Journal of gastrointestinal oncology最新文献

{"title":"From clinical insight to trial design: advancing circulating tumor DNA-informed care in pancreatic cancer.","authors":"Benjamin Ascherman, Daniel King","doi":"10.21037/jgo-2026-1-0153","DOIUrl":"10.21037/jgo-2026-1-0153","url":null,"abstract":"<p><p>Accurate, timely measurement of disease burden is a cornerstone of cancer care- particularly for pancreatic cancer, an aggressive malignancy often requiring strenuous treatment regimens with poor survival outcomes. However, current measures of pancreatic cancer, including imaging and biomarkers, are inadequate and often fail to keep up with real time changes in tumor biology and patient symptoms. The level of evidence in support of circulating tumor DNA (ctDNA) varies by disease, but remains largely empiric in pancreatic cancer. We analyze the use of ctDNA in five key settings along the pancreatic cancer continuum. We demonstrate a variety of potentially useful applications for ctDNA, including assessment of neoadjuvant therapy efficacy to better inform surgical management, early detection of recurrence during surveillance, and differentiation of tumor progression from pseudoprogression. To our knowledge, this is the first practice review with cases that present real-world examples of ctDNA-guided pancreatic cancer management while concurrently evaluating current standards and future directions across all major treatment settings. This integrated perspective highlights insights not available from single-setting cohorts, underscoring the substantial work still needed to define the precise role, standardization, and clinical implementation of ctDNA assays in both localized and advanced pancreatic cancer. A more deliberate and evidence-based integration of ctDNA with established imaging, biomarkers, and therapeutic strategies represents a critical objective in pancreatic cancer, for which we review representative trial designs intended to enable prospective validation and better define its impact on clinical outcomes.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 4","pages":"266"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900680","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":"Chronic psychological stress and gastric cancer: bidirectional associations, biological mechanisms, and clinical implications-a narrative review.","authors":"Lingran Zhao, Longjun Yang, Ninghui Zhao, Qiang Ding, Panpan Lu, Xinxia Feng, Mei Liu","doi":"10.21037/jgo-2026-0546","DOIUrl":"10.21037/jgo-2026-0546","url":null,"abstract":"<p><strong>Background and objective: </strong>Gastric cancer (GC) remains one of the major malignancies worldwide, and its development and progression are shaped by the complex interplay of tumor-related, patient-related, and psychosocial factors. Chronic psychological stress, particularly anxiety and depression, may be associated with GC susceptibility, treatment tolerance, survival-related outcomes, and quality of life. This narrative review aims to synthesize current GC-specific evidence on the bidirectional relationship between chronic psychological stress and GC.</p><p><strong>Methods: </strong>Targeted searches of PubMed, Web of Science, and relevant reference lists were conducted up to February 2026. Search terms included \"gastric cancer\", \"chronic psychological stress\", \"depression\", \"anxiety\", \"psychological distress\", \"β2-adrenergic receptor\", \"hypothalamic-pituitary-adrenal axis\", \"inflammation\", \"immune escape\", \"microbiota\", \"gut-brain axis\", and \"supportive care\". Priority was given to GC-specific clinical, epidemiological, mechanistic, and interventional studies.</p><p><strong>Key content and findings: </strong>Current evidence suggests a clinically meaningful but still evolving bidirectional association between chronic psychological stress and GC. Anxiety and depression are common in patients with GC and may affect treatment tolerance and survival-related outcomes. Mechanistic studies further suggest that chronic psychological stress may be linked to GC progression through neuroendocrine dysregulation, oxidative-inflammatory amplification, immune escape, hormonal and metabolic remodeling, and microbiota-related pathways. Conversely, GC itself may act as a persistent stressor that aggravates anxiety and depressive symptoms.</p><p><strong>Conclusions: </strong>Chronic psychological stress should be considered a clinically relevant factor in GC management. Further prospective clinical studies, integrated mechanistic investigations, and multidisciplinary intervention trials are needed to clarify causality and determine whether stress-informed management can improve both psychological and oncologic outcomes.