This study aimed to construct a novel model and validate its predictive power in non-esophageal squamous cell carcinoma (NESCC) patients.

This retrospective study included 151 patients between October 2006 and September 2016. The LASSO Cox and Random Survival Forest (RSF) models were developed with the help of hematological biomarkers and clinical characteristics. The concordance index (C-index) was used to assess the prognostic power of the LASSO Cox model, RSF model, and TNM staging. Based on the risk scores of the LASSO Cox and RSF models, we divided patients into low-risk and high-risk subgroups.

We constructed two models in NESCC patients according to LASSO Cox regression and RSF models. The RSF model reached a C-index of 0.841 (95% CI: 0.792-0.889) in the primary cohort and 0.880 (95% CI: 0.830-0.930) in the validation cohort, which was higher than the C-index of the LASSO Cox model 0.656 (95% CI: 0.580-0.732) and 0.632 (95% CI: 0.542-0.720) in the two cohorts. The integrated C/D area under the ROC curve (AUC) values for the LASSO Cox and RSF models were 0.701 and 0.861, respectively. In both two models, Kaplan-Meier survival analysis and the estimated restricted mean survival time (RMST) values indicated that the low-risk subgroup had a better prognostic outcome than the high-risk subgroup (p < 0.05).

The RSF model has better prediction power than the LASSO Cox and the TNM staging models. It has a guiding value for the choice of individualized treatment in patients with NESCC.

The purpose of this study was to investigate the safety and efficacy of left thoracic approach (LTA) and right thoracic approach (RTA) in patients with esophageal squamous cell carcinoma (ESCC) after neoadjuvant immunochemotherapy (NICT).

This study included 83 ESCC patients who underwent right transthoracic esophagectomy (n = 61) and left transthoracic esophagectomy (n = 22) after NICT in our hospital from October 2019 to September 2023. The data of these patients were retrospectively analyzed.

Compared with the LTA group, the RTA group had a longer operation time (245.6 ± 27.8 min vs. 356.5 ± 83.2 min, p < 0.001) and more lymph nodes were removed (21.0 ± 7.9 vs. 29.3 ± 10.8, p = 0.001). The 3-year disease free survival (DFS) of the LTA group and the RTA group were 61.0% and 65.7% (p = 0.861), and the 3-year overall survival (OS) were 60.7% and 77.4% (p = 0.753) respectively. There was no significant difference in prognosis between the two groups. Lymphovascular invasion was an independent risk factor for DFS (HR = 4.042, p = 0.004) and OS (HR = 4.607, p = 0.003) in patients with ESCC undergoing NICT combined with surgery.

There was no difference in postoperative complications and short-term survival in patients with ESCC underwent surgery after NICT regardless of left or right thoracic approach. It is worth noting that lymphovascular invasion has an important impact on the prognosis of these patients.

Preoperative treatment has become widely recognized for improving survival in patients with esophageal cancer. The present study aimed to compare the prognosis between patients with pathological node-negative status treated with surgery alone (SA-pN0) and those who were clinically node-positive but converted to ypN0 following neoadjuvant chemotherapy (NAC-ypN0) in cases of advanced thoracic esophageal squamous cell carcinoma (ESCC).

This retrospective analysis used a multicenter database of 4849 consecutive patients who underwent treatment for esophageal cancer. Patients with clinical T2 or more advanced ESCC who underwent standard subtotal esophagectomy between 1990 and 2017 were included. The NAC-ypN0 group was compared with the SA-pN0 group in terms of patient characteristics, recurrence patterns, and survival outcomes using propensity score-matched analysis.

In total, 109 patients were classified as NAC-ypN0 and 137 as SA-pN0. Propensity score matching resulted in the selection of 87 patients per group. Compared with the SA-pN0 group, the NAC-ypN0 group had a significantly more advanced clinical TNM stage and underwent significantly more three-field lymphadenectomies. Pathological findings showed downstaging of the pT stage in the NAC-ypN0 group, resulting in an equivalent distribution between the two groups. Additionally, the NAC-ypN0 group had significantly lower rates of lymphatic invasion (33% vs. 56%) and venous invasion (21% vs. 52%). Recurrence rates (21% vs. 22%) and survival outcomes (5-year overall survival: 83.9% vs. 76.1%, P = 0.110) were comparable between the two groups.

The NAC-ypN0 group demonstrated reduced lymphovascular invasion and showed a prognosis comparable to that of the SA-pN0 group.

Chemoradiotherapy (CRT) induces an antitumor immune response in esophageal squamous cell carcinoma (ESCC), and thereby has enormous potential by itself and in combination with immune checkpoint inhibitors (ICI). Our previous studies indicated that human positive cofactor 4 (PC4) was an independent predictor of poor survival in patients with ESCC or lung cancer who were treated with definitive chemoradiation, with a mechanism involving the enhancement of nonhomologous end joining (NHEJ)-mediated DNA repair. Due to the important role of double-strand DNA (dsDNA) in the antitumor immune response, the present study aims to investigate PC4 as a predictor of pathological response and antitumor immune response in ESCC patients who underwent neoadjuvant CRT. In ESCC, low PC4 expression levels have significant power to predict pCR. In particular, pCR is 61.2% in patients with low PC4 expression, but only 23.4% in patients with high PC4. Both disease-free survival (DFS) and overall survival (OS) are significantly longer for patients with low PC4 than for those with high PC4. In agreement with our previous finding that PC4 participates in NHEJ-mediated DNA repair, our further analysis indicates that the expression of PC4 is not only significantly negatively correlated with cyto-free dsDNA in postoperative specimens, but also with tumor-infiltrating CD8+T lymphocytes (CD8+TILs) and GZMB+CD8+TILs, suggesting a possible mechanism that high PC4 negatively regulates the antitumor response and therefore results in poor prognosis. Together, our findings demonstrate that low expression of PC4 is a potential biomarker for predicting the antitumor immune response to chemoradiation in patients with operable locally advanced ESCC.

Neoadjuvant chemoradiation therapy (RT) (nCRT) followed by surgical resection is the current standard of care for patients with esophageal cancer (EC). This treatment is associated with a variety of complications, with pneumonia being the most common. We hypothesized that proton RT (PRT) can significantly reduce the incidence of pneumonia compared with photon RT (PhRT).

