World Journal of Gastrointestinal Oncology最新文献

{"title":"Relationship between preoperative modified frailty index, immune-inflammation index, and outcomes of colorectal cancer surgery in older patients.","authors":"Xing-Si Qi, Jing Xie, Nai-Ling Liu, Lin Yang","doi":"10.4251/wjgo.v18.i2.115224","DOIUrl":"10.4251/wjgo.v18.i2.115224","url":null,"abstract":"<p><strong>Background: </strong>With the aging of the population, the proportion of older patients with colorectal cancer (CRC) is increasing annually. Preoperative frailty and chronic inflammatory responses may increase the risk of postoperative complications and affect long-term survival.</p><p><strong>Aim: </strong>To assess modified frailty index (mFI) and systemic immune-inflammation index (SII) for predicting postoperative prognosis in older patients with CRC.</p><p><strong>Methods: </strong>We retrospectively analyzed 247 older patients with CRC who underwent radical resection. The SII was calculated as platelet count × neutrophil count/lymphocyte count. Patients were grouped by complication occurrence. Univariate and multivariate analyses were performed for mFI, SII, and postoperative complications. Using receiver operating characteristic curve analysis, the critical SII value for predicting postoperative recurrence was identified, which was then used to divide patients into high/low mFI and high/low SII groups. Using Kaplan-Meier method between-group survival curves were drawn.</p><p><strong>Results: </strong>The 30-day complication rate was 12.55%. Multivariate logistic regression analysis identified smoking history [odds ratio (OR) = 4.822], prolonged operation time (OR = 1.037), and elevated preoperative mFI (OR = 9.342) and SII (OR = 1.002) as independent risk factors for postoperative complications (<i>P</i> < 0.05). On survival analysis, the average recurrence-free survival (RFS) for patients with a low mFI was 47.04 months [95% confidence interval (CI): 45.30-48.79], significantly better than the 33.83 months (95%CI: 31.31-36.36) for patients with a high mFI (log-rank, <i>P</i> < 0.001). The average RFS for patients with a low SII was 47.00 months (95%CI: 45.07-48.94), significantly better than the 40.06 months (95%CI: 31.37-43.74) for those with a high SII (log-rank, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>In older patients with CRC, the preoperative mFI and SII were significantly correlated with postoperative complications and RFS, warranting closer attention to early recurrence detection and intervention.</p>","PeriodicalId":23762,"journal":{"name":"World Journal of Gastrointestinal Oncology","volume":"18 2","pages":"115224"},"PeriodicalIF":2.5,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202603","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":"Ethnic genomic diversity in esophageal squamous cell carcinoma.","authors":"Wen-Mao Li, Yan Jiao, Si-Qi Liu, Chun-Xi Wang, Miao He","doi":"10.4251/wjgo.v18.i2.116345","DOIUrl":"10.4251/wjgo.v18.i2.116345","url":null,"abstract":"<p><p>Esophageal squamous cell carcinoma (ESCC) remains one of the most lethal malignancies worldwide, with pronounced geographic and ethnic disparities in incidence and outcomes. Rapid advances in genome-wide and sequencing technologies have revealed population-specific mutation spectra and risk loci, highlighting the interplay between inherited susceptibility and environmental exposures. The recent Han-Kazakh whole-exome study provided compelling evidence that ethnic background can shape the mutational landscape of Chinese ESCC, identifying population-restricted alterations such as GIGYF1 and distinct mutational signatures related to apolipoprotein B mRNA-editing enzyme catalytic polypeptide activity. These findings underscore the biological consequences of ethnic heterogeneity but also expose critical gaps: Most available data derive from limited Asian cohorts, cross-sectional designs, and coding-region analyses, leaving African, Central Asian, and multi-ancestry populations underrepresented and the functional relevance of non-coding and epigenetic changes unresolved. Building on this foundation, the present review synthesizes current genomic, transcriptomic, and epigenomic evidence