Journal of gastrointestinal oncology最新文献

{"title":"Critical analysis of prognostic study in esophageal squamous cell carcinoma.","authors":"Dong-Mei Liu, Jian Zhang","doi":"10.21037/jgo-2025-173","DOIUrl":"10.21037/jgo-2025-173","url":null,"abstract":"","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 3","pages":"1356-1357"},"PeriodicalIF":2.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the combined diagnostic power of alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II for hepatocellular carcinoma.","authors":"Shangdi Zhang, Caiyan Gao, Yubin Wang, Linmei Chen, Shan Gao","doi":"10.21037/jgo-2024-863","DOIUrl":"10.21037/jgo-2024-863","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths globally, largely due to delayed diagnosis. Alpha-fetoprotein (AFP), a traditional biomarker for HCC, suffers from limited sensitivity and specificity, particularly in early-stage disease. Protein induced by vitamin K absence or antagonist-II (PIVKA-II) has emerged as a promising complementary marker. This study aimed to evaluate the diagnostic performance of AFP and PIVKA-II, individually and in combination, in HCC detection.</p><p><strong>Methods: </strong>A total of 210 HCC patients and 270 chronic hepatitis B (CHB) patients were enrolled between June 2021 and February 2023. Additionally, 91 HCC patients and 88 CHB patients were included as a validation cohort. Serum levels of AFP and PIVKA-II were measured, and their diagnostic efficacy was assessed using receiver operating characteristic (ROC) curve analysis. A multivariate logistic regression model incorporating clinical features and biomarkers was developed and validated. A meta-analysis of relevant studies was also conducted to further confirm the diagnostic value of AFP.</p><p><strong>Results: </strong>PIVKA-II levels were significantly higher in HCC patients compared to CHB controls and showed superior diagnostic performance [area under the curve (AUC) =0.970] compared to AFP (AUC =0.890). The combination of AFP and PIVKA-II significantly improved sensitivity (98.6%) and specificity (91.1%). A predictive model integrating AFP, PIVKA-II, age, sex, aspartate aminotransferase (AST), and albumin (ALB) demonstrated excellent diagnostic accuracy (AUC =0.995) and was successfully validated (AUC =0.986). Meta-analysis supported AFP as a reliable biomarker for HCC, although with heterogeneity across studies. PIVKA-II was also effective in monitoring treatment response, with postoperative levels markedly decreasing in patients undergoing hepatectomy.</p><p><strong>Conclusions: </strong>PIVKA-II offers superior diagnostic accuracy for HCC and complements AFP to enhance early detection, especially in AFP-insensitive cases. The combined biomarker strategy and predictive model provide a robust framework for clinical screening and early intervention. Integration of PIVKA-II into routine diagnostic workflows could improve patient outcomes and reduce diagnostic delays in HCC.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 3","pages":"1157-1175"},"PeriodicalIF":2.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver transplantation in a patient with metastatic hepatocellular carcinoma after downstaging with single-agent immunotherapy: the first case report.","authors":"Angelo Pirozzi, Celine Hoyek, Oluseyi Abidoye, Naohiro Okano, Michelle C Nguyen, Thomas Byrne, Bashar Aqel, David Chascsa, Sadeer Alzubaidi, Lorenza Rimassa, Tanios Bekaii-Saab, Mitesh J Borad","doi":"10.21037/jgo-24-764","DOIUrl":"10.21037/jgo-24-764","url":null,"abstract":"<p><strong>Background: </strong>Immunotherapy in hepatocellular carcinoma (HCC) has changed the clinical practice for unresectable and advanced setting after the approvals of atezolizumab plus bevacizumab and durvalumab plus tremelimumab (STRIDE regimen). A growing field for its application is the use of systemic therapy to achieve disease control in patients already listed for liver transplantation (LT) (bridging therapy) and fitting those not eligible within the LT criteria (conversion therapy). However, there is still a lack of prospective data for using immune checkpoint regimens in this setting, especially regarding the treatment-free interval before LT which may be different based on the immunotherapy drug chosen. Here, we present the first case in the literature of a patient with metastatic extrahepatic disease [Barcelona Clinic Liver Cancer (BCLC)-C] and severe alcoholic cirrhosis who successfully LT after a prolonged radiologic complete response (CR) to single-agent immunotherapy.