crossing96/oncoscreening huggingface dataset:
Risk Reduction of Severe Anastomotic Leakage by Evaluation of Blood Perfusion Using Indocyanine Green After Minimally Invasive Esophagectomy Followed by Narrow Gastric Tube Reconstruction.	BACKGROUND: Anastomotic leakage (AL) is a major complication after esophagectomy and gastric tube reconstruction. This retrospective study aims to reveal the factors in prevention of AL and in reduction of its severity. METHODS: Enrolled in this study were the 183 patients diagnosed with esophageal cancer who underwent minimally invasive esophagectomy followed by narrow gastric tube reconstruction at Wakayama Medical University Hospital between January 2018 and March 2023. Evaluation of blood perfusion using indocyanine green began in September 2020. RESULTS: AL occurred in 42 patients (22%) and did not occur in 141 patients (78%). Patient characteristics were not significantly different between patients with and without AL. Evaluation of blood perfusion of the gastric tube was performed in 69 of the 183 patients (37.7%), and after its introduction the rates of AL decreased from 28.0% to 14.4%. Blood perfusion was less evaluated in the AL group than in the non-AL group (23.8% vs. 41.8%, P=0.034). Multivariate analysis demonstrated that non-evaluation of blood perfusion using indocyanine green (odds=3.115) was an independent risk factor for AL. For the patients with AL, active interventions (eg, tube insertion into the gastric tube through the nose or fistula, embolization of cyanoacrylate) were performed significantly more often in the group without evaluation of blood perfusion than in the group with evaluation. Without evaluation of blood perfusion, there was significantly longer time from onset to resumption of diet and significantly longer postoperative hospital stays. CONCLUSIONS: Evaluation of qualitative blood perfusion can lead to both risk reduction and prevention of severe AL after narrow gastric tube reconstruction for esophageal cancer.	esophagus
Comparison of outcomes between surgery and chemoradiotherapy after endoscopic resection for pT1a-MM with lymphovascular invasion or pT1b esophageal squamous cell carcinoma: Japanese multicenter propensity score-matched study.	BACKGROUND: Lymphovascular invasion (LVI) or pT1b is noncurative after endoscopic resection (ER) for esophageal squamous cell carcinoma (ESCC), and therefore surgery or chemoradiotherapy (CRT) is recommended. However, there has been debate regarding which treatment has better outcomes and whether individual risks should be considered. METHODS: This was a multicenter, retrospective study conducted at 65 hospitals in Japan. The inclusion criteria were patients with ESCC who underwent ER between January 2006 and December 2015, with pT1a-muscularis mucosa (MM) with LVI or pT1b, with negative vertical margins, cN0M0, and who underwent surgery or CRT. A 1:1 propensity score-matched analysis was performed between two groups. The primary and secondary end points were overall survival (OS) and relapse-free survival (RFS). OS and RFS were also compared between two subgroups: low risk (pT1a-MM with LVI and pT1b without LVI) and high risk (pT1b with LVI) for metastatic recurrence. RESULTS: Among 472 patients, 160 patients were selected from each group. The OS and RFS did not differ between surgery and CRT groups (hazard ratio, 0.887; P = .635 and hazard ratio, 1.036; P = .876, respectively). Subgroup analysis showed that CRT had a better prognosis in the low-risk group, and conversely, surgery had a better prognosis in the high-risk group. But these were not significant. The high-risk CRT group had a significant worse prognosis than the low-risk CRT group. CONCLUSIONS: In patients with noncurative ER for ESCC, surgery and CRT showed no difference in long-term outcomes. Indications for CRT in the high-risk group need further investigation because of poor prognosis.	esophagus
Nomograms for predicting the prognosis in multiple primary esophageal squamous cell carcinoma.	