Patterns and predictors of recurrence after curative liver resection for hepatocellular carcinoma: Insights from a single Egyptian center.

Impact of contrast-enhanced computed tomography surveillance frequency on survival outcomes in patients with stage I-III colorectal cancer: A propensity score-matched retrospective cohort study.

Methylated Septin9 as an auxiliary biomarker for the diagnostic, recurrence monitoring and prognosis of colorectal cancer.

Integrated psychosocial, sleep, and nutritional support improves postoperative recovery, immune modulation, and survival after curative resection for low rectal cancer: A randomized controlled trial.

Utilization of invasive mediastinal nodal staging and prevalence of occult nodal disease in patients with synchronous primary lung cancers.

Efficacy and safety of adjuvant transarterial chemoembolization in high-risk HCC after curative hepatectomy: a phase III RCT protocol.

Adjuvant nivolumab has become a standard treatment after curative resection for locally advanced esophageal cancer; however, postoperative recurrence remains common. The efficacy of immune checkpoint inhibitor (ICI)-based therapy for postoperative recurrence in patients treated with adjuvant nivolumab remains unclear. This study evaluated the clinical outcomes of first-line ICI-based therapy for postoperative recurrence, focusing on the impact of prior adjuvant nivolumab exposure. This single-center retrospective study included 81 patients who developed postoperative recurrence after radical esophagectomy and subsequently received first-line ICI-based therapy. Propensity score matching (PSM) was performed to adjust for baseline differences. Treatment outcomes were assessed based on treatment response, progression-free survival, and overall survival (OS) after recurrence. Among the 81 patients, 27 had received adjuvant nivolumab and 54 had not. Treatment responses, including the proportion of patients achieving early tumor shrinkage ≥ 20%, were similar between patients with and without prior adjuvant nivolumab exposure. After PSM, no statistically significant differences were observed in treatment response. No significant differences were observed in progression-free survival (hazard ratio 1.4, 95% confidence interval 0.74-2.64, p = 0.298) or OS (hazard ratio 1.23, 95% confidence interval 0.61-2.50, p = 0.56). Two-year OS was 44% and 42.9% in the adjuvant and non-nivolumab groups, respectively. First-line ICI-based therapy for postoperative recurrence demonstrated no statistically significant differences in clinical outcomes irrespective of prior exposure to adjuvant nivolumab, suggesting that previous adjuvant immunotherapy does not preclude clinical benefit from subsequent ICI-based therapy at recurrence.

Endoscopic submucosal dissection (ESD) has become a first-line treatment for early esophageal cancer and precancerous lesions; however, non-curative resection (N-CR) occurs in a significant proportion of cases, necessitating additional surgical or chemoradiotherapy treatment. This study aimed to analyze the risk factors associated with N-CR following ESD and compare the efficacy of different secondary treatment strategies. We conducted a retrospective analysis of 306 patients who underwent ESD for early esophageal lesions at The Fourth Hospital of Hebei Medical University between January 2017 and December 2021. Patients were divided into curative resection (CR) and non-curative resection (N-CR) groups. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for N-CR. A predictive nomogram model was constructed using R software. For the 49 patients with N-CR, we compared recurrence rates at 3months, 1year, and 2years among three treatment strategies: no additional treatment (n = 22), surgical resection (n = 17), and chemoradiotherapy (n = 10). The overall N-CR rate was 16.0% (49/306). Multivariate analysis identified four independent risk factors for N-CR: gastroscopic pathology (OR = 0.186, 95% CI: 0.037-0.948, P = 0.043), depth of infiltration (OR = 0.012, 95% CI: 0.002-0.077, P < 0.001), lesion location (OR = 0.185, 95% CI: 0.038-0.890, P = 0.035), and gross morphological type (OR = 0.018, 95% CI: 0.002-0.209, P = 0.001). The nomogram demonstrated good predictive accuracy. The 2-year recurrence rates were 18.18% for the no-treatment group, 11.79% for the surgical group, and 10.00% for the chemoradiotherapy group. No significant differences in overall survival or disease-free survival were observed among the three groups (P > 0.05). ESD is a safe and effective treatment for early esophageal lesions. Gastroscopic pathology, depth of infiltration, lesion location, and gross type are independent predictors of N-CR. The predictive nomogram can assist clinical decision-making. Both surgical resection and chemoradiotherapy provide effective secondary treatment options for N-CR cases, with comparable oncological outcomes.

