crossing96/oncoscreening huggingface dataset:
Polymeric micellar paclitaxel, cisplatin, and tislelizumab as first-line therapy for advanced unresectable esophageal squamous cell carcinoma: A phase II study with resistance profiling in poor responders.	OBJECTIVE: To evaluate the efficacy and safety of polymeric micellar paclitaxel (Pm-Pac), cisplatin, and tislelizumab as first-line therapy for advanced/metastatic esophageal squamous cell carcinoma (ESCC), addressing limitations of conventional paclitaxel regimens related to steroid-induced immunosuppression. METHODS: This phase II clinical trial enrolled 27 treatment-naïve patients with stage IV ESCC. The regimen consisted of Pm-Pac (230 mg/m²), cisplatin (70 mg/m²), and tislelizumab (200 mg) administered on day 1 of 21-day cycles. After two induction cycles, non-progressive patients received two additional cycles, followed by 12-month tislelizumab maintenance. PRIMARY ENDPOINT: objective response rate (ORR); secondary endpoints: progression-free survival (PFS), overall survival (OS), disease control rate (DCR), and safety. Exploratory analyses included blood counts, tumor markers, lymphocyte subsets, survival analysis, Kruskal-Wallis tests, clustering, and LASSO regression. RESULTS: The regimen achieved an ORR of 62.96 % (95 % CI: 0.45-0.81) with complete response (CR) in 7.4 % and partial response (PR) in 55.6 % of patients. Median PFS was 10.2 months, with 1-year OS probability of 81.48 %. Treatment was well-tolerated without grade ≥ 3 treatment-related adverse events or deaths. Exploratory predictive analyses suggested potential correlations between outcomes and hyperkalemia, CD4 +CD25 + T cells, lung metastases, and distant lymph node metastases. CONCLUSIONS: The Pm-Pac-based chemoimmunotherapy suggests encouraging efficacy and favorable safety in advanced ESCC, supporting its potential as a first-line steroid-free option. These findings highlight the role of nanotechnology in optimizing chemoimmunotherapy.	esophagus
A multidimensional deep ensemble learning model predicts pathological response and outcomes in esophageal squamous cell carcinoma treated with neoadjuvant chemoradiotherapy from pretreatment CT imaging: A multicenter study.	PURPOSE: Neoadjuvant chemoradiotherapy (nCRT) followed by esophagectomy remains standard for locally advanced esophageal squamous cell carcinoma (ESCC). However, accurately predicting pathological complete response (pCR) and treatment outcomes remains challenging. This study aimed to develop and validate a multidimensional deep ensemble learning model (DELRN) using pretreatment CT imaging to predict pCR and stratify prognostic risk in ESCC patients undergoing nCRT. METHODS: In this multicenter, retrospective cohort study, 485 ESCC patients were enrolled from four hospitals (May 2009-August 2023, December 2017-September 2021, May 2014-September 2019, and March 2013-July 2019). Patients were divided into a discovery cohort (n = 194), an internal cohort (n = 49), and three external validation cohorts (n = 242). A multidimensional deep ensemble learning model (DELRN) integrating radiomics and 3D convolutional neural networks was developed based on pretreatment CT images to predict pCR and clinical outcomes. The model's performance was evaluated by discrimination, calibration, and clinical utility. Kaplan-Meier analysis assessed overall survival (OS) and disease-free survival (DFS) at two follow-up centers. RESULTS: The DELRN model demonstrated robust predictive performance for pCR across the discovery, internal, and external validation cohorts, with area under the curve (AUC) values of 0.943 (95 % CI: 0.912-0.973), 0.796 (95 % CI: 0.661-0.930), 0.767 (95 % CI: 0.646-0.887), 0.829 (95 % CI: 0.715-0.942), and 0.782 (95 % CI: 0.664-0.900), respectively, surpassing single-domain radiomics or deep learning models. DELRN effectively stratified patients into high-risk and low-risk groups for OS (log-rank P = 0.018 and 0.0053) and DFS (log-rank P = 0.00042 and 0.035). Multivariate analysis confirmed DELRN as an independent prognostic factor for OS and DFS. CONCLUSION: The DELRN model demonstrated promising clinical potential as an effective, non-invasive tool for predicting nCRT response and treatment outcome in ESCC patients, enabling personalized treatment strategies and improving clinical decision-making with future prospective multicenter validation.	esophagus
Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection in Barrett's Esophagus.	Early detection of neoplastic lesions in Barrett's esophagus is essential for curative treatment. Endoscopic resection (ER) is effective for the treatment of these lesions and enables accurate histologic diagnosis. Most used ER techniques include band-assisted endoscopic mucosal resection (multiband mucosectomy [MBM]) and endoscopic submucosal dissection (ESD). MBM allows for quick removal of lesions less than 20 mm. ESD is a more challenging technique and enables en-bloc resection of larger, deeper invading lesions. Both have similar safety and efficacy outcomes. While we await data of prospective studies, the choice should be individualized based on lesion characteristics, patient factors, and endoscopist expertise.	esophagus
Predicting pathological complete response to chemoradiotherapy using artificial intelligence-based magnetic resonance imaging radiomics in esophageal squamous cell carcinoma.	BACKGROUND: Advanced esophageal squamous cell carcinoma (ESCC) has an extremely poor prognosis. Preoperative chemoradiotherapy (CRT) can significantly prolong survival, especially in those who achieve pathological complete response (pCR). However, the pretherapeutic prediction of pCR remains challenging. AIM: To predict pCR and survival in ESCC patients undergoing CRT using an artificial intelligence (AI)-based diffusion-weighted magnetic resonance imaging (DWI-MRI) radiomics model. METHODS: We retrospectively analyzed 70 patients with ESCC who underwent curative surgery following CRT. For each patient, pre-treatment tumors were semi-automatically segmented in three dimensions from DWI-MRI images (b = 0, 1000 second/mm²), and a total of 76 radiomics features were extracted from each segmented tumor. Using these features as explanatory variables and pCR as the objective variable, machine learning models for predicting pCR were developed using AutoGluon, an automated machine learning library, and validated by stratified double cross-validation. RESULTS: pCR was achieved in 15 patients (21.4%). Apparent diffusion coefficient skewness demonstrated the highest predictive performance [area under the curve (AUC) = 0.77]. Gray-level co-occurrence matrix (GLCM) entropy (b = 1000 second/mm²) was an independent prognostic factor for relapse-free survival (RFS) (hazard ratio = 0.32, P = 0.009). In Kaplan-Meier analysis, patients with high GLCM entropy showed significantly better RFS (P < 0.001, log-rank). The best-performing machine learning model achieved an AUC of 0.85. The predicted pCR-positive group showed significantly better RFS than the predicted pCR-negative group (P = 0.007, log-rank). CONCLUSION: AI-based radiomics analysis of DWI-MRI images in ESCC has the potential to accurately predict the effect of CRT before treatment and contribute to constructing optimal treatment strategies.	esophagus
Exploring the Diagnostic and Predictive Value of Oral Microbiome in Esophageal Cancer: A Systematic Review and Meta-Analysis.	The research interest in the oral microbiome's role in esophageal cancer is growing, yet a comprehensive synthesis of available evidence is still lacking. This study aimed to explore the effects of oral microbiome on the development of esophageal cancer through a systematic review of existing literature retrieved from the Embase, PubMed, and Web of Science databases. Eighteen studies published between 2015 and 2024 were obtained, involving 1191 cases and 1403 controls, mostly using oral saliva samples and 16S rRNA gene sequencing. Findings on alpha-diversity were inconsistent, while most studies reported significant beta-diversity differences between cases and controls. Notably, several investigations on esophageal squamous cell carcinoma showed higher levels of Prevotella, Porphyromonas, and Fusobacterium, while two studies on esophageal adenocarcinoma reported elevated levels of Actinomyces species. A fixed-effect meta-analysis of two studies showed that individuals with specific oral microbial signatures had significantly higher odds of developing esophageal squamous cell carcinoma (OR = 9.50; 95% CI: 5.89-15.29). Quality assessments highlighted methodological strengths but noted variability in group comparability and local applicability. These results reveal the potential of oral microbiome shift as an early detection biomarker and for developing personalized strategies in treating esophageal cancer, meriting further clinical investigation.	esophagus
"Consensus Meeting on the ""Anatomy on the Border"": Systematic Thoracic Lymph Node Dissection Procedures for Lung and Esophageal Cancer."	BACKGROUND: This study aimed to explore the commonalities and differences in systematic lymph node dissection between lung and esophageal cancer surgeries. METHODS: A survey comprising 11 questions related to systematic lymph node dissection techniques for both lung and esophageal cancer was conducted across 265 facilities specializing in thoracic and esophageal surgeries. Additionally, a comprehensive search was performed using the MEDLINE database. RESULTS: Responses were received from 63 facilities specializing in thoracic surgery and 79 facilities specializing in esophageal surgery. Many facilities chose minimally invasive surgery for lung and esophageal cancer. Most thoracic and esophageal surgeons paid attention to the concepts of visceral and vascular sheaths. The results of the survey and literature review revealed the key anatomical structures that define the area of mediastinal lymph node dissection. CONCLUSION: This survey and the literature review have clarified the current consensus among thoracic and esophageal surgeons regarding systematic mediastinal lymph node dissection.	esophagus
Impact of lymph node dissection on survival after neoadjuvant immunochemotherapy for esophageal squamous cell cancer: a double-center real-world retrospective study.	BACKGROUND: Previous studies indicated that over-dissection of lymph nodes might impair the efficacy of immunotherapy. This study aims to explore the prognostic value of ypN + status and the impact of lymph node dissection (LND) on survival after neoadjuvant immunochemotherapy (NICT) for esophageal squamous cell cancer (ESCC). METHODS: This double-center retrospective study enrolled 206 consecutive ESCC patients who underwent NICT followed by esophagectomy between 2018 and 2024. Overall survival (OS) and disease-free survival (DFS) were compared based on ypN/ypT status and LND count. Cutoff values for LND were determined by restricted cubic spline (RCS) analysis based on Cox regression models. RESULTS: ypN + status was significantly associated with worse OS (3-year OS: 69.3% vs. 92.8%, p = 0.0063) and DFS (3-year DFS: 52.4% vs. 85.3%, p < 0.001) compared to ypN0. Multivariate Cox analysis confirmed ypN status (ypN2: OS HR = 8.510, p < 0.001; DFS HR = 8.162, p < 0.001. ypN3 DFS HR = 18.82, p = 0.001) as a stronger independent prognostic factor than ypT status. RCS curves identified the cutoff values of 32 and 48 for LND. Patients with 32 < LND ≤ 48 had the best OS and DFS. LND > 48 was associated with significantly worse OS (p = 0.033) and DFS (p = 0.025) compared to 32 < LND ≤ 48. Although not statistically significant, the LND > 48 group had higher rates of total complications (52.3% vs. 42.6%; p = 0.330). CONCLUSIONS: ypN status is a more powerful prognostic factor than ypT status in ESCC patients treated with NICT and surgery. LND exceeding 48 nodes is associated with diminished survival. An optimal LND range of 32 to 48 nodes is recommended to balance accurate staging, therapeutic benefit, and preservation of immune function.	esophagus
Critical insights on real-life PD-L1 histopathological workflow and assessment in esophageal, esophagogastric junction, and gastric carcinoma in Italy.	BACKGROUND: Immune checkpoint inhibitors (ICIs) targeting programmed cell death protein 1/programmed death-ligand 1 (PD-1/PD-L1) have improved survival in locally advanced and metastatic esophageal, esophagogastric junction, and gastric carcinoma (GEC). Patient selection for ICI-treatment relies on PD-L1 protein expression assessment via immunohistochemistry (IHC). This study aimed to evaluate the real-world assessment of PD-L1 IHC results compared with clinical trial data. PATIENTS AND METHODS: This multicentric, real-world retrospective study analyzed PD-L1 IHC data from 28 Italian pathology centers of GEC cases diagnosed between October 2023 and September 2024. The study documented PD-L1 expression distribution via combined positive (CPS), tumor proportion (TPS), and tumor area positivity (TAP) scores, and investigated the impact of several factors on IHC results. RESULTS: We collected 1936 cases: 1802 adenocarcinomas (ADCA), 131 squamous carcinomas (SCC), and 3 carcinomas of non-specific histotype. Most institutions reported CPS and TPS data, whereas a minority used TAP. Overall, CPS, TPS, and TAP scores were in line with