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World J Gastrointest Oncol. Nov 15, 2026; 18(11): 122992
Published online Nov 15, 2026. doi: 10.4251/wjgo.122992
Published online Nov 15, 2026. doi: 10.4251/wjgo.122992
Direct gastric invasion is associated with poor prognosis in esophageal squamous cell carcinoma involving the lower-third esophagus
Yao-Kuang Wang, Chun-Sheng Shen, Fang-Jung Yu, Yi-Hsun Chen, Wei-Chung Chen, I-Chen Wu, Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan
Yao-Kuang Wang, Fang-Jung Yu, I-Chen Wu, Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
Yao-Kuang Wang, Yi-Hsun Chen, Jui Ying Lee, Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
Yao-Kuang Wang, Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
Jui Ying Lee, Division of Chest Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan
Ming-Tsang Wu, Program in Environmental and Occupational Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
Ming-Tsang Wu, Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan
I-Chen Wu, Biomedical Artificial Intelligence Academy, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
Co-corresponding authors: Ming-Tsang Wu and I-Chen Wu.
Author contributions: Wang YK, Wu IC, and Wu MT conceived the study, conducted the literature review, and drafted the manuscript; Wu MT was responsible for statistical analysis, data interpretation, and manuscript revision; Wang YK, Shen CS, Yu FJ, Chen YH, Chen WC, Lee JY, and Wu IC participated in patient recruitment, acquisition of clinical data, and data collection; all authors reviewed and approved the final manuscript. Wu IC and Wu MT are designated as co-corresponding authors because they jointly provided scientific leadership and oversight throughout the study. Wu IC contributed to the study’s conception, literature review, manuscript preparation, study design, and interpretation of the findings, while Wu MT contributed to the study’s conception, statistical analysis, data interpretation, critical revision of the manuscript, and overall scientific supervision. Both authors were actively involved in the development of the research framework, interpretation of the results, and decision-making during manuscript preparation and revision. We would like to designate two co-corresponding authors because they provided complementary expertise that was essential to the successful completion of this study. One author was primarily responsible for the statistical design, data analysis, and interpretation of the study results, ensuring the scientific rigor and validity of the findings. The other author led the clinical aspects of the study, including study conception, patient management, clinical data collection, and interpretation of the clinical significance of the results. Both authors were actively involved in manuscript preparation, critical revision, and final approval of the submitted version.
AI contribution statement: The authors take full responsibility and accountability for all content of this manuscript. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.
Supported by Taiwan’s Ministry of Science and Technology, No. MOST 110-2314-B-037-099; National Science and Technology Council, No. NTSC 113-2221-E037-005-MY2; Kaohsiung Medical University Hospital, No. KMUH114-4R02 and No. KMUH-DK(C)-114008; and Kaohsiung Medical University, No. KMU-TC114A205-1.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki. This study was approved by the appropriate ethics review board of the Kaohsiung Medical University Hospital, No. UHIRB-E(II)-20220189.
Informed consent statement: This study is retrospective in nature and was conducted using de-identified data. Therefore, informed consent from individual patients was waived by the ethics review board of the Kaohsiung Medical University Hospital.
Conflict-of-interest statement: The authors declare no competing interests.
Data sharing statement: The dataset supporting the conclusions of this article is included within the article.
Corresponding author: I-Chen Wu, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100 Tzyou 1st Road, Kaohsiung 807377, Taiwan. minicawu@gmail.com
Received: May 9, 2026
Revised: June 15, 2026
Accepted: July 15, 2026
Published online: November 15, 2026
Processing time: 171 Days and 12.6 Hours
Revised: June 15, 2026
Accepted: July 15, 2026
Published online: November 15, 2026
Processing time: 171 Days and 12.6 Hours
Core Tip
Core Tip: Direct gastric invasion is a rare but clinically important manifestation of esophageal squamous cell carcinoma (ESCC). In our cohort, patients with direct gastric invasion of ESCC typically presented with advanced-stage disease and experienced significantly poorer survival than those without gastric invasion. Although patients treated with chemoradiotherapy followed by surgery demonstrated longer survival, this finding should be interpreted cautiously because of the small sample size and potential treatment selection bias. Overall, our results suggest that direct gastric invasion may serve as a marker of poor prognosis and warrants further investigation in larger prospective studies.