World Journal of Gastrointestinal Oncology最新文献

Gastric cancer (GC) has high morbidity and mortality worldwide. Due to the absence of noticeable symptoms, diagnosing GC at an early stage is very difficult, which consequently leads to advanced GC and poor prognosis. Effective biomarkers are essential for prolonging patients' survival. Helicobacter pylori (H. pylori) infection represents the most significant risk factor for GC, with nearly all cases linked to this infection. Many non-coding RNAs (ncRNAs) are dysregulated in H. pylori-infected GC, indicating that ncRNAs may serve as biomarkers of early-stage GC. In this editorial, we discuss the study by Chen et al. Although previous studies have identified roles for miR-136 in gastric cancer proliferation, apoptosis, and invasion, none have specifically explored its relationship with H. pylori-associated gastric carcinogenesis.

Background: Inappropriate selection of patients with early gastric cancer (EGC) for endoscopic submucosal dissection (ESD) may lead to non-curative resection, necessitating additional gastrectomy. Conversely, inappropriate selection for gastrectomy may result in overtreatment, adversely affecting patients' quality of life. Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC. To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients', we specifically assess the suitability of Japanese guidelines in non-Japanese populations. This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan.

Aim: To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies.

Methods: A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022. Cases were categorized into three groups: Same-estimated (preoperative therapeutic indication with postoperative pathological criteria matched), underestimated (preoperative ESD indication but postoperative surgical criteria), and overestimated (preoperative surgical indication but postoperative ESD criteria). The rate of discrepancy and associated risk factors were assessed.

Results: The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0% (321/430) and 76.0% (278/366), respectively. The overall discrepancy rate was 25.6% (204/796). Multivariate analysis identified tumor location in the upper-third stomach (odds ratio = 2.158, 95% confidence interval: 1.373-3.390, P = 0.001) was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy (odds ratio = 2.005, 95% confidence interval: 1.036-3.879, P = 0.039) was more likely to be overestimated. Significant differences were observed in tumor diameter (P < 0.001), depth of infiltration (P < 0.001), ulcerative findings (P < 0.001), and histologic type (P < 0.001) between preoperative and postoperative evaluations.

Conclusion: The accuracy of preoperative EGC indications is 74.4%. Upper-third stomach and undifferentiated histology are primary discrepancy predictors. Upper-third tumors are prone to underestimation, while undifferentiated tumors are prone to overestimation.

Background: Regorafenib is approved as a second-line treatment for advanced hepatocellular carcinoma (HCC), but its comparative efficacy remains under evaluation.

Aim: To evaluate the efficacy and safety of regorafenib vs other second-line therapies in advanced HCC.

Methods: This systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed, EMBASE, Web of Science, and the Cochrane Library was performed on June 6, 2025. Studies were included if they reported at least one relevant clinical outcome: Overall survival, progression-free survival, objective response rate, or disease control rate. Data was extracted independently by two reviewers. Quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies. Pooled effect estimates were calculated using random- or fixed-effects models depending on the degree of heterogeneity. Sensitivity analyses and Egger's test were performed to evaluate the robustness of the results and potential publication bias.

Results: Nine studies met inclusion criteria. Regorafenib significantly improved overall survival compared to controls [weighted mean difference = 2.54 months; 95% confidence interval (CI): 0.26-4.81; P < 0.05], but no significant benefit was observed for progression-free survival (weighted mean difference = 1.04; 95%CI: -1.27 to 3.36). The pooled objective response rate showed no overall difference, though regorafenib was inferior to nivolumab in subgroup analysis (odds ratio = 0.34; 95%CI: 0.20-0.58). Disease control rate did not differ significantly. No publication bias was detected.

Conclusion: Regorafenib offers a survival advantage in advanced HCC but does not significantly improve tumor response rates compared to alternative therapies.

Background: Hepatocellular carcinoma (HCC) is a major type of liver cancer worldwide. In advanced stages, portal vein tumor thrombosis (PVTT) and jaundice are common, whereas obstructive jaundice (OJ) is relatively rare. Both conditions markedly reduce survival and increase therapeutic complexity. Recently, hepatic artery infusion chemotherapy (HAIC) in combination with targeted immunotherapy has shown promise for advanced HCC.

Case summary: We report a 47-year-old male with advanced HCC complicated by PVTT and OJ, who was admitted with marked jaundice of the skin and sclera. Imaging revealed a large hepatic mass (14.5 cm × 11.3 cm) in the right lobe with associated portal vein tumor thrombus. The tertiary bile duct was only mildly dilated, making percutaneous transhepatic cholangiography drainage infeasible. The patient underwent reduced-dose HAIC, which resulted in significant tumor shrinkage and marked reduction in serum bilirubin. This improvement enabled sequential treatment with lenvatinib and camrelizumab. After six cycles, both liver function and alpha-fetoprotein levels improved. The patient achieved a progression-free survival of 20 months and an overall survival of 29 months.

