Journal of Gastrointestinal Cancer最新文献

{"title":"Correspondence: Radiation Boost to Lateral Pelvic Nodes in Rectal Cancer: Promising is not yet Proven.","authors":"Yu Zhang","doi":"10.1007/s12029-026-01607-7","DOIUrl":"10.1007/s12029-026-01607-7","url":null,"abstract":"","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":"149081151","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":"Second-Line Systemic Therapy Following First-Line FOLFIRINOX or NALIRIFOX in Metastatic Pancreatic Ductal Adenocarcinoma: A Systematic Review and Meta-Analysis.","authors":"Pouyan Shaker, Daniyaal Kamran, Lingling Du, Shubham Pant, Jane E Rogers, Jonathan D Mizrahi","doi":"10.1007/s12029-026-01601-z","DOIUrl":"10.1007/s12029-026-01601-z","url":null,"abstract":"<p><strong>Purpose: </strong>FOLFIRINOX and NALIRIFOX are now preferred first-line treatments for metastatic pancreatic ductal adenocarcinoma (mPDAC), yet optimal second-line therapy after frontline triplet chemotherapy remains unclear. Prior evidence largely addressed second-line treatment after gemcitabine-based first-line therapy, limiting relevance today. We conducted the first contemporary systematic review and meta-analysis of second-line therapy after frontline triplet chemotherapy.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, CINAHL, and PsycINFO through January 2026 for studies of second-line therapy after first-line FOLFIRINOX/NALIRIFOX in adults with advanced/metastatic PDAC. Two reviewers independently selected studies, extracted data, and assessed quality (ROBINS-I or RoB 2). Random-effects meta-analyses pooled median overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR). Registered in PROSPERO (CRD420251276176) per PRISMA 2020 guidelines.</p><p><strong>Results: </strong>Twenty-three studies (3888 patients) met inclusion criteria, mostly retrospective cohorts after first-line FOLFIRINOX. Pooled median OS from second-line initiation was 7.57 months (95% CI, 6.00-9.55); pooled median PFS was 3.18 months (95% CI, 2.74-3.68). Pooled ORR was 11.6%; pooled DCR was 47.8%. Combination gemcitabine-based regimens outperformed monotherapy, particularly with ECOG 0-1. The only randomized phase-III trial (GEMPAX) showed significantly improved PFS and ORR with gemcitabine plus paclitaxel versus gemcitabine alone, without significant OS benefit. ECOG performance status was the strongest outcome predictor.</p><p><strong>Conclusion: </strong>This first contemporary synthesis of post-triplet second-line therapy in mPDAC shows meaningful benefit in carefully selected, fit patients. Gemcitabine-based combination therapy is a reasonable option for ECOG 0-1 patients, though treatment should remain individualized based on performance status, toxicity, and preference. These findings provide contemporary benchmarks for practice and future trials.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075022","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":"Impact of Socioeconomic Status on Early Gastric Cancer Outcomes and Treatment Disparity: a SEER analysis.","authors":"Rinrada Worapongpaiboon, Sonmoon Mohapatra, Kasenee Tiankanon, Saowanee Ngamruengphong","doi":"10.1007/s12029-026-01604-w","DOIUrl":"10.1007/s12029-026-01604-w","url":null,"abstract":"<p><strong>Purpose: </strong>The influence of socioeconomic determinants of health on early gastric adenocarcinoma (GAC) remains understudied. We evaluated the association between median household income (MHI), treatment patterns, and survival in T1aN0M0 GAC.</p><p><strong>Methods: </strong>Using the SEER-17 Research Plus database (2004-2021), we identified 3,792 patients with T1aN0M0 GAC. MHI was stratified into tertiles. Overall survival (OS), cancer-specific mortality (CSM), and non-cancer-specific mortality (NCSM) were assessed with Kaplan-Meier methods. Independent predictors of CSM were identified using multivariable Fine-Gray competing-risk regression.