crossing96/oncoscreening huggingface dataset:
Current status of prehabilitation before esophagectomy for patients with esophageal cancer among board-certified hospitals by the Japan Esophageal Society.	"BACKGROUND: Prehabilitation has been shown to prevent postoperative pneumonia and physical function decline after esophagectomy in recent systematic reviews and meta-analyses. However, the implementation status of prehabilitation for esophagectomy remains unknown. This nationwide survey was performed to investigate the current status of and barriers to prehabilitation before esophagectomy among Japanese hospitals. METHODS: This multicenter nationwide survey was performed using the postal mail method. The eligible facilities were 155 Japanese hospitals that had been certified as Authorized Institutes for Board-Certified Esophageal Surgeons by the Japan Esophageal Society within the past 10 years. We administered the original questionnaire to investigate the current status of prehabilitation before esophagectomy, excluding neoadjuvant therapy. RESULTS: The response rate was 75% (117/155 facilities). The number of facilities providing prehabilitation for esophagectomy was 77 (66%), including prehabilitation in the preoperative outpatient setting in 39 (33%) and in the preoperative inpatient setting in 53 (45%). Among the facilities that did not provide prehabilitation, the most common reasons for not providing prehabilitation (i.e., responses of ""agree"" and ""strongly agree"" on questionnaire) were a lack of human resources, preoperative period too short to provide prehabilitation, difficultly using reimbursed medical fees, and no establishment of a standard prehabilitation program. CONCLUSIONS: We elucidated the current implementation status of prehabilitation, identified the critical gap between evidence and practice. This information will contribute to building an effective medical system and framework of prehabilitation for patients with esophageal cancer in Japan and other countries."	esophagus
Radiomics and prognostic nutritional index for predicting postoperative survival in esophageal carcinoma.	BACKGROUND: Surgery offers the potential for a radical cure and prolonged survival in individuals diagnosed with esophageal squamous cell carcinoma (ESCC). However, survival rates exhibit significant variability among patients. Accurately assessing surgical outcomes remains a critical challenge. This study aimed to evaluate the predictive value of preoperative radiomics and the prognostic nutritional index for individuals with ESCC and to develop a comprehensive model for estimating postoperative overall survival (OS) in these patients. METHODS: A retrospective analysis was conducted on 466 patients with ESCC from two medical centers. The dataset was randomly divided into a training cohort (TC, hospital 1, 246 cases), an internal validation cohort (IVC, hospital 1, 106 cases), and an external validation cohort (EVC, hospital 2, 114 cases). Radiological features were extracted after delineating the region of interest, followed by the application of the least absolute shrinkage and selection operator (LASSO) regression to identify optimal radiomics features and compute the radiomics score (RS). Independent prognostic factors identified via Cox regression analysis were incorporated with the RS to construct a combined nomogram. The predictive performance of the model was evaluated using the concordance index, time-dependent receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis. RESULTS: The predictive model, which integrated preoperative radiomics, the prognostic nutritional index, and tumor-node-metastasis (TNM) staging to estimate the 3 year OS rate, achieved area under the ROC curve (AUC) values of 0.812, 0.786, and 0.810 in the TC, IVC, and EVC, respectively, demonstrating excellent prognostic accuracy. These values surpassed the AUCs of the TNM staging model in the TC, IVC, and EVC, which were 0.717, 0.612, and 0.699, respectively. The combined model's concordance indexes in the TC, IVC, and EVC were 0.780, 0.760, and 0.764, respectively. Calibration and decision curves highlighted the nomogram's superior calibration and clinical utility. CONCLUSION: This study developed a predictive model by combining radiomics with the prognostic nutritional index, enabling the estimation of OS in postoperative patients with ESCC. This model holds promise as a tool for preoperative risk stratification.	esophagus