We performed an analysis on a prospective cohort of patients with EC who completed nCRT with PRT or PhRT and underwent esophagectomy between October 2014 and June 2022. Multivariable logistic regression was used to analyze the effect of the RT technique on pneumonia while correcting for confounders. To access the dose-effect relationships, dose-volume histogram parameters of the lungs and the heart were analyzed using a principal component (PC) analysis.

We included 313 patients, of whom 28% developed pneumonia. The incidence was lower after PRT compared with PhRT (12% vs 32%, P < .01). PRT was associated with a significant reduction of the incidence of pneumonia (odds ratio [OR], 0.33; 95% CI, 0.14-0.72; P = .01), even when correcting for surgical approach and planning target volume size. Three PCs were identified: PC1: associated with the mean dose in the heart and lungs, PC2: associated with the distribution of dose between the lungs and the heart, and PC3: associated with the volume receiving a low dose (≤20 Gy). If the dose-related variables were replaced by the PCs, PC1 (OR, 1.1; 95% CI, 1.02-1.22) and PC3 (OR, 1.27; 95% CI, 1.06-1.53) were significantly associated with pneumonia. PRT had significantly lower values for both PC1 and PC3, compared with PhRT.

PRT significantly reduces the incidence of pneumonia compared with PhRT in patients with EC treated with nCRT followed by surgical resection. The reduction of pneumonia was associated with the lower mean dose and a reduction of the volume irradiated to low doses in the lungs and/or heart.

Prehabilitation is increasingly being used in patients undergoing multimodality treatment for oesophagogastric cancer (OGC). Most studies to date have been small, single-centre trials. This collaborative study sought to assess the overall impact of prehabilitation on patient outcomes following OGC surgery.

Data came from four prospective prehabilitation trials conducted in the UK or Ireland in patients undergoing multimodality treatment for OGC. The studies included three randomised and one non-randomised clinical trial, each comparing a prehabilitation intervention group to controls. The prehabilitation interventions included aerobic training delivered by exercise physiologists alongside dietetic input throughout the treatment pathway. The primary outcome was survival (all-cause and disease-specific mortality). Secondary outcomes were differences in complications, cardio-respiratory fitness (changes in VO2 peak and anaerobic threshold (AT)), chemotherapy completion rates, hospital length of stay, changes in body mass index, tumour regression and complication rates of anastomotic leak and pneumonia. Cox and logistic regression analysis provided hazard ratios (HR) and odds ratios (OR), respectively, with 95% confidence intervals (CI), adjusted for confounders.

Among 165 patients included, 88 patients were in the prehabilitation group and 77 patients were in the control group. All-cause and disease-specific mortality were not improved by prehabilitation (HR 0.67 95% CI 0.21-2.12 and HR 0.82 95% CI 0.42-1.57, respectively). The prehabilitation group experienced fewer major complications (20% vs. 36%, p = 0.034; adjusted OR of 0.54; 95%CI 0.26-1.13). There was a mitigated decline in VO2 peak following neo-adjuvant therapy (delta prehabilitation -1.07 mL/kg/min vs. control -2.74 mL/kg/min; p = 0.035) and chemotherapy completion rates were significantly higher following prehabilitation (90% vs. 73%; p = 0.016). Hospital length of stay (10 vs. 12 days, p = 0.402) and neoadjuvant chemotherapy response (Mandard 1-3 41% vs. 35%; p = 0.494) favoured prehabilitation, albeit not statistically significantly.

Despite some limitations in terms of heterogeneity of study methodology, this study suggests a number of meaningful clinical benefits from prehabilitation before surgery for OGC patients. Current initiatives to agree on national standards for delivering prehabilitation and the results of ongoing trials will help to further refine this important intervention and expand the evidence base to support the widespread adoption and implementation of prehabilitation programs.

Elderly patients, particularly those aged 70 and above, often present with comorbidities such as coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), and high blood pressure (HBP). These comorbid diseases complicate treatment. However, the impact of these comorbidities on survival outcomes and complications in elderly patients undergoing esophagectomy for esophageal squamous cell carcinoma (ESCC) remains under-researched.

This cohort study examined ESCC patients aged 70 and older who underwent esophagectomy. Patients were divided into two cohorts: those without preoperative comorbid diseases (NCD group) and those with preoperative comorbid diseases (CD group). Data were obtained from the Sichuan Cancer Hospital and Institute Esophageal Cancer Case Management Database between May 2016 and August 2021, with follow-up concluding on December 20, 2023.

A total of 469 patients met the inclusion criteria, with 206 patients in the comorbid diseases (CD group) and 263 patients without (NCD group). The median follow-up period was 47.5 months, the median overall survival (OS) was 51.6 months and median disease-free survival (DFS) was 33.0 months, with no statistically significant difference in OS and DFS in 2 groups. The incidence of grade 3 or higher complications in the NCD and CD groups was similar, with no statistically significant difference. The most common grade 3 or higher complications were pulmonary infection, hydrothorax, anastomotic stenosis, and anastomotic leakage.

Preoperative comorbidities, including CHD, COPD, DM, and HBP, did not significantly impact the long-term survival or disease-free survival of elderly ESCC patients undergoing esophagectomy.

Postoperative hyperglycemia in diabetic patients is a widely known risk factor for postoperative infectious complications (PICs) after esophagectomy; however, the significance of glycemic control in non-diabetic patients is less clear. In diabetic patients, early postoperative management of esophagectomy favors low-carbohydrate enteral nutrition (EN) over standard EN to suppress the risk of glycemic spike. Our single-center, randomized phase II trial seeks to test the hypothesis that low-carbohydrate EN can suppress hyperglycemia in non-diabetic patients who undergo esophagectomy. Herewith we present the study protocol.

