Journal of Gastrointestinal Cancer最新文献

{"title":"Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery for Minimally Invasive Esophagectomy in Esophageal Cancer: A GRADE-Assessed Systematic Review and Meta-Analysis.","authors":"Fahad Amin, Rija Fatima, Saira Iqbal, Muhammad Bilal, Hamza Sajid, Amna Raza, Noorullah Ahmed, Subhan Shah, Lameez Saif, Sai Han Htun","doi":"10.1007/s12029-026-01615-7","DOIUrl":"10.1007/s12029-026-01615-7","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive esophagectomy has become the preferred surgical approach for esophageal cancer, with uniportal video-assisted thoracoscopic surgery (uVATS) emerging as a potential refinement over conventional multiportal VATS (mVATS). However, comparative evidence remains limited to small single-centre studies. This systematic review and meta-analysis aimed to comprehensively evaluate perioperative and safety outcomes of uVATS versus mVATS in patients undergoing minimally invasive esophagectomy.</p><p><strong>Methods: </strong>A systematic search was conducted across PubMed/MEDLINE, Embase, Scopus, Cochrane Library, Web of Science, ClinicalTrials.gov, and CNKI from inception through April 2026. Studies directly comparing uVATS with mVATS in adults undergoing minimally invasive esophagectomy were eligible. Binary outcomes were pooled as odds ratios and continuous outcomes as mean differences under REML random-effects model. Heterogeneity was assessed using I² statistics. Certainty of evidence was evaluated using the GRADE framework.</p><p><strong>Results: </strong>Nine studies comparing uVATS and mVATS were included. uVATS was associated with significantly lower postoperative pain on day one (MD - 2.10, 95% CI - 3.63 to - 0.57; I² = 99.3%), reduced postoperative pneumonia (OR 0.41, 95% CI 0.22-0.76; I² = 43.5%), and shorter length of hospital stay (MD - 2.13 days, 95% CI - 3.64 to - 0.63; I² = 96.8%). No significant differences were observed between approaches for anastomotic leakage (OR 1.13, 95% CI 0.61-2.09), overall complications (OR 0.79, 95% CI 0.47-1.32), recurrent laryngeal nerve injury (OR 0.89, 95% CI 0.43-1.85), perioperative mortality (OR 0.53, 95% CI 0.16-1.81), intraoperative blood loss, or total operative time.</p><p><strong>Conclusion: </strong>UVATS esophagectomy appears to be a feasible and safe alternative to mVATS, with potential advantages in postoperative pain, pulmonary morbidity, and hospital stay while maintaining comparable perioperative safety. The evidence base remains limited by high heterogeneity and predominance of observational studies. Multicenter randomized trials with standardized protocols and long-term oncologic follow-up are needed to consolidate these findings.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resistance Phenotypes and Treatment Sequencing After Immune Checkpoint Blockade in MSI-H/dMMR Metastatic Colorectal Cancer: A Review.","authors":"Tamotsu Sagawa, Masahiro Hirakawa, Hiroyuki Nagashima, Koshi Fujikawa","doi":"10.1007/s12029-026-01611-x","DOIUrl":"https://doi.org/10.1007/s12029-026-01611-x","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICIs) have transformed microsatellite instability-high or mismatch repair-deficient metastatic colorectal cancer, but clinically relevant progression still occurs and treatment after progression remains undefined. We performed a clinically oriented narrative review, updated August 8, 2026, and separated direct prospective evidence, retrospective post-ICI evidence, extrapolation from general metastatic colorectal cancer trials, case-level evidence, and biological rationale. In the absence of prospective post-dual-ICI sequencing studies, we propose an evidence-informed conceptual framework. Apparent early progression should prompt confirmation of MSI/MMR status and exclusion of pseudoprogression before classification as early global progression, late systemic progression, or oligoprogression. BRAF V600E is common in MSI-H/dMMR metastatic colorectal cancer and is not an absolute predictor of ICI failure, but it is a major treatment-defining branch after progression. Repeat tissue biopsy or circulating tumor DNA profiling should be selective, used when findings can alter management and without delaying urgent therapy. ctDNA-based molecular residual disease is prognostic after curative-intent colorectal cancer resection, including metastasectomy, but is not validated to direct treatment of radiographically evident post-ICI progression. Oligoprogression warrants multidisciplinary consideration of local therapy, while ICI rechallenge remains investigational. Most recommendations are retrospective or extrapolated; transparent evidence boundaries and prospective post-dual-ICI studies are essential.