Treatment patterns and outcomes in advanced or metastatic gastric/gastroesophageal junction adenocarcinoma in China.	AIMS: Describe the characteristics, treatment patterns and outcomes of Chinese patients with unresectable advanced/metastatic (UAM) gastric/gastroesophageal junction adenocarcinoma (GA/GEJA). METHODS: This multicenter, retrospective, observational study included adults diagnosed with UAM GA/GEJA in China from 2017-2020. RESULTS: Among 2,745 patients, 1,902, 729, and 284 received first-, second- and third-line (1 L, 2 L and 3 L) therapy-respectively. Most patients received chemotherapy alone in 1 L (84.1%) and 2 L (63.6%), and targeted-therapy-based treatment in 3 L (49.2%). Median real-world progression-free survival (rwPFS) was 6.5, 4.2, and 3.2 months in 1 L, 2 L, and 3 L, respectively. CONCLUSIONS: Chinese patients with UAM GA/GEJA mainly received chemotherapy alone in 1 L/2 L and targeted therapy in 3 L. Median rwPFS was short in all lines, highlighting the need for more effective treatments.	esophagus
Associations between body mass index and gastroesophageal cancer incidence and mortality: novel insights from a nationwide registry-based cohort study.	The association between body mass index (BMI) and cancers of the esophagus and the stomach remains complex and requires further exploration. This study aimed to investigate this association, including early-onset (< 50 years) cancer and cancer related mortality. A nationwide registry-based cohort study was performed by linking data from multiple national registries in Norway. The cohort included 1,723,692 individuals, with 22,473 gastroesophageal cancer cases identified over 55,701,169 person-years of follow-up. In men, a 5 kg/m2 increase in BMI was associated with an increased risk of esophageal (HR 1.34, 95%CI 1.22-1.48) and cardia adenocarcinoma (HR 1.36, 95% CI, 1.22-1.50). This finding extended to individuals with high BMI in early life (16-29 years) for esophageal adenocarcinoma. The highest risk per 5 kg/m2 increase in BMI was observed for early-onset esophageal (HR 2.49, 95%CI 1.23-5.02) and cardia adenocarcinoma (HR 2.26, 95%CI 1.19-4.27). Among women, increased BMI was associated with a higher risk of both esophageal (HR 1.28, 95%CI 1.13-1.44) and gastric adenocarcinoma (HR 1.04, 95%CI 1.01-1.07). Women with elevated BMI in early life also demonstrated increased risk for these cancers. In both sexes, a 5 kg/m2 increase in BMI was inversely associated with squamous cell carcinoma of the esophagus. No association was observed between BMI and risk of cancer-related mortality. This study highlights an elevated risk of gastroesophageal adenocarcinomas with increasing BMI, with notable sex, age, and site-specific variations. The findings also point to a heightened risk of early-onset esophageal and cardia adenocarcinoma in men with high BMI.	esophagus
Predicting anastomotic leak in patients with esophageal squamous cell cancer treated with neoadjuvant chemoradiotherapy using a nomogram based on CT radiomic and clinicopathologic factors.	BACKGROUND: Anastomotic leak (AL) is a common complication in patients with operable esophageal squamous cell carcinoma (ESCC) treated with neoadjuvant chemoradiotherapy (NCRT) and radical esophagectomy. Therefore, this study aimed to establish and validate a nomogram to predict the occurrence of AL. METHODS: Between March 2016 and December 2022, ESCC patients undergoing NCRT and radical esophagectomy were retrospectively collected in China. Clinicopathologic and radiomics characteristics were included in the univariate logistic regression analysis, and statistically significant factors were enrolled to develop the nomogram, which was evaluated by the area under the curve (AUC) of the receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA). RESULTS: 231 eligible patients were divided into training (n = 159) and validation cohorts (n = 72). Univariate and multivariate analyses revealed that dose at the anastomosis ≥ 24 Gy, gross tumor volume ≥ 60 cm3, postoperative albumin < 35 g/L, comorbidities, duration of surgery ≥ 270 min, and computed tomography-based radiomics characteristics were independent predictors of AL. The nomogram AUC in the training and validation cohorts was 0.845 (95% confidence interval [CI]: 0.770-0.920) and 0.839 (95% CI: 0.718-0.960), respectively, indicating good discriminatory ability. The calibration curves showed good agreement between the predicted and actual AL occurrence and the DCA demonstrated favorable clinical outcomes. CONCLUSIONS: We developed and validated a nomogram based on radiomics and clinicopathologic characteristics. This predictive model could be a powerful tool to predict AL occurrence in patients with ESCC treated with NCRT.	esophagus
