Journal of gastrointestinal oncology最新文献

{"title":"Machine learning-based gastric cancer risk prediction in an asymptomatic screening population: a retrospective cohort study.","authors":"Ji Hyun Song, San Wang, Young Sun Kim, Sun Young Yang, Hae Yeon Kang, Marharyta Kurban, Sanghee Lim, Jeong Yoon Yim","doi":"10.21037/jgo-2026-0245","DOIUrl":"10.21037/jgo-2026-0245","url":null,"abstract":"<p><strong>Background: </strong>Early detection of gastric cancer is critical for improving survival. Although established risk factors are known, few studies comprehensively assess individual gastric cancer risk across diverse clinical features, particularly within a general screening population. Existing machine learning (ML) models often rely on high-risk clinical cohorts or utilize classification methods that fail to account for the essential time-to-event nature of survival data, thus limiting their utility for developing personalized, long-term screening strategies in asymptomatic individuals. This study aimed to develop and evaluate clinically explainable survival-based ML models for personalized gastric cancer risk stratification during longitudinal follow-up using data from a large cohort of asymptomatic individuals undergoing routine health screening.</p><p><strong>Methods: </strong>Comprehensive medical annual check-up data, including endoscopic findings and blood test results, were collected from 129,223 patients who visited one of the largest medical screening facilities in South Korea between 2007 and 2020. We trained several survival-based ML models [e.g., Extreme Gradient Boosting (XGBoost) Survival, DeepSurv, Random Survival Forest] as well as a conventional Cox Proportional Hazards (CPH) regression model. Model behavior was interpreted using SHapley Additive exPlanations (SHAP).</p><p><strong>Results: </strong>Survival-based ML models demonstrated comparable discrimination performance, with the XGBoost Survival model achieving an average concordance index of 0.78. <i>Helicobacter pylori</i> infection, chronic atrophic gastritis, and intestinal metaplasia were the most significant risk factors contributing to cancer development. Model explanations derived from SHAP analysis were well aligned with established clinical knowledge.</p><p><strong>Conclusions: </strong>This study demonstrates the feasibility of applying explainable survival-based ML approaches for gastric cancer risk stratification in a general screening population. While the findings suggest potential clinical relevance, further calibration assessment, external validation, and prospective evaluation are required before translation into clinical decision-making or surveillance strategy development.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 3","pages":"133"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13350361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421561","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":"Transanal drainage tube versus diverting stoma for reducing anastomotic leakage after rectal cancer surgery: a systematic review and meta-analysis.","authors":"Xiaobin Zhang, Zhao Chen, Zongyu Liang","doi":"10.21037/jgo-2026-1-0053","DOIUrl":"10.21037/jgo-2026-1-0053","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leakage (AL) remains a significant postoperative concern in rectal cancer patients following anterior resection. This study aims to compare the effectiveness of a transanal drainage tube (TDT) versus a diverting stoma (DS) in reducing the incidence of this complication.</p><p><strong>Methods: </strong>The systematic review was conducted following a comprehensive search of the PubMed, EMBASE, Web of Science, and Cochrane Library databases for all relevant studies published from inception to December 2025. For the meta-analyses, Review Manager 5.4 software was used, with a random-effects model applied as needed.</p><p><strong>Results: </strong>A total of seven studies encompassing 1,347 participants were included in the analysis. Overall, no significant difference in the risk of AL was observed between the TDT and DS groups [odds ratio (OR) =0.73, 95% confidence interval (CI): 0.42 to 1.29, P=0.28]. Specifically, the TDT group exhibited a significantly lower incidence of bowel obstruction (OR =0.16, 95% CI: 0.08 to 0.32, P<0.01). Rates of other complications and postoperative length of stay were comparable between the two groups.</p><p><strong>Conclusions: </strong>Our findings indicate that no significant difference was observed between TDT and DS in reducing AL after anterior resection for rectal cancer. Notably, TDT use was associated with a significantly lower incidence of postoperative bowel obstruction. For selected patients, TDT may offer a strategy to avoid stoma-related complications and the need for reversal surgery.