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 4","pages":"263"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900724","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":"Clinical efficacy and safety of apatinib plus S-1 combined with oxaliplatin (SOX) in postoperative stage III gastric cancer patients with high VEGFR-2 expression.","authors":"Qin Deng, Rong Wang, Hongbin Qi, Yongjin Zhou, Jiaju Chen, Lei Zhang, Xiaoqiang Gao, Xiangren Jin, Zhiqiang Yan, Haibin Wang, Qian Wang, Hongxin Yang","doi":"10.21037/jgo-2026-0370","DOIUrl":"10.21037/jgo-2026-0370","url":null,"abstract":"<p><strong>Background: </strong>The S-1 combined with oxaliplatin (SOX) regimen is the standard adjuvant chemotherapy regimen for stage III gastric cancer (GC) in China, yet 5-year survival remains only 30-40%, partly due to marked tumor heterogeneity. Apatinib, a vascular endothelial growth factor receptor 2 (VEGFR-2) inhibitor, has shown significant efficacy in unresectable or metastatic GC and the neoadjuvant treatment of locally advanced GC, with response positively correlated with VEGFR-2 expression. However, SOX + apatinib has not been evaluated as an adjuvant treatment regimen in postoperative stage III GC patients with high VEGFR-2 expression. Therefore, this study aimed to evaluate the efficacy and safety of SOX + apatinib in postoperative stage III GC patients with high VEGFR-2 messenger RNA (mRNA)expression.</p><p><strong>Methods: </strong>In this retrospective single-center study, data of 112 postoperative stage III GC patients with high VEGFR-2 mRNA expression treated at The Affiliated Hospital of Guizhou Medical University between January 2015 and June 2021 were analyzed. Patients received six 21-day cycles of adjuvant SOX alone (n=55) or SOX + apatinib (n=57), according to whether oral apatinib was administered. Disease-free survival (DFS), overall survival (OS), and safety were compared between the two groups.</p><p><strong>Results: </strong>High VEGFR-2 mRNA expression was detected in 30.8% of stage III GC patients. All 112 patients had complete follow-up records, and the follow-up time was 59.3±24.2 months (range, 13-115 months). The 3-year DFS of the SOX group <i>vs.</i> the SOX + apatinib group was 41.8% <i>vs.</i> 70.2%, P=0.002; the 5-year DFS was 32.1% <i>vs.</i> 62.5%, P=0.002; the 3-year OS was 74.5% <i>vs.</i> 86.0%, P=0.13; and the 5-year OS was 34.0% <i>vs.</i> 64.6%, P=0.002. Univariate survival analysis and Multivariate Cox analyses both identified Borrmann classification, pathologic nodal (pN) stage, and postoperative regimen as independent predictors of DFS and OS. Kaplan-Meier analysis showed significantly improved DFS and OS with SOX + apatinib compared with SOX alone (both P<0.001). Toxicities were predominantly grade I-II and did not differ significantly between groups.</p><p><strong>Conclusions: </strong>For stage III GC patients with high expression of VEGFR-2 mRNA, SOX + apatinib therapy could improve DFS and OS and had an acceptable safety. Thus, apatinib may potentially become another targeted drug in postoperative stage III GC patients. However, future large-scale randomized clinical trials are still needed for further verification.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 4","pages":"223"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900771","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":"Non-structural maintenance of chromosome condensin I complex subunit H knockdown suppresses malignant progression of esophageal squamous cell carcinoma via the Wnt/β-catenin signaling pathway.","authors":"Yang Xu, Ao Guo, Jing Yang, Mingjun Zhang, Bin Yuan","doi":"10.21037/jgo-2025-1-1060","DOIUrl":"10.21037/jgo-2025-1-1060","url":null,"abstract":"<p><strong>Background: </strong>Esophageal squamous cell carcinoma (ESCC) remains a major cause of cancer-related mortality, and effective therapeutic targets are still limited. Non-structural maintenance of chromosome condensin I complex subunit H (NCAPH) has been implicated in tumorigenesis; however, its clinical relevance, functional roles, and underlying mechanisms in ESCC are not fully defined. We aimed to characterize the expression pattern, prognostic value, biological functions, and mechanistic basis of NCAPH in ESCC.</p><p><strong>Methods: </strong>Public datasets from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) were analyzed to evaluate NCAPH expression and clinical associations. Single-cell RNA sequencing (scRNA-seq) data were used to map cell-type-specific distribution of NCAPH in tumor and adjacent tissues. NCAPH was silenced in KYSE150 and KYSE510 cells using lentiviral short hairpin RNAs (shRNAs), followed by Cell Counting Kit-8 (CCK-8), colony formation, wound-healing, and Transwell migration/invasion assays. A nude mouse xenograft model was established to assess the effect of NCAPH knockdown <i>in vivo</i>. RNA sequencing (RNA-seq), quantitative polymerase chain reaction (qPCR), western blotting, and enzyme-linked immunosorbent assay (ELISA) were performed to explore potential mechanisms.</p><p><strong>Results: </strong>NCAPH was consistently upregulated in ESCC across multiple cohorts and was associated with unfavorable clinicopathological features and poorer survival. Functional assays demonstrated that NCAPH knockdown significantly inhibited ESCC cell proliferation, migration, invasion, and clonogenic growth. <i>In vivo</i>, NCAPH silencing suppressed xenograft tumor growth. Mechanistically, transcriptomic profiling and molecular validation indicated attenuation of Wnt/β-catenin signaling following NCAPH depletion, accompanied by reduced β-catenin and downstream targets.