The IL-6/STAT3 Signaling Pathway Is Involved in Radiotherapy-Mediated Upregulation of PD-L1 in Esophageal Cancer.	OBJECTIVE: This study aimed to investigate the mechanism whereby ionizing radiation improves anti-programmed cell death protein 1 (PD-1)/programmed cell death 1 ligand 1 (PD-L1) immunotherapy for esophageal squamous cell carcinoma (ESCC). METHODS: The protein levels of interleukin 6 (IL-6), signal transducer, and activator of transcription 3 (STAT3), and PD-L1 in human ESCC specimens and histologically normal tissues were analyzed by western blot. The effects of radiation exposure on PD-L1, STAT3, and IL-6 were determined in three esophageal cancer (EC) cell lines. Radiation therapy plays an important role in the treatment of esophageal cancer, so cell proliferation, invasion, colony formation, and cell cycle were measured before and after radiation exposure. RESULTS: The protein expression levels of PD-L1, IL-6, and STAT3 were significantly greater in ESCC specimens versus normal tissues. Notably, the protein levels of PD-L1 and STAT3 were positively correlated with the T stage, and IL-6 was positively related to the T stage and tumor site. Cox proportional hazard model multivariate analysis indicated that the expression levels of PD-L1, IL-6, and STAT3 were not independent prognostic factors for ESCC. In vitro studies showed that the PD-L1, STAT3, and IL-6 mRNA and protein expression levels in EC cells exposed to radiation were markedly increased. Further mechanistic investigations found that blocking the IL-6/STAT3 pathway significantly abrogated the radiotherapy-mediated increase in p-STAT3 and PD-L1 levels. CONCLUSION: Radiotherapy significantly upregulates PD-L1 through the IL-6/STAT3 signaling pathway, suggesting that anti-PD-1/PD-L1 immunotherapy combined with radiotherapy may improve the treatment for ESCC.	esophagus
Impacts of combining PD-L1 inhibitor and radiotherapy on the tumour immune microenvironment in a mouse model of esophageal squamous cell carcinoma.	BACKGROUND: The combination of radiation with immune checkpoint inhibitors (ICIs) has been demonstrated to display synergistic effects in solid cancers. Nevertheless, the anti-tumor effect of combining radiation with programmed cell death 1 ligand 1 (PD-L1) inhibitor in esophageal squamous cell carcinoma (ESCC) has remained unclear. Therefore, the objectives of our study were to evaluate the anti-tumor effects of PD-L1 inhibitors combined with radiotherapy in a mouse model of ESCC and to depict the immune landscape within the tumor microenvironment (TME). METHODS: Murine ESCC cells (mEC25) were injected subcutaneously into the right flanks of C57BL/6 mice. Tumor-bearing mice were exposed to different treatments: IgG antibody (control), anti-PD-L1 antibody, radiation, or radiation + anti-PD-L1 antibody. Tumor growth and survival time of mice were monitored. Tumour immune microenvironment was assessed by flow cytometry, including CD4(+)T cells, CD8(+)T cells, regulatory T cells (Tregs), tumor-associated macrophages (TAMs), myeloid-derived suppressor cells (MDSCs), and the activation and exhaustion of CD8(+)T cell. In addition, transcriptomic analysis was used to examine the changes in immune gene expression in the TME. RESULTS: Radiotherapy combined with anti-PD-L1 inhibitors (radioimmunotherapy) synergistically enhanced anti-tumor immune response, leading to decreased tumor growth and prolonged survival of tumor-bearing mice. The radioimmunotherapy increased the infiltration of CD8(+) T cells, the ratio of CD8(+) T cells to Tregs, the population of central memory CD8(+) T cells (T(CM)), interferon-gamma (IFN-γ) secretion of tumor-infiltrating CD8(+) T cells, and reduced the accumulation of M2-type TAMs and Tregs in the TME in mouse model. In addition, the radioimmunotherapy induced anti-tumor immune response in the spleen and tumor-draining lymph node (TDLN). Moreover, transcriptomic analysis suggested that the radioimmunotherapy promoted the activation of immune regulatory pathways and increased the expression of cytokines such as CXCL9 and CXCL10, thus creating an immunoinflammatory tumor microenvironment. CONCLUSIONS: Our research revealed that anti-PD-L1 inhibitors combined with radiotherapy caused systemic anti-tumor immunity by reshaping the immune microenvironment in a mouse model of ESCC.	esophagus
Approaches for thoracoabdominal oesophagectomy for oesophageal cancer: a network meta-analysis - study protocol.	INTRODUCTION: Oesophageal cancer is the seventh most frequently diagnosed cancer and the sixth leading cause of cancer-related deaths worldwide. Oesophagectomy remains the main curative treatment option. The effect of different surgical approaches (completely open, hybrid, completely minimally invasive and robot-assisted) on patients undergoing thoracoabdominal oesophagectomy (Ivor-Lewis's procedure) for oesophageal cancer is evaluated, focusing on overall survival, postoperative mortality and morbidity. METHODS AND ANALYSIS: A systematic literature search will be conducted in PubMed/Medline, Cochrane Library, Embase, Cumulated Index in Nursing and Allied Health Literature, ClinicalTrials.gov and International Clinical Trials Registry Platform using predefined search terms. A random-effects (network) meta-analysis using the frequentist framework will be performed. ETHICS AND DISSEMINATION: As this study is based on previously published data, no ethical approval is required. Findings will be disseminated through peer-reviewed publications and conference presentations to inform clinical decision-makers (eg, surgeons, gastroenterologists). TRAIL REGISTRATION NUMBER: CRD42024564915.	esophagus