A total of 50 patients will be enrolled and randomly assigned (1:1 ratio) to standard or low-carbohydrate EN. Randomization will be stratified by operation time (≥560 vs. < 560 min) and HbA1c (6.0-6.4% vs. < 6.0%). Both EN formula will be fed according to the following protocol: 400 mL/24 h on postoperative day (POD)-1; 800 mL on POD-2; 1200 mL on POD-3 and 1600 mL from POD-4 to POD-8. On POD-9, oral food intake will be initiated. A continuous glucose monitoring (CGM) device will be used to monitor blood glucose levels from POD-1 to -8. The primary outcome is the mean time-in-range (TIR) across the 48 h from POD-1 to -2. TIR is defined as the percentage-time that blood glucose remains within the targeted range of 70-180 mg/dL. The primary analysis will calculate the least squares mean difference in TIR over the 48 h (POD-1 to -2) between the two groups, with p-values calculated to test the null hypothesis that the mean difference between the groups is zero. The secondary outcomes will be as follows: 1) the incidence of PICs and/or other adverse events within 30 days after esophagectomy or during the hospital stay; 2) the number of cases requiring any dose alteration in EN formula during monitoring; 3) the number of cases requiring interventions for hyperglycemia or hypoglycemia; 4) the rates in change of nutritional indicators, such as serum albumin, prealbumin, and total protein levels, during the post-surgical hospital stay (vs. those values on the day of admission); and 5) the following CGM indices in relation to the incidence rate of PICs within 30 days after esophagectomy: the mean values for time-above-range (TAR), area under the curve (AUC), and TIR for each POD or from POD-1 to -8. TAR is defined as the percentage of time of a patient is recorded as having hyperglycemia (>blood glucose level of 180 mg/dL), and is indicative of the frequency and duration of hyperglycemia. AUC, which identifies periods of hyperglycemia and provides a comprehensive picture of glucose variability and control in diabetes management, is defined as the area under the curve over blood glucose level of 180 mg/dL on CGM monitoring.

This study is the first to investigate the impact of a low-carbohydrate EN formula on hyperglycemic control during perioperative nutritional management of esophageal cancer. These results will help to outline whether glycemic control should be also considered for non-diabetic patients during hospital care.

This trial has been registered in the Japanese Registry of Clinical Trials (jRCTs031240081).

Esophageal cancer ranks among the most lethal malignancies globally, with China accounting for more than half of worldwide esophageal squamous cell carcinoma (ESCC) cases. Late-stage diagnosis frequently precludes surgical intervention, contributing to poor outcomes. While precise clinical assessment is essential for treatment planning, therapeutic responses and prognosis exhibit substantial inter-patient heterogeneity, underscoring the urgent need for reliable biomarkers to enhance prognostic accuracy and guide personalized therapeutic strategies. Radiomics, an emerging field that extracts high-dimensional features from medical images, provides non-invasive approaches to improve diagnostic accuracy, predict survival, monitor adverse events, detect recurrence, and optimize treatment strategies. Radiomics has shown promising potential in the modern management of ESCC. Here, we review the critical contributions of radiomics to ESCC research and clinical practice, examining its workflow, applications, strengths, and limitations. Radiomics represents a compelling frontier with substantial potential to advance precision medicine for ESCC patients.

Exercise during neoadjuvant chemoradiotherapy (NCRT) has potential to mitigate treatment-related declines in physical fitness, and to improve clinical outcomes, including toxicity and tumor response. However, optimal frequency and timing of exercise remains to be determined. Therefore, this pilot trial aimed to assess feasibility of 2 different exercise interventions during NCRT in patients with esophageal and rectal cancer and to evaluate potential clinical effects.

Patients were randomized into 1 of 3 study arms during NCRT: (a) 30-min aerobic exercise in-hospital within 1 h prior to each radiotherapy fraction (ExPR), (b) two 60-min supervised combined aerobic and resistance exercise sessions per week (AE+RE), and (c) usual care (UC). Feasibility was assessed by examining participation rate and exercise adherence. Intervention effects on physical fitness, health-related quality of life, treatment-related toxicity, and tumor response in patients with esophageal cancer were explored using regression analyses and 85% confidence intervals (85%CI).

Thirty-seven patients with esophageal cancer (participation rate: 45%) and 2 patients with rectal cancer (participation rate: 14%) were included. Median session attendance was 98% (interquartile range (IQR): 96-100) in the ExPR and 78% (IQR: 33-100) in the AE+RE group. We found clinically relevant benefits of exercise on maximal oxygen uptake (VO2max)(ExPR: β = 9.7 mL/kg/min, 85%CI: 6.9-12.6; AE+RE: β = 5.6 mL/kg/min, 85%CI: 2.6-8.5) and treatment-related toxicity (ExPR: β = -2.8, 85%CI: -5.4 to -0.2; AE+RE: β = -2.6, 85%CI: -5.3 to 0.0). Additionally, good tumor response was found in 70% in AE+RE and ExPR vs. 55% in UC (OR = 1.9, 85%CI: 0.5-7.7).

Starting prehabilitation during NCRT is feasible, can increase starting fitness of traditional pre-surgical programs, and has potential to improve clinical outcomes.

This review provides a comprehensive discussion about the importance of adequate lymphadenectomy, its anatomic and oncologic significance, principles and rationale of sentinel lymph node mapping, current evidence stratified by tracer substrate, challenges, and future directions. Esophageal cancer has one of the worst cancer-related survival rates, and nodal status is the single most significant prognostic factor. Submucosal penetration generally demands esophagectomy, often following neoadjuvant therapy in the presence of deeper extension. Guidelines recommend resecting ≥15 lymph nodes. Variability in surgical approach and dissection in concert with aberrant esophageal lymphatic anatomy make adequate lymphadenectomy difficult.

A narrative review was conducted to explore existing literature regarding lymphadenectomy with its requisite anatomic and oncologic significance in esophageal cancer, as well as the rationale for and present state of sentinel lymph node mapping stratified by substrates. Tables and figures were constructed by the authors using Microsoft Office applications and Biorender software, respectively.

Sentinel lymph node mapping exploits the tumoral lymphatic network to identify the nodes most prone to metastasis, directing further dissection. Targeting sentinel lymph nodes with dyes, radiotracers, or hybrid tracers can assist surgeons with lymphadenectomy, potentially improving staging accuracy and personalizing care to individual anatomy.

While this approach would benefit from larger studies and long-term data, early evaluations suggest improved detection of metastases outside the en bloc field without significantly increasing morbidity.