Esophageal achalasia is a rare disease characterized by impaired peristalsis throughout the esophagus, marked esophageal dilation, and nonorganic stenosis of the lower esophagus due to degeneration of the Auerbach's plexus, and it is a known risk factor for esophageal cancer. To the best of our knowledge, this is the first reported case of achalasia‑associated advanced esophageal squamous cell carcinoma successfully treated using a multidisciplinary approach. A 69-year-old female presented to our department with a 10-yr history of dysphagia and vomiting, accompanied by worsening hematemesis and passage disturbance. Esophagogastroduodenoscopy revealed a protruding lesion with stricture in the mid-to-lower thoracic esophagus, and biopsy confirmed squamous cell carcinoma. Further evaluation revealed unresectable advanced esophageal cancer with multiple lymph node metastases involving the dorsal descending aorta and left supraclavicular region. Following induction chemotherapy, marked shrinkage and disappearance of the primary tumor and metastatic lymph node were observed. However, nonorganic narrowing of the esophagogastric junction, along with esophageal tortuosity and dilation, persisted, leading to a diagnosis of esophageal achalasia. The patient subsequently underwent conversion thoracoscopic esophagectomy with the intent of achieving radical resection. Histopathological examination of the resected specimen demonstrated pathological complete response of both the primary tumor and lymph nodes, resulting in curative resection. Additionally, a reduction in the Auerbach's plexus and intramural nerve fibers was observed, consistent with achalasia. One year after surgery, paraaortic lymph node recurrence was detected and treated with local radiotherapy. Despite subsequent chemotherapy for recurrence, the patient ultimately died of cancer 25 months after surgery. This case represents a rare instance of conversion surgery achieving pathological complete response following induction chemotherapy for unresectable advanced esophageal cancer associated with achalasia. We report this case with a comparison of histopathological findings to those of other esophageal cancer cases with pathological complete response encountered at our institution, along with a review of the relevant literature.

Among patients with colorectal cancer, the liver is the most common site of metastases and is frequently the only site of disease. Curative intent resection offers the best chance for survival; however, access to surgery and outcomes may be influenced by social drivers of health. Using the 2022 National Cancer Database, we identified adults with colorectal liver metastases (CRLM) without extrahepatic spread. Patients were categorized into four surgical groups: combined primary and liver resection, liver-only resection, primary-only resection, and no surgery. Demographic, socioeconomic, and clinical factors were compared, and multivariable logistic and Cox models were used to assess predictors of surgery and overall survival and mortality risk. Of 40,670 patients, 49.8% received no surgery, 32.8% underwent primary-only resection, 1.6% underwent liver-only resection, and 15.8% underwent combined primary and liver resection. Combined resections were most common among younger, privately insured patients treated at academic centers in higher-income and higher-education regions (p < 0.001). Median OS differed significantly by treatment: combined resection, 59.5 months; liver-only, 41.5 months; primary-only, 28.2 months; and no surgery, 13.8 months. Adjusted mortality was higher for primary-only (HR 1.66), liver-only (HR 1.71), and no surgery (HR 3.21) compared with combined resection. Combined primary and liver resection was associated with the longest survival and lowest mortality among patients with CRLM. Significant disparities in surgical treatment and survival were observed across key social drivers of health, underscoring the need to address inequities in access to comprehensive, curative-intent care.