Preexpanded Perforator Flaps for Neoesophageal Reconstruction after Bipolar Upper Gastrointestinal Tract Exclusion.	BACKGROUND: Total esophageal reconstruction after failure of conventional techniques is a significant surgical challenge, particularly in fragile patients who have undergone multiple surgical procedures. Traditional options, including gastroplasties, colon transfers, and free jejunal flaps, are associated with high morbidity rates, failure rates, or surgical complexity. METHODS: The authors report an innovative 4-step strategy for esophageal reconstruction using a presternal skin tube created with tissue expanders and perforator flap techniques. Six patients with previous definitive esophageal exclusion underwent reconstruction between 2009 and 2023. The procedure involved patients with complex medical history and multiple reconstruction failures, including gastroplasties, coloplasties, or ileocoloplasties, and consisted of chest skin expansion with tissue expanders, tubularization of a perforator flap based on internal mammary vessels, anastomosis of the distal skin tube with a jejunal Y loop, and proximal anastomosis to the native cervical esophagus. RESULTS: The entire reconstructive process was completed over 17.5 ± 7.3 months. All patients achieved restoration of digestive tract continuity. Minor complications, including wound dehiscence and fistulas, were observed in all patients, but resolved without major intervention. Functional outcomes were favorable, with a maximum follow-up of 15 years and patients tolerating liquids, semisolids, and solid foods after 2 to 3 months. Imaging and endoscopy confirmed lumen integrity, absence of strictures, and static skin-like epithelium without ulceration. CONCLUSIONS: This staged reconstruction offers a viable and safe alternative for total esophageal replacement in complex, high-risk cases, avoiding additional extensive intrathoracic procedures. The presternal neoesophagus provides acceptable function with manageable complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.	esophagus
Association of NR0B1 with Malignant Phenotypes in Esophageal Squamous Cell Carcinoma Through Modulation of p53-Independent Cell-Cycle Regulation.	BACKGROUND: Transcriptome analysis of primary tumor tissues from esophageal squamous cell carcinoma (ESCC) patients with early postoperative distant metastasis identified nuclear receptor subfamily 0, group B, member 1 (NR0B1) as a novel gene associated with the malignant phenotypes of ESCC. This study aimed to elucidate the oncological functions of NR0B1 in ESCC and assess the significance of its tissue expression. METHODS: We investigated the effects of NR0B1 knockdown on the proliferation, migration, and adhesion capacities, in vivo tumor growth, and intracellular signaling pathways of ESCC cell lines. The correlation between tissue NR0B1 expression at both the mRNA and protein levels and postoperative prognosis was analyzed by using two independent cohorts. RESULTS: Silencing NR0B1 significantly inhibited the proliferation, migration, and adhesion capacities of ESCC cell lines and decreased tumor growth in mouse cell line derived xenograft models. Knockdown of NR0B1 results in the upregulation of cell cycle regulators p21 and p27, alongside the downregulation of TK1, cyclin E1, CDK2 and CDT1, in a manner independent of p53. Although elevated tissue NR0B1 expression did not show a significant association with TNM stage, it was identified as an independent prognostic factor at both the mRNA and protein levels across two distinct patient cohorts. CONCLUSIONS: NR0B1 plays a critical role in the malignant phenotype of ESCC by modulating cell cycle regulators. Tissue NR0B1 expression may serve as a valuable biomarker for assessing prognostic risk in ESCC patients.	esophagus
Non-coding RNAs in thoracic disease: Barrett's esophagus and esophageal adenocarcinoma.	