</p><p><strong>Case description: </strong>A 61-year-old man with a diagnosis of advanced hepatocellular carcinoma (aHCC) (abdominal lymph nodes, lung, mediastinal nodes, bone) in the setting of alcoholic cirrhosis with a history of esophageal varices was treated with single-agent nivolumab 480 mg intravenous (IV) every four weeks for approximately 17 months (18 cycles) with partial response (PR). Considering the prolonged disease control, systemic therapy was discontinued. Three months after the treatment stopped, a new hepatic lesion was detected on abdominal magnetic resonance imaging (MRI). The new hepatic lesion was treated with microwave ablation (MWA) with a CR. After 10 months from MWA, the patient was free of active disease in the context of a slow, delayed response to immunotherapy. With the aim to treat his underlying liver disease, the patient received orthotopic LT, and he is currently free of cancer after one year of follow-up.</p><p><strong>Conclusions: </strong>LT in patients with aHCC with CR to immunotherapy may be feasible and safe in carefully selected patients, potentially curing the underlying liver disease, which impacts both survival and quality of life. However, the immunosuppressive state induced by LT may facilitate the disease progression of extrahepatic disease, therefore this should be considered only in selected patients with a prolonged CR to systemic therapy.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 3","pages":"1321-1330"},"PeriodicalIF":2.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of indeterminate focal hepatic observations less than 20 mm followed up with gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI).","authors":"Fei Xing, Yichen Xu, Yue Cao, Lijuan Zhai, Jian Lu, Jifeng Jiang, Qinrong Ma, Wei Xing, Ralf Weiskirchen, Vasileios K Mavroeidis, Tao Zhang, Songhua Ma","doi":"10.21037/jgo-2025-302","DOIUrl":"10.21037/jgo-2025-302","url":null,"abstract":"<p><strong>Background: </strong>Indeterminate hepatic observations classified as Liver Imaging Reporting and Data System (LI-RADS) category 3 (LR-3) exhibit uncertain malignant potential and pose a diagnostic challenge during hepatocellular carcinoma (HCC) surveillance. Although most LR-3 observations remain stable, recent studies have reported variable progression rates to HCC. The purpose of the present study was to investigate and assess the clinical outcomes and progression-associated factors of LR-3 observations less than 20 mm in high-risk patients, on follow-up with serial gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI).</p><p><strong>Methods: </strong>A retrospective review was conducted on 125 patients with hepatitis B virus (HBV)-related cirrhosis who underwent Gd-EOB-MRI examinations at index and during follow-up. A total of 149 untreated LR-3 observations less than 20 mm in size were included in the study. Stepwise multivariate Cox proportional hazards model analysis was performed to identify the predictive risk factors for progression (upgraded to LR-4 or LR-5), including patient demographics and LI-RADS imaging features. Overall cumulative risk for progression was calculated using the Kaplan-Meier method, and significant predictive risk factors were compared using the log-rank test.</p><p><strong>Results: </strong>Over a median follow-up period of 18.3 months (range, 2.7-78.5 months), the overall cumulative risk of progression for LR-3 observations was 41.6% (62/149) and was 1.3%, 9.5%, 17.3%, and 37.3% at 3, 6, 12, and 24 months, respectively. The multivariate analysis revealed three significant independent predictors of progression: non-rim arterial phase hyperenhancement (APHE) [hazard ratio (HR) =2.19; P=0.005], subthreshold growth (HR =2.78; P=0.001), and mild-to-moderate T2 hyperintensity (HR =5.25; P<0.001). LR-3 observations with non-rim APHE or mild-to-moderate T2 hyperintensity showed a significantly higher cumulative risk of progression (53.3% <i>vs.