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 3","pages":"159"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13350357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421586","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":"Efficacy and safety of modified FLOT chemotherapy in gastric or gastroesophageal junction adenocarcinoma: a retrospective cohort study.","authors":"Cody Eslinger, Oudai Sahwan, Fares Jamal, Douglas Dias E Silva, Skye Buckner-Petty, Jennah Bauernfeind, Daniel Ahn, Mitesh J Borad, Christina Wu, Mojun Zhu, Nabil Wasif, Jason Starr, Umair Majeed, Tanios Bekaii-Saab, Pedro Luiz Serrano Uson, Mohamad Bassam Sonbol","doi":"10.21037/jgo-2026-1-0111","DOIUrl":"10.21037/jgo-2026-1-0111","url":null,"abstract":"<p><strong>Background: </strong>Perioperative fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) is the standard treatment for resectable gastric and gastroesophageal junction (GEJ) adenocarcinoma, with fluorouracil administered at 2,600 mg/m² as a 24-hour continuous infusion. However, toxicity can limit treatment delivery in routine practice. Dose-modified FLOT regimens are frequently used to improve tolerability, though data supporting clinical outcomes are limited. This study aimed to evaluate the safety, treatment delivery, and clinical outcomes of a predefined modified perioperative FLOT regimen in routine clinical practice.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients with resectable gastric or GEJ adenocarcinoma treated with predefined, modified perioperative FLOT at three institutions between 2019 and 2025. The regimen consisted of fluorouracil 2,400 mg/m² over 46-48 hours, oxaliplatin 85 mg/m², and docetaxel 40-50 mg/m². Safety, treatment delivery, and clinical outcomes were assessed, with survival estimated using Kaplan-Meier methods.</p><p><strong>Results: </strong>Twenty-nine patients were included (median age 66 years; 62% male; 59% gastric and 34% GEJ tumors). Curative-intent resection was achieved in 86% of patients, with an R0 resection rate of 88% and a pathological complete response (pCR) rate of 16%. At a median follow-up of 30.3 months, median overall survival (OS) was 53.6 months (3-year OS 75.3%), and median recurrence-free survival (RFS) was 46.1 months (3-year RFS 52.4%). Grade 3 or higher neutropenia occurred in 34% of patients, and infections in 10%; no treatment-related deaths were observed.</p><p><strong>Conclusions: </strong>In this multi-institutional, real-world cohort, modified perioperative FLOT was associated with acceptable treatment delivery, manageable toxicity, and favorable clinical outcomes in selected patients with resectable gastric and GEJ adenocarcinoma. These findings support the feasibility of dose-modified FLOT in routine clinical practice, particularly for patients at risk for treatment-related toxicity.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 3","pages":"141"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13349967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421429","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":"Interpreting ctDNA dynamics in gastrointestinal stromal tumor (GIST) therapy-timing may be key.","authors":"Jing Yi Lee, Tun Kiat Ko, Jason Yongsheng Chan","doi":"10.21037/jgo-2026-1-0197","DOIUrl":"10.21037/jgo-2026-1-0197","url":null,"abstract":"","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 3","pages":"182"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13349941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421588","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":"T-helper 1 and 2 cell densities, and mesenteric cytokine levels, are prognostic markers in colorectal cancer.","authors":"Ibrahim M Sayed","doi":"10.21037/jgo-2026-1-0127","DOIUrl":"10.21037/jgo-2026-1-0127","url":null,"abstract":"","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 3","pages":"193"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13350688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421570","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":"Solid pseudopapillary neoplasm of the pancreas with postoperative multiple liver metastases in an older woman: a case report.","authors":"Yishan Lu, Nana Huang, Ruzhu Wang, Yuting Zhang, Haitao Duan, Ping Gao","doi":"10.21037/jgo-2026-0296","DOIUrl":"10.21037/jgo-2026-0296","url":null,"abstract":"<p><strong>Background: </strong>Solid pseudopapillary neoplasm of the pancreas (SPN), also known as Frantz's tumor is a peculiar pancreatic neoplasm with an unclear pathogenesis. Early surgery often results in a curative effect; however, rare postoperative metastasis can occur. Currently, no standard systemic treatment strategy has been established for metastatic SPN. In this article, we report an older woman with SPN who developed postoperative multiple liver metastases and experienced rapid progression despite sequential systemic therapies.</p><p><strong>Case description: </strong>A 68-year-old woman who underwent surgical resection of a SPN (approximately 44 months earlier) presented with multiple liver lesions despite having no obvious clinical findings. After laparoscopic distal pancreatectomy and splenectomy, multiple postoperative liver metastases were diagnosed by ultrasound-guided percutaneous liver biopsy, and a <i>CTNNB1</i> gene mutation was detected. The patient received sequential palliative systemic therapies, however, the disease continued to progress, and she ultimately died 8 months later.</p><p><strong>Conclusions: </strong>SPN is an extremely rare tumor with a relatively good prognosis. Complete surgical resection remains the mainstay of treatment; however, evidence for systemic therapy in unresectable or metastatic SPN remains limited. We report the case of a SPN patient with rare postoperative metastases and a poor prognosis, and describe the treatment course and systemic therapeutic strategy, which may serve as a reference for the management of similar cases.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 3","pages":"179"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13350735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421471","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":"Paeoniflorin inhibits colorectal cancer stem cell properties via regulating LINC01711/KMT2D/KLF7 axis.","authors":"Wei Wang, Mei Li, Fan Hu, Renjing Lin, Chongsi Xu, Biao Xie","doi":"10.21037/jgo-2025-1-975","DOIUrl":"10.21037/jgo-2025-1-975","url":null,"abstract":"<p><strong>Background: </strong>Paeoniflorin (PF) exerts anti-tumor effects in various cancers. However, the effects of PF on colorectal cancer (CRC) are still unknown. The purpose of this study was to investigate the effects of PF on CRC.</p><p><strong>Methods: </strong>Message RNA (mRNA) levels were analyzed by reverse transcription quantitative polymerase chain reaction. Protein expression was determined by Western blot. Cell migration was determined by transwell assay. Cell viability was determined using cell counting kit-8. Cell proliferation was detected using colony formation and 5-ethynyl-2'deoxyuridine assay. CRC cell stem-like properties were analyzed by sphere formation assay and flow cytometry assay. The interaction between LINC01711 and lysine methyltransferase 2D (KMT2D)/KLF transcription factor 7 (KLF7) was analyzed by RNA pull-down assay. The transcription of LINC01711 was analyzed by luciferase and chromatin immunoprecipitation assays.</p><p><strong>Results: </strong>The results showed that PF inhibited the proliferation, migration, and stem-like behaviors of CRC cells. Moreover, PF inhibited the expression of LINC01711, which formed a turnery structure with KMT2D and KLF7. This turnery structure mediated the activation of KLF7/Wnt/β-catenin signaling. However, PF blocked the interaction between LINC01711 and KMT2D/KLF7, as well as inhibited KLF7-mediated transcription and upregulation of LINC01711. Furthermore, PF inhibited the tumor growth of CRC.</p><p><strong>Conclusions: </strong>Taken together, PF inhibits CRC cell proliferation and stem-like properties via blocking LINC01711/KMT2D/KLF7 axis.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 3","pages":"151"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13349990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421575","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 impact of adjuvant chemotherapy on overall survival and cancer-specific survival in patients with extrahepatic cholangiocarcinoma across different age groups: a population-based study.","authors":"Tingyu Liu, Chang Liu, Hefei Ren, Lin Zhou","doi":"10.21037/jgo-2026-0342","DOIUrl":"10.21037/jgo-2026-0342","url":null,"abstract":"<p><strong>Background: </strong>Extrahepatic cholangiocarcinoma (ECC) has a high postoperative recurrence rate, and the value of adjuvant chemotherapy (AC) by age remains unclear. This study investigated the influence of AC on long-term survival in patients with ECC, with analysis stratified by age.</p><p><strong>Methods: </strong>Patient data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database for individuals diagnosed with ECC from 2010 to 2020. Kaplan-Meier (KM) analysis evaluated the association between AC and long-term survival across age strata. Subsequently, univariate and multivariate Cox regression analyses were performed to analyze the overall survival (OS) and cancer-specific survival (CSS) of ECC patients across different age groups. Furthermore, propensity score matching (PSM) was used to reduce the potential selection bias. Lastly, sensitivity analysis was conducted to assess the robustness of the results.