</p><p><strong>Conclusions: </strong>NCAPH promotes malignant progression of ESCC, at least in part through activation of the Wnt/β-catenin pathway, and may serve as a potential biomarker and therapeutic target.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 4","pages":"213"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900728","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":"Comparative analysis of outcomes and sociodemographic factors in early- and late-onset colorectal cancer hospitalizations.","authors":"Manali Shah, Ravi Upadhyay, Lawanya Singh, Shari Forbes, Maliyat Matin, Sharon Li","doi":"10.21037/jgo-2026-0285","DOIUrl":"10.21037/jgo-2026-0285","url":null,"abstract":"<p><strong>Background: </strong>The incidence of early-onset colorectal cancer (EOCRC), defined as diagnosis before age 50, is rising despite declining overall colorectal cancer (CRC) rates. EOCRC presents distinct clinical challenges, with emerging associations to obesity and sociodemographic disparities. This study compares hospitalization trends, inpatient outcomes, and sociodemographics in EOCRC <i>vs.</i> late-onset CRC (LOCRC).</p><p><strong>Methods: </strong>Using the National Inpatient Sample (NIS) (2016-2020), we identified hospitalizations with a primary diagnosis of CRC. Patients were categorized from a hospital-based classification of EOCRC (<50 years) or LOCRC (≥50 years). Multivariate logistic regression assessed associations between body mass index (BMI), demographics, and outcomes including inpatient mortality, length of stay (LOS), and chemotherapy use.</p><p><strong>Results: </strong>Among 246,231 CRC hospitalizations, 13.7% (n=33,662) were EOCRC. Compared to LOCRC, EOCRC patients were more likely to be female [odds ratio (OR): 1.09], Black (OR: 1.17), Hispanic (OR: 1.56), or Asian (OR: 1.29), and more often covered by Medicaid, private insurance, or have no coverage. EOCRC patients had higher rates of tobacco use disorder (OR: 1.26) and depression (OR: 1.13), but lower prevalence of diabetes, coronary artery disease (CAD), and alcohol use disorder. EOCRC hospitalizations had lower inpatient mortality (OR: 0.649). Inpatient chemotherapy was more common in EOCRC (OR: 1.78). Obesity was positively associated with EOCRC for BMI 30-39 (OR: 1.07) and BMI ≥40 (OR: 1.50), while LOCRC showed inverse associations for the same BMI groups.</p><p><strong>Conclusions: </strong>EOCRC is associated with unique demographic and clinical profiles when compared to LOCRC, highlighting disparities by race, insurance status, and comorbidities. The higher rate of inpatient chemotherapy use in EOCRC warrants further study to evaluate its clinical necessity and outcomes. These findings reinforce the need for targeted screening and inpatient care strategies for younger and underserved patient populations.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 4","pages":"239"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900768","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":"A predictive nomogram model for overall survival in obstructive colorectal cancer based on clinical and laboratory indicators.","authors":"Pingxia Lu, Wanyun Su, Dingman Huang, Xinyu Huang, Cuifeng Zheng, Baowei Xu, Xianqiang Chen, Junrong Zhang, Zhengyuan Huang","doi":"10.21037/jgo-2026-0529","DOIUrl":"10.21037/jgo-2026-0529","url":null,"abstract":"<p><strong>Background: </strong>Obstructive colorectal cancer (oCRC) correlates with advanced disease and poor outcomes. This study aimed to identify independent prognostic factors using clinical and laboratory data and construct a predictive nomogram for oCRC patients' individualized survival estimation and clinical decision-making.</p><p><strong>Methods: </strong>A retrospective cohort of 167 patients with histologically confirmed oCRC admitted to hospital between February 2019 and February 2021 was analyzed. Patients were randomly divided into a training cohort (n=116) and a validation cohort (n=51) in a 7:3 ratio. Prognostic variables were identified using univariate and multivariate Cox proportional hazards regression analyses. A nomogram was developed based on independent prognostic factors. Model performance was assessed using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA) to evaluate its discrimination, calibration, and clinical utility, respectively.</p><p><strong>Results: </strong>Multivariate Cox regression analysis identified five independent prognostic factors: M stage [hazard ratio (HR) =1.917, 95% confidence interval (CI): 1.005-3.657, P=0.048], tumor grade (HR =0.229, 95% CI: 0.096-0.543, P<0.001), carbohydrate antigen 19-9 (CA19-9; HR =3.919, 95% CI: 2.038-7.538, P<0.001), albumin-to-globulin ratio (AGR; HR =2.103, 95% CI: 1.158-3.817, P=0.02), and platelet-to-lymphocyte ratio (PLR; HR =1.873, 95% CI: 1.013-3.464, P=0.045). These variables were incorporated into a prognostic nomogram. The model demonstrated good discriminatory ability, with area under the curve (AUC) values of 0.721 in the training cohort and 0.776 in the validation cohort. Additionally, the model exhibited satisfactory calibration and clinical utility, as evidenced by DCA.