across diverse ethnic groups to delineate shared and population-specific drivers of ESCC carcinogenesis. We emphasize how polymorphisms in alcohol-metabolizing enzymes (ADH1B, ALDH2), DNA-repair and oxidative-stress pathways, and immune-related networks interact with lifestyle and environmental factors to influence tumor initiation and progression. By integrating multi-ethnic multi-omics data, we highlight emerging biomarkers and therapeutic targets that may inform ancestry-aware screening, risk stratification, and individualized treatment strategies. Bridging these ethnic and molecular divides is essential for translating genomic discoveries into equitable precision oncology for ESCC.</p>","PeriodicalId":23762,"journal":{"name":"World Journal of Gastrointestinal Oncology","volume":"18 2","pages":"116345"},"PeriodicalIF":2.7,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203054","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":"Role of microRNA-136 in <i>Helicobacter pylori</i>-induced early-stage gastric cancer: Mechanistic insights and future directions.","authors":"Yi-Xiao Chen, Ying-Hua Zhang, Sai-Jun Mo","doi":"10.4251/wjgo.v18.i2.114163","DOIUrl":"10.4251/wjgo.v18.i2.114163","url":null,"abstract":"<p><p>This commentary critically appraises Chen <i>et al</i>, who delineate the nuclear factor kappa B (NF-κB)-microRNA-136 (miR-136)-programmed cell death protein 11 (PDCD11) axis in <i>Helicobacter pylori</i> (<i>H. pylori</i>)-associated gastric carcinogenesis and propose <i>H. pylori-</i>induced miR-136 as a potential biomarker for early gastric cancer (GC). The study's major strength lies in its multi-level validation - clinical specimen analysis, <i>in vitro</i> assays, and <i>in vivo</i> models - which collectively support a model in which <i>H. pylori</i> activates NF-κB to upregulate miR-136, and miR-136 in turn suppresses PDCD11 to promote GC cell proliferation, migration, and tumorigenicity. These findings lend experimental weight to the inflammation → molecular alteration → carcinogenesis paradigm and identify a novel axis for early intervention. Nonetheless, important mechanistic and methodological gaps limit translational readiness. Mechanistically, the work does not dissect how specific <i>H. pylori</i> virulence factors trigger NF-κB activation, nor does it define the downstream effectors and signaling cascades through which PDCD11 loss drives malignant phenotypes. Furthermore, this study did not detect the apoptotic properties of the PDCD11 protein. The study also omits an analysis of why miR-136 function may vary across histological subtypes. At the methodological level, <i>in vitro</i> validation was confined to only two GC cell lines. It lacked models representing the early stages of gastric mucosal transformation, which hinders the study's ability to unravel the temporal dynamics of miR-136 function and its subtype specificity. Additionally, the experimental result figures of this study contain several flaws in terms of labeling, completeness, and consistency, which may interfere with readers' accurate understanding of the results. To advance clinical translation, future studies should clarify the precise molecular links between <i>H. pylori</i> components and NF-κB activation, elucidate the downstream pathways of PDCD11, and investigate the heterogeneity of miR-136 across different pathological subtypes. Furthermore, conducting robust validation in multicenter, larger-scale cohorts and establishing expanded cellular models that include gastric mucosal cells and subtype-representative cell lines will also be essential tasks. Despite these limitations, by identifying a targetable regulatory axis and providing directions for in-depth mechanistic and translational research on miR-136 as an early diagnostic and therapeutic target, this study still makes a meaningful contribution to research on <i>H. pylori</i>-associated GC.