BACKGROUND: Due to its rarity, it is challenging to predict the survival of patients with synchronous multiple primary esophageal squamous carcinomas (SMPESCs). We aimed to construct nomograms to predict survival outcomes and help to make therapeutic strategy for patients with SMPESCs. MATERIALS AND METHODS: The clinical and survival data of 135 patients with SMPESCs were analyzed retrospectively. Univariate and multivariate Cox analyses were used to identify independent prognostic factors. Nomograms were constructed to predict 1-year, 3-year and 5-year disease-free survival (DFS) and overall survival (OS). In addition, we further evaluated the effect of postoperative adjuvant therapy on SMPESCs patients with lymph node metastasis. RESULTS: In univariate and multivariate analyses of DFS and OS, age, site of the main lesion, lymph node metastasis, total number of lymph nodes dissected, lactate dehydrogenase level and lymphocyte-to-monocyte ratio were identified as independent prognostic factors. These characteristics were further included to establish nomograms. For the internal validation of the nomogram predictions of survival outcomes, the concordance indices were 0.752 and 0.756, respectively. Decision curve analysis also proved the efficacy of the nomograms. Furthermore, adjuvant therapy had a statistically significant benefit for OS but not DFS in patients with lymph node metastasis. CONCLUSIONS: These nomograms could effectively predict the 1-year, 3-year and 5-year survival outcomes of patients with SMPESCs. Furthermore, adjuvant therapy has the potential to improve OS in patients with lymph node metastasis.	esophagus
Radiation source detection for the accurate location of lymph node metastases using robotic forceps-type coincidence radiation detector.	PURPOSE: We have developed a forceps-type coincidence radiation detector for supporting lymph node dissection in esophageal cancer treatment. For precise detecting, this study aims to measure the 2D point-spread function of the detector at three difference tip angles, to devise a method to determine the position of a point source using the 2D point-spread function. METHOD: The 2D sensitivity distribution on the surface of the detector was investigated to assess sensitivity variation caused by differences in the relative positions of the detector and radiation source. Based on the results, we identified the peak sensitivity value and proposed a detection method using this value. We evaluated the effectiveness of the proposed method by detecting radiation source location using this simulated distribution. RESULT: From the radiation sensitivity distribution measurements, we observed a gradual decrease in radiation detection sensitivity from the center toward the edges of the detector surface. Additionally, we verified that the peak sensitivity value was attainable. Through the basic verification of the detection method, we confirmed that the radiation source location could be detected within a maximum error of 1.4 mm. CONCLUSION: We developed a peak value search method aimed at mitigating sensitivity variations by leveraging the sensitivity distribution across the detector surface. The proposed device is thought to be able to quantitatively evaluate the desired target assuming that the field of view could be limited to the area clamped by the detector. As a next research step, more precise search methods should be verified in an environment resembling the one of the target clinical uses.	esophagus
[Neoadjuvant chemoradiotherapy versus neoadjuvant chemo-immunotherapy for locally advanced esophageal squamous cell carcinoma].	Objective: To compare the clinical efficacy of neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemo-immunotherapy (nCIT) for locally advanced esophageal squamous cell carcinoma (ESCC). Methods: Clinical data of patients who received nCRT or nCIT followed by esophagectomy for locally advanced ESCC between January 2010 and December 2022 were retrospectively collected from Zhejiang Cancer Hospital, with 155 patients in the nCRT group and 470 patients in the nCIT group. Propensity score matching (PSM) was performed in the two groups. After PSM, 120 patients were allocated to the nCRT group and 192 patients to the nCIT group. The pathological response and disease recurrence were compared between the two groups after PSM. Log rank test were used to compare the survival outcomes before and after PSM. Univariate and multivariate Cox regression analyses were performed to identify the prognostic factors for locally advanced ESCC. Results: After PSM, the R0 resection rate in the nCRT group and the nCIT group was 93.3% (112/120) and 93.8% (180/192), respectively, with no statistical significance (P=0.884). However, the pathological complete response rate in the nCRT group [36.7% (44/120)] was higher than that in the nCIT group [21.4% (41/192), P=0.003]. For patients with R0 resection, the major recurrence pattern was distant metastasis [18.8% (21/112)] in the nCRT group, while the pattern was locoregional recurrence [12.2% (22/180)] in the nCIT group. The 3-year disease-free survival rates were 52.7% and 66.1% (P=0.022) and the 3-year overall survival rates were 59.2% and 75.5% (P=0.002) in the nCRT and nCIT groups, respectively. Multivariate Cox regression analysis also revealed that the neoadjuvant therapy mode was an independent prognostic factor for patients with locally advanced ESCC. Compared with nCRT, nCIT could significantly prolong disease-free survival (HR=0.58, 95% CI: 0.40-0.86) and overall survival (HR=0.53, 95% CI: 0.35-0.79). Conclusion: These results suggest that nCIT could significantly improve disease-free survival rate and overall survival rate over nCRT in locally advanced ESCC, even with lower pathological complete response rate.	esophagus