ABSTRACTBackground and AimsTo evaluate the prognostic significance of pathological response in patients with initially unresectable hepatocellular carcinoma (uHCC) who underwent salvage resection after successful conversion with lenvatinib, anti‐PD‐1 antibodies, and locoregional therapy (LPLRT).MethodsThis multicenter retrospective study included 102 uHCC patients who achieved curative resection after LPLRT across four tertiary centers in China. Residual viable tumour (pRVT) ratio was used to assess pathological response. Optimal pRVT cutoffs for overall survival (OS) and recurrence‐free survival (RFS) were identified using X‐tile (a statistical tool that identifies optimal prognostic cutoff values for continuous variables by systematically maximizing the log‐rank statistic). Survival was analysed by Kaplan–Meier and log‐rank tests, and prognostic factors by Cox regression analyses.ResultsAmong 102 patients, 25 (24.5%) achieved pathological complete response (pCR). X‐tile identified pRVT thresholds of 10% and 35% as optimal for predicting OS and RFS, respectively. Patients with pRVT ≤ 10% had superior OS (1‐, 2‐, 3 year: 96.6%, 89.8%, 82.5%) compared with pRVT > 10% (95.5%, 73.0%, 49.4%; p = 0.002). pRVT ≤ 35% was associated with longer RFS (1‐, 2 year: 60.5%, 47.1% vs. 24.0%, 10.0%; p < 0.001). Similar trends persisted after excluding pCR cases. On multivariate analysis, NLR < 2.6, adjuvant therapy, and pRVT ≤ 10% independently predicted improved OS, while age < 60 years was adverse for RFS, and NLR < 2.6 and pRVT ≤ 35% were independently associated with prolonged RFS. No clinical variables predicted pRVT thresholds.ConclusionspRVT refines postoperative prognostic assessment in uHCC after multimodal conversion therapy. Thresholds of ≤ 10% for OS and ≤ 35% for RFS serve as practical cutoffs for postoperative risk stratification.

Immune dysfunction, systemic inflammation, and malnutrition are closely associated with tumor progression and prognosis in intrahepatic cholangiocarcinoma (ICC). This multicenter retrospective study aimed to evaluate the prognostic value of immune-inflammatory-nutritional biomarkers and to establish a novel cholangiocarcinoma immune-inflammatory-nutritional score (CIINS). A total of 284 ICC patients who underwent curative surgical resection at three medical centers were retrospectively analyzed and divided into a training cohort (n = 182) and a validation cohort (n = 102). Twelve immune, inflammatory, and nutritional biomarkers derived from routine preoperative blood tests were assessed. The CIINS was constructed using least absolute shrinkage and selection operator Cox regression. Nomograms integrating CIINS with independent clinicopathological factors were developed to predict overall survival (OS) and progression-free survival (PFS). Model performance was evaluated using time-dependent receiver operating characteristic curves, calibration plots, and decision curve analysis. The CIINS consisted of four biomarkers: neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, neutrophil-to-albumin ratio, and prognostic nutritional index. Patients were stratified into high- and low-CIINS groups using the median value. High CIINS was significantly associated with poorer OS and PFS in both the training (both p < 0.001) and validation cohorts (OS: p = 0.006; PFS: p = 0.007). Elevated CIINS correlated with obstructive jaundice, increased CA19-9 levels, and advanced AJCC TNM stage. Multivariate analysis confirmed CIINS as an independent prognostic factor. CIINS-based nomograms demonstrated good discrimination and calibration for survival prediction. CIINS is a simple and clinically applicable prognostic tool for patients with resected ICC, supporting individualized risk stratification and postoperative management.

Pyloromyotomy is a technique for relieving infantile hypertrophic pyloric stenosis and is performed almost safely without severe complications during long-term outcomes. To the best of our knowledge, this is the first reported case of pancreatic cancer arising from the pancreatic parenchyma embedded within the pyloric ring after neonatal pyloromyotomy. A 39-year-old woman with a history of infantile hypertrophic pyloric stenosis underwent a pyloromyotomy during the neonatal period and presented with progressive nausea and vomiting. Imaging studies suggested the presence of ectopic pancreatic or gastric cancer invading the pancreas. After laparotomy, tumor invasion of the pancreatic head was identified; therefore, pancreaticoduodenectomy was performed. Pathological examination confirmed pancreatic cancer arising from the pancreatic parenchyma embedded within the duodenal and pyloric muscle layers. The patient completed 6 months of adjuvant chemotherapy with oral S-1. Peritoneal dissemination was observed 23 months postoperatively. Abnormal embedding of the pancreatic head in the walls of the duodenum and pyloric ring was considered to be related to neonatal pyloromyotomy. This alteration requires careful preoperative evaluation and flexible surgical planning to achieve curative resection of atypical presentations of gastrointestinal malignancies. The cancer in the present case may be associated with long-term anatomical alterations following neonatal pyloromyotomy, although a direct causal relationship cannot be established.