Background/Objectives: Survival rates for esophageal cancer patients have markedly improved. Inevitably, attention has been drawn to functional and quality-of-life problems. The aim of the current study was to investigate the prevalence of dumping syndrome in patients following esophageal resection and its correlation with postoperative quality of life. Methods: This cross-sectional study involved disease-free patients who underwent a potentially curative resection for esophageal or gastroesophageal junction carcinoma between January 2019 and January 2024 in a single academic institution. Patients were asked to fill in two questionnaires: the Dumping Syndrome Rating Scale (DSRS) and the QLQ-OG25. A Composite Dumping Syndrome Index (CDSI) was calculated by adding the summary severity and frequency scores for each patient. Results: During the study period, 42 patients underwent esophagectomy for malignant esophageal or junctional tumors. In total, 14 eligible patients responded to the questionnaires at a mean time of 19.7 (±20.8) months following their operation. Three patients (21%) reported having at least quite severe problems related to at least two dumping symptoms. Six patients (43%) reported that they avoid certain foods in order to alleviate related problems. A high CDSI score was associated with significantly increased OG25 scores for dysphagia, eating restriction, odynophagia, pain and discomfort, and reflux (p < 0.05). Conclusions: Early dumping syndrome can occur in a significant proportion of patients following esophagectomy and may adversely affect quality of life.

Neoadjuvant chemoradiotherapy has been established as the standard of care for locally advanced oesophageal cancers. Most of the evidences on neoadjuvant chemoradiotherapy (NACTRT) comes from the Western world where the predominant histology is adenocarcinoma. This study aimed to study the outcomes of neoadjuvant chemoradiotherapy using CROSS protocol and volumetric modulated arc therapy (VMAT) in locally advanced squamous cell oesophageal cancers.

We report a multicentric abdominal inflammatory myofibroblastic tumor in a 6-year-old girl who presented with massive abdominal distention. The sheer size of the mass, coupled with multicentric presentation and absent mobility on clinical examination, would have led to a very morbid surgical exploration. This patient was treated with initial chemotherapy, which led to a dramatic response in both symptoms and size of masses, facilitating a complete surgical resection with negligible postoperative morbidity.

This was a single-institute retrospective analysis utilizing a prospectively collected database where all patients with locally advanced operable oesophageal cancers with squamous histology diagnosed between 2021 and 2022 were screened and included. All patients received neoadjuvant chemoradiotherapy in accordance with the CROSS protocol with all patients receiving radiotherapy using VMAT technique.

A total of 102 patients with locally advanced oesophageal cancers with squamous histology were included in the study. The median follow-up for the cohort was 29 months. The 3-year overall survival (OS), disease-free survival (DFS), and local control (LC) were 72%, 59.1%, and 72%, respectively. Pathological complete response was 59.4%. The major Clavien-Dindo classification (≥ class 3) of surgical complications was 32%. Lower incidence of pulmonary (17.7%) and cardiac (5.2%) complications was observed in this cohort.

NACTRT using the CROSS protocol enhances the pathological complete response rates and the survival outcomes in locally advanced oesophageal cancers with squamous histology. The utilization of VMAT has been associated with a reduction in postoperative cardiopulmonary toxicities. However, further prospective randomised studies are required to validate the technique's superiority.

Recently, robot-assisted surgical systems have become more and more popular, but have not been reported in functional minimally invasive radical resection of esophageal cancer,which preserves the mediastinal pleura, the azygos arch, bronchial artery, and pulmonary branch of the vagus nerve.

Retrospective analysis of all patients in our hospital who underwent surgery for esophageal cancer from September 2022 to February 2024. Robot-assisted functional minimally invasive esophagectomy (RAFMIE)was performed for 44 patients who were compared with 66 functional minimally invasive esophagectomy (FMIE) cases.

Significantly, shorter operation time was taken in RAFMIE (222.98 ± 28.02 vs 250.45 ± 30.25 min P < 0.001), thoracic operation time (75.50 ± 14.23 vs 89.59 ± 16.34 min P < 0.001), abdominal operation time (51.93 ± 14.18 vs 71.75 ± 14.85 min P < 0.001). Both groups were equal regarding intraoperative blood loss (82.73 ± 57.23 vs 94.55 ± 60.19 ml, P = 0.286), radical resection (R0) rate (97.73% vs 96.97%, P = 0.813) and total lymph node yield (25.45 ± 7.40 vs 21.03 ± 7.00, P = 0.013). Postoperative hospital stay (9.75 ± 2.23 vs 10.47 ± 2.72, P = 0.402); incidence of postoperative complications (25.76% vs 20.45%, P = 0.519).

Early results suggest that RAFMIE is safe and feasible for the treatment of esophageal cancer. The operation time of RAFMIE is shorter than FMIE, and the lymph node dissection results are better. Long-term results need to be further investigated.

There is no gold standard method to predict pathological complete response (pCR) in esophageal squamous cell carcinoma (ESCC) patients before surgery after neoadjuvant chemoradiotherapy (nCRT). This study aims to investigate whether dual layer detector dual energy CT (DECT) quantitative parameters and clinical features could predict pCR for ESCC patients after nCRT.

This study retrospective recruited local advanced ESCC patients who underwent nCRT followed by surgical treatment from December 2019 to May 2023. According to pCR status (no visible cancer cells in primary cancer lesion and lymph nodes), patients were categorized into pCR group (N = 25) and non-pCR group (N = 28). DECT quantitative parameters were derived from conventional CT images, different monoenergetic (MonoE) images, virtual non-contrast (VNC) images, Z-effective (Zeff) images, iodine concentration (IC) images and electron density (ED) images. Slope of spectral curve (λHU), normalized iodine concentration (NIC), arterial enhancement fraction (AEF) and extracellular volume (ECV) were calculated. Difference tests and spearman correlation were used to select quantitative parameters for DECT model building. Multivariate logistic analysis was used to build clinical model, DECT model and combined model.

A total of 53 patients with locally advanced ESCC were enrolled in this study who received nCRT combined with surgery and underwent DECT examination before treatment. After spearman correlation analysis and multivariate logistic analysis, AEF and ECV showed significant roles between pCR and non-pCR groups. These two quantitative parameters were selected for DECT model. Multivariate logistic analysis revealed that LMR and RBC were also independent predictors in clinical model. The combined model showed the highest sensitivity, specificity, PPV and NPV compared to the clinical and DECT model. The AUC of the combined model is 0.893 (95%CI: 0.802-0.983). Delong's test revealed the combined model significantly different from clinical model (Z =-2.741, P = 0.006).

Dual-layer DECT derived ECV fraction and AEF are valuable predictors for pCR in ESCC patients after nCRT. The model combined DECT quantitative parameters and clinical features might be used as a non-invasive tool for individualized treatment decision of those ESCC patients. This study validates the role of DECT in pCR assessment for ESCC and a large external cohort is warranted to ensure the robustness of the proposed DECT evaluation criteria.