</i> 33.7% and 50.0% <i>vs.</i> 28.8%, respectively; both P<0.001), as well as a shorter median interval to LR category upgrade (14.7 <i>vs.</i> 18.9 months and 15.1 <i>vs.</i> 26.5 months, respectively; both P<0.001), compared to those without these features.</p><p><strong>Conclusions: </strong>Non-rim APHE, subthreshold growth, and mild-to-moderate T2 hyperintensity were significantly associated with an increased risk of progression among high-risk patients with LR-3 observations.. In particular, the presence of non-rim APHE or mild-to-moderate T2 hyperintensity was linked to both a higher cumulative incidence of progression and a shorter median interval to LR category upgrade.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 3","pages":"1078-1091"},"PeriodicalIF":2.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular characterisation of Mozambican patients diagnosed with colorectal adenocarcinoma.","authors":"Carlos Selemane, Dylan Ferreira, Isabel Veiga, Patrícia Rocha, Luisa Jamisse, Landim Buane, Assucena Guisseve, Carla Carrilho, Mamudo Ismail, Manuel R Teixeira, Lúcio Lara Santos","doi":"10.21037/jgo-24-677","DOIUrl":"10.21037/jgo-24-677","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) represents a major healthcare problem worldwide, with significant impact in more unfavourable populations. Reports sustain an increased frequency of cases in these populations; however, the real scale remains to be fully disclosed. Data unveil that CRC in Africa manifests at younger age and in advanced stages of the disease that, in combination with scarce clinical strategies to manage patient treatment, leads to high rates of mortality. In this study, we aim to address the mutation landscape of Mozambican CRC tumours to improve the patient clinical management, focusing on <i>KRAS</i>, <i>NRAS</i>, <i>BRAF</i>, <i>TP53</i>, and microsatellite instability (MSI) phenotype.</p><p><strong>Methods: </strong>A patient sample set of 30 CRC tumours from Mozambican patients was used to assess mutations in <i>KRAS</i>, <i>NRAS</i>, <i>BRAF</i>, and MSI phenotype through the Idylla^TM platform and the levels of p53 protein by immunohistochemistry.</p><p><strong>Results: </strong>Our results, opposing to previous reports published on African or African descent populations, reveal a predominance of mutations in KRAS and overexpression of p53 protein, with much lower mutation frequencies in the remaining genes.</p><p><strong>Conclusions: </strong>Identification of the mutational pattern of Mozambican CRC patients can help Mozambican clinicians better optimise treatment planning and therefore patient's outcome. Promising results obtained in our study, allied to scarcity of molecular data from Mozambican CRC patients, make imperative to enlarge our patient sample set to obtain more clinicopathological data and demographic/ancestry information.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 3","pages":"1025-1037"},"PeriodicalIF":2.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world effectiveness of anamorelin in patients with unresectable and relapse pancreatic cancer: a prospective observational study.","authors":"Atsushi Yamaguchi, Hiroki Kamada, Shigeaki Semba, Naohiro Kato, Yuji Teraoka, Takeshi Mizumoto, Yuzuru Tamaru, Tsuyoshi Hatakeyama, Hirotaka Kouno, Yoshiyuki Shibata, Sho Tazuma, Takeshi Sudo, Midori Ishida, Yuki Hotehama, Hidemi Kane, Hisashi Tagashira, Sayo Yoshiyama, Mitsunobu Kubota, Shigeto Yoshida","doi":"10.21037/jgo-2025-162","DOIUrl":"10.21037/jgo-2025-162","url":null,"abstract":"<p><strong>Background: </strong>Anamorelin, a ghrelin receptor agonist, has recently been used to treat cachexia in patients with pancreatic cancer (PC). Although it was accepted in Japan for advanced PC for the first time in the world in 2020, its efficacy and safety were not fully tested. Thus, we sought to determine the safety and efficacy of anamorelin in patients with inoperable and relapsed PC.