Conclusion: HAIC can treat high-bilirubin HCC with PVTT and OJ, allowing for subsequent targeted immunotherapy.

Hepatocellular carcinoma presents with three distinct immune phenotypes, including immune-desert, immune-excluded, and immune-inflamed, indicating various treatment responses and prognostic outcomes. The clinical application of multi-omics parameters is still restricted by the expensive and less accessible assays, although they accurately reflect immune status. A comprehensive evaluation framework based on "easy-to-obtain" multi-model clinical parameters is urgently required, incorporating clinical features to establish baseline patient profiles and disease staging; routine blood tests assessing systemic metabolic and functional status; immune cell subsets quantifying subcluster dynamics; imaging features delineating tumor morphology, spatial configuration, and perilesional anatomical relationships; immunohistochemical markers positioning qualitative and quantitative detection of tumor antigens from the cellular and molecular level. This integrated phenomic approach aims to improve prognostic stratification and clinical decision-making in hepatocellular carcinoma management conveniently and practically.

Rectal neuroendocrine tumors (NETs) are increasingly detected and are the most common gastrointestinal NET sites. Often discovered incidentally during endoscopy, most are small, well differentiated, and have an excellent prognosis. Local resection is typically considered curative. Several guidelines, namely the European Neuroendocrine Tumor Society guidelines 2023, National Comprehensive Cancer network 2025, and the Polish Network of Neuroendocrine Tumors (2017) emphasize the use of endoscopic and endoscopic ultrasound staging to select the appropriate therapy, ranging from resection to advanced techniques for larger or metastatic diseases, highlighting the need for an accurate initial assessment.

Background: Gastrointestinal (GI) tumors are among the most prevalent malignancies, and surgical intervention remains a primary treatment modality. However, the complexity of GI surgery often leads to prolonged recovery and high postoperative complication rates, which threaten patient safety and functional outcomes. Enhanced recovery after surgery (ERAS) principles have been shown to improve perioperative outcomes through evidence-based, multidisciplinary care pathways. Despite its widespread adoption, there is a paucity of research focusing specifically on optimizing ERAS-guided nursing processes in the post-anesthesia care unit (PACU) and evaluating its impact on perioperative safety in patients undergoing GI tumor surgery. This study aimed to investigate whether an ERAS-based PACU nursing protocol could enhance recovery, reduce complications, and improve patient safety in this surgical population.

Aim: To explore the impact of optimizing the recovery room nursing process based on ERAS on the perioperative safety of patients with GI tumors.

Methods: A total of 260 patients with GI tumors who underwent elective surgeries under general anesthesia in our hospital from August 2023 to August 2025 and were then observed in the recovery unit (PACU) were selected. They were randomly divided into the observation group (the PACU nursing process was optimized based on ERAS) and the control group (the conventional PACU nursing process was adopted) by the random number grouping method, with 130 cases in each group. The time of gastric tube removal, urinary catheter removal, defecation time, hospital stay, time of leaving the room after tube removal, retention time in the recovery room, occurrence of complications, satisfaction and readmission rate were compared between the two groups after entering the room. Compare the occurrence of adverse events in the PACU nursing process between the two groups.

Results: The time of gastric tube removal, urinary catheter removal, defecation time, hospital stay, retention time in the recovery room, total incidence of complications and readmission rate in the observation group were significantly lower than those in the control group, and the satisfaction rate was higher than that in the control group (P < 0.05). The occurrence of adverse events in the PACU nursing process in the observation group was lower than that in the control group (P < 0.05).

Conclusion: Optimizing the PACU nursing process based on ERAS can effectively accelerate the recovery process of patients undergoing GI tumor surgery, reduce adverse events, improve nursing satisfaction, and at the same time, lower the incidence of adverse events in the PACU nursing process, providing a more refined management basis for clinical practice.

Delayed wound healing following radical gastrectomy remains an important yet underappreciated complication that prolongs hospitalization, increases costs, and undermines patient recovery. In An et al's recent study, the authors present a machine learning-based risk prediction approach using routinely available clinical and laboratory parameters. Among the evaluated algorithms, a decision tree model demonstrated excellent discrimination, achieving an area under the curve of 0.951 in the validation set and notably identifying all true cases of delayed wound healing at the Youden index threshold. The inclusion of variables such as drainage duration, preoperative white blood cell and neutrophil counts, alongside age and sex, highlights the pragmatic appeal of the model for early postoperative monitoring. Nevertheless, several aspects warrant critical reflection, including the reliance on a postoperative variable (drainage duration), internal validation only, and certain reporting inconsistencies. This letter underscores both the promise and the limitations of adopting interpretable machine learning models in perioperative care. We advocate for transparent reporting, external validation, and careful consideration of clinically actionable timepoints before integration into practice. Ultimately, this work represents a valuable step toward precision risk stratification in gastric cancer surgery, and sets the stage for multicenter, prospective evaluations.