</p>","PeriodicalId":23762,"journal":{"name":"World Journal of Gastrointestinal Oncology","volume":"18 2","pages":"114163"},"PeriodicalIF":2.5,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202680","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":"Radiomics-based model for predicting neoadjuvant therapy response in esophageal cancer: Limitations and suggestions.","authors":"Zong-Xian Zhao","doi":"10.4251/wjgo.v18.i2.114981","DOIUrl":"10.4251/wjgo.v18.i2.114981","url":null,"abstract":"<p><p>A core challenge in the diagnosis and treatment of esophageal cancer (EC) lies in accurately identifying patients who will benefit from neoadjuvant therapy (NAT). Yang <i>et al</i> reported a predictive model for NAT response in EC, constructed using radiomics from T2-weighted magnetic resonance imaging (MRI) and machine learning. The model achieved an area under the curve of 0.932 in the training cohort and 0.900 in the validation cohort. While encouragingly, we urge caution with limitation. First, the study's single-center, retrospective design with an insufficient sample size limits the model's generalizability and significantly increases the risk of overfitting. Second, the study only extracted features from the T2-weighted MRI sequence, failing to integrate data from other functional MRI sequences such as diffusion-weighted imaging and dynamic contrast-enhanced MRI. Third, the model suffers from a \"black box\" issue regarding its extracted features-its low interpretability hinders clinicians' trust in and acceptance of the model. This editorial reviews the study by Yang <i>et al</i>, identifies its limitations, and puts forward in-depth suggestions to further optimize the model.</p>","PeriodicalId":23762,"journal":{"name":"World Journal of Gastrointestinal Oncology","volume":"18 2","pages":"114981"},"PeriodicalIF":2.5,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203028","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":"Taurine suppresses gastric intestinal metaplasia in patient-derived organoids and <i>Atp4a</i> ^-/- mice.","authors":"Ke Liu, Xi Zhang, Fa-Zhan Li, Peng-Yuan Zheng, Yang Mi","doi":"10.4251/wjgo.v18.i2.114161","DOIUrl":"10.4251/wjgo.v18.i2.114161","url":null,"abstract":"<p><strong>Background: </strong>Gastric intestinal metaplasia (GIM) represents a critical precancerous condition in the progression from chronic gastritis to gastric cancer, with limited therapeutic options. Emerging evidence suggests that taurine, a cytoprotective amino acid, may modulate gastric epithelial dysfunction. However, its application and efficiency in the context of GIM remain poorly understood.</p><p><strong>Aim: </strong>To investigate the therapeutic effects of taurine on GIM using patient-derived organoids and <i>Atp4a</i> ^-/- mouse models.</p><p><strong>Methods: </strong>Patient-derived GIM organoids (<i>n</i> = 3) and <i>Atp4a</i> ^-/- mice, which spontaneously develop GIM, were used as experimental models. Morphological changes were assessed <i>via</i> Alcian blue-periodic acid Schiff staining. The expression levels of the gastric epithelial marker mucin 5AC (<i>MUC5AC</i>) and GIM-associated markers (caudal type homeobox 2 [<i>CDX2</i>], <i>MUC2</i>, Trefoil factor family 3 [<i>TFF3</i>]) were quantified <i>via</i> quantitative PCR, Western blotting, and immunohistochemistry.</p><p><strong>Results: </strong>We confirmed that taurine treatment significantly attenuated pathological changes, including glandular hypertrophy and vacuolar dilation, in <i>Atp4a</i> ^-/- mice. It also reduced GIM severity compared with that in the untreated model group. Under taurine treatment, <i>MUC5AC</i> expression was significantly increased, whereas the intestinal-specific markers <i>CDX2</i>, <i>MUC2</i>, and <i>TFF3</i> were reduced (<i>P</i> < 0.05). In parallel, in patient-derived GIM organoids, taurine treatment significantly ameliorated GIM features, as evidenced by increased <i>MUC5AC</i> expression and decreased <i>CDX2</i>, <i>MUC2</i>, and <i>TFF3</i> expression.</p><p><strong>Conclusion: </strong>This study highlights the potential application of taurine as a therapeutic agent for treating GIM, offering a promising strategy for its clinical management.