</p><p><strong>Methods: </strong>We prospectively enrolled patients with inoperable and relapsed PC who had started anamorelin, lost their appetite, and met the criteria for cachexia. Appetite, body weight (BW), and muscle weight were measured at 0, 1, 2, 3, and 4 months. Characteristics and survival rates were compared between those who demonstrated anamorelin efficacy and those who did not.</p><p><strong>Results: </strong>Out of the 45 patients studied, 31 continued anamorelin for 1 month and 20 for 4 months. After 1 month, appetite improved significantly (+1, range 0-4, P<0.001). BW (+1.8 kg, IQR 0.13-3.08, P<0.05) and muscle weight (+0.9 kg, IQR -0.05-2.6, P<0.05) showed significant increases. At 4 months, the increase in appetite, BW, and muscle weight remained stable. Patients who showed anamorelin effectiveness lived significantly longer than those who did not (366 <i>vs.</i> 106 days, respectively).</p><p><strong>Conclusions: </strong>In inoperable and relapsed PC, anamorelin may be more effective in patients with a better overall condition and is associated with longer survival. To improve patient outcomes, appetite and BW must be monitored regularly and anamorelin treatment should begin early.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 3","pages":"1268-1279"},"PeriodicalIF":2.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated machine learning predicts liver metastases in patients with early-onset gastroenteropancreatic neuroendocrine tumors.","authors":"Fuli Gao, Jian Chen, Xiaodan Xu","doi":"10.21037/jgo-2024-946","DOIUrl":"10.21037/jgo-2024-946","url":null,"abstract":"<p><strong>Background: </strong>The incidence of early-onset gastroenteropancreatic neuroendocrine tumors (GEP-NETs) is increasing, with liver metastases often occurring early and adversely affecting prognosis. This study aimed to develop a predictive model for liver metastases detection in patients with early-onset GEP-NETs (<50 years) using an automated machine learning (AutoML) approach.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients diagnosed with early-onset GEP-NETs [2000-2021] using data from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly divided into a training set (n=8,983) and a validation set (n=3,819) in a 7:3 ratio. A nomogram-based scoring system was constructed using least absolute shrinkage and selection operator (LASSO) and logistic regression. AutoML was applied to build predictive models using gradient boosting machine (GBM), generalized linear model (GLM), deep learning (DL), and distributed random forest (DRF) algorithms. Model performance was assessed using receiver operating characteristic (ROC), calibration, decision curve analysis (DCA), and interpretability tools including SHapley Additive exPlanations (SHAP), partial dependence plots (PDPs), and locally interpretable model-agnostic explanations (LIME) plots.</p><p><strong>Results: </strong>A total of 12,802 patients were included, of whom 1,187 (9.3%) developed liver metastases, comprising 851 (9.5%) and 336 (8.8%) cases in the training and validation sets, respectively. Comparative analyses demonstrated that the AutoML models outperformed traditional logistic regression models, with the GBM algorithm achieving the highest performance. The GBM model achieved an area under the curve (AUC) of 0.961 in the training set and 0.953 in the validation set. Tumor location was identified as the most important predictor in the GBM model, followed by surgery, tumor size, chemotherapy, and T-staging.</p><p><strong>Conclusions: </strong>The AutoML model leveraging the GBM algorithm provides a robust and clinically valuable tool for the early prediction of liver metastases in patients with early-onset GEP-NETs.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 3","pages":"937-949"},"PeriodicalIF":2.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive analysis identifies AMIGO2 as a potential prognosis biomarker of pancreatic adenocarcinoma.","authors":"Jiawei Cao, Tong Zhou, Jiayu Chen, Dejin Shi, Xueting Liu, Changrui Qian, Guang Wu, Shaofei Yuan, Lan Li","doi":"10.21037/jgo-2025-7","DOIUrl":"10.21037/jgo-2025-7","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic adenocarcinoma (PAAD) is a highly aggressive form of cancer characterized by a low survival rate. Adhesion molecule with Ig like domain family 2 (AMIGO2), a cell adhesion molecule, has been found to be expressed abnormally in various solid tumors, but its specific role in PAAD has not yet been investigated. This study aimed to investigate the potential prognostic value of AMIGO2 in pan-cancer, especially in PAAD.