</p><p><strong>Results: </strong>This study included 2,189 patients with ECC, who were divided into four groups according to age: 18-55, 56-65, 66-75 and 76-85 years old. Before PSM adjustment, no statistically significant association was observed between AC and long-term survival in the 18-55 and 56-65 years age groups. In contrast, significant differences in long-term survival were observed in patients aged 66-75 years. For those aged 76-85 years, only OS showed a significant difference. Following adjustment, the absence of significant differences persisted in the two younger age groups. Statistically significant differences in long-term survival, however, were maintained in both the 66-75 and 76-85 years age groups. Multivariate Cox regression analysis demonstrated that patients in the 18-55 and 56-65 years age groups did not benefit from AC. In the 66-75 years age group, AC acted as an independent protective factor. In the 76-85 years age group, AC was an independent protective factor for OS but provided no benefit for CSS.</p><p><strong>Conclusions: </strong>AC conferred age-heterogeneous survival benefits in patients with ECC, wherein the population aged 66-75 years derived the maximum benefit. In contrast, patients aged 18-65 years failed to obtain a statistically significant benefit from AC, while those aged over 75 years exhibited outcome-specific clinical benefits.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 3","pages":"166"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13349943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421551","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":"Deep learning model based on MRI-derived microvascular network simulation parameters for noninvasive assessment of lymphovascular invasion in rectal cancer patients.","authors":"Yue Di, Xiaofeng Jin, Lei Han, Qin Lu, Tingting Han","doi":"10.21037/jgo-2026-0226","DOIUrl":"10.21037/jgo-2026-0226","url":null,"abstract":"<p><strong>Background: </strong>Accurate preoperative assessment of lymphovascular invasion (LVI) in patients with rectal cancer (RC) is important for guiding postoperative management. This study aimed to develop and validate a deep learning model based on magnetic resonance imaging (MRI)-derived microvascular network simulation parameters for the preoperative assessment of LVI in RC patients.</p><p><strong>Methods: </strong>A total of 453 patients with pathologically confirmed rectal adenocarcinoma from two medical centers were retrospectively enrolled. All patients underwent multi-b-value diffusion-weighted imaging (DWI) before surgery. First, a steady-state Navier-Stokes hemodynamic model of the tumor microvascular network was constructed based on the multi-b-value DWI images. Subsequently, voxel-wise least squares fitting was performed to match the DWI signals with the dictionary, enabling the inversion and generation of spatial parametric maps for mean flow velocity (V-m), velocity standard deviation (V-s), and angiogenic branching index (ANB). These parametric maps were then input into a Vision Transformer (ViT) network to extract deep features from each modality. A cross-attention fusion module was designed to capture spatial interactions among the parametric maps and construct a multiparametric fusion model. The model's performance was comprehensively evaluated using the area under the curve (AUC), calibration curves, and decision curve analysis (DCA).</p><p><strong>Results: </strong>The multiparametric fusion model achieved favorable performance, with AUCs of 0.901 [95% confidence interval (CI): 0.808-0.993] and 0.863 (95% CI: 0.800-0.926) in the internal and external validation cohorts, respectively. DCA demonstrated that within the threshold range of 0.2-0.8, the fusion model provided substantially greater clinical net benefit than the individual parameter models. Gradient-weighted Class Activation Mapping (Grad-CAM) visualization revealed that the model's attention was primarily focused on the invasive front of the tumor and regions with high peritumoral vascular density, providing supportive visual evidence and suggesting potential biological relevance.</p><p><strong>Conclusions: </strong>The deep learning model based on MRI-simulated microvascular network parameters provides a promising and noninvasive approach for the preoperative assessment of LVI status in RC patients. The model demonstrated encouraging performance in both internal and external validation cohorts. However, further prospective and multicenter validation is required before clinical application.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 3","pages":"155"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13350638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421503","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":"Natural product-based nanoengineering in gastrointestinal stromal tumors: early promise and translational challenges.","authors":"Liyang Cai, Yuki Nakanishi","doi":"10.21037/jgo-2026-1-0179","DOIUrl":"10.21037/jgo-2026-1-0179","url":null,"abstract":"","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"17 3","pages":"187"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13350260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421597","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}