World Journal Of Gastrointestinal Oncology[JOURNAL]
Sun
200 papers
Clinical characteristics of programmed death-1 inhibitors for older patients with advanced pancreatic cancer.
Lu YY, Chen P, Lu Y
World J Gastrointest Oncol · 2026 Feb · PMID 41695921 · Full text
BACKGROUND: Pancreatic cancer (PC), a highly malignant gastrointestinal cancer, is generally diagnosed at an advanced stage. However, traditional therapies for advanced PC are limited and often unsuitable for older patie...
BACKGROUND: Pancreatic cancer (PC), a highly malignant gastrointestinal cancer, is generally diagnosed at an advanced stage. However, traditional therapies for advanced PC are limited and often unsuitable for older patients. AIM: To identify clinical predictors in older patients with advanced PC to facilitate individualized treatment. METHODS: This was a retrospective clinical analysis involving 99 patients aged ≥ 65 years with advanced PC who received programmed death-1 (PD-1) inhibitors at Ningbo Medical Center Lihuili Hospital from January 2019 to January 2025. Univariate and multivariate analyses were conducted to identify clinical predictors for survival outcomes, utilizing blood levels and other clinical information. RESULTS: The median progression-free survival (PