crossing96/oncoscreening huggingface dataset:
Reliability of data-driven versus expert-driven composite indicators in between-hospital comparisons on quality of oesophagogastric cancer surgery: a population-based retrospective cohort study.	OBJECTIVE: To construct a data-driven composite from (a subset of) currently used quality indicators for oesophagogastric cancer surgery and to evaluate whether this approach enhances the reliability of between-hospital comparisons on outcome relative to the expert-driven composite indicator 'textbook outcome (TO)'. DESIGN: In this retrospective cohort study, we applied Item Response Theory (IRT) to construct a data-driven continuous composite indicator reflecting a single latent variable-the quality of surgical care-and estimated latent variable scores for all individual patients. Reliability was compared between the expert-driven (TO) and data-driven (IRT) composite indicators. SETTING: All Dutch hospitals providing oesophagogastric cancer surgery. PARTICIPANTS: All patients who underwent oesophagectomy (n=3588) or gastrectomy (n=1782) between 2018 and 2022 as registered in the Dutch Upper GI Cancer Audit (DUCA). PRIMARY AND SECONDARY OUTCOME MEASURES: We evaluated the reliability of between-hospital comparisons using 'rankability', which quantifies the proportion of observed variation in indicator scores between hospitals not attributable to chance. RESULTS: Seven out of 15 quality indicators were included in the IRT composite indicator. Most of the patients were assigned the artificial maximum of the continuous quality score (ie, ceiling effect), resulting in similar average hospital scores. Relative to TO, rankability increased when using the IRT composite for oesophagectomy (57% vs 41%) but declined for gastrectomy (38% vs 47%). CONCLUSIONS: The selected seven quality indicators for oesophageal and gastric cancer surgery represent a single latent variable but are not yet optimal for differentiating surgical care quality due to ceiling effects. Despite using fewer indicators, the continuous IRT score showed a promising increase in rankability for oesophagectomy, suggesting that data-driven composite indicators may enhance hospital benchmarking reliability.	esophagus
A modified double tract reconstruction with the NI method following proximal gastrectomy: a novel approach to prevent reflux and preserve nutritional status.	BACKGROUND: Double-tract reconstruction is commonly performed after proximal gastrectomy to prevent gastroesophageal reflux and ensure adequate nutrition. We developed a modified double-tract reconstruction intervention, denominated the NI method, in which the anastomosis between the remnant stomach and jejunum was strategically configured to optimize food passage and suppress gastroesophageal reflux. METHODS: This retrospective study included patients with upper-third gastric cancer and adenocarcinoma of the esophagogastric junction who underwent proximal gastrectomy with either conventional or NI-modified double-tract reconstruction at two institutions. Postoperative outcomes, including body weight loss and incidence of reflux esophagitis, were compared. RESULTS: In total, 115 patients underwent proximal gastrectomy with double-tract reconstruction, including 35 with the NI method and 110 using the conventional method. No significant differences were observed in the baseline characteristics between the two groups. The incidence of reflux esophagitis was significantly lower in the NI group (0% vs. 14.3%, P = 0.032). Although not statistically significant, the NI group showed consistently lower weight loss rates, with approximately 2% less reduction at both 6 and 12 months after surgery. CONCLUSIONS: The NI-modified double-tract reconstruction is a safe and function-preserving technique for proximal gastrectomy. The unique gastrojejunostomy design may contribute to reduce reflux and achieve better nutritional outcomes by restoring more physiological food passage.	esophagus
New quantitative blood flow assessment of gastric conduit with indocyanine green fluorescence in oesophagectomy: prospective cohort study.	BACKGROUND: Anastomotic leakage (AL) remains a critical complication following oesophagectomy, with inadequate perfusion of the conduit identified as a major contributing factor. Although indocyanine green (ICG) fluorescence angiography has been used intraoperatively to assess conduit blood flow, the clinical utility of objective ICG fluorescence indicators for anastomotic site determination has not been well established. This study investigated the association between ICG fluorescence intensity, measured using a new quantitative blood flow assessment technique, and the incidence of AL in patients undergoing gastric conduit reconstruction. METHODS: Prospective analysis of patients who underwent subtotal oesophagectomy with gastric conduit reconstruction between July 2023 and May 2024. Intraoperative real-time perfusion was assessed using the SPY-PHI imaging system in conjunction with SPY-QP software. Quantitative fluorescence intensity measurements were obtained at the terminal branch of the right gastroepiploic artery and the planned anastomotic site. RESULTS: Of 100 included patients, AL occurred in nine patients. Although there was no significant difference in ICG enhancement time between the AL and non-AL groups, fluorescence intensity at both the end of the right gastroepiploic artery (75 versus 101%; P = 0.004) and the anastomotic line (67 versus 90%; P = 0.009) was significantly lower in patients who developed AL. Multivariable analysis identified tumour location in the upper oesophagus and fluorescence intensity ≤ 90% at the anastomotic site as independent predictors of AL, with odds ratios of 6.99 (P = 0.023; 95% confidence interval (c.i.) 1.31 to 37.30) and 12.50 (P = 0.004; 95% c.i. 2.15 to 72.9), respectively. CONCLUSION: Quantitative ICG fluorescence intensity assessment facilitates objective intraoperative evaluation of gastric conduit perfusion and may support optimal anastomotic site selection, potentially reducing AL risk.	esophagus
Trajectories of postoperative nutritional risk changes in patients with oesophageal cancer and their relationship with symptom recovery-a multicentre longitudinal study.	PURPOSE: This study aimed to chart the trajectory of predicted postoperative nutritional risk in patients with oesophageal cancer and to explore further the impact of patients' postoperative symptom burden on the nutritional risk trajectory. METHOD: The nutritional risk of patients with oesophageal cancer was assessed using the geriatric nutritional risk index (GNRI), prognosis nutritional index (PNI), and lymphocyte count, and symptom burden was assessed using the Convalescent Symptom Assessment Scale for Oesophagectomy Patients. The trajectory of postoperative nutritional change in patients was depicted using unconditional free estimation Latent Growth Curve Model (LGCM), and factors influencing the trajectory of nutritional risk change and the effect of symptom burden on the trajectory of nutrition were explored using conditional LGCM. RESULTS: Postoperative nutritional risk of patients with oesophageal cancer generally declined 1-2 days after surgery. The GNRI declined by less than 10%, the PNI by more than 20%, and the change in lymphocyte counts dropped by more than 60%. Gender, residence, chronic diseases, healthcare payment methods, and chemotherapy were significant factors influencing patients' nutritional risk changes. Overall symptoms at 1-2 days postoperatively affect initial postoperative levels of PNI, overall and late symptoms affect initial postoperative levels of lymphocytes, while late and psychological symptoms affect the rate of lymphocyte recovery. CONCLUSION: Postoperative days 1-2 are a critical period for nutritional risk in patients with oesophageal cancer, when symptom burden affects the trajectory of changes in nutritional risk. Medical personnel can improve the nutritional risk of patients by reducing the symptom burden.	esophagus
Effect of electroacupuncture on postoperative gastrointestinal dysfunction in patients with perioperative oesophageal cancer: study protocol for a randomised controlled trial.	INTRODUCTION: Postoperative gastrointestinal dysfunction (PGD) is a common complication in patients with oesophageal cancer (OC). This complication is also a crucial factor affecting the prognosis of patients and increasing their medical burden. Gastrointestinal decompression and gastrointestinal motility-promoting oral drugs can partially relieve the symptoms, but some limitations of these treatment methods remain. Alternative therapies offer a new option for postoperative patients. This experiment will evaluate the safety and efficacy of electroacupuncture for PGD in patients with OC. METHODS AND ANALYSIS: From January 2024 to December 2025, 156 patients with perioperative EC will be recruited from three Grade-A tertiary hospitals in China. The participants will be randomly assigned to one of the three groups: electroacupuncture plus standard treatment group, sham electroacupuncture plus standard treatment group and standard treatment group at a 1:1:1 ratio (with the treatment conducted four sessions). The follow-up period is 30 days. The primary outcome indicator is the time of first defecation. The secondary outcome indicators are the time of first exhaust, quality of life after surgery, length of hospital stay after surgery, tolerance time for semiliquid and solid foods, time of first ambulation, I-FEED scores, demand for postoperative analgesics and defecation drugs, European Quality of Life-5 Dimensions-5 Levels scores, Hospital Anxiety and Depression Scale scores and changes in laboratory examination indicators. All adverse reactions will be recorded. ETHICS AND DISSEMINATION: This study has been approved by the ethics committee of the First Affiliated Hospital of Naval Medical University (No CHEC-2024-209). Written informed consent was obtained from all participants before the formal start of the clinical trial. The results of the clinical trial will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER: ITMCTR2024000118.	esophagus
Surgical workflow analysis for Surgomics and context-aware assistance in robot-assisted minimally invasive esophagectomy (RAMIE): a retrospective, single-arm, multicenter annotation and machine learning study.	INTRODUCTION: Robot-assisted minimally invasive esophagectomy (RAMIE) is a complex procedure that may benefit from workflow analysis for context-aware assistance and surgical data science. This study aimed to model the RAMIE workflow, validate the applicability of the obtained workflow model in the operating room (OR) and retrospectively assess its generalizability across three academic centers using video data and automated workflow analysis with machine learning (ML). METHODS: A RAMIE workflow model was developed based on currently available literature, participatory OR observation, and expert interviews. This model was formalized to be included into a checklist tool to document the workflow live in the OR. To investigate generalizability of the workflow model, the surgical phases of 36 RAMIE videos from three different academic hospitals were retrospectively annotated. Based on this data set, a ML model was trained and tested within a six-fold cross validation. RESULTS: Ten surgical phases with 60 underlying steps were identified for RAMIE. The applicability of the workflow model was validated with live documentation in the OR. Multicenter video annotations revealed significant inter-institutional differences in the duration of all ten RAMIE phases. The ML model for automatic phase recognition showed an accuracy of 0.872 ± 0.091 and an f1-score of 0.872 ± 0.082 over all videos. The center with the best performing videos achieved a mean accuracy of 0.919 ± 0.036. CONCLUSION: The RAMIE workflow was successfully modeled and validated in a retrospective multicenter setting. Despite high variability in phase duration between surgical centers, ML-based phase recognition achieved highly promising results.	esophagus
Analysis of the Yield of Intestinal Metaplasia Based on Biopsy Numbers and Follow-Up Endoscopy in a Large Series of Asian Patients With Barrett's Esophagus.	OBJECTIVES: Intestinal metaplasia (IM) is a premalignant lesion within the columnar-lined esophagus (CLE). The detection of IM stratifies the risk of cancer progression. We aim to investigate the random biopsy yield of IM in Asian patients with CLE. METHODS: A total of 117,526 consecutive esophagogastroduodenoscopies (EGDs) in the outpatient setting were retrospectively screened. The histopathological findings independently reviewed by two pathologists were correlated with the clinical and endoscopic features and the number of biopsies. RESULTS: Among 5963 EGDs, 3135 patients (5.1%) were diagnosed with CLE. A total of 4675 EGDs involving 8994 biopsies (median = 1, range 1-9) exhibited a 35.1% yield of IM per endoscopy. The yield of IM was higher in cases of long-segment CLE (74.8%) compared with short-segment (32.9%). IM detection was significantly associated with male gender (odds ratio, 95% confidence interval = 1.58, 1.37-1.83), chronological age (1.02, 1.02-1.03), longer segment CLE (1.75, 1.58-1.94), and number of biopsies per endoscopy (1.40, 1.32-1.49). One biopsy during each EGD resulted in a 26% IM yield, which was significantly lower than the yields after three biopsies (2.85, 2.25-3.62) and after following the Seattle protocol (2.86, 2.34-3.50). In 1772 patients without IM on index endoscopy, subsequent endoscopies increased the IM detection rate by 6%, with 4% attributed to the second endoscopy and 2% to the third through eighth endoscopy. CONCLUSIONS: This study provides insights into the number of biopsies needed to characterize IM in Barrett's esophagus. Further research is needed to optimize biopsy strategies, particularly in Asian countries.	esophagus