Validation of the Node Reporting and Data System (Node-RADS) for standardized CT evaluation of regional lymph nodes in esophageal squamous cell carcinoma patients.	OBJECTIVES: The accurate identification of positive lymph nodes in esophageal squamous cell carcinoma (ESCC) influences patient risk assessment and treatment decisions, but there is no standardized approach for radiological evaluation. The aim of this study was to verify the diagnostic performance of the new Node Reporting and Data System 1.0 (Node-RADS) in the assessment of lymph node metastasis in patients with ESCC, as verified by final histopathology. METHODS: Node-RADS is a scoring system composed of different criteria for evaluating lymph node metastasis, with scores ranging from 1 to 5, corresponding to the degree of suspicion of lymph node involvement. In this single-center study, Node-RADS was used to retrospectively evaluate regional lymph nodes in 173 ESCC patients who underwent computed tomography (CT) before radical resection. In addition, the area under the ROC curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the Node-RADS score and individual criteria. RESULTS: Node-RADS outperformed the individual assessment criteria (AUC: 94.3%, sensitivity: 96.5%, specificity: 92.0%), with scores ≥ 3 indicating the maximum diagnostic effectiveness. The diagnostic efficiency of the highest Node-RADS score surpassed that of the short axis score (AUC: 94.3% vs. 81.9%, p < 0.001). Our results indicated that the best diagnostic cut-off points for the short axis, long axis and short axis/long axis ratio were 9 mm, 11 mm, and 0.74, respectively. CONCLUSION: Node-RADS has emerged as a practical, repetitive method for the early identification of high-risk metastatic lymph nodes, providing therapeutic guidance and predicting disease prognosis in ESCC patients. KEY POINTS: Question How does the Node Reporting and Data System 1.0 (Node-RADS) perform in the assessment of lymph node metastasis in patients with esophageal squamous cell carcinoma (ESCC)? Findings The maximum diagnostic efficiency was achieved with a Node-RADS score of ≥ 3. Clinical relevance The Node-RADS has improved diagnostic efficiency for distinguishing lymph node metastasis in patients with ESCC.	esophagus
Differences in Gender and Overall Survival for Temperature-Sensitive TP53 Mutations in Gastroesophageal Cancer.	Background and Objectives: Temperature-sensitive (TS) mutants of TP53 are thermally unstable, unfolded, and inactive at body temperature but can be refolded and reactivated at sub-physiological temperatures. TS TP53 may be amenable for functional rescue by hypothermia or structure-stabilizing drugs, and may retain low-level transcriptional activity at 37 °C. TP53 mutations are observed in 47% of all esophageal cancers (ECs) and 25% to 40% of gastric cancers (GCs). We aimed to investigate the trends and outcomes of EC and GC with TS TP53 mutations using cBioportal. We hypothesize that TS TP53 mutants in EC and GC present a unique prognostic profile distinct from non-TS TP53 mutants, potentially affecting overall survival and cancer progression. Materials and Methods: We identified 1924 patients from cBioportal with GC or EC, harboring any TP53 mutation. Patients were then stratified based on the TP53 temperature sensitivity according to a recently reported functional analysis of its activity. Patients were also stratified based on a history of Barrett's esophagus (BE), cancer stage, sex, and race. We then compared populations (TS vs. non-TS TP53) to assess differences and evaluated survival outcomes. Results: Males represented 77% of the cohort, and 51.6% of the samples were from patients with stage IV cancer. No association was found between TS vs. non-TS mutational status and BE, cancer stage, or race. Interestingly, a significantly higher proportion of females (22.9%) than males (14.5%) displayed a TS TP53 mutation (p = 0.012). No significant difference was seen in overall survival between the TS and non-TS mutations capable of ≥50% growth suppression at 32 °C (median = 33 vs. 28 months, p = 0.36). This trend was also observed when the patients were filtered based on cancer location. The median survival for EC was 32.5 months compared to 33 months (p = 0.67). In cases of GC, median survival times could not be determined due to the insufficient number of events. Conclusions: Although no statistical significance was observed, a decrease in overall survival for patients with TS TP53 mutations was noted. The result is counterintuitive given that TS mutants have less severe structural destabilization and suggests TS TP53 mutations may have a unique prognostic value that warrants further investigation.	esophagus