</p>","PeriodicalId":23762,"journal":{"name":"World Journal of Gastrointestinal Oncology","volume":"18 2","pages":"114161"},"PeriodicalIF":2.5,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202849","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":"Frequency and characteristics of synchronous gastric cancers: Need for improved awareness and better detection.","authors":"Amit Kumar Dutta, Nicholas Vijay Rao, Pegatraju Krishna Bharadwaj, Stephan Benny","doi":"10.4251/wjgo.v18.i2.113508","DOIUrl":"10.4251/wjgo.v18.i2.113508","url":null,"abstract":"<p><p>The pathway of gastric cancer involves progression from atrophic gastritis to intestinal metaplasia to dysplasia and then cancer. The background mucosa in patients with gastric cancer is likely to have areas of atrophy and metaplasia, and hence, coexisting gastric cancer may be present. In this paper, we have reviewed the prevalence, characteristics, and predictors of synchronous neoplasm in patients with gastric cancer. Data on synchronous gastric neoplasms (SGNs) are mainly available from two types of studies, those detected on surgically resected specimens and those detected endoscopically. The prevalence of SGN cancer generally ranges between 5%-12% although the number may vary. Most of the synchronous lesions are noted in the distal stomach and are well differentiated on histology. Increasing age, male gender, well-differentiated histology of primary cancer, early stage of the primary cancer, and presence of atrophy and intestinal metaplasia in the background gastric mucosa increase the risk of synchronous neoplasm. SGN cancers may be missed in about one-third of cases during initial endoscopy. Overall, there is an urgent need to improve awareness of SGN cancer and improve its detection by using appropriate endoscopic evaluation. This would lead to a greater chance of curative treatment and better patient outcomes.</p>","PeriodicalId":23762,"journal":{"name":"World Journal of Gastrointestinal Oncology","volume":"18 2","pages":"113508"},"PeriodicalIF":2.5,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203033","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":"Endoscopic <i>vs</i> laparoscopic resection for gastric gastrointestinal stromal tumors: Oncological outcomes.","authors":"Lan Huang, Jiang-Tao Li, Wen-Jie Zhou, Qin-Fang Wu","doi":"10.4251/wjgo.v18.i2.115199","DOIUrl":"10.4251/wjgo.v18.i2.115199","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Surgical resection is the core treatment for localized gastric gastrointestinal stromal tumors (LGISTs). Advances in minimally invasive techniques have led to the use of both endoscopic and laparoscopic resections; however, there is controversy regarding their oncological efficacy and safety, especially due to the lack of head-to-head comparative data with balanced baselines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To systematically compare the perioperative outcomes and mid-term oncological efficacy of endoscopic &lt;i&gt;vs&lt;/i&gt; laparoscopic resection for LGISTs, and provide an evidence-based reference for clinical surgical approach selection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients with LGIST who underwent surgery in our hospital between January 2023 and January 2024 were retrospectively enrolled. After 1:1 propensity score matching, 45 patients who received endoscopic resection were assigned to the endoscopic group, and 45 patients who underwent laparoscopic resection were included in the laparoscopic group. Intraoperative indicators (such as operation time, blood loss, R0 resection rate), postoperative recovery indicators (including hospital stay, time to first flatus), complication rate, and mid-term oncological outcomes [1-year/3-year recurrence-free survival (RFS), overall survival (OS)] were compared between the two groups. Multivariate Cox regression was used to identify prognostic factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;After matching, the baseline data of the two groups were comparable (&lt;i&gt;P&lt;/i&gt; &gt; 0.05). The endoscopic group was superior to the laparoscopic group in terms of operation time [80 minutes (65-100 minutes) &lt;i&gt;vs&lt;/i&gt; 95 minutes (80-120 minutes), &lt;i&gt;P&lt;/i&gt; = 0.002], intraoperative blood loss [25 mL (15-35 mL) &lt;i&gt;vs&lt;/i&gt; 55 mL (40-90 mL), &lt;i&gt;P&lt;/i&gt; &lt; 0.001], and postoperative hospital stay [5 days (4-7 days) &lt;i&gt;vs&lt;/i&gt; 7 days (6-9 days), &lt;i&gt;P&lt;/i&gt; &lt; 