BGN Secreted by Cancer-Associated Fibroblasts Promotes Esophageal Squamous Cell Carcinoma Progression via Activation of TLR4-Mediated Erk and NF-κB Signaling Pathways.	Esophageal squamous cell carcinoma (ESCC) is associated with poor prognosis due to aggressive invasion and therapy resistance. Cancer-associated fibroblasts (CAFs) are key stromal components that promote tumor progression; however, their specific roles in ESCC remain unclear. Using a direct co-culture model of ESCC cell lines (TE-9, -10, and -15) and mesenchymal stem cells (MSCs) to generate CAF-like cells, we identified biglycan (BGN) as a significantly upregulated gene in CAF-like cells via cDNA microarray analysis. Public single-cell RNA sequencing data also demonstrated elevated BGN expression in CAF clusters. We confirmed that CAF-like cells exhibited elevated BGN expression and secretion at both the mRNA and protein levels. Recombinant human BGN enhanced ESCC cell proliferation and migration by activating Erk and NF-κB signaling pathways, effects abrogated by TLR4 blockade. Furthermore, BGN promoted CAF marker expression in MSCs, M2-like macrophage polarization, and enhanced proliferation and migration abilities in both cell types. Immunohistochemical analysis of 66 ESCC tissues revealed that high stromal BGN expression correlated with greater tumor invasion, lymphatic invasion, and shorter disease-free survival. These findings indicate that CAF-derived BGN promotes ESCC progression via TLR4-mediated signaling and modulates stromal cell behavior, highlighting its potential as a prognostic biomarker and therapeutic target.	esophagus
Predictive role of preoperative nutritional indicators for the risk of anastomotic leakage in patients with esophageal cancer undergoing esophagectomy: a meta-analysis.	PURPOSE: This study aimed to clarify the predictive significance of several preoperative nutritional indexes including the prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), modified Glasgow prognostic score (mGPS), and controlling nutritional status score for the occurrence of anastomotic leakage (AL) after esophagectomy among patients with esophageal cancer. METHODS: Several databases were searched up to September 28, 2024. Relative risks (RRs) with 95% CIs were combined, and subgroup analysis based on pathological type, type of surgery, and source of RR was performed. RESULTS: Thirteen retrospective studies with 3333 cases were included, and the incidence rate of AL was 9.12% (304 of 3333); 11, 3, and 1 studies explored the predictive role of PNI, GNRI, and mGPS for postoperative AL, respectively. Pooled results indicated that decreased preoperative PNI was related to a significantly increased risk of AL (RR, 2.90; 95% CI, 1.75-4.82; P <.001). Subgroup analysis stratified by the pathological type (squamous cell carcinoma), type of surgery (minimally invasive surgery), and source of RR (univariate and multivariate analysis) manifested similar results. However, no significant association of GNRI (RR, 1.37; 95% CI, 0.69-2.74; P =.368) or mGPS (RR, 1.41; 95% CI, 0.70-2.86; P =.345) with the risk of AL was observed. CONCLUSION: Preoperative PNI might serve as predictor for postoperative AL among patients undergoing esophageal cancer surgery.	esophagus
Development and Validation of an Online Nomogram Calculator to Predict Postoperative Pneumonia in Elderly Patients with Esophageal Cancer after Transthoracic Esophagectomy.	OBJECTIVES: Postoperative pneumonia after esophagectomy is common, which may seriously burden elderly patients and aggravate their postoperative conditions. We sought to create an online nomogram calculator to predict postoperative pneumonia in elderly patients with esophageal cancer after transthoracic esophagectomy. DESIGN: Multivariable prediction models. SETTING: The Chinese People's Liberation Army (PLA) General Hospital. PARTICIPANTS: Elderly patients (N = 607) underwent transthoracic esophagectomy between January 2012 and December 2019. INTERVENTIONS: Confirm the occurrence of postoperative pneumonia. MEASUREMENTS AND MAIN RESULTS: Univariable and multivariable logistic regression analyses were used to identify independent risk factors for postoperative pneumonia. A nomogram calculator was constructed according to the independent risk factors in the training cohort and then