the data in literature and clinical trials for both ADCA and SCC, but inter-institutional heterogeneity was observed as represented by CPS ≥1 ADCA cases (range among institutions: 43.6%-100%). Inter-institutional heterogeneity was significantly associated with several variables, including (i) PD-L1 IHC case workload, with lower workload centers reporting more CPS ≥1 cases on average, and (ii) PD-L1 clone, with the 22C3 clone showing higher CPS scores than the SP263 clone. Tissue block aging was also significantly associated with a lower PD-L1 score, with a critical time window at 24-60 months. CONCLUSIONS: This study confirms the alignment of GEC PD-L1 expression in Italian real-world practice with clinical trials. Inter-institutional variability and the significant influence of preanalytical factors, particularly tissue aging and PD-L1 clone, highlight important challenges in routine PD-L1 testing. Addressing these issues is crucial to enhance the reliability of PD-L1 IHC assessment and ensure optimal patient selection for ICIs in GEC.	esophagus
Current Concepts for Diagnosing Non-Dysplastic and Dysplastic Barrett's Esophagus.	Barrett's Esophagus (BE) is the precursor lesion of esophageal adenocarcinoma, which has a poor survival rate while having the fastest growing incidence of any cancer in the United States. Identifying patients with BE in the general population and optimizing surveillance programs to treat patients before the onset of adenocarcinoma are significant challenges. Clinical translation of advances in understanding BE pathogenesis and drivers of progression, along with improving pathologic diagnostic accuracy of precancerous lesions, holds promise to improve outcomes. This review highlights current concepts in BE-related surgical and molecular pathology and how these advances are being incorporated into daily clinical practice.	esophagus
Comparison of Pretreatment Strategies for cT2cN0 Staged Adenocarcinoma of the Esophagus and the Gastroesophageal Junction: A European High-Volume Center Cohort Analysis.	After the ESOPEC trial showed a survival benefit for fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT)-treated adenocarcinomas of the esophagus (EAC) and the gastroesophageal junction (GEJ) compared with Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS), a European, high-volume center study for stage cT2cN0 EAC and GEJ was undertaken, as it has been published that a third of these patients are understaged and could benefit from a multimodal approach PATIENTS AND METHODS: Retrospective analysis of prospective databases from ten high-volume European centers was performed. Inclusion criteria were GEJ Siewert type I/II or EAC with cT2cN0 status at diagnosis undergoing multimodal treatment with FLOT or CROSS. Primary endpoint was overall survival (OS) RESULTS: Between 2012 and 2023, 133 patients met the inclusion criteria, of whom 73 (54.9%) received CROSS and 60 (45.1%) underwent treatment with FLOT. In both groups, patients were mainly male (p = 0.08), older than 70 years (p = 0.24), and had American Society of Anesthesiologists (ASA) II classification (p = 0.45). Regarding surgical treatment, more patients underwent gastrectomy in the FLOT than in the CROSS cohort (23.3% versus 6.8%, p = 0.007). There were no differences regarding pT, pN, and pM category (p > 0.05). Median survival was not reached, while mean survival was 74.6 months (95% CI 60.5-88.7 months) for CROSS versus 100.8 months (95% CI 72.5-94.5 months, p = 0.028) for FLOT. The 3-year survival was 87% in the FLOT group versus 59% in the CROSS group. In multivariable analyses, FLOT was independent factor for survival (p < 0.001) CONCLUSIONS: For cT2cN0 staged EAC and GEJ type I /II patients FLOT chemotherapy showed a survival benefit and should be the preferred treatment in a multimodal approach.	esophagus