Background: The liver represents a common site of distant metastasis in patients with esophageal cancer (EC). Conventional chemotherapy (CMT) presents limited efficacy for EC, and EC patients with liver metastases typically experience a poor prognosis, highlighting an urgent need to explore novel treatment approaches. This study evaluated the overall efficacy and safety of CMT vs CMT combined with immune checkpoint inhibitors (ICIs) in the treatment of EC patients with liver metastases. Furthermore, prognostic factors influencing outcomes in this patient population were identified.

Aim: To evaluate the efficacy and safety of first-line chemoimmunotherapy for EC patients with liver metastases and to analyze prognostic factors.

Methods: This retrospective study included 126 EC patients with liver metastases at Zhejiang Cancer Hospital between 2014 and 2024. Patients receiving CMT were compared with those receiving CMT + ICI. Analyzed variables included clinicopathological features, treatment history, characteristics of metastasis, systemic and local treatments, overall survival (OS), and treatment-related adverse events (TRAEs). Prognostic factors were evaluated using univariate and multivariate Cox proportional-hazards regression models. Finally, efficacy outcomes and TRAE profiles were compared between the two groups.

Results: A significant difference in median OS was identified between the two groups (10.8 months in the CMT group vs 20.8 months in the CMT + ICI group, P = 0.004). The CMT + ICI group also demonstrated a significantly longer median progression-free survival of 11.7 months (P < 0.001). Patients receiving combination therapy exhibited significantly improved systemic objective response rate and disease control rate. Multivariate analysis identified key factors significantly influencing OS in EC patients with liver metastases: Karnofsky Performance Status score ≥ 70, receipt of local therapy for liver metastases, and the number of cycles of CMT and immunotherapy received. Furthermore, the incidence of TRAEs did not significantly differ between the CMT + ICI and CMT groups.

Conclusion: For EC patients with liver metastases, the combination of CMT and ICIs demonstrates significantly superior efficacy compared with CMT alone, while maintaining manageable TRAEs.

Background: The treatment technology of liver cancer is progressing. In addition to traditional surgical resection, combined therapies of immunotherapy based on immune checkpoint inhibitors, chemotherapy, and transcatheter arterial chemoembolization for hepatocellular carcinoma are more and more widely used. Accurate preoperative diagnosis of liver cancer will provide important information for comprehensive treatment and prognosis evaluation of liver cancer. Sonazoid-contrast-enhanced ultrasound is not only helpful for the qualitative diagnosis of liver lesions, but also has great potential in the diagnosis of histological differentiation of liver cancer.

Aim: To assess the differentiation of hepatocellular carcinoma (HCC) by utilizing the parameters and imaging features of Sonazoid-contrast-enhanced ultrasound (CEUS).

Methods: A retrospective analysis was conducted on the CEUS data of 239 lesions through case-control study. These patients received Sonazoid-CEUS within one week before surgery and were confirmed as HCC by postoperative pathology. Within the cases, patients were further categorized into well-differentiated and poorly-differentiated group. Time-intensity curves of the region of interest in both arterial and Kupffer phases were generated, allowing for the acquisition of quantitative parameters to assess the diagnostic efficacy in distinguishing lesions between these two groups and determining an appropriate cut-off value.

Results: Univariate analysis showed that the absolute value of enhancement intensity (EIAV), intensity ratio (IR) and intensity difference (ID) in Kupffer phase were statistically different between the groups with different degree (P = 0.015, P = 0.000, P = 0.000). The sensitivity and specificity were 40.2%, 82.4%, 80.4% and 78.1%, 86.9% and 74.5%, respectively, for differentiating HCC lesions with EIAV ≥ 56.384 dB, IR ≥ 1.215 and ID ≥ 9.184 dB. The area under the receiver operating characteristic curve were 0.590, 0.877, 0.815. There was no significant difference in the parameters of arterial phase, including peak time, initial growth time, rise time and the absolute value of peak intensity of lesions between the two groups (P > 0.05). Multivariate analysis showed that the level of alpha-fetoprotein (AFP) and IR were risk factors for poor differentiation (P = 0.001).

Conclusion: Among the parameters of Sonazoid-CEUS, IR in Kupffer phase exhibits superior diagnostic efficacy with high sensitivity and specificity in the diagnose of pathological differentiation of HCC. Combined with preoperative AFP level, a more accurate diagnosis will be obtained. Compared with portal vein phase, Kupffer phase showed the ability to identify HCC lesions more sensitive. These findings hold significant guiding implications and reference value for clinical practice.