Tislelizumab for consolidation therapy in patients with pathologically residual Esophageal Squamous Cell Carcinoma after definitive concurrent Chemoradiotherapy: a multicenter, randomized, controlled phase II trial.	Although concurrent Chemoradiotherapy (cCRT) is presently the standard intervention for patients with inoperable, locally advanced Esophageal Squamous Cell Carcinoma (ESCC), it has been associated with poor long-term survival outcomes. Notably, Immune Checkpoint Inhibitors (ICIs) improve the long-term survival of Esophageal Cancer (EC) patients, with manageable Adverse Effects (AEs). Herein, 90 patients with residual pathology after radical simultaneous Radiotherapy (RT) for inoperable/refused-to-operate ESCC were enrolled and randomized into two treatment groups (Chemotherapy+immunotherapy and chemotherapy alone) in a 2:1 ratio. This study will also discuss the value of immunotherapy in improving long-term survival outcomes in patients with pathological residuals after concurrent RT for locally advanced, inoperable ESCC.Clinical trial registration: http://www.chictr.org.cn/identifier is ChiCTR2200063345.	esophagus
Value of Computed Tomography Scan for Detecting Lymph Node Metastasis in Early Esophageal Squamous Cell Carcinoma.	BACKGROUND: The necessity of computed tomography (CT) scan for detecting potential lymph node metastasis (LNM) in early esophageal squamous cell carcinoma (ESCC) before endoscopic and surgical treatments is under debate. METHODS: Patients with histologically proven ESCC limited to the mucosa or submucosa were examined retrospectively. Diagnostic performance of CT for detecting LNM was analyzed by comparing original CT reports with pathology reports. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS: A total of 625 patients from three tertiary referral hospitals were included. The rate of pathologically confirmed LNM was 12.5%. Based on original CT reports, the sensitivity, specificity, accuracy, PPV, and NPV of CT to determine LNM in T1 ESCC were 41.0%, 83.2%, 77.9%, 25.8%, and 90.8% respectively. For mucosal cancers (T1a), these parameters were 50.0%, 81.7%, 80.9%, 6.8%, and 98.4%, respectively. For submucosal cancers (T1b), they were 40.0%, 85.0%, 75.0%, 43.0%, and 83.3%, respectively. Additionally, the diagnostic performance of CT for LNM was relatively better for ESCC in the lower esophagus. Pathologically, 69.2% of patients with LNM did not exhibit lymphovascular invasion (LVI), and the sensitivity of CT for recognizing LNM in these patients (33.3%) was lower than those with LVI (58.3%). CONCLUSIONS: Computed tomography can detect nearly half of the LNM cases in early ESCC with high specificity. The performance of CT further improved in LNM cases with LVI. Therefore, we conclude that routine preoperative CT for the assessment of potential LNM risk in patients with early ESCC is necessary.	esophagus
Entirely Intramural Growth Pattern: A Rare Presentation of Esophageal Squamous Cell Carcinoma and Review of the Literature.	Esophageal squamous cell carcinoma (ESCC) is a malignant tumor originating from the squamous epithelium. In contrast, esophageal submucosal tumors are common benign lesions arising from mesenchymal tissues. To date, an entirely intramural growth of ESCC is very rare. This study described a case of an esophageal submucosal tumor resected by endoscopic submucosal dissection (ESD) that was finally diagnosed as ESCC.A 51-year-old woman presented with progressive dysphagia and was provisionally diagnosed with esophageal leiomyoma by further diagnostic modalities. The patient did not have any obvious suspicious malignant features and underwent ESD. However, the histopathology of the resected specimen was reported as poorly differentiated infiltrating squamous cell carcinoma with normal overlying squamous epithelium. Consequently, the patient received additional chemoradiotherapy, and no recurrence was observed during the 2-year follow-up.A comprehensive literature