Transpacific multicenter collaborative study of minimally invasive proximal gastrectomy vs. minimally invasive total gastrectomy for proximal gastric and gastroesophageal junction cancers: 3-month follow-up results.	BACKGROUND: Total gastrectomy (TG) remains the standard surgical approach for proximal gastric and gastroesophageal junction (P/GEJ) cancers. However, experts increasingly perform proximal gastrectomy (PG) with anti-reflux reconstruction. The benefits of minimally invasive PG (MIPG) over minimally invasive TG (MITG), particularly regarding postoperative quality of life (QoL), remain unclear. METHODS: We conducted a transpacific, multicenter, nonrandomized, prospective cohort study to compare symptom burden outcomes (symptom occurrence, symptom severity, and daily functioning) between MIPG and MITG in patients with P/GEJ cancers. Symptom burden data was collected using the MD Anderson Symptom Inventory (MDASI-GI +). RESULTS: Among 71 patients with P/GEJ cancers enrolled from 2022 through 2024, 64 underwent either MITG (n = 26, 41%) or MIPG (n = 38, 59%). Thirty-nine (61%) patients were treated at Asian centers, and 25 (39%) patients were treated at U.S. CENTERS: Compared to the MIPG patients, the MITG patients had a larger mean tumor size (5.7 vs. 2.3 cm) and a higher prevalence of signet ring cell histology (50 vs. 18%). Operation times were comparable between the MITG and MIPG groups (median: 288.5 vs. 277.0 min), as were the rates of postoperative complications (19 vs. 24%), anastomotic leaks (0 vs. 3%), 90-day mortality (0 vs. 3%), and positive proximal margins (8 vs. 0%, all p > 0.05). QoL data (MDASI-GI +) were collected from at least 95% of patients at all time points. Key metrics related to QoL-appetite, reflux, total symptom burden, and functional interference-did not differ significantly between groups at 1 and 3 months postoperatively. A linear mixed-effects model showed that body-weight trajectories over time did not differ significantly between the MITG and MIPG groups, and there was no significant difference between their highest weight loss percentages within the first 3 months postoperatively. At postoperative month 3, hemoglobin, albumin, vitamin B12, and ghrelin levels were comparable between the groups. CONCLUSION: MIPG and MITG demonstrated equivalent short-term safety, and MIPG did not confer measurable QoL advantages, including in appetite, within 3 months after surgery. Longer-term follow-up is ongoing to evaluate potential delayed advantages. TRIAL REGISTRATION NUMBER: On January 11, 2022, this trial was registered with the Clinical Trials Reporting Program under the registration number NCI-2022-00267 and with ClinicalTrials.gov under the registration number NCT05205343.	esophagus
Pan-immune-inflammation value predicts survival of patients with oesophageal squamous cell carcinoma receiving immunotherapy and chemoradiotherapy: a pooled analysis of two phase II trials.	PURPOSE: To evaluate the prognostic role of pan-immune-inflammation value (PIV) in patients with oesophageal squamous cell carcinoma (ESCC) receiving chemoradiotherapy (CRT) combined with anti-programmed cell death 1 (PD-1) immunotherapy, and to explore the underlying mechanisms and dosimetric parameters that affect PIV zenith. METHODS: In this pooled analysis, 86 patients from two phase II trials who received toripalimab plus CRT were analysed. PIV was calculated as follows: (neutrophil count × platelet count × monocyte count)/lymphocyte count. The optimal cut-off value was determined using the receiver operating characteristic curve. Survival analysis was conducted using the Kaplan-Meier method and Cox regression models. Univariate and multivariable logistic regression analyses identified predictors of high PIV zenith. Pretreatment tumour samples from 46 patients were subjected to RNA and whole-exome sequencing (WES). Gene set enrichment analysis was performed on RNA sequencing (RNA-seq) data, and somatic mutations were assessed using WES to further explore molecular correlates. RESULTS: Significant changes in immuno-inflammatory biomarkers were observed during CRT, which gradually normalized post-radiotherapy. After a median follow-up of 35.5 months, patients with high PIV zenith during CRT exhibited significantly poorer progression-free survival (p = 0.007) and overall survival (p = 0.015). In multivariable analysis, high PIV zenith remained a significant prognostic indicator for survival. Mean lung dose (MLD) was identified as an independent predictor of high PIV zenith. Patients with high PIV zenith had decreased interferon α response, interferon γ response, transforming growth factor-β signalling and more frequent mutations in the Hippo pathway genes, resulting in pathway downregulation. CONCLUSIONS: High PIV zenith during CRT strongly predicts poorer survival outcomes in patients with ESCC treated with combined immunotherapy and CRT. These peaks are associated with higher MLD, reduced interferon α response, interferon γ response and increased prevalence of Hippo pathway mutations.	esophagus