tested in the validation cohort. Multivariable logistic analysis showed that preoperative leukocyte count (p = 0.018), partial pressure of carbon dioxide (pCO(2)) (p = 0.024), tumor location (p = 0.038), and operative duration (p < 0.001) were independent risk factors for postoperative pneumonia. We then developed a nomogram calculator using these four factors. The C-statistics of this nomogram in the training, validation, and entire cohorts were 0.680, 0.655, and 0.669, respectively. Risk analysis and decision curve analysis revealed that the nomogram provided good diagnostic power and net benefit. CONCLUSION: We developed an online nomogram calculator that can predict the risk of postoperative pneumonia in elderly patients with esophageal cancer after transthoracic esophagectomy simply and conveniently.	esophagus
Identification of COL3A1, PLAU, and SPP1 as Key Biomarkers for Early Detection of Esophageal Cancer.	Esophageal cancer (EC) is a highly lethal malignancy often diagnosed at advanced stages due to the lack of effective early diagnostic markers. This study aimed to identify molecular markers and construct a diagnostic model for early-stage esophageal cancer using bioinformatics approaches. Using bioinformatics, we screened three GEO datasets, locating 506 differentially expressed genes crucial to cancer progression. Our results connect ECM-receptor interaction and cytoskeleton reorganization pathways to EC. Two core gene modules came up during the protein-protein interaction analysis. From the 22 hub genes singled out, COL3A1, PLAU, and SPP1 significantly impacted patient survival, showing considerable overexpression in cancer subjects. These genes' expression patterns changed across cancer stages. The main novelty of our study lies in integrating these three well-known ECM-associated genes into a machine learning-based diagnostic model with an AUC of 0.98, rather than focusing on individual genes. This combined model demonstrates high diagnostic accuracy, suggesting that COL3A1, PLAU, and SPP1 may serve as effective early-stage EC biomarkers. The diagnostic model based on these genes shows high accuracy, making it a promising tool for early-stage cancer screening.	esophagus
Uniportal thoracoscopic and single-incision plus one port laparoscopic esophagectomy with direct vision retrosternal reconstruction for esophageal cancer a single center retrospective cohort study.	INTRODUCTION: Despite being highly invasive, esophagectomy remains the mainstay of treatment for early- and intermediate-stage esophageal cancer. With the advancement of minimally invasive techniques, single-port thoraco-laparoscopic esophagectomy has been increasingly applied in clinical practice, offering advantages in terms of improved cosmetic outcomes, reduced postoperative pain, and enhanced recovery. However, the procedure is technically demanding. In addition, the traditional posterior mediastinal route for reconstruction is associated with a relatively high risk of complications, whereas reconstruction via the substernal route may significantly reduce cardiopulmonary morbidity. OBJECTIVE: To evaluate the short-term outcomes of uniportal thoracoscopic and single-incision plus one port laparoscopic minimally invasive esophagectomy combined with direct retrosternal approach for radical esophagectomy. METHODS AND ANALYSIS: The clinical data of 60 patients who underwent uniportal thoracoscopic and single-incision plus one port laparoscopic minimally invasive esophagectomy combined with direct retrosternal approach for radical esophagectomy between January 2024 and February 2025 were retrospectively analyzed. Perioperative indicators and postoperative follow-up data were recorded in detail. RESULTS: All surgeries were successfully completed with no conversion to open thoracotomy or laparotomy, and no perioperative deaths occurred. The mean operative time was 209.35 ± 28.57 min, the mean intraoperative blood loss was 64.17 ± 20.53 mL, and the mean number of lymph nodes dissected was 32.35 ± 11.51. The visual analog scale (VAS) scores for pain at postoperative were 2.20 ± 0.99. The average length of hospital stay was 7.92 ± 2.11 days. Ten patients developed postoperative complications, with a complication rate of 16.67%. CONCLUSION: Uniportal thoracoscopic and single-incision plus one port laparoscopic minimally invasive esophagectomy combined with direct retrosternal approach is a safe and feasible technique for esophageal cancer, with potential advantages in terms of cosmetic outcomes and reduced postoperative incisional pain.	esophagus