Malnutrition is a common complication among patients with esophageal cancer, significantly increasing the risk of postoperative complications and mortality. Multiple studies have shown that immunoenteric nutrition (IEN) can reduce postoperative infectious complications in patients with esophageal cancer. However, its prognostic impact on patients undergoing radical surgery following neoadjuvant therapy remains unclear. This study aimed to compare the prognostic effects of IEN versus standard enteral nutrition (EN) in patients with esophageal squamous cell carcinoma (ESCC) following radical esophageal cancer surgery after neoadjuvant therapy. This retrospective study included 197 patients with ESCC who underwent radical esophagectomy following neoadjuvant therapy between 2016 and 2022. Of these, 133 patients received postoperative standard EN, while 64 patients received IEN. The primary endpoints were overall survival (OS) and progression-free survival (PFS). The secondary endpoints included the incidence of postoperative complications and changes in relevant blood markers before and after surgery. No significant differences were observed in postoperative hospitalization duration or complications between the two groups. Postoperative C-reactive protein and immunoglobulin M levels were significantly lower in the IEN group compared to the EN group (P = 0.018 and 0.042). Kaplan-Meier survival curves were plotted for 1, 2, 3, and 5 years to compare the effects of IEN and EN on OS and PFS. The log-rank test revealed the following survival rates: 90.6% versus 77.2% (1-year PFS, P = 0.023); 95.3% versus 82.7% (1-year OS, P = 0.015); 71.9% versus 56.7% (2-year PFS, P = 0.035); 76.6% versus 62.4% (2-year OS, P = 0.03); 54.6% versus 41.7% (3-year PFS, P = 0.064); 61.4% versus 49.3% (3-year OS, P = 0.08); 39.4% versus 30.7% (5-year PFS, P = 0.093); and 41.5% versus 32.6% (5-year OS, P = 0.104). Univariate and multivariate analyses identified several independent predictors of 2-year PFS and OS. For 2-year PFS, the independent predictors included body mass index (P = 0.005), ypTNM stage (Pathologic TNM-staging after neoadjuvant therapy) (P = 0.045), ypT stage (Pathologic T-staging after neoadjuvant therapy) (P = 0.030), ypN stage (Pathologic N-staging after neoadjuvant therapy) (P = 0.007), tumor differentiation (P = 0.031), and type of EN (P = 0.004). For 2-year OS, the independent predictors were age (P = 0.015), body mass index (P = 0.004), ypTNM stage (P = 0.013), ypT stage (P = 0.010), ypN stage (P = 0.009), tumor differentiation (P = 0.026), and type of EN (P = 0.001). In patients with ESCC undergoing esophagectomy after neoadjuvant therapy, postoperative IEN accelerates the resolution of the inflammatory state and improves short-term survival, though its long-term benefits remain uncertain. Furthermore, IEN does not significantly affect the postoperative hospitalization duration or the incidence of complications.

Neoadjuvant immunochemoradiation therapy (nICRT) is emerging as a promising treatment for resectable esophageal cancer, but comprehensive analyses comparing it with standard neoadjuvant chemoradiation therapy (nCRT) are limited. This meta-analysis aimed to evaluate the efficacy, safety, and survival outcomes of nICRT versus nCRT. A systematic search of PubMed, Embase, the Cochrane Library, and major conference proceedings up to October 30, 2024, identified studies involving resectable esophageal cancer treated with nICRT or nCRT. Data on pathologic complete response, major pathologic response, treatment-related adverse events, overall survival (OS), and progression-free survival were extracted. A one-stage meta-analysis using reconstructed individual patient data was performed, calculating hazard ratios with 95% CIs. Thirty-seven studies were included, comprising 811 patients treated with nICRT and 1796 with nCRT. nICRT demonstrated significantly longer OS than nCRT (hazard ratio, 0.714; 95% CI, 0.550-0.926; P = .011). The 1-, 2-, and 3-year OS rates were 89.9%, 76.0% and 66.4%, respectively, for nICRT, compared with 85.0%, 66.5%, and 57.3% for nCRT. The pathologic complete response rate was significantly higher in nICRT (50% vs 38%; P = .040) for squamous cell carcinoma. Safety profiles were comparable, with no significant differences in grades 3 and 4 treatment-related adverse events or postoperative complications between the groups. nICRT showed potential for superior survival compared with standard nCRT in resectable esophageal cancer and showed enhanced pathologic response in squamous cell carcinoma, with a possibly acceptable safety profile. These findings support future trials integrating immunotherapy into neoadjuvant treatment regimens for esophageal cancer.

Delays to definitive surgery in esophageal cancer may be associated with disease progression and worsened survival. The objective of this study was to perform a national assessment for predictors of delay to esophagectomy and to assess for their impact on oncologic and survival outcomes.

The National Cancer Database, 2010 to 2020, was queried for patients with locally advanced esophageal adenocarcinoma (stage I-III). Patients were divided into up-front and postneoadjuvant chemoradiation cohorts. The primary outcome was time to surgery. Time to surgery was examined as a continuous and categorical variable, where patients were divided into timely and delayed cohorts (96 days for up-front cohort; 56 days for postneoadjuvant chemoradiation cohort).

Of 16,486 patients, 4066 (24.7%) underwent up-front surgery and 12,420 (75.3%) underwent postneoadjuvant chemoradiation surgery. In the up-front surgery group, median [interquartile range] time to surgery was 61 [40-96] days. Risk-adjusted predictors of delay included lack of insurance, lowest quartile of education, biopsy-based staging or surgical staging, and robotic-assisted approach. In the postneoadjuvant chemoradiation, cohort time to surgery was 55 [44-70] days. Risk-adjusted predictors of delay included Hispanic ethnicity, Medicaid or other government-based insurance, lowest quartile of educational status, and robotic approach. In the up-front surgery group, patients who received delayed surgery had increased odds of pathologic upstaging (1.31, 95% CI, 1.06-1.61). In the postneoadjuvant chemoradiation group, patients with surgical delay had increased odds of 90-day mortality (1.27, 95% CI, 1.06-1.51).

After risk adjustment for patient, oncologic, facility, and surgical characteristics, there were several predictors of increased time to esophagectomy associated with consequences of upstaging and survival.