Esophageal adenocarcinoma (EAC) is a highly aggressive malignancy with increasing incidence and poor survival rates, primarily due to late-stage diagnosis. This cancer often develops from Barrett's Esophagus (BE), a precancerous condition linked to chronic gastroesophageal reflux disease (GERD). The transition from BE to EAC is a complex multistep process involving numerous genetic, epigenetic, and molecular changes that lead to the malignant transformation of the esophageal epithelium. Despite advancements in understanding the molecular mechanisms underlying EAC, early detection and effective treatment options remain limited, highlighting an urgent need for innovative diagnostic and therapeutic strategies. Recent research has focused on non-coding RNAs (ncRNAs), which play crucial roles in regulating gene expression and cellular processes relevant to cancer progression. Various types of ncRNAs, including microRNAs, long non-coding RNAs, and circular RNAs, have been implicated in the development of BE and EAC by modulating key signaling pathways such as Wnt/β-catenin and NF-κB. Additionally, ncRNAs are stable in biological fluids, presenting opportunities for their use as non-invasive biomarkers for early detection and monitoring of EAC. This review aims to elucidate the involvement of ncRNAs in the progression from BE to EAC, their potential as therapeutic targets, and their emerging roles in intercellular communication. We will also discuss the challenges in translating ncRNA research into clinical applications, emphasizing their promise in revolutionizing early detection and treatment strategies for EAC.	esophagus
Potential biomarkers develop for predicting the prognosis of patients with esophageal squamous cell carcinoma after optimized chemoradiotherapy using serum metabolomics.	BACKGROUND: Esophageal squamous cell carcinoma (ESCC), the most common type of esophageal cancer, characterized by low five-year survival rate, and concurrent chemoradiotherapy (CCRT) has been proposed to treat ESCC, while potential biomarkers for prognostic monitoring after optimized CCRT remains unknown. METHODS: Serum samples from 45 patients with ESCC were collected and categorized into three groups: Control (pre-CCRT), CCRT (during CCRT), and CCRT-1 M (one-month post-CCRT). The therapeutic effect was evaluated using CT imaging and established evaluation criteria. Untargeted metabolomic analysis was performed on the serum samples to identify differential metabolites caused by CCRT treatment, assessing their potential for prognostic monitoring. RESULTS: CCRT had significant therapeutic efficacy in patients with ESCC, as indicated by CT imaging and RECIST 1.1 solid tumor evaluation criteria. Notably, several metabolic markers were identified through non-targeted metabolomic analysis, highlighting changes following CCRT treatment. These differential metabolites are involved in the dysregulation of phenylalanine, tyrosine, and tryptophan biosynthesis, as well as histidine, arginine, and proline metabolism, and glycine, serine, and threonine metabolism, suggesting a reduction in glucose metabolism in patients with ESCC after CCRT. Additionally, ROC analysis indicated that the AUC of these metabolites exceeded 0.661, underscoring their diagnostic value for assessing CCRT efficacy and their potential use in prognostic monitoring. Comparative metabolomic analysis identified L-phenylalanine and lysine as promising serum biomarkers for predicting therapeutic outcomes. CONCLUSIONS: CCRT shows considerable therapeutic benefit in patients with ESCC, with observed reductions in glucose metabolism post-treatment. L-phenylalanine and lysine may serve as potential serum biomarkers to predict CCRT efficacy.	esophagus
Evaluating the Impact of Minimally Invasive Surgery on Long-Term Quality of Life in Foregut Cancer Patients.	"INTRODUCTION: Compared to open surgery (OS), minimally invasive surgery (MIS) for foregut cancer improves perioperative outcomes. However, the impact of MIS on long-term quality of life (QOL) is unknown. We compare the long-term QOL of patients who underwent MIS and OS for foregut cancer. METHODS: Surgically managed esophageal and gastric cancer patients were surveyed globally via online support groups. Physical (P-QOL) and mental (M-QOL) well-being were determined using the Short Form-12 questionnaire and compared based on the surgical approach (MIS vs OS). We defined ""long-term"" as greater than 3 months from surgery. RESULTS: Out of 100 respondents with esophageal and gastric cancer, 64 survivors underwent surgical management greater than 3 months before the survey. They were 56.6 ± 9.9 years, 46.0% female, and 95.2% White, with a median survival of 33.0 (14.0-63.0) months. The most common diagnosis was esophageal adenocarcinoma (69.8%). Surgical procedures included esophagectomy (56.5%), esophagogastrectomy (29.0%), and gastrectomy (14.5%), of which 45.2% were OS and 48.4% were MIS. The cohort overall exhibited lower P-QOL (40.7 ± 10.4) and M-QOL (44.6 ± 15.2) compared to the general population (50.0 ± 10.0; p < 0.050). There was no difference in age, sex, race, education, income, diagnosis, and adjuvant therapy between OS and MIS cohorts (all p > 0.050). Long-term P-QOL (38.5 ± 11.6 OS vs. 42.8 ± 9.5 MIS, p = 0.123) and M-QOL (44.7 ± 15.3 OS vs. 44.9 ± 14.9 MIS, p = 0.901) was similar between patients who underwent OS and MIS for foregut cancer. CONCLUSION: MIS is not associated with higher long-term QOL in patients who have undergone surgery for foregut malignancy."	esophagus