</p><p><strong>Results: </strong>Patients in the lowest MHI tertile were younger, more likely to be Black, unemployed, and to receive no definitive treatment (surgery or endoscopic therapy (ET)) despite similar tumor size (all P < 0.001) vs higher tertiles. Treatment patterns varied by income: highest MHI patients were more likely to undergo ET, while lowest MHI patients more often received chemotherapy/radiation and no definitive therapy. Compared with the highest MHI group, the lowest MHI group had worse outcomes, with lower 5-year OS (82.3% vs. 86.0%) and higher 5-year CSM (17.6% vs. 13.6%; both P < 0.001). NCSM did not differ across income tertiles. Compared with the lowest MHI tertile, the middle (sHR 0.68, 95% CI 0.55-0.83; P < 0.001) and highest MHI tertiles (sHR 0.72, 95% CI 0.56-0.93; P = 0.011) were associated with significantly lower CSM. Older age ( ≥ 65 years), tumor size ≥ 2 cm, poor tumor differentiation, no definitive treatment, and receipt of radiation therapy were independently associated with higher CSM, whereas Asian or Pacific Islander race, residence in the Northern region and diagnosis during 2019-2021 were associated with lower CSM.</p><p><strong>Conclusions: </strong>Lower MHI was independently associated with poorer survival in early GAC, highlighting persistent socioeconomic disparities in access to definitive treatment. Strategies to improve equitable access to curative therapy are warranted.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074985","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 Circulating Tumor DNA in Resectable Gastric and Gastroesophageal Junction Adenocarcinoma: Molecular Residual Disease, Recurrence Prediction, and a Trial-Ready Framework for Treatment Adaptation.","authors":"Tamotsu Sagawa, Masahiro Hirakawa, Hiroyuki Nagashima, Koshi Fujikawa","doi":"10.1007/s12029-026-01598-5","DOIUrl":"10.1007/s12029-026-01598-5","url":null,"abstract":"<p><p>Recurrence remains a major cause of treatment failure after curative-intent therapy for resectable gastric and gastroesophageal junction adenocarcinoma. Clinicopathological staging, pathological response, serum tumor markers, and imaging incompletely identify patients with molecular residual disease (MRD). Circulating tumor DNA (ctDNA) has therefore emerged as a minimally invasive biomarker for perioperative risk stratification, response assessment, postoperative MRD detection, and recognition of molecular recurrence before radiographic relapse. In gastric and gastroesophageal junction cancer, postoperative ctDNA positivity has shown the most reproducible association with recurrence and survival, while serial studies indicate that early clearance during neoadjuvant therapy, persistence after preoperative therapy, and residual ctDNA after surgery or adjuvant chemotherapy represent distinct molecular states. However, several barriers remain: assay heterogeneity, variable sampling windows, clonal hematopoiesis, low shedding in diffuse-type and peritoneal-predominant disease, limited negative predictive value, and the absence of randomized evidence that ctDNA-guided intervention improves survival. Lessons from colorectal cancer are cautionary: randomized escalation and de-escalation trials have not uniformly translated strong prognostic validity into clinical utility. This review summarizes perioperative ctDNA evidence in resectable gastric and gastroesophageal junction adenocarcinoma, compares tumor-informed and tumor-agnostic platforms, examines peritoneal and molecular-subtype-specific limitations, and proposes a trial-ready framework for escalation, de-escalation, and molecular surveillance. At present, ctDNA is suitable for risk stratification and clinical-trial enrollment as an adjunct to, rather than a replacement for, conventional surveillance; it is not ready for routine treatment adaptation outside prospective studies.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061931","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 Perspectives on Radiotherapy Utilization for Pancreatic Ductal Adenocarcinoma.","authors":"Bradley N Reames, Eric D Miller, Ziyi Zhou, Amol Narang, Patrick L Quinn, Bradley White, Emile Gogineni, Aslam Ejaz","doi":"10.1007/s12029-026-01600-0","DOIUrl":"10.1007/s12029-026-01600-0","url":null,"abstract":"<p><strong>Purpose: </strong>Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy requiring multi-modality treatment. Radiotherapy (RT) may improve local control and resection rates, though evidence to support use across various stages of disease is mixed and evolving. This study sought to investigate international practice patterns and provider preferences for the use of radiotherapy in the multidisciplinary management of PDAC.</p><p><strong>Methods: </strong>A 39-item electronic survey was distributed in 2025 through three sub-specialty organizations to providers who have recently treated PDAC.</p><p><strong>Results: </strong>A total of 176 PDAC providers from six continents completed the survey, with the majority practicing in Europe (n= 76, 43%) and North America (n= 62, 35%). Respondents included mostly surgeons (n= 143, 81%) with 81% (n= 142) practicing in academic centers. Nearly 1 in 5 respondents did not offer or consider any indication for neoadjuvant (n= 32, 19%) or adjuvant (n= 46, 30%) RT. The most commonly cited indication for neoadjuvant RT was for locally advanced disease (n= 88, 52%) and surgically unresectable disease (n= 86, 51%), while the use of adjuvant RT was primarily for positive surgical margins (n= 97, 63%) and positive nodal disease (n= 46, 30%).</p><p><strong>Conclusion: </strong>In an international cohort of surgeons and radiation oncologists, there is substantial variation in perceptions of effectiveness, management preferences, and the propensity to utilize radiotherapy for PDAC. These results underscore the lack of strong evidence to support management, and the need for consensus guidelines and clinical trials to inform best practice.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061961","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":"Prognostic Value of the C-Reactive Protein-Albumin-Lymphocyte Index in Hepatobiliary and Pancreatic Cancers: A Systematic Review and Meta-Analysis.","authors":"Mohammadsadra Shamohammadi, Ehsan Arianezhad, Danial Yarahmadi, Sana Ehsan Ullah, Mohammad Hossein Teymoori, Zubayer Shams, Alireza Nikkhah, Adnan Tizmaghz, Seyed Yahya Zarghami","doi":"10.1007/s12029-026-01603-x","DOIUrl":"10.1007/s12029-026-01603-x","url":null,"abstract":"<p><strong>Background: </strong>The C-reactive protein-albumin-lymphocyte (CALLY) index integrates systemic inflammation, nutritional status, and immune competence, but evidence in hepatobiliary and pancreatic (HBP) malignancies remains uncertain. We evaluated its association with survival outcomes.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, Scopus, and Web of Science was performed from inception to 9 September 2026. Observational studies involving adults with hepatobiliary and pancreatic malignancies were eligible if they evaluated pretreatment CALLY and reported HRs for survival outcomes. Random-effects were used to pool HRs for overall survival (OS) and recurrence-free/disease-free survival (RFS/DFS). Risk of bias was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was evaluated using GRADE.</p><p><strong>Results: </strong>Sixteen studies (17 cohorts; 3,833 participants) were included. High CALLY was associated with better OS across 17 cohorts (HR 0.50, 95% CI 0.44-0.58; I²=35.3%) and better RFS/DFS across eight cohorts (HR 0.60, 95% CI 0.49-0.73; I²=55.0%). Cancer-specific OS estimates favored high CALLY in hepatocellular carcinoma (HR 0.58), cholangiocarcinoma (CCA)/biliary tract cancer (HR 0.47), and pancreatic cancer (HR 0.46). Exploratory anatomical stratification of CCA reduced heterogeneity from 56.5% overall to 11.0% in intrahepatic CCA and 0% in mixed CCA/biliary cohorts. Leave-one-out analyses identified no influential cohort. Funnel-plot asymmetry suggested small-study effects for OS. Evidence certainty was moderate for both outcomes.</p><p><strong>Conclusion: </strong>High pretreatment CALLY was associated with favorable survival across HBP malignancies. Predominantly retrospective evidence, heterogeneous clinical settings, variable cutoffs, and possible small-study effects preclude routine clinical use. Prospective multicenter validation using standardized thresholds is required.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039019","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":"Effectiveness and Safety of Colorectal Cancer Screening Via Fecal Occult Blood Testing: A Systematic Review and Meta-Analysis.","authors":"Mayra Calil Jorge Frankenfeld, Giovanna Camarotto Patah, Luiza Teixeira Soares, Sarah Nascimento Silva, Fernando Gomes Romeiro, Vania Dos Santos Nunes Nogueira","doi":"10.1007/s12029-026-01605-9","DOIUrl":"10.1007/s12029-026-01605-9","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review evaluated the effectiveness of population-based colorectal cancer (CRC) screening programs using fecal occult blood tests (gFOBT or FIT) among adults aged 45-75 years.</p><p><strong>Methods: </strong>We included studies comparing participants in population-based CRC screening programs with unscreened individuals. Outcomes were all-cause mortality, CRC-specific mortality, CRC incidence, and stage IV CRC incidence. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. Pooled RRs were calculated by meta-analysis, and certainty of evidence was assessed using GRADE.</p><p><strong>Results: </strong>No difference was observed in all-cause mortality (RR = 1.00, 95% CI 0.99-1.01; 5 studies, 1,474,576 participants; moderate-certainty evidence). RCTs evaluating gFOBT demonstrated a reduction in CRC-specific mortality (RR = 0.89, 95% CI 0.84-0.94; 5 studies, 1,474,576 participants; moderate-certainty evidence), corresponding to 38 fewer CRC deaths per 100,000 individuals screened (95% CI, 55 fewer to 21 fewer). Non-RCTs evaluating FIT reported larger reductions in CRC-specific mortality (RR = 0.21, 95% CI 0.20-0.21; 5 studies, 7,435,956 participants), although the certainty of evidence was low. RCTs showed no significant effect on CRC incidence or stage IV CRC incidence, whereas non-RCTs evaluating FIT suggested reductions in both outcomes; however, the certainty of evidence was also low.</p><p><strong>Conclusion: </strong>Fecal occult blood test-based screening reduces CRC-specific mortality but not all-cause mortality. FIT-based screening may provide additional benefits by reducing CRC incidence and stage IV disease; however, these findings are supported by low-certainty evidence and require confirmation in RCTs.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030684","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":"Long-Term Association Between GLP-1 Receptor Agonist Use and Incident Pancreatic Cancer: A Propensity Score-Matched Retrospective Cohort Study Using the TriNetX Network.","authors":"Muhammad Ali Ibrahim Kazi, Junaid Khan, Syed Musa Mufarrih, Maham Siddiqui, Huzaifa Ul Haque Ansari, Muhammad Ahmed, Imran Qureshi, Abdulhameed Al-Sabban, Nihaal Prashant Karnik, Andrew Gilman, Sanmeet Singh, Andrew Canakis","doi":"10.1007/s12029-026-01523-w","DOIUrl":"10.1007/s12029-026-01523-w","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely prescribed for type 2 diabetes mellitus (T2DM) and obesity. Whether GLP-1 RA use is associated with altered long-term pancreatic cancer risk remains uncertain, with conflicting evidence from prior observational studies. We aimed to evaluate the association between initiation of GLP-1 RA therapy and incident pancreatic cancer risk compared with six classes of antidiabetic agents.</p><p><strong>Methods: </strong>We conducted a retrospective, new-user cohort study using the TriNetX global federated electronic health record network. Adults with T2DM initiating GLP-1RA therapy were compared with incident users of insulin, metformin, dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium-glucose cotransporter-2 (SGLT2) inhibitors, sulfonylureas, and thiazolidinediones in six separate propensity score-matched analyses (1:1, greedy nearest-neighbor algorithm, caliper 0.1 pooled standard deviations). Matching was performed on 39 baseline covariates,, including demographics, comorbidities, procedures, and medication exposures. The primary outcome was incident pancreatic cancer (ICD-10-CM C25) occurring between 365 and 7,300 days after the index prescription. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression.</p><p><strong>Results: </strong>After propensity score matching, GLP-1 RA users compared with insulin users had a lower hazard of pancreatic cancer (HR 0.43, 95% CI 0.35, 0.53; absolute risk: GLP-1 RA 0.15% vs. insulin 0.11%; absolute risk difference [ARD] 0.04% points). In contrast, users of metformin (HR 1.39, 95% CI 1.16, 1.66; ARD 0.04% points), sulfonylureas (HR 1.37, 95% CI 1.13, 1.65; ARD 0.07% points), thiazolidinediones (HR 1.30, 95% CI 1.001, 1.678; ARD 0.15% points) and DPP-4i (HR 1.31; 95% CI 1.06, 1.61; ARD 0.08% points) had significantly higher hazards of pancreatic cancer compared with GLP-1 RA users. No significant difference was observed between GLP-1 RA users and users of SGLT2 inhibitors (HR 1.08, 95% CI 0.87, 1.34).</p><p><strong>Conclusions: </strong>In this large, real-world, propensity score-matched analysis, the direction and magnitude of the association between GLP-1 RA use and pancreatic cancer risk varied by comparator agent. GLP-1 RA use was associated with a lower hazard of pancreatic cancer relative to metformin, sulfonylureas, thiazolidinediones, and DPP-4i while no significant difference relative to SGLT2i, and a higher hazard relative to insulin.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977030","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":"Postoperative ctDNA-Guided Adjuvant Therapy in Resected Colorectal Cancer: A Systematic Review and Meta-analysis of Prognostic Validity Versus Treatment-Decision Utility.","authors":"Zheng Han, Yan Zhang, Qingjie Tian, Hongcheng Zhu, Hongwei Wang, Changzai Li","doi":"10.1007/s12029-026-01578-9","DOIUrl":"10.1007/s12029-026-01578-9","url":null,"abstract":"<p><p>Postoperative circulating tumor DNA (ctDNA) is a strong marker of molecular residual disease after curative-intent colorectal cancer resection, but prognostic validity alone does not establish treatment-decision utility. We performed a PRISMA 2020 systematic review and meta-analysis with search coverage through March 31, 2026, separating randomized ctDNA-guided treatment-decision evidence from prospective prognostic cohorts, platform-trial evidence, implementation evidence, and ongoing trials. Thirty-eight reports or programs were included in the evidence map, and seven independent prospective cohorts contributed to the prognostic meta-analysis. Postoperative ctDNA positivity was associated with increased recurrence risk (pooled hazard ratio, 7.60; 95% CI, 4.70-12.31), with substantial heterogeneity (I²=80.6%) and a wide prediction interval (1.60-36.25). Decision evidence was scenario-specific: DYNAMIC supports consideration of selective stage II colon cancer de-escalation, whereas DYNAMIC-III did not establish non-inferiority for routine stage III de-escalation. Current evidence does not support routine empiric escalation for MRD-positive disease. Postoperative ctDNA should therefore be interpreted as a powerful risk-stratification tool whose treatment-changing role remains limited to selected clinical contexts.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976989","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":"Radiomics-Driven Imaging Biomarkers for Predicting Chemoradiotherapy Response in Locally Advanced Rectal Cancer.","authors":"Jawad Ali Memon, Mohammad Sibtain Shah, Zubair Ali Memon, Uzma Malik","doi":"10.1007/s12029-026-01592-x","DOIUrl":"10.1007/s12029-026-01592-x","url":null,"abstract":"<p><strong>Purpose: </strong>Pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC) predicts excellent prognosis, yet conventional morphological MRI achieves only 52-71% sensitivity. Radiomics models show promising discrimination, but performance variation across platforms limits clinical translation.</p><p><strong>Methods: </strong>This prospective cohort study enrolled 615 LARC patients (cT3-T4 or cN+) across four centers. Centers 1-3 contributed the development cohort (n = 405); Center 4 was the sole external validation site, contributing mutually exclusive 1.5T (n = 98; 19 pCR, 19.4%) and 3T (n = 112; 24 pCR, 21.4%) cohorts. Baseline MRI yielded 107 radiomics features (42 retained). Clinical-only, radiomics-only and combined models predicting pCR (ypT0N0) were fitted by LASSO logistic regression in Python, with ComBat harmonization estimated on development data only, DeLong testing, calibration assessment and decision curve analysis.</p><p><strong>Results: </strong>Development pCR prevalence was 20.0% (81/405). The combined model achieved AUC 0.887 (95% CI 0.846-0.928; sensitivity 87.7% [71/81], specificity 84.6% [274/324]) versus radiomics-only 0.842 and clinical-only 0.723 (DeLong p < 0.001). External validation gave AUC 0.821 at 1.5T and 0.908 at 3T. ComBat improved 1.5T discrimination (ΔAUC + 0.060, p = 0.041) but did not abolish the field-strength gradient. Calibration slopes were 0.91-0.96. At a 15% threshold probability the combined model showed the highest net benefit (0.135). pCR predicted 3-year disease-free survival 98.8% versus 66.0% (p < 0.001).</p><p><strong>Conclusions: </strong>Combined radiomics-clinical models discriminate pCR across MRI platforms. Because external validation was confined to one center and no management decision followed model output, these findings are hypothesis-generating and require prospective interventional verification.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982593","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}