The Chemoradiotherapy for Oesophageal Cancer followed by Surgery Study (CROSS) regimen is currently offered to locally advanced esophageal cancer patients beyond the original eligibility criteria. This national population-based study assessed the safety in implementation regarding treatment outcome when extending these criteria.

Locally advanced esophageal cancer (cT1N+/T2-4aN0-3/M0) patients (n = 5061) from the Netherlands Cancer Registry treated according to the neoadjuvant chemoradiotherapy (nCRT) CROSS regimen between 2015 and 2022 were analyzed. A total of 1958 complied with the original criteria (O-CROSS group) and 1348 with one or more extended criteria (tumor length >8 cm, age >75 years, WHO score >2 and/or weight loss >10%) (E-CROSS group), eventually followed by resection in 1342 O-CROSS patients and 852 E-CROSS patients. Primary outcome was overall survival (OS), i.e. time interval from onset of nCRT (OS-nCRT) and from date of surgery (OS-surgery) until death or last follow-up. Secondary outcomes were disease-free survival, pathological complete response (pCR), surgical radicality, post-operative morbidity and mortality. Data were analyzed using the Kaplan-Meier method and Cox proportional hazards models.

OS-nCRT was significantly lower in the E-CROSS compared with the O-CROSS (median of 30.3 months, 95% confidence interval 27.2-33.5 months versus 45.9 months, 95% CI 38.4-53.4 months, P < 0.001). Similarly, differences were observed in OS-surgery. When OS-nCRT and OS-surgery were adjusted for baseline covariates, however, no difference was found between both groups. Moreover, no differences were observed in disease-free survival, surgical radicality, and pCR. While not affecting post-operative mortality, significantly more anastomotic leakages and thromboembolic post-operative complications were seen in the O-CROSS group.

Extending the CROSS criteria was associated with lower OS, which was caused by the higher age, weight loss >10% and WHO score in the E-CROSS group. The CROSS regimen can be used in a 'real-world' setting but individual factors that may contribute to OS should be considered in decision-making.

Locally advanced esophageal adenocarcinoma remains difficult to treat and the ecological and evolutionary dynamics responsible for resistance and recurrence are incompletely understood. Here, we performed longitudinal multiomic analysis of patients with esophageal adenocarcinoma in the MEMORI trial. Multi-region multi-timepoint whole-exome and paired transcriptome sequencing was performed on 27 patients before, during and after neoadjuvant treatment. We found major transcriptomic changes during treatment with upregulation of immune, stromal and oncogenic pathways. Genetic data revealed that clonal sweeps through treatment were rare. Imaging mass cytometry and T cell receptor sequencing revealed remodeling of the tumor microenvironment during treatment. The presence of genetic immune escape, a less-cytotoxic T cell phenotype and a lack of clonal T cell expansions were linked to poor treatment response. In summary, there were widespread transcriptional and environmental changes through treatment, with limited clonal replacement, suggestive of phenotypic plasticity.

This study proposes a modified lymph node (LN) staging category (BALN) on the basis of the number of positive LNs before (prepN) and after (ypN) neoadjuvant chemoradiotherapy (nCRT) to improve prognostic stratification in esophageal squamous cell carcinoma (ESCC).

A total of 381 patients with ESCC who underwent nCRT at three medical centers were retrospectively enrolled. The ypN categories were scored according to the eighth edition of the American Joint Committee of Cancer (AJCC) staging manual. LNs with regression changes or vital tumor cells were used for interpretation of the prepN stage, reflecting the estimated number of originally involved LNs. BALN category was organized on the basis of the sum of the number of positive LNs in prepN and ypN categories.

BALN category revealed clearer survival classification and prognostic value of disease-free survival (DFS) in patients with ESCC (p < 0.0001). Multivariate cox proportional risk model identified BALN stage as a significant risk factor of DFS of patients with ESCC (p < 0.001). The results of 5-year time-area under the curve (AUC) demonstrated better predictive ability of the BALN category than the ypN category (AUC 0.755 versus 0.707, p = 0.004). The rypTNM system based on BALN category exhibited comparable survival discrimination and better predictive performance than ypTNM system (AUC 0.799 versus 0.756, p = 0.020).

The BALN stage and the revised ypTNM system showed preferable prognosis outcomes to the ypN stage and the ypTNM system, respectively. Evaluating LN status before and after nCRT could allow for more accurate esophageal cancer staging.

Neoadjuvant radiochemotherapy (NARCT) is an established standard of care in various tumor entities, promoting high response rates at commonly lower toxicities as compared to adjuvant approaches. This retrospective analysis was designed to investigate NARCT in early-stage high-risk cervical cancer.

Forty patients with early-stage high-risk cervical cancer (i.e., L1, V1, G3, N+, > 2/3 stromal invasion, > 4 cm tumor size, borderline resectability) were treated with NARCT prior to surgical resection. Downstagings based on clinical, imaging, and pathological responses were recorded. Survival rates were calculated according to Kaplan-Meier, and prognostic factors were analyzed with uni- and multivariable Cox regression analyses using SPSS software (v. 26; IBM Corp., Armonk, NY, USA).

Both NARCT and subsequent tumor resection were feasible and conducted in 39 of 40 patients (95%). Early toxicity was moderate, with no grade 3 or higher toxicities following NARCT and surgery. NARCT yielded significant downstaging in all patients, and pathological complete remission (pCR) was achieved in 14 patients (36%). After 5 years, overall survival (OS), freedom from local progression (FFLP), and freedom from distant progression (FFDP) rates were 84.2%, 75.9%, and 73.1%, respectively. Late proctitis (grade 1 in 8%) and urinary cystitis (grade 1-3 in 35%) occurred at acceptable rates.

In resectable early-stage high-risk cervical cancer, NARCT is feasible and safe. Clinical, imaging, and pathological response rates are high. Impressive long-term survival and tumor control rates at modest toxicities encourage the initiation of a prospective and randomized trial.

