Journal of Gastrointestinal Cancer最新文献

Purpose: Esophageal stricture is a common and debilitating late-onset complication after definitive chemoradiotherapy (dCRT) for esophageal squamous cell carcinoma (ESCC). Several risk factors have been identified; however, evidence remains limited in advanced (T2-T4) disease, particularly regarding quantitative endoscopic parameters and nutritional status.

Methods: We retrospectively analyzed 93 patients with T2-T4 ESCC who achieved complete response after dCRT between 2008 and 2025. Tumor characteristics, nutritional indices, and treatment parameters were evaluated. Independent predictors of post-dCRT stricture were assessed using multivariate logistic regression. Receiver operating characteristic analyses were performed. Survival outcomes were analyzed using time-dependent Cox proportional hazards models.

Results: Clinically significant strictures developed in 44.1% of patients. Multivariate analysis identified three independent predictors: pre-treatment endoscopic non-passability (OR = 18.3, p < 0.001), greater tumor length (OR = 1.61, p = 0.008), and higher luminal obstruction ratio (OR = 1.07, p = 0.007). Lower baseline serum albumin showed a trend toward an inverse association with stricture development. No association was observed between stricture risk and chemotherapy regimen or radiation dose. Patients who developed strictures had worse overall survival (HR = 2.17, p = 0.009) and disease-specific survival (HR = 2.40, p = 0.025).

Conclusion: In T2-T4 ESCC treated with dCRT, stricture formation was strongly associated with impaired endoscopic patency and larger tumor burden. Poorer baseline nutritional status may also increase risk. Pre-treatment endoscopic and nutritional assessments may help identify high-risk patients and guide early supportive interventions.

Purpose: This study evaluates the accuracy of computed tomography (CT), magnetic resonance imaging (MRI), and endorectal ultrasound (ERUS) in preoperative staging of colon and rectal cancers, comparing imaging results with histopathological findings. The aim is to identify strengths and limitations of each modality to optimize therapeutic strategies, particularly for neoadjuvant therapy in locally advanced cases.

Methods: This retrospective study analyzed 487 patients treated surgically for colon and rectal cancers between 2012 and 2018. Patients with incomplete imaging or histopathological data were excluded. Preoperative staging with CT, MRI, and ERUS was assessed against histopathological findings, focusing on sensitivity, specificity, and predictive accuracy (PAC). Statistical analyses were conducted to evaluate the performance of each modality for tumor (T) and nodal (N) staging, as well as risk stratification for low-risk (T1/T2) and high-risk (T3/T4) tumors.

Results: MRI showed the highest PAC for rectal cancer (89% for T-staging, 82% for N-staging), particularly for advanced tumors. CT achieved robust results for colon cancer, with PACs of 82% for T-staging and 73% for N-staging. ERUS demonstrated high accuracy for early rectal cancer, achieving an 85% PAC for low-risk tumors but performed weaker for advanced cases. MRI and CT outperformed ERUS in detecting advanced-stage tumors and nodal involvement. Risk stratification analysis confirmed MRI's superiority in rectal cancer and CT's consistency in colon cancer staging.

Conclusion: MRI is the modality of choice for rectal cancer staging, while CT remains the cornerstone for colon cancer staging. ERUS is best suited for early rectal tumors. These findings highlight the complementary roles of these imaging modalities and underline the need for advanced techniques to enhance diagnostic accuracy in colorectal cancer management.

Purpose: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, with incidence and mortality projected to rise. Most patients present with advanced or unresectable disease, where treatment efficacy is often constrained by frailty and impaired physical function. As physical function has emerged as a key determinant of treatment eligibility and survival, there is growing interest in physical activity as a supportive intervention in HCC care. This narrative review synthesises observational, pre-clinical, and trial evidence on the role of physical activity in patients with HCC, examining its potential to improve treatment tolerance, quality of life, and survival.

Methods: A literature search was conducted across four databases (PubMed, Scopus, Web of Science, Embase) using keywords related to HCC, physical activity, exercise, and survivorship.

Results: Pre-clinical studies reveal multiple mechanisms through which physical activity may enhance anti-tumour responses, including metabolic reprogramming, modulation of oncogenic signalling and immune activation. Observational studies suggest that frailty and sarcopenia - markers of reduced physical function, are possibly associated with early treatment discontinuation and shorter survival in HCC. Preliminary interventional data suggest that structured exercise programmes, delivered in hospital, outpatient, telehealth, or mobile formats, can improve frailty, preserve muscle mass, and may potentially support survival. However, clinical studies to date are limited by small sample sizes, non-randomised designs, and short follow-up periods.

Conclusion: Current evidence provides a biologically plausible and clinically promising rationale for integrating physical activity into HCC care pathways. While findings are encouraging, robust randomised trials are needed to establish efficacy, define optimal exercise regimens, and evaluate long-term outcomes.

Background: Completion extended cholecystectomy (CEC) is the standard treatment for incidental gallbladder cancer (iGBC) to reduce early recurrence and improve survival. However, the necessity of laparoscopic port site excision (PSE) during CEC remains controversial. This scoping review evaluates whether routine PSE is warranted in the management of iGBC.

Methods: A systematic search was conducted across PubMed, Google Scholar, Scopus, and the Cochrane Library using keywords such as "incidental gallbladder carcinoma," "radical cholecystectomy," "extended cholecystectomy," "port site excision," "port site recurrence," and "port site metastasis."

Results: Three original studies involving 503 iGBC patients were analyzed, comparing outcomes between those who underwent PSE and those who did not. Of the 170 patients who received PSE, 14 (8.2%) had malignant port site involvement. Recurrence rates were comparable between the PSE and non-PSE groups (36% vs. 40%). Although the median overall survival was numerically higher in the PSE group (36-89 months vs. 30-45 months), this difference was not statistically significant.

Conclusion: Routine PSE during CEC for iGBC may not be necessary, as it does not significantly reduce distant recurrence or improve overall survival.