search related to ESCC with entirely intramural growth was performed in PubMed and Embase from their inception up to November 2023, and 12 articles including 13 cases were finally included in the literature review. Subsequently, we extracted information about these cases.It is concluded that ESCC may masquerade as a submucosal tumor with a complete submucosal growth pattern and is easily misdiagnosed because endoscopic biopsy and iodine staining are always negative. Therefore, if a patient with a submucosal tumor has dysphagia or weight loss in the short term, clinicians should be alert to the possibility of ESCC with a complete submucosal growth pattern. Endoscopic ultrasonography (EUS), chest computed tomography (CT), or positron emission tomography-computed tomography (PET-CT) may help assist in the diagnosis, and EUS-guided fine-needle aspiration (EUS-FNA) could be used to confirm the diagnosis.	esophagus
Induction chemotherapy plus chemoradiotherapy in esophageal cancer: long-term results and exploratory analyses of a randomized controlled trial.	BACKGROUND: Previous results of our trial demonstrated that the addition of induction chemotherapy (IC) prior to definitive chemoradiotherapy (CRT) failed to significantly improve the response rate or 3-year survival in patients with locally advanced esophageal squamous cell carcinoma (ESCC). Here, we report long-term results and exploratory analyses to further evaluate the therapeutic value of IC. METHODS: Patients with previously untreated, unresectable, stage II-IVA ESCC were randomly assigned to receive IC followed by CRT or CRT alone. The relationship between tumor response to IC and long-term survival was analyzed. Baseline tumor biopsies were collected for RNA-Seq to identify patients who may benefit from IC. RESULTS: Eligible patients were randomized to either the IC + CRT group (n = 55) or the CRT group (n = 55). With a median follow-up of 74.9 months, the 5-year overall survival rate was 31.8% in the IC + CRT group and 29.1% in the CRT group (P =.675; HR, 0.91; 95% CI, 0.58-1.43). Similarly, no significant differences were identified in 5-year progression-free survival between groups (30.5% vs 25.5%, P =.508; HR, 0.86; 95% CI, 0.56-1.34). Patients who responded to IC had significantly better survival than nonresponders. A risk-score model incorporating 6 key genes to predict IC efficacy was also constructed. CONCLUSIONS: Compared with definitive CRT alone, the addition of IC before CRT still failed to demonstrate superior survival in patients with unselected ESCC, based on long-term follow-up. However, because IC responders were associated with more favorable survival, potential molecular biomarkers were identified for selection of benefit population from IC. CLINICAL TRIALS REGISTRATION: NCT02403531.	esophagus
[Hiatal hernia after esophagectomy].	OBJECTIVE: To analyze the causes and surgical treatment of hiatal hernia after esophagectomy, technical features of surgery and methods of prevention. MATERIAL AND METHODS: We retrospectively analyzed the incidence of postoperative hiatal hernias after esophagectomy in patients with esophageal cancer between 2018 and 2023. Structure of hernias, surgical options and postoperative results were assessed. RESULTS: We analyzed 161 patients after Ivor Lewis (n=101) and McKeown (n=60) esophagectomies (open surge surgeries - 43.5%, thoraco- and laparoscopic procedures - 23%, hybrid procedures - 33.5%). The incidence of postoperative hiatal hernia was 3.7%. Hernia occurred within 1-15 months. There were 5 men and 1 woman (mean age 65 years). In all cases, partial or complete dissection of the left diaphragmatic crura was performed. The incidence of hernia after minimally invasive surgery was 4.4%, after open surgery - 2.9%. Two (33.3%) patients underwent urgent surgery for ileus within 2 months after primary esophageal surgery. Three (50%) patients underwent elective surgery. One (16.6%) patient is currently followed-up. The complication was asymptomatic in 2 (33.3%) patients. One (16.6%) patient died after emergency surgery in a COVID hospital due to strangulated hernia and progressive respiratory failure. Mean follow-up period was 16 months. No recurrent hernias were diagnosed. CONCLUSION: Hiatal hernias occur 2 times more often after minimally invasive esophagectomies. Active surgical strategy is necessary for symptomatic hernias due to high risk of strangulation and emergency interventions. The incidence of this complication is lower without wide diaphragmotomy, transection of the left diaphragmatic crus and high abdominal pressure during laparoscopic stage.	esophagus