0.001]. There were no significant differences in the rates of R0 resection (95.6% &lt;i&gt;vs&lt;/i&gt; 97.8%, &lt;i&gt;P&lt;/i&gt; = 0.617), intraoperative tumor rupture (2.2% &lt;i&gt;vs&lt;/i&gt; 4.4%, &lt;i&gt;P&lt;/i&gt; = 1.000), and 30-day postoperative complications (11.1% &lt;i&gt;vs&lt;/i&gt; 22.2%, &lt;i&gt;P&lt;/i&gt; = 0.152) between the two groups. With a median follow-up of 32 months, the 3-year RFS (93.3% &lt;i&gt;vs&lt;/i&gt; 91.1%, &lt;i&gt;P&lt;/i&gt; = 0.695) and 3-year OS (97.8% &lt;i&gt;vs&lt;/i&gt; 95.6%, &lt;i&gt;P&lt;/i&gt; = 1.000) rates were comparable between the two groups. Multivariate analysis showed that tumor size (HR = 1.38, &lt;i&gt;P&lt;/i&gt; = 0.002), mitotic count (HR = 1.18, &lt;i&gt;P&lt;/i&gt; = 0.010), and National Institutes of Health risk stratification (intermediate risk &lt;i&gt;vs&lt;/i&gt; low risk: HR = 5.12, &lt;i&gt;P&lt;/i&gt; = 0.001) were independent risk factors for RFS, while surgical approach was not an independent prognostic factor (&lt;i&gt;P&lt;/i&gt; = 0.558).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In carefully selected LGIST cases, endoscopic resection achieves comparable mid-term oncological efficacy to that of laparoscopic resection, while offering the advantages of shorter operation tim","PeriodicalId":23762,"journal":{"name":"World Journal of Gastrointestinal Oncology","volume":"18 2","pages":"115199"},"PeriodicalIF":2.5,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203061","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":"Recent advances in spasmolytic polypeptide expressing metaplasia research.","authors":"Rui-Rui Yang, Ya-Ru Yan, Yu-Feng Li","doi":"10.4251/wjgo.v18.i2.113995","DOIUrl":"10.4251/wjgo.v18.i2.113995","url":null,"abstract":"<p><p>Gastric cancer remains a leading cause of global cancer mortality, with limited advances in its prevention and treatment owing to an incomplete understanding of its pathogenesis. Among the key precancerous lesions, spasmolytic polypeptide-expressing metaplasia has emerged as a critical driver in gastric carcinogenesis. This review summarizes the recent advances in the mechanistic roles of spasmolytic polypeptide-expressing metaplasia in gastric mucosal diseases. By elucidating these pathways, this review sought to provide novel insights that could inform future strategies for early intervention and prevention of gastric cancer.</p>","PeriodicalId":23762,"journal":{"name":"World Journal of Gastrointestinal Oncology","volume":"18 2","pages":"113995"},"PeriodicalIF":2.5,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203069","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":"Total neoadjuvant therapy in rectal cancer: Challenging traditions without compromising surgical safety.","authors":"Riya Karmakar, Aditya Kandalkar, Arvind Mukundan","doi":"10.4251/wjgo.v18.i2.115507","DOIUrl":"10.4251/wjgo.v18.i2.115507","url":null,"abstract":"<p><p>Total neoadjuvant therapy (TNT) is swiftly transforming the therapeutic approach for locally advanced rectal cancer; yet, its integration as a standard practice necessitates meticulous evaluation of surgical safety, long-term outcomes, and patient-centered considerations. The research conducted by Jabbar <i>et al</i> offers an extensive evaluation of the preliminary surgical outcomes of patients using the Rectal Cancer and Preoperative Induction therapy followed by Dedicated Operation based TNT regimen in contrast to conventional long-course chemoradiotherapy. Their data indicate that TNT does not elevate operational complexity, create issues, or negatively affect the quality of oncologic resection, even with a prolonged interval between neoadjuvant therapy and surgery. Conversely, TNT correlated with a reduction in overall stoma duration and the incidence of persistent stomas, data that hold significant implications for postoperative quality of life. This study supports the increasing evidence that TNT is a safe and effective method for enhancing systemic control without negatively impacting surgical performance. However, its retrospective single-center approach restricts external validity, and long-term oncological consequences remain undetermined. The retrospective design presents potential confounders, including selection bias and variability in surgical skill. The experience of surgeons and institutional protocols may impact outcomes, highlighting the necessity for consistent surgical quality indicators in upcoming trials. As TNT begins to solidify its status as a novel treatment standard, multicenter studies and translational research will be essential in the future to determine its effects on survival, functional recovery, and organ preservation. Concerns persist over the long-term toxicity linked to increased chemotherapy regimens, including neuropathy and hematologic consequences. The financial implications of TNT, difficulty in patient adherence, and the danger of overtreatment underscore the importance of rigorous patient selection and thorough supportive care techniques. The study by Jabbar <i>et al</i> contributes to the growing body of literature demonstrating that TNT can be safely incorporated into the modern care of rectal cancer, signifying a notable progression towards individualized and patient-centered multimodal therapy.</p>","PeriodicalId":23762,"journal":{"name":"World Journal of Gastrointestinal Oncology","volume":"18 2","pages":"115507"},"PeriodicalIF":2.5,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202820","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":"Predicting the magnitude of risk for non-curative endoscopic submucosal dissection in superficial esophageal cancer using explainable artificial intelligence.","authors":"Zi-Chen Luo, Hai-Yang Guo, Xiao Tang, Xin-Rui Chen, Cheng-Yu Zhang, Yu-Tong Cui, Ji Zuo, Hao-Rui Li, Xue-Mei Hou, Hao Chen, Shao-Bi Song, Xian-Fei Wang","doi":"10.4251/wjgo.v18.i2.114782","DOIUrl":"10.4251/wjgo.v18.i2.114782","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic submucosal dissection (ESD) serves as a critical treatment modality for superficial esophageal cancer. However, non-curative resection is significantly associated with residual tumors and unfavorable prognosis. Effective preoperative predictive tools are currently lacking.</p><p><strong>Aim: </strong>To develop and validate a machine learning-based prediction model for accurate preoperative assessment of the risk of non-curative ESD resection.</p><p><strong>Methods: </strong>This multicenter retrospective study included 366 superficial esophageal cancer patients from the Affiliated Hospital of North Sichuan Medical College as a training set, and 129 patients from Langzhong People's Hospital as an independent external validation set. Predictors were selected using least absolute shrinkage and selection operator and multivariate logistic regression. Nine machine learning classifiers, including logistic regression, LightGBM, and XGBoost, were integrated to develop the models, and SHapley Additive exPlanations (SHAP) were employed to achieve risk visualization.</p><p><strong>Results: </strong>Key predictive factors identified included esophageal stricture, computed tomography-based esophageal wall thickening > 7 mm, endoscopically estimated invasion depth > superficial layer (SM1) (endoscopic ultrasound or magnifying endoscopy with narrow-band imaging collectively referred to as EOM > SM1), multiple lesions, circumferential ratio ≥ 3/4, and preoperative pathological type. The logistic regression model constructed with these factors demonstrated optimal performance (training set area under the curve (AUC) = 0.887; internal validation AUC = 0.872; external validation AUC = 0.849). SHAP analysis further revealed computed tomography-based esophageal wall thickening > 7 mm and EOM > SM1 as core risk-driving factors.</p><p><strong>Conclusion: </strong>The logistic regression prediction model developed in this study effectively identifies patients at high risk of non-curative resection prior to ESD. By incorporating SHAP-based interpretability, the model provides a reliable and transparent tool to support clinical decision-making.</p>","PeriodicalId":23762,"journal":{"name":"World Journal of Gastrointestinal Oncology","volume":"18 2","pages":"114782"},"PeriodicalIF":2.5,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203043","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}