</p><p><strong>Methods: </strong>RNA profiles and corresponding clinical data of PAAD patients in The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) datasets were obtained. Kaplan-Meier survival analysis was conducted to assess the relationship between AMIGO2 expression and overall survival. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed to evaluate the functional enrichment of AMIGO2 in PAAD. Subsequently, immune infiltration and single-cell RNA (scRNA) sequencing analyses were employed to investigate the composition of immune cells. The half maximal inhibitory concentration (IC50) value was utilized to estimate the drug sensitivity associated with AMIGO2. Finally, <i>in vitro</i> experiments were conducted to assess the biological function of AMIGO2 in PAAD.</p><p><strong>Results: </strong>AMIGO2 exhibited abnormal expression patterns and demonstrated prognostic significance in various types of cancer. AMIGO2 was observed to be up-regulated in PAAD tissues. Its high expression was indicative of a poor prognosis. Additionally, elevated level of AMIGO2 was found to be associated with mutations in <i>KRAS</i> and <i>TP53</i>, as well as with dysregulation of key cellular processes such as \"MAPK signaling\" and \"p53 signaling pathway\". Furthermore, AMIGO2 expression exhibited correlations with the infiltration of macrophages and cancer-associated fibroblasts. PAAD patients with high AMIGO2 expression were more sensitive to BRD4 inhibitor BI-2536. The growth of PAAD cells was found to be inhibited upon knockdown of AMIGO2.</p><p><strong>Conclusions: </strong>AMIGO2 was identified as prognostic factor in PAAD, suggesting its potential as a biomarker and therapeutic target for PAAD patients.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 3","pages":"1287-1304"},"PeriodicalIF":2.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving survival patterns in pancreatic adenocarcinoma: a 23-year retrospective observational analysis.","authors":"Tiago Cordeiro Felismino, Diego Rodrigues, Angelo Brito, Virgilio Silva, Lais Durant, Heber Ribeiro, Alessandro Diniz, Igor Farias, André Godoy, Silvio Torres, Maria Paula Curado, Felipe Coimbra","doi":"10.21037/jgo-2024-942","DOIUrl":"10.21037/jgo-2024-942","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic adenocarcinoma (PA) remains one of the most lethal malignancies. However, treatment options have expanded. Since 2011, FOLFIRINOX (fluorouracil, leucovorin, oxaliplatin, and irinotecan) and nab-paclitaxel plus gemcitabine have demonstrated superior outcomes over gemcitabine for advanced disease and have become standard chemotherapy regimens. This study aimed to analyze 23-year survival trends in PA at a Brazilian cancer center, focusing on comparisons between the pre- and post-FOLFIRINOX eras.</p><p><strong>Methods: </strong>This retrospective study analyzed patients diagnosed and treated at a large cancer center from 2000 to 2023, examining survival trends and changes in clinicopathological features and treatment across two 12-year periods: Period 1 (2000-2011), before FOLFIRINOX, and Period 2 (2012-2023), after FOLFIRINOX incorporation. The primary objective was to compare overall survival rates between the two time periods. The secondary objective was to evaluate changes in clinicopathological characteristics and treatment modalities.</p><p><strong>Results: </strong>A total of 1,078 patients were included in this analysis, with 274 patients in Period 1 and 804 patients in Period 2. The proportion of female patients increased in Period 2 (43.8% in Period 1 <i>vs.</i> 50.9% in Period 2, P=0.051), and the median age at diagnosis rose from 62.5 to 66 years (P<0.001). Early-stage tumors (stages I-II) were more frequently diagnosed in Period 2 (16% <i>vs.