crossing96/oncoscreening huggingface dataset:
Phase II trial of radiotherapy plus Huachansu in elderly or chemotherapy-ineligible patients with locally advanced esophageal squamous cell carcinoma.	BACKGROUND: Preclinical studies have demonstrated that Huachansu, a traditional Chinese medicine derived from toad venom, exhibits radiosensitizing properties. This study aimed to explore whether Huachansu plus radiotherapy can improve the tumor control in elderly and chemotherapy-ineligible patients with locally advanced esophageal squamous cell carcinoma (ESCC). METHODS: Eligible patients were randomly assigned at a 1:1 ratio to receive either radiotherapy alone (RT) or combined Huachansu and radiotherapy (Huachansu + RT). The primary endpoint was locoregional control, and the secondary endpoints were overall survival (OS), progression-free survival (PFS), and treatment-related toxicities. RESULTS: From September 2015 to January 2020, 126 patients who met the eligibility criteria were randomly assigned to the Huachansu + RT group (n = 65) or the RT alone group (n = 61) from three hospitals. At a median follow-up of 64.8 months (IQR 37.8-78.3), the median locoregional control time was 12.9 months (95% CI 0-27.0) in the Huachansu + RT group and 22.0 months (95% CI 0-52.0) in the RT alone group (HR = 1.35, 95% CI 0.82-2.22; P = .235). The median OS time was 15.0 months (95% CI 10.3-19.7) in the Huachansu + RT group and 17.2 months (95% CI 11.3-23.1) in the RT alone group (HR 1.03 95% CI 0.71-1.51 P = .868). There was no significant difference between the two groups in the incidence of acute grade 3 or higher adverse events. CONCLUSIONS: Compared with radiotherapy alone, concurrent radiotherapy with Huachansu injection did not improve the locoregional control rate or survival rate in elderly patients or chemotherapy-ineligible patients with locally advanced ESCC. The trial is registered with ClinicalTrials.org, NCT02647125.	esophagus
Short-term and Long-term Outcomes of Prophylactic Corticosteroid in Esophageal Cancer Surgery: A Multicenter Retrospective Study.	BACKGROUND/AIM: The incidence of postoperative infections after esophagectomy is relatively high and may adversely affect cancer survival. The aim of the study was to investigate the effect of prophylactic corticosteroid administration on short-term and long-term outcomes after esophagectomy. PATIENTS AND METHODS: The Clinical Trial Committee of the Japan Society for Surgical Infection conducted this multicenter retrospective cohort study involving 407 patients with pStage I/II/III esophageal cancer at 11 Centers between April 2013 and March 2015. The patients were divided into the With Steroid group (n=287) and Without Steroid group (n=120), and 94 matched pairs were created using 1:1 propensity score matching for comparison. The median follow-up period was 51.7 months. RESULTS: Background characteristics were balanced after matching. Methylprednisolone was administered in 79.8% of cases (single preoperative dose for all patients). The incidences of overall surgical site infection (SSI) (17.0% vs. 30.9%, p=0.040), incisional SSI, and organ/space SSI, including anastomotic leakage (10.6% vs. 28.7%, p=0.003), were significantly lower in the With Steroid group. The 5-year relapse-free survival rates were 59.3% in the With Steroid group and 43.6% in the Without Steroid group, while the 5-year overall survival rates were 64.6% and 51.9%, respectively. Although the 5-year relapse-free and overall survival rates were numerically higher in the With Steroid group compared to the Without Steroid group, the differences were not statistically significant (p=0.051 and p=0.074, respectively). CONCLUSION: Prophylactic corticosteroid administration was associated with a reduction in SSI, including anastomotic leakage, and a potential benefit for long-term survival after esophagectomy for esophageal cancer. Larger prospective trials are warranted to confirm these findings and further refine perioperative management strategies.	esophagus