Endoscopic resection (ER) is the standard treatment for superficial esophageal squamous cell carcinoma (ESCC). However, in patients aged ≥ 80 years, ER has limited long-term benefits owing to the higher mortality risk from other diseases. We assessed the therapeutic outcomes and prognostic predictors of ER in patients with ESCC aged ≥ 80 years at three institutions. Patient characteristics and overall survival (OS) were evaluated using Cox proportional hazards regression models. This study included 161 patients with 161 lesions. The median patient age was 82 years. Patient characteristics included a median Brinkman Index (BI) of 570, Eastern Cooperative Oncology Group Performance Status (ECOG-PS) class 0-1 in 150 patients (93.2%), median Charlson Comorbidity Index (CCI) of 2, and high-sensitivity modified Glasgow Prognostic Score (HS-mGPS) class 0 in 122 patients (75.8%). Procedure-related outcomes revealed that 122 patients (75.8%) underwent curative resection, with no treatment-related deaths. Fifty-five patients (34.2%) died, including two from ESCC. The 5-year OS rate was 71.2%. BI ≥ 570 (hazard ratio [HR], 2.37; 95% confidence interval [CI], 1.07-5.25; P = 0.034), ECOG-PS 2-3 (HR, 3.25; 95% CI, 1.29-8.19; P = 0.012), CCI ≥ 3 (HR, 2.49; 95% CI, 1.37-4.53; P = 0.003), and HS-mGPS ≥ 1 (HR, 2.07; 95% CI, 1.03-4.19; P = 0.042) were identified as poor prognostic predictors, with 5-year OS rates of 63.2, 28.3, 56.9, and 52.3%, respectively. The 5-year OS rate was 19.0% (95% CI, 0.9-55.6) among patients with both BI ≥ 570 and ECOG-PS 2-3, and combinations of ECOG-PS 2-3 with other predictors were associated with lower OS. Higher BI, ECOG-PS, CCI, and HS-mGPS scores were independent predictors of poor prognosis. In patients with multiple predictors, particularly those involving higher ECOG-PS, observation without ER may be considered as a treatment option after a thorough discussion with the patient.

The impact of sustained virological response (SVR) on outcomes of patients with hepatocellular carcinoma (HCC) undergoing liver resection (LR) was assessed. This retrospective cohort study included 344 patients with hepatitis C virus (HCV)-related HCC who underwent LR. Patients were divided into three groups: preoperatively achieving SVR (pre-SVR); postoperatively achieving SVR (post-SVR); and not achieving SVR (non-SVR). 145 patients received direct-acting antivirals, 76 received interferon-based therapy, and 123 were untreated. 95 patients were pre-SVR, 87 were post-SVR, and 162 were non-SVR, including untreated patients. Five-year overall survival was 83% in the pre-SVR group, 92% in the post-SVR group, and 50% in the non-SVR group (p < 0.001). Pre-SVR (adjusted HR (aHR) 0.35; 95% CI 0.19-0.62; p < 0.001) and post-SVR (aHR 0.18; 95% CI 0.09-0.36; p < 0.001) were independent predictors of mortality. Five-year recurrence-free survival was 75% in the pre-SVR group, 55% in the post-SVR group, and 45% in the non-SVR group (p < 0.001). Pre-SVR (aHR 0.45; 95% CI 0.28-0.73; p = 0.001) was an independent predictor of recurrence, whereas post-SVR (aHR 0.84; 95% CI 0.57-1.24; p = 0.37) was not. Achieving SVR before or after LR decreased the mortality risk and achieving SVR before LR decreased the recurrence risk of patients with HCV-related HCC undergoing LR.

Long-term outcomes of endoscopic submucosal dissection for esophageal squamous high-grade dysplasia and early squamous cell carcinoma in the west: Absolute versus Outside Criteria.