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence: Interpreting Hazard Ratios in Meta-Analyses on ctDNA in Colorectal Cancer.","authors":"Xiaoxiang Zhang, Yu Zhang","doi":"10.1007/s12029-026-01619-3","DOIUrl":"https://doi.org/10.1007/s12029-026-01619-3","url":null,"abstract":"","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Meta-Analysis on Outcomes of Zanidatamab Plus Chemotherapy in Patients with Advanced HER2-positive Gastroesophageal Adenocarcinoma.","authors":"Henrique Jin Son Kim, Murilo Lauria Freire Ribeiro, Leonardo Gil-Santana, Guilherme Rossato de Almeida, Angelo Borsarelli Carvalho Brito, Tiago Cordeiro Felismino","doi":"10.1007/s12029-026-01608-6","DOIUrl":"10.1007/s12029-026-01608-6","url":null,"abstract":"<p><strong>Background: </strong>Zanidatamab is a novel HER2-targeted antibody that binds to two non-overlapping extracellular domains of the HER2 receptor. Early-phase trials have shown clinical benefit of first-line Zanidatamab in patients with advanced HER2-positive esophageal adenocarcinoma (GEA). We performed a meta-analysis to evaluate the efficacy and safety of zanidatamab in this patient population.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Cochrane, ASCO, and ESMO databases for studies examining zanidatamab as first-line treatment in patients with HER2-positive advanced GEA. Outcomes of interest included progression-free survival (PFS); objective response rate (ORR); disease control rate (DCR); duration of response (DOR); and incidence of adverse events (AEs). Analyses were presented as median or proportions in percentages with 95% confidence intervals (CIs). Random-effect models were used for analysis, which were carried out using R software (v4.5.2).</p><p><strong>Results: </strong>Three clinical trials involving 685 patients with advanced HER2-positive GEA treated with zanidatamab in combination with chemotherapy and/or tislelizumab were included. Overall, the reconstructed pooled median OS was 26.05 months (95% CI: 23.60-30.04), while the pooled median PFS was 12.61 months (95% CI: 11.05-14.60). The pooled ORR was 70% (95% CI, 67-74), DCR was 96% (95% CI, 78-100), and median DOR was 17.11 months (95% CI, 13.07-22.40). Treatment-related diarrhea leading to dose reduction was observed in 16% (95% CI, 1%-75%) of patients. Treatment discontinuation due to any cause rate was 20% (95% CI, 3%-44%). Serious treatment-emergent AEs occurred in 66% (95% CI, 50%-81%) of patients. Common any-grade AEs included diarrhea (89%; 95% CI, 75%-98%), nausea (60%; 95% CI, 45%-74%), and infusion-related reactions (30%; 95% CI, 19%-43%). Grade ≥ 3 diarrhea, nausea, and treatment-related AEs rates were as follows: 26% (95% CI, 19%-34%), 5% (95% CI, 2%-13%), and 65% (95% CI, 58%-71%), respectively. Other important AEs include immune-mediated AEs (25% incidence rate), left ventricular dysfunction (6% incidence rate), and non-infectious pulmonary toxicity (4% incidence rate).</p><p><strong>Conclusions: </strong>Our pooled analyses suggest that zanidatamab exhibits meaningful activity as first-line treatment of advanced HER2-positive GEA. Yet, concerning toxicity rates were also consistently reported across studies. Future randomized studies are needed to further explore its activity and safety profile in this population.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neoadjuvant and Perioperative Immunotherapy for Resectable Esophageal Squamous Cell Carcinoma: Current Evidence, Endpoints, and Clinical Integration.","authors":"Tamotsu Sagawa, Masahiro Hirakawa, Hiroyuki Nagashima, Koshi Fujikawa","doi":"10.1007/s12029-026-01614-8","DOIUrl":"https://doi.org/10.1007/s12029-026-01614-8","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICIs) are being investigated across curative-intent treatment pathways for resectable esophageal squamous cell carcinoma (ESCC). Randomized studies show that programmed cell death-1 blockade can increase pathological complete response (pCR) when added to neoadjuvant chemotherapy, while immunochemoradiotherapy can produce high pathological response rates. This structured narrative review summarizes current evidence for neoadjuvant and perioperative immunotherapy in ESCC within the context of established chemotherapy and chemoradiotherapy backbones. Particular attention is given to randomized ICI trials, the role of radiotherapy, interpretation of pathological and survival endpoints, circulating tumor DNA (ctDNA), postoperative therapy, perioperative safety, clinical response assessment, and regional applicability. pCR is a useful early activity endpoint and may carry prognostic information within individual regimens, but definitions and pathological assessment vary and trial-level surrogacy for overall survival has not been established. Longitudinal ctDNA is promising as a complementary measure of molecular residual disease but remains investigational for treatment adaptation. When radiotherapy is combined with ICI, established thoracic organ-at-risk constraints and careful monitoring for overlapping pulmonary and esophageal toxicity remain important because ICI-specific normal-tissue constraints have not been validated. Clinical complete response assessment also requires multimodal evaluation; post-treatment inflammatory changes can limit CT and PET-CT specificity. Overall, current data support continued phase III evaluation of ICI-containing strategies with mature event-free and overall survival endpoints and with comparators appropriate to regional treatment standards.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, Regional, and National Burden of Liver Cancer Due to Alcohol Use, 1990-2021: a Systematic Analysis for the Global Burden of Disease Study 2021.","authors":"Shuxiong Nong, Meng Wang, Chaoren Zhang","doi":"10.1007/s12029-026-01609-5","DOIUrl":"10.1007/s12029-026-01609-5","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the global, regional, and national burden of liver cancer attributable to alcohol use from 1990 to 2021, and to project trends to 2050.</p><p><strong>Methods: </strong>Systematic analysis of GBD 2021 data covering 204 countries and territories, 21 regions, and 5 SDI quintiles. Numbers and age-standardised rates of deaths, DALYs, prevalence, and incidence were analysed. EAPC and AAPC quantified temporal trends; Spearman correlation, decomposition analysis, health inequality assessment, and efficiency frontier analysis were performed. ARIMA models projected trends to 2050.</p><p><strong>Results: </strong>In 2021, alcohol use accounted for 92,228 deaths (95% UI 75,053-112,160) and 2.32 million DALYs (95% UI 1.89-2.85 million) globally, with age-standardised mortality and DALY rates of 1.17 and 29.35 per 100,000. From 1990 to 2021, the age-standardised mortality, DALY, incidence, and prevalence rates all increased. The highest rates were observed in Western Europe, Australasia, and High-income Asia Pacific. High SDI regions had the greatest burden and the steepest increases, whereas Low SDI regions showed modest declines. SDI was positively correlated with all burden metrics. Population growth and aging were the primary drivers of increasing death counts, and the SII for mortality widened from 1990 to 2021. Mongolia had the largest avoidable burden.</p><p><strong>Conclusion: </strong>The global burden of alcohol-attributable liver cancer has increased substantially over three decades, with marked geographical and socioeconomic disparities.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibrolamellar Carcinoma in the Molecular Era: From DNAJB1::PRKACA Biology to Precision Therapeutic Strategies.","authors":"Tuba Baydaş, İlker Nihat Ökten","doi":"10.1007/s12029-026-01610-y","DOIUrl":"10.1007/s12029-026-01610-y","url":null,"abstract":"<p><strong>Purpose: </strong>Fibrolamellar carcinoma (FLC) is a rare primary liver cancer of adolescents and young adults that arises in a non-cirrhotic liver and was long treated as a variant of hepatocellular carcinoma (HCC). The 2014 discovery of the recurrent DNAJB1::PRKACA gene fusion as a near-universal event reframed FLC as a distinct, fusion-driven malignancy with specific diagnostic and therapeutic consequences. This review focuses on advances in systemic and precision therapies for FLC.</p><p><strong>Methods: </strong>PubMed/MEDLINE and ClinicalTrials.gov were searched from inception through 16 September 2026 to inform a narrative synthesis of clinical and translational evidence on systemic and precision therapies for FLC.</p><p><strong>Results: </strong>Molecular and functional studies establish DNAJB1::PRKACA as the defining oncogenic driver of FLC, while alternative PKA-activating lesions broaden its molecular spectrum. Surgery remains the cornerstone of curative-intent treatment, but frequent recurrence and the absence of effective adjuvant therapy underscore the need for systemic strategies. Available systemic treatments are supported predominantly by small, non-randomized studies, with no established comparative superiority. Fusion-directed immunotherapy has provided early clinical proof of concept: a phase 1 trial of a fusion peptide vaccine combined with nivolumab and ipilimumab reported an objective response rate of 19%, with fusion-specific T-cell responses in 9 of 12 patients completing the priming phase. These findings support further investigation, although the contribution of vaccination cannot be separated from that of checkpoint blockade.</p><p><strong>Conclusion: </strong>The molecular characterization of FLC has established a rationale for fusion-directed therapeutic development. Current care should integrate molecular confirmation, multidisciplinary management, and early clinical trial referral, consistent with the 2026 guideline.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence: Cachexia-Related Status in Advanced Gastric Cancer: Marker of Progression or Driver of Prognosis?","authors":"Yu Zhang","doi":"10.1007/s12029-026-01612-w","DOIUrl":"10.1007/s12029-026-01612-w","url":null,"abstract":"","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Effectiveness and Safety of FOLFOXIRI Plus Cetuximab Versus FOLFOXIRI Plus Bevacizumab in Metastatic Colorectal Cancer: A GRADE-assessed Systematic Review and Meta-analysis.","authors":"Ahmed Raza, Maria Qadri, Faiza Fatima, Muhammad Saffi Ullah, Muhammad Ansab, Mahnoor Fatima, Zain Sadiq, Zaheer Qureshi, Navkirat Kahlon","doi":"10.1007/s12029-026-01595-8","DOIUrl":"10.1007/s12029-026-01595-8","url":null,"abstract":"<p><strong>Introduction: </strong>Metastatic colorectal cancer (mCRC) is a leading cause of cancer-related mortality worldwide. FOLFOXIRI combined with targeted agents has shown promising outcomes in mCRC. This meta-analysis compares efficacy and safety of FOLFOXIRI plus cetuximab versus FOLFOXIRI plus bevacizumab in patients with mCRC.</p><p><strong>Methods: </strong>A literature search was conducted across PubMed, Cochrane, Embase, Scopus, and clinicaltrials.gov until February 2025. Analysis was performed using RStudio v4.5.0. Pooled estimates are reported as hazard ratios, odds ratios, risk ratios, and mean difference with 95% CIs using random-effects model. Heterogeneity was assessed using I² statistics.</p><p><strong>Results: </strong>Four studies (3 RCTs, 1 observational) comprising 561 patients were included. Overall survival did not differ significantly between FOLFOXIRI-cetuximab and FOLFOXIRI-bevacizumab (HR: 1.22; 95% CI: 0.78 - 1.90; p = 0.386). Progression-free survival also did not differ significantly (HR: 1.32; 95% CI: 0.76-2.31; p = 0.324). Objective response rate, complete response, and partial response did not differ significantly [(OR: 1.48; 95% CI: 0.50-4.37; p = 0.4772), (OR: 1.59; 95% CI: 0.66-3.86; p = 0.303), and (OR: 1.60; 95% CI: 0.52-4.93, p = 0.414) respectively]. Depth of response showed no significant difference (MD: 15.29; 95% CI: -1.35-31.94; p = 0.07). Hypomagnesemia and acneiform rash were significantly more frequent with cetuximab (p < 0.01). However, alopecia, anemia, neurotoxicity, and all-grade stomatitis showed no difference between the two arms.</p><p><strong>Conclusions: </strong>FOLFOXIRI-cetuximab did not improve PFS, OS, or response rates in patients with mCRC compared with the bevacizumab combination; however, it was associated with significantly higher rates of hypomagnesemia and acneiform rash.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Chemoimmunotherapy for Resectable Gastric and Gastroesophageal Junction Cancer: A Conceptual, Biomarker-Informed, and Regionally Adapted Framework.","authors":"Tamotsu Sagawa, Hiroyuki Nagashima, Koshi Fujikawa","doi":"10.1007/s12029-026-01602-y","DOIUrl":"10.1007/s12029-026-01602-y","url":null,"abstract":"<p><p>Perioperative treatment for resectable gastric and gastroesophageal junction (GEJ) adenocarcinoma is changing rapidly as immune checkpoint inhibition enters a field historically shaped by distinct chemotherapy and surgical paradigms. This review critically appraises contemporary perioperative and adjuvant evidence and proposes a biomarker-informed, regionally adaptable framework for clinical decision-making. We conducted a structured narrative review of perioperative and adjuvant systemic therapy, surgical outcomes, treatment completion, safety, and biomarker evidence in resectable gastric and GEJ adenocarcinoma, with emphasis on randomized phase III trials, mature follow-up, prospective biomarker studies, and relevant regulatory data. MATTERHORN demonstrated significant event-free survival and subsequently overall survival benefits with perioperative durvalumab plus fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT), supporting regulatory approvals. In contrast, KEYNOTE-585 increased pathological complete response but did not meet the prespecified event-free survival statistical boundary, while ATTRACTION-5 did not establish postoperative nivolumab after D2 gastrectomy as a new standard. MSI-H/dMMR is the most clinically relevant perioperative biomarker, although chemotherapy-free strategies remain investigational. PD-L1 thresholds validated in advanced disease should not be directly transferred to the curative setting. Pathological response, ypN status, circulating tumor DNA/molecular residual disease, and emerging multimodal risk models are prognostic, but none currently provides validated treatment-effect prediction sufficient to mandate postoperative escalation or de-escalation. Perioperative treatment should integrate resectability, surgical quality, patient fitness, regional chemotherapy backbones, MSI-H/dMMR status, treatment completion, and postoperative recovery. The proposed framework is conceptual rather than a guideline and requires prospective validation.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}