Proton beam-based chemoradiotherapy versus surgery plus adjuvant chemotherapy for esophageal squamous cell carcinoma: a comparison of the long-term survival from a single-center cohort study.	BACKGROUND: Chemoradiotherapy using proton beam therapy is a novel and promising option for patients with esophageal squamous cell carcinoma (ESCC) who do not prefer surgical treatment. MATERIALS AND METHODS: This was a single-center retrospective cohort study. Patients diagnosed with thoracic ESCC, clinical Stages I, II, or III, who underwent definitive proton-based chemoradiotherapy (PBC) or surgery-based treatment (SBT) between 2009 and 2020 were included. Patients intolerant to surgery or palliative radiotherapy were excluded. PBC was defined as radical-intent chemoradiotherapy using a proton beam with chemotherapy, and a combination of photon radiation was allowed. SBT was defined as subtotal esophagectomy with lymph node dissection with or without adjuvant chemotherapy. The propensity score matching was performed using potential confounding factors as covariates. The primary endpoints were the hazard ratio (HR) and 5-year overall survival (5yOS). RESULTS: This study included 247 patients (112 with SBT and 135 with PBC). Survival outcomes were compared between the 95 patients in each group using propensity score matching. The mean observation period was 57.5 months. The 5yOS was 62.0% in the SBT and 55.3% in the PBT group (P = 0.421). The adjusted HR for PBC was 1.22 (0.79-1.90). No treatment-related deaths occurred in the PBC group. Serious adverse events included neutropenia (n = 5), esophageal ulcer (n = 3) in the early phase, and esophageal fistula (n = 3), pleural effusion (n = 1), and pericardial effusion (n = 1) in the late phase. CONCLUSION: Radical chemoradiotherapy using proton beams is a promising treatment option for patients with ESCC who do not prefer surgery in terms of safety and efficacy.	esophagus
Improved circulating tumor DNA identification for detection of esophageal squamous cell carcinoma by enzymatic methyl sequencing and hybrid neural network.	Detection of cancer at early stage can significantly improve the five-year survival rate of patients. Bisulfite-based methylation detection can cause DNA damage, especially in high GC content regions which was associated with the development of cancers. Loss of aberrant methylated CpG sites in cfDNA will lead to the undetectability of certain circulating tumor DNA (ctDNA), consequently may affect the cancer detection. Our study uses enzymatic method to detect whole genome abnormal methylation regions in esophageal squamous cell carcinoma (ESCC). We also provide a pretrained neural network, hybrid of BERT and CNN (BCNN), to identify ctDNA robustly. Maximum posterior probability is utilized to estimate the fraction of ESCC-derived ctDNA in plasma for predicting the risk of ESCC cancer. Our results analysis indicated that enzyme-based whole-genome methylation sequencing retained more longer cfDNA and detected more CpG sites than bisulfite-based method in both gDNA and cfDNA. Enrichment analysis of differentially methylated regions (DMR) showed that top five pathways were associated with ESCC. Compared to traditional models, our BCNN demonstrates the best performance in identifying ctDNA (AUC = 0.970). By estimating the fraction of plasma ctDNA, our BCNN exhibits high accuracy in ESCC detection even at ultralow sequencing depths (AUC = 0.946). Specifically, in the validation cohort, when the specificity is 93.75%, 7 out of 8 early-stage ESCC (TNM Stage I) were identified as positive in our preliminary results. In conclusion, our preliminary results reinforce the idea of employing BCNN as a novel strategy for ESCC early detection in clinical practice. However, to be applied in clinical, further validation with a larger sample size is necessary.	esophagus
Retrospective Analysis of CT-based Habitat Analysis for Predicting pCR and Survival of ESCC Treated by Neoadjuvant Chemoradiotherapy and Esophagectomy.	IntroductionThis study sought to develop a predictive model using CT-based habitat radiomics to forecast pathological complete response (pCR) and progression-free survival (PFS) in esophageal squamous cell carcinoma (ESCC) patients receiving standardized neoadjuvant chemoradiotherapy (nCRT) followed by curative surgery.MethodsWe retrospectively analyzed baseline CT imaging data from 228 ESCC patients in a prospective cohort database. Patients were randomly divided into training and validation sets (7:3 ratio). Whole-tumor and habitat-derived radiomic features were extracted from pretreatment CT scans. For pCR prediction, habitat signatures were developed using Logistic Regression (LR), RandomForest (RF), and XGBoost models, optimized via grid search. PFS prediction employed Cox proportional hazards modeling with selected features. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow calibration curves, and decision curve analysis.ResultsThe habitat models retained 10 features for pCR prediction and 12 for PFS prediction. For pCR, the habitat-derived RF model demonstrated superior performance (training AUC: 0.821; validation AUC: 0.826), outperforming both other habitat models and the whole-tumor radiomics model (training AUC: 0.645). Similarly, the habitat-based RF model for PFS achieved higher AUCs (training: 0.759, 95% CI: 0.627-0.889; validation: 0.810, 95% CI: 0.653-0.966) compared to whole-tumor radiomics (training: 0.623; validation: 0.519).ConclusionOur analyses indicated a trend where habitat radiomics might outperform whole-tumor radiomics in predicting pCR and PFS for resectable ESCC after nCRT. While this merits further investigation, current evidence is insufficient to confirm its clinical utility for personalized treatment guidance.	esophagus
Complex diagnosis and management of metastatic esophagogastric junction adenocarcinoma with colonic and meningeal involvement.	This report presents a case of a 59-year-old male diagnosed with metastatic esophagogastric junction adenocarcinoma, who presented with mild dysphagia and vertigo. Brain magnetic resonance imaging initially showed no abnormalities. Upper gastrointestinal endoscopy revealed a vegetative lesion in the distal esophagus, and concurrent colonoscopy identified a laterally-spreading tumor in the transverse colon. Immunohistochemistry confirmed a poorly differentiated adenocarcinoma, suggesting an upper gastrointestinal origin. Further investigation of the worsening neurological symptoms led to the identification of leptomeningeal carcinomatosis via cerebrospinal fluid analysis. Somatic genetic testing detected TP53 mutations and CDK6 amplification; however, no germline mutations were identified. The patient received first-line treatment with 5-fluorouracil, leucovorin, oxaliplatin, and nivolumab, followed by whole-brain radiotherapy due to rapid progression of the leptomeningeal disease. Despite aggressive treatment, the patient experienced multiple complications, including pulmonary embolism and seizures, and died from disease progression after six cycles of therapy. This case highlights the diagnostic challenges and poor prognosis of metastatic esophagogastric junction adenocarcinomas with de novo meningeal and colonic involvement and underscores the importance of early diagnosis and comprehensive evaluation of atypical presentations to optimize patient management.	esophagus
Delayed gastric conduit emptying after esophagectomy: attempt at a clinically relevant classification.	Delayed gastric conduit emptying (DGCE) is a common functional syndrome after esophagectomy. The clinical phenotype is characterized by regurgitation, reflux, and the inability to meet caloric requirements by oral intake. Diagnosis and cause-directed therapy are often challenging because of variable underlying pathomechanisms. Against this background and based on our clinical experience, we propose a classification that categorizes DGCE according to the predominant case-specific pathophysiology: Class I: functional-DGCE due to impaired antro-pyloric motilityClass II: conduit-related-DGCE caused by specific patho-anatomical features of the conduitClass III: hiatal-DGCE resulting from mechanical obstruction at the diaphragmatic hiatusClass IV: other-Other causes of DGCE at or distal to the pylorus (e.g. luminal occlusion, intestinal adhesions or peritoneal carcinomatosis) We believe that this classification has the potential to promote a better understanding of the symptom spectrum of DGCE and to facilitate cause-oriented, focused treatment. Moreover, we are convinced that a structured definition of DGCE according to pathophysiology will improve the comparability of different patient cohorts and thus promote future collaborative research.	esophagus
Clinico-pathological findings in a series of gastrointestinal endoscopic submucosal dissection specimens: A retrospective 5-year study.	Endoscopic submucosal dissection (ESD) enables en-bloc resection of superficial gastrointestinal lesions, offering curative treatment while preserving organ function. This study aimed to characterize the clinico-pathological spectrum of gastrointestinal ESD specimens at a tertiary care centre over five years and identify factors influencing patient management. All ESD specimens received from January 2020 to December 2024 were retrospectively reviewed, with grossing performed according to International Collaboration on Cancer Reporting (ICCR) guidelines. Histological evaluation included lesion type, depth of invasion, margin status, lymphovascular and perineural invasion, and tumour budding, with follow-up obtained from electronic medical records. Seventy-two specimens were analyzed (mean age 68 years; M:F = 1.5:1), with lesion sites comprising stomach (32 %), esophagus (21 %), rectum (21 %), sigmoid colon (18 %), and duodenum (8 %). Epithelial lesions constituted 69 % (50/72), of which malignant epithelial tumours formed 24 % (17/72), including esophageal squamous cell carcinomas (n = 4), esophageal adenocarcinoma (n = 1), gastric adenocarcinomas (n = 4), and colorectal adenocarcinomas (n = 8). En-bloc resection was achieved in 93 % overall and 88 % of malignant specimens. After excluding two indeterminate cases, R0 resection was achieved in 60 % (9/15) of malignant tumours, enabling accurate margin assessment and staging. Additional surgical intervention was required in 29.4 % (5/17) malignant cases due to margin positivity, with one specimen showing further high-risk features. No patients received neoadjuvant therapy. Residual tumour and lymph node metastasis were identified in three and one malignant specimens, respectively. The use of standardized grossing and reporting protocols facilitated accurate pathological risk stratification and guided subsequent clinical decision-making.	esophagus
Impact of consolidation immunotherapy after definitive chemoradiotherapy in locally advanced esophageal squamous cell carcinoma: a real-world multicenter study.	PURPOSE: To compare the efficacy of dCRT versus dCRT plus consolidation ICIs (dCRT + cICIs) in LA-ESCC and to evaluate the safety of dCRT + cICIs. METHODS: Patients with LA-ESCC who received dCRT or dCRT + cICIs were included. sIPTW adjusted for sex, age, clinical TNM stage, smoking, and alcohol consumption between the two groups. The study analyzed overall survival (OS) and progression-free survival (PFS) between the two groups, and evaluated immune-related adverse events (irAEs) within the dCRT + cICIs cohort. RESULTS: We retrospectively identified 176 ESCC patients, with 123 in the dCRT group and 53 in the dCRT + cICIs group. Pre-sIPTW analysis showed significantly improved OS in the dCRT + cICIs group (median, 46.4 vs. 20.9 months; P = 0.02). The dCRT + cICIs group had a better PFS than the dCRT group (median, 27.4 vs. 12.9 months; P = 0.02). After sIPTW, the OS was numerically better in the dCRT + cICIs group than in the dCRT group (median, 42.9 vs. 21.6 months; P = 0.1), with improvement in 1- and 2-year OS rates. There was no significant difference in PFS between dCRT + cICIs group and dCRT group (median, 23.0 vs. 13.0 months; P = 0.2), with numerically better 1- and 2-year PFS in the dCRT + cICIs group. In the dCRT + cICIs group, approximately 43.4 % of patients experienced irAEs, and grade 3-4 irAEs occurred in 13.2 % of patients. The most common was hypothyroidism in 11.3 % of patients. CONCLUSIONS: Our preliminary findings suggested that consolidation immunotherapy following dCRT might trend toward prolonged OS and PFS in patients with LA-ESCC, and that irAEs are generally tolerated.	esophagus
Efficacy and safety of postoperative radiotherapy in locally advanced esophageal squamous cell carcinoma patients with pathologic incomplete response after neoadjuvant immunochemotherapy: a retrospective cohort study.	BACKGROUND: Neoadjuvant immunotherapy combined with chemotherapy (NICT) has demonstrated a good pathological complete response (pCR) rate and prognosis in locally advanced esophageal squamous cell carcinoma (LA-ESCC). However, the value and safety of postoperative radiotherapy (PORT) in the group that does not achieve pCR remain unclear. METHODS: This retrospective study included LA-ESCC patients with non-pCR after NICT. Propensity score matching (PSM) was used to balance baseline characteristics between the PORT and non-PORT groups. The outcomes assessed were disease-free survival (DFS), recurrence patterns, and treatment-related toxicity. RESULTS: In the cohort of 204 enrolled patients, 50 underwent PORT, while the remaining 154 did not, with a median follow-up of 27.0 months. 32 (20.8%) of the non-PORT patients experienced recurrence events, including locoregional recurrence (10/32, 31.3%), distant metastasis (10/32, 31.3%), and mixed patterns (12/32, 37.5%), and 71.9% of cases underwent disease progression within 12 months. With regard to patterns of locoregional recurrence, mediastinal lymph node metastasis represented the most prevalent failure pattern. In terms of distant metastasis, supraclavicular lymph node metastasis was the most commonly observed mode. By PSM analysis, DFS was improved for the patients receiving PORT (HR, 0.26; 95% CI, 0.09-0.77; P = 0.008). Subgroup and analyses revealed a significant increase in both 1- and 2-year DFS rates in patients with ypN+, ypT3-4, yp Stage III-IVA, tumor regression grade (TRG) 2-3, non-downstaging of T stage or middle/lower thoracic esophageal tumors. In patients with non-downstaging of N or TNM status, there was a notable enhancement in the 2-year DFS rate. Treatment-related adverse events (TRAEs) were predominantly grade 1-2 in the PORT group, with radiation esophagitis and myelosuppression being the most frequently observed. CONCLUSION: Mediastinal and supraclavicular lymph node metastasis remains the primary cause of treatment failure in LA-ESCC patients with non-pCR after NICT and without PORT. PORT significantly improves DFS in patients with high-risk clinicopathological features or poor response to NICT, and demonstrates a favorable safety profile, indicating an effective adjuvant treatment strategy for improving prognosis.	esophagus
Small bowel obstruction in patients associated with immune checkpoint inhibitors combined with chemotherapy: Two case reports and a review.	RATIONALE: The broader application of immune checkpoint inhibitors (ICIs) has led to increased recognition of rare but clinically significant adverse effects (AEs), including small bowel obstruction (SBO). This case aims to elucidate the clinical features and management challenges of ICI-associated SBO. PATIENT CONCERNS: The first case involves a 67-year-old male patient with esophageal malignancy who was hospitalized due to painful abdominal distension following the 2 cycles administration of tislelizumab in conjunction with nab-paclitaxel. The second case concerns a 59-year-old male patient with pancreatic malignancy who developed abdominal pain and distension after undergoing combination capecitabine with sintilimab. DIAGNOSES: Imaging confirmed incomplete SBO in the first patient, while the second showed SBO with abdominal effusion. INTERVENTIONS: In consideration of the AEs associated with ICI therapy, the patient was treated with glucocorticoids. Initial management included fasting, and administration of cefoperazone-sulbactam for anti-infection therapy along with methylprednisolone. Another patient underwent catheter placement and received octreotide treatment, but the therapeutic response was unsatisfactory. OUTCOMES: The patient 1 symptoms gradually improved. However, despite therapy, the patient 2's SBO did not improve, and he was subsequently transferred to the hospital for further management. LESSONS: With expanding use of ICIs, immune-related AEs have emerged. Clinicians should remain highly vigilant for gastrointestinal symptoms in patients receiving ICIs, as early recognition of SBO is crucial for timely diagnosis and treatment.	esophagus
Validation and refinement of the 8th edition of the AJCC staging system for esophageal squamous cell carcinoma treated with definitive IMRT or chemo-IMRT: a Chinese multi-institutional retrospective study.	OBJECTIVE: This study evaluated the 8th edition American Joint Committee on Cancer (AJCC) staging system for esophageal squamous cell carcinoma (ESCC) and developed an improved staging framework using automated recursive partitioning analysis (autoRPA). METHODS: This retrospective study included 2773 ESCC patients treated with definitive intensity-modulated radiation therapy (IMRT) or chemo-IMRT across 8 Chinese centers (2001-2019). Kaplan‒Meier curves and log-rank tests were used to assess overall survival (OS). AutoRPA-derived stage groupings were optimized via the revised T/N criteria. The proposed staging was compared with the 8th edition AJCC staging via hazard discrimination, consistency, sample balance, and predictive accuracy. RESULTS: The 3-year, and 5-year rates for the entire cohort were 43.5%, and 34.0%, respectively. The AJCC T4a/T4b stages exhibited overlapping OS curves, prompting their consolidation into a single T4 stage. While the AJCC N2 and N3 stages showed overlapping OS curves, supraclavicular lymph node (SLN) metastasis independently predicted worse OS than N2, with outcomes similar to those of N3. Location-based SLN classification further refined nodal staging, with cervical esophageal-SLN metastasis classified as N1, upper thoracic-SLN metastasis as N2, and middle or lower thoracic-SLN metastasis as N3, yielding distinct OS stratification. The autoRPA-derived staging outperformed the 8th edition AJCC staging in hazard consistency, sample balance, and predictive accuracy, with RPA-I exhibiting distinctly sharper OS curves than other stages. CONCLUSION: Combining T4a/T4b and SLN subclassification enhanced prognostic precision in ESCC, with the autoRPA staging demonstrating superior hazard consistency, sample balance, and predictive accuracy compared to the 8th edition AJCC staging, thereby guiding therapeutic strategies.	esophagus