Gastric cancer remains a major health challenge worldwide, with nearly 1 million new cases annually contributing to more than 650 000 deaths. Epidemiologically, gastric cancer shows substantial geographical variation in incidence, with higher rates in Asia, South America, and eastern Europe, and a rapid increase in early-onset cases among people younger than 50 years. Key risk factors for gastric cancer include Helicobacter pylori infection, diet, obesity, smoking, and genetic predisposition. Early detection through comprehensive diagnostic procedures is crucial for optimising treatment outcomes. Standard treatment approaches for locally advanced gastric cancer include surgical resection, particularly D2 lymphadenectomy, complemented by chemotherapy and radiotherapy. There is increasing implementation of minimally invasive surgical techniques for operable disease and integration of immune checkpoint inhibitors and targeted therapies for advanced stages. Emerging therapies, such as novel targeted treatments and next-generation immunotherapies, show promise in improving survival and quality of life. Future directions in the management of gastric cancer focus on precision medicine, continued advancement in immunotherapy, novel early detection methods, and a multidisciplinary approach to care. These strategies aim to enhance the overall effectiveness of treatment and prognosis worldwide.

Neoadjuvant immunochemotherapy is expected to become the standard treatment mode for locally advanced esophageal squamous cell carcinoma (ESCC). This study aims to analyze the clinical outcomes and long-term survival of neoadjuvant immunochemotherapy for locally advanced ESCC, and explore the feasibility of using major pathological response (MPR) as a surrogate endpoint.

This real-world retrospective study consecutively included eligible patients with stage II-IVA locally advanced ESCC who received neoadjuvant immunochemotherapy and surgery between 2019 and 2022 at the Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine.

This study collected a total of 166 patients, and ultimately included 126 patients after screening. The objective response rate (ORR) was 69.8% (88/126). The incidence of grade 3-4 adverse events (AEs) was 13.5% (17/126). MPR was observed in 49 (38.9%) patients, and 24 (19.0%) patients achieved a complete pathological response (pCR). The median progression-free survival (PFS) was 31.7 months and the 3-year PFS rate was 56.3%. The median overall survival (OS) was not reached and the 3-year OS rate was 70.6%. The median PFS of the non-MPR group was 25.0 months, with the MPR group not achieved (hazard ratio [HR], 2.503; 95% CI 1.359-4.610; P = 0.0022). The median OS in the non-MPR group was 31.7 months and not reached in the MPR group (HR, 3.607; 95% CI 1.576-8.254; P = 0.0012). MPR is an independent prognostic factor affecting OS (HR, 2.522; 95% CI 1.018-6.401; P = 0.046).

Neoadjuvant immunochemotherapy is safe and effective for locally advanced ESCC, and can result in certain survival benefits. MPR can serve as a surrogate endpoint for predicting long-term OS.

Esophageal cancer is an aggressively malignant neoplasm characterized by a high mortality rate. Frequently diagnosed at an advanced stage, it presents challenges for optimal therapeutic intervention due to its non-specific symptoms, resulting in lost opportunities for effective treatment, such as surgery, radiotherapy, chemotherapy and target therapy. The N6-methyladenosine (m6A) modification represents the most critical post-transcriptional modification of eukaryotic messenger RNA (mRNA). The reversible m6A modification is mediated by three regulatory factors: m6A methyltransferases, demethylating enzymes, and m6A recognition proteins. These components identify and bind to specific RNA methylation sites, thereby modulating essential biological functions such as RNA processing, nuclear export, stability, translation and degradation, which significantly influence tumorigenesis, invasion, and metastasis. Given the importance of m6A modification, this paper offers a comprehensive examination of the regulatory mechanisms, biological functions, and future therapeutic implications of m6A RNA methylation in the context of esophageal cancer.

The work aimed to compare the efficacy and safety of chemotherapy regimen (oxaliplatin + capecitabine, XELOX) combined with neoadjuvant radiotherapy (NART) and neoadjuvant chemotherapy (NACT) in locally advanced gastric cancer.

We retrospectively analyzed clinical data from patients with locally advanced gastric cancer who underwent radical gastrectomy with D2 lymph node dissection at our center between January 2019 and December 2020. The study compared tumor markers, postoperative pathology, short-term efficacy, postoperative complications, and hospital stay between the chemoradiotherapy (CRT, XELOX + NART) group and the NACT-only group. Pearson correlation coefficients was used to analyze the correlations between clinical variables and tumor biomarkers. Inverse probability weighting (IPW) was used to adjust for confounding factors.

A total of 409 patients were included, with 369 (90.2%) in the NACT group and 40 (9.8%) in the CRT group. Significant correlations were found between clinical variables and tumor biomarkers, which may help identify potential prognostic factors for gastric cancer treatment. After IPW adjustment, baseline characteristics were similar between groups. The negative conversion rate of CEA-positive patients was significantly higher in the CRT group (38.1% vs. 11.8%, P < 0.001). The rate of pathological complete response was also higher in the CRT group (15.8% vs. 4.7%, P = 0.017). Postoperative pathological stages ypT0 and T1 were observed in 35.5% of the CRT group compared to 13.5% in the NACT group (P = 0.031). The CRT group had a lower average number of lymph nodes dissected (17 vs. 24, P < 0.001) but a higher ypN0 rate (60.3% vs. 39.8%, P = 0.024). The proportion of patients with tumor regression grade (TRG) 0-1 was higher in the CRT group (60.3% vs. 24.3%, P = 0.003). The R0 resection rate after IPW was 100% in the CRT group versus 96.5% in the NACT group (P = 0.001). No significant differences were found between the CRT and NACT groups in nerve invasion, vascular embolus, peritoneal invasion, bone marrow suppression, nausea, vomiting, esophagitis, diarrhea, other adverse reactions, postoperative complications, or average hospitalization time. The CRT group showed superior disease-free survival while no overall survival advantage (P < 0.05).

The XELOX regimen combined with neoadjuvant chemoradiotherapy provided superior downstaging, short-term pathological response, and local control benifits compared to perioperative chemotherapy alone, with similar surgical safety profiles.

While neoadjuvant chemoradiotherapy (CRT) is considered the standard of care for patients with locally advanced esophageal or gastroesophageal junction (GEJ) cancer, the optimal radiation dosing remains undefined. We aimed to assess the perioperative and long-term outcomes comparing patients treated with low-dose (LD-RT) versus high-dose (HD-RT) radiation therapy.

Our institutional database was queried for patients with cT2-T4 or node-positive esophageal or GEJ cancer, who underwent surgery with neoadjuvant chemoradiation from 2010 through 2019. LD-RT and HD-RT regimens were defined as receiving total radiation dose ≤45 Gy and ≥50 Gy, respectively. Kaplan-Meier analysis, Cox proportional hazard modeling, and logistical regression were utilized for statistical analysis.