</i> 29.8%, P<0.001). Chemotherapy use increased from 70.1% (192 patients) in Period 1 to 83.2% (669 patients) in Period 2 (P<0.001), while multimodal therapy (surgery + chemotherapy) rose from 11.3% to 16.7% (P<0.001). Median overall survival (mOS) improved from 7.29 months in Period 1 to 13.24 months in Period 2 (P<0.001), with the 5-year survival increasing from 5.2% to 14.3%. Among the early-stage patients, mOS increased from 19.7 to 34.4 months (P=0.01). No survival difference was observed for stage III disease (mOS: 16.7 <i>vs.</i> 14.8 months, P=0.76), while outcomes for stage IV improved (mOS: 4.76 <i>vs.</i> 9.99 months, P<0.001).</p><p><strong>Conclusions: </strong>This 23-year analysis highlights the evolving treatment landscape and improved outcomes in PA with the introduction of more effective therapies.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 3","pages":"1280-1286"},"PeriodicalIF":2.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The diagnostic efficiency of tissue factor pathway inhibitor 2 methylation in the detection of colorectal cancer: a systematic review and meta-analysis.","authors":"Xiao-Ling Wang, Shuo Qin, Li Liu, Yu-Qi Jia, Ying Wang, Yu-Jie Zhou, Bruno Ramos-Molina, Manuel Valladares-Ayerbes, Moritz Eidens, Zhi-Zhen Liu","doi":"10.21037/jgo-2025-319","DOIUrl":"10.21037/jgo-2025-319","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) is a common malignant tumor of the digestive tract. Screening of high risk populations and early diagnosis of CRC are of great importance. Tissue factor pathway inhibitor 2 (<i>TFPI2</i>) methylation is an important indicator for screening CRC. However, the sensitivity and specificity of <i>TFPI2</i> methylation vary significantly across different studies, and its diagnostic performance is susceptible to the influence of detection methods and sample types. This study set out to evaluate the diagnostic value of <i>TFPI2</i> methylation in blood and stool samples for CRC.</p><p><strong>Methods: </strong>A search strategy based on the Population, Intervention, Comparison, Outcomes and Study (PICOS) principle was employed to retrieve relevant literatures from the PubMed, Web of Science, and EMBASE databases focused on the diagnosis of CRC patients with <i>TFPI2</i> methylation. The literature must include the following details: the types of tissue samples tested, detailed sample sizes of both control and case groups, comprehensive diagnostic parameters, and specific methodologies for methylation detection. The quality of the included articles was evaluated using the guidelines for the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). Deeks' funnel plot was used for the assessment of the publication bias. Data were extracted from the studies, and the random-effects model was used for the meta-analysis.</p><p><strong>Results: </strong>In total, 14 diagnostic test accuracy studies, comprising 3,330 subjects (1,983 CRC patients and 1,347 non-CRC controls), were included in the meta-analysis. The meta-analysis demonstrated a non-significant publication bias (P=0.29). Meta-regression further identified country, detection methodology, and sample type as significant contributors to heterogeneity. The combined sensitivity and specificity of <i>TFPI2</i> in diagnosing CRC were 0.83 [95% confidence interval (CI): 0.72-0.91] and 0.96 (95% CI: 0.93-0.97), respectively. While the combined positive likelihood ratio (PLR) was 19.2 (95% CI: 11.1-33.5), the combined negative likelihood ratio (NLR) was 0.18 (95% CI: 0.10-0.31), the diagnostic odds ratio (DOR) was 109 (95% CI: 45-261), and the area under the summary receiver operating characteristic curve (SROC) for the included studies was 0.97 (95% CI: 0.95-0.98).</p><p><strong>Conclusions: </strong>Our findings showed that <i>TFPI2</i> methylation in blood and stool samples could be a potential biomarker for the detection of CRC. <i>TFPI2</i> methylation demonstrates potential as a non-invasive screening tool and dynamic monitoring biomarker for CRC, offering a complementary or alternative approach to invasive procedures such as colonoscopy. This is particularly applicable for preliminary risk stratification in populations with low screening adherence or high-risk profiles.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 3","pages":"965-977"},"PeriodicalIF":2.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}