</p><p><strong>Conclusions: </strong>The nomogram (incorporating M stage, tumor grade, CA19-9, AGR, PLR) provides individualized prognosis for oCRC patients, and may aid clinical risk stratification and therapeutic decision-making.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 4","pages":"224"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900628","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":"Identifying actionable targets: predicting imatinib nonadherence in patients with gastrointestinal stromal tumors.","authors":"Lauren M Janczewski","doi":"10.21037/jgo-2026-0362","DOIUrl":"10.21037/jgo-2026-0362","url":null,"abstract":"","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 4","pages":"277"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900639","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":"Therapeutic drug-monitoring-guided desensitization for severe imatinib-associated rash.","authors":"Paul Stendahl Dy, Emil Lou","doi":"10.21037/jgo-2026-0174","DOIUrl":"10.21037/jgo-2026-0174","url":null,"abstract":"","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 4","pages":"278"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900598","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":"DNA-dependent protein kinase inhibition as a radiosensitizer in rectal cancer: toxicity must be evaluated in the context of organ preservation.","authors":"Revathi Ravella, Wini Zambare, Diana Roth O'Brien, Paul B Romesser","doi":"10.21037/jgo-2026-0480","DOIUrl":"10.21037/jgo-2026-0480","url":null,"abstract":"","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 4","pages":"273"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900595","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":"Development and validation of a novel nomogram for predicting long-term survival in gallbladder cancer: a large population-based study using the SEER database.","authors":"Hao Song, Zuo-Biao Li, Qin-Wen Tai, Jun Lyu","doi":"10.21037/jgo-2026-0515","DOIUrl":"10.21037/jgo-2026-0515","url":null,"abstract":"<p><strong>Background: </strong>Gallbladder cancer (GBC) remains an aggressive malignancy with a generally poor long-term outlook. In this study, we sought to develop and internally validate a prognostic nomogram for predicting overall survival (OS), aiming to improve individualized risk assessment for these patients.</p><p><strong>Methods: </strong>We identified 3,892 patients diagnosed with GBC between 2000 and 2021 from the Surveillance, Epidemiology, and End Results (SEER) database. Eligible cases were randomly divided into a training cohort (70%, n=2,724) and an internal validation cohort (30%, n=1,168). Candidate predictors covered demographic characteristics, tumor‑related factors and treatment information. Univariate and multivariate Cox proportional hazards regression were performed sequentially on the training set to identify independent prognostic factors, which were then used to construct a nomogram predicting 3-, 5- and 8-year OS. Model performance was evaluated comprehensively using the concordance index (C‑index), time‑dependent receiver operating characteristic (ROC) curves, area under the curve (AUC), calibration plots, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA). All statistical tests were two‑sided, with significance set at P<0.05.</p><p><strong>Results: </strong>Independent prognostic factors included age, tumor grade, T stage, N stage, M stage, surgery, and radiotherapy. The nomogram yielded a C‑index of 0.708 [95% confidence interval (CI): 0.670-0.745] in the training set and 0.623 (95% CI: 0.583-0.622) in the internal validation set. Time‑dependent AUCs for 3-, 5- and 8‑year OS were 0.752, 0.757, and 0.763 in the training set, and 0.758, 0.767, and 0.771 in the validation set, respectively. Compared with the American Joint Committee on Cancer (AJCC) staging system, our nomogram showed significantly improved risk reclassification at 3, 5 and 8 years (NRI =0.460, 0.467 and 0.494; all P<0.001) as well as better IDI (IDI =0.058, 0.044 and 0.041; all P<0.001) in the internal validation cohort. Calibration curves indicated excellent agreement between predicted and observed survival probabilities. DCA confirmed that the nomogram offered a higher net clinical benefit across a wide range of threshold probabilities, suggesting its potential usefulness in clinical decision‑making.</p><p><strong>Conclusions: </strong>Compared to the AJCC system, this novel nomogram provides better risk stratification for 3-, 5- and 8‑year survival in GBC, with moderate discrimination, good calibration, and clinical utility. It may serve as a practical tool for individualized prognosis and treatment planning.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 4","pages":"247"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900579","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}