A total of 287 patients were identified: 77 (27%) received LD-RT; 210 (73%) received HD-RT. Median follow-up from diagnosis to death or last contact was 37.1 months for the study cohort. Older age at diagnosis (odds ratio [OR] 1.03/year, p = 0.02) and year of diagnosis (OR 0.77/year, p < 0.001) were independently associated with receipt of HD-RT relative to LD-RT. Compared with HD-RT, LD-RT was associated with improved 5 year overall survival (OS; 55.1 vs. 44.1%, p = 0.03). On multivariate hazard modeling, receipt of HD-RT was independently associated with worse OS (hazard ratio [HR] 1.79, 95% 1.19-2.68, p = 0.005), disease-free survival (HR 1.78, 95% CI 1.09-2.88, p = 0.02), and recurrence-free survival (HR 1.68, 95% CI 1.11-2.55, p = 0.01) compared with those treated with LD-RT.

Despite less frequent utilization than HD-RT strategies, LD-RT is associated with improved survival in those treated with neoadjuvant CRT for esophageal or GEJ cancer.

This review provides an in-depth analysis and comprehensive overview of recent advancements in MRI techniques for evaluating esophageal cancer (EC). It discusses the specific MRI acquisition protocols and parameters that enhance image quality and diagnostic accuracy. The review highlights MRI's role and performance in the initial TNM staging and its potential to refine treatment strategies by improving tumor delineation and characterization. Additionally, the paper explores MRI utility in restaging after NAT, focusing on its accuracy in assessing treatment response and detecting residual or recurrent disease. Comparisons with other imaging modalities currently used-such as endoscopic ultrasound (EUS), contrast-enhanced computed tomography (CE-CT), and 18F-fluorodeoxyglucose (FDG) positron emission tomography/CT (PET/CT)-are included to highlight the strengths and limitations of each method. Illustrated with numerous Figures, this article proposes a novel MRI-based strategy for EC staging and restaging. It aims to integrate MRI into clinical practice by leveraging its superior soft-tissue contrast and functional imaging capabilities to enhance diagnostic precision and improve patient outcomes. Through this comprehensive evaluation, the review underscores the potential of MRI to become a cornerstone in the precision diagnosis and management of EC.

Gastroesophageal cancers are highly prevalent internationally, with many patients diagnosed with metastatic disease, leading to challenging treatment and poor survival. This study uses real-world evidence from a population-level database to describe demographics, clinical characteristics, initial treatment patterns, and survival for patients with gastroesophageal cancer in Norway.

Individual patient data was sourced from the Cancer Registry of Norway for patients diagnosed with oesophageal squamous cell carcinoma (ESCC), oesophageal adenocarcinoma (EAC), gastroesophageal junction cancer (GEJC), and gastric cancer from 2001 to 2021, with follow-up from diagnosis to death or last follow-up. Treatment patterns were captured from 2010 to 2022, defined as curative or palliative based on surgery, chemotherapy, and radiotherapy.

The cohort included 14,334 Norwegian patients with gastroesophageal cancer; predominantly male, mean age 69-73 years, with a median follow-up of 9-11 months across cancer subtypes. Approximately 40% of patients received curative treatment, and multi-modality treatments increased for EAC, GEJC, and ESCC. Median survival ranged from 6 to 11 months for patients treated palliatively, and 17-95 months for those treated with curative intent. Interestingly, median survival was higher for patients with EAC and GEJC treated with neoadjuvant chemotherapy (86.1 and 75.1 months) versus neoadjuvant chemoradiotherapy (49.1 and 42.1 months), which was confirmed by a multivariate Cox regression model adjusted for age, sex, and disease stage. This study demonstrates that multimodal treatment strategies, consisting of chemotherapy and surgery, may be associated with improved survival outcomes for gastroesophageal cancers. Future studies are required to identify optimum treatment strategies for gastroesophageal cancer subtypes.

Gastric cancer is the fifth most common cancer globally and is associated with significant morbidity and mortality. Despite its alarming prevalence, limited comparative evidence exists on its treatment efficacy and prognosis across diverse China populations.

To address this, our study used a large-scale dataset from the National Cancer Information Database, including data from 220,304 patients from 53 leading hospitals across 27 provinces in China.

From 2017 to 2023, early-stage (Stages I-II) gastric cancer diagnoses increased to 35.63% of all cancer cases. Our study evaluated the neoadjuvant treatment strategies, adjuvant post-operative therapy, first- and second-line management for progressive stages, alongside current gastric cancer treatment guidelines in China. Notably, immunotherapy accounted for 16.17% and 23.28% of first- and second-line treatments for late-stage gastric cancers, and 14.56% and 5.00% for neoadjuvant and adjuvant therapies, respectively. Analysis of survival rates revealed that the 1-, 2-, 3-, 4-, and 5-year survival rates were 74.07%, 54.89%, 44.21%, 37.97%, and 33.53%, respectively. The 5-year survival rates across stages I-IV were 85.07%, 49.34%, 35.56%, and 13.15%, respectively.

These findings offer critical insights into the current state of gastric cancer treatment in China and can inform future initiatives to improve therapeutic outcomes for patients with gastric cancer.

Esophageal squamous cell carcinoma (ESCC) is a common and aggressive form of esophageal cancer, particularly prevalent in East Asia. This study aimed to investigate the impact of sex on clinical outcomes, including survival and postoperative complications, in elderly ESCC patients following esophagectomy.

We conducted a retrospective cohort study using data from the Sichuan Cancer Hospital & Institute Esophageal Cancer Case Management Database, involving patients aged 70 years and older who underwent esophagectomy from May 2016 and August 2021. Patients were grouped by sex, and subgroup analyses were performed on non-smoking, non-drinking patients. OS and DFS were analyzed using the Kaplan-Meier method, and between-group comparisons were conducted using the log-rank test. Propensity score matching (PSM) was applied to adjust for potential confounders.

Although females showed a longer median OS (60.2 months) compared to males (40.0 months), the difference was not statistically significant after PSM (HR = 0.885, P = 0.573). Similarly, no significant differences were observed in DFS between sexes. In non-smoking, non-drinking subgroups, OS and DFS remained higher but without significant sex-based differences. Postoperative adverse events such as pulmonary infection and anastomotic leakage were common across groups.

While sex does not significantly affect OS and DFS in elderly ESCC patients, male patients may experience higher rates of certain postoperative complications, such as abnormal liver function and pneumothorax.