Despite recent advances in chemotherapy for colorectal cancer (CRC), chemotherapy-sensitive tumours often develop resistance to treatment, which remains a major clinical challenge. This acquired chemoresistance limits the efficacy of subsequent therapies and is associated with a poor prognosis. Therefore, this study identified the mechanisms of acquired chemoresistance in CRC and developed innovative targeted therapies. 5-fluorouracil (5-FU)-and oxaliplatin (OX)-resistant CRC cells were established through long-term exposure to anticancer drugs, and RNA sequencing (RNA-seq) was performed. RNA-seq data integrated analysis from resistant cells and public single-cell RNA-seq datasets from clinical CRC samples was conducted to identify key drivers of chemoresistance. Prognostic significance was evaluated by immunohistochemical analysis of liver metastasis specimens from patients with CRC who underwent curative resection of the primary tumours. Chemotherapy exposure enriched high stemness and activated TGF-β signalling. GDF15 was identified as a key molecule upregulated in both chemoresistant and high-stemness cells. Clinically, high GDF15 expression is associated with early recurrence and poor prognosis. Functional assays demonstrated that GDF15 overexpression promoted chemoresistance, stemness, and migratory capacity of CRC cells. GDF15 promotes chemoresistance in CRC by promoting stem cell-like properties. These findings provide insights into therapeutic strategies for overcoming acquired chemoresistance and improving outcomes.

To evaluate the predictive value of whole-tumor iodine density (ID) histogram parameters and resection margin distance for early recurrence (ER) after curative resection of hepatocellular carcinoma (HCC). This retrospective study included patients with HCC who underwent R0 resection and received preoperative spectral CT scans. Patients were categorized into ER+ (n = 42) and ER- (n = 43) groups. Independent predictors of recurrence-free survival (RFS) were identified using multivariate Cox regression analysis. The performance of the prediction model was assessed using time-dependent receiver operating characteristic (td-ROC) curves, calibration and decision curves analysis. Kaplan-Meier analysis was used to evaluate differences in RFS between groups. Multivariate Cox regression identified Max, Skewness, microvascular invasion (MVI), and resection margin distance as independent risk factors for ER. Kaplan-Meier analysis revealed significantly shorter mean RFS in patients with MVI+ (12.34 months vs. 29.02 months), extremely narrow margin (9.54 months) and narrow margin (15.42 months) compared to wide margin (28.41 months), high Max (≥ 2041.00 vs. <2041.00; 15.15 vs. 26.13 months), and high Skewness (≥ 0.22 vs. <0.22; 16.83 vs. 23.62 months) (all P < 0.05). Whole-tumor ID histogram parameters (Max and Skewness) and clinicopathological factors (MVI and resection margin distance) are independent predictors of ER. These factors allow effective stratification of RFS and may guide individualized postoperative management. Whole-tumor iodine density histogram features and resection margin distance provide independent predictors of early recurrence after hepatectomy in HCC, enabling improved risk stratification and guiding individualized postoperative management.

Colorectal cancer liver metastasis remains a significant challenge, with systemic inflammation and liver fibrosis emerging as key prognostic factors. This study evaluates the individual and combined prognostic significance of the Systemic Inflammation Index and Fibrosis-4 index in CRLM patients undergoing curative liver resection after neoadjuvant chemotherapy. A retrospective cohort of 255 CRLM patients was stratified into high/low SII and FIB-4 groups based on median values. SII and FIB-4 were calculated using preoperative laboratory data. Primary outcomes included overall survival (OS) and disease-free survival (DFS), with secondary outcomes assessing postoperative complications and recurrence. Kaplan-Meier analysis and Cox regression were used for survival analysis. Higher SII levels were associated with worse DFS (HR = 0.67, p = 0.028). Similarly, higher FIB-4 levels correlated with increased recurrence rates (p = 0.03) and poorer DFS (HR = 0.69, p = 0.047). For Overall Survival (OS), no significant difference was observed between the High SII and Low SII groups, nor between the High FIB-4 and Low FIB-4 groups. The Low FIB-4 & Low SII group showed significantly better DFS (HR = 0.47, p = 0.048). In terms of postoperative outcomes, the FIB-4 Low group had more transfusions and incision infections. Additionally, the SII High group had higher recurrence rates and more R1 resections (p = 0.045). SII and FIB-4 are valuable biomarkers for predicting DFS and recurrence in CRLM patients. Their combined use enhances risk stratification, offering a comprehensive approach to guide personalized treatment strategies. Future studies should explore targeted therapies to modulate inflammation and fibrosis, improving outcomes for high-risk patients.

ASO Visual Abstract: Prognosis After Curative Resection of Esophageal Basaloid Squamous Cell Carcinoma: A Single-Institution Retrospective Study.