3.55, P<0.001) and PPC (OR = 2.06, 95% CI: 1.71-2.48, P<0.001). Besides, GNRI was associated with the risk of anastomotic leakage (OR = 1.83, P = 0.007), pneumonia (OR = 3.87, P<0.001) and respiratory failure (OR = 9.71, P = 0.003). CONCLUSION: Based on available evidence, GNRI could serve as a prognostic indicator and a lower GNRI predicted increased incidence of postoperative complications among surgical esophageal cancer patients. However, due to the limitations of this meta-analysis like the small sample size, more high-quality studies are still needed to verify above findings. TRIAL REGISTRATION: This meta-analysis was registered in INSPLAY platform (INPLASY202590012; DOI: https://doi.org/10.37766/inplasy2025.9.0012 ).	esophagus
[Primary Malignant Melanoma of the Esophagus Treated with Nivolumab and Ipilimumab Post-Esophagectomy-A Case Report].	A 62-year-old man presented at our hospital with a 30 mm-sized black tumor in the middle esophagus detected by upper gastrointestinal endoscopy. Biopsy confirmed a diagnosis of malignant melanoma. Computed tomography and positron emission tomography revealed no evidence of distant or lymph node metastases. The patient underwent a thoracoscopic subtotal esophagectomy, gastric tube reconstruction, and 2-area lymph node dissection. Based on the Japanese Classification of Esophageal Cancer(11th edition), the diagnosis was pT2(MP)N1M0, Stage Ⅱ. Post-operative chemotherapy with nivolumab(240 mg)was initiated in the fourth post-operative week. However, liver metastasis was detected in the third post-operative month. The patient was subsequently treated with nivolumab and ipilimumab, but there was no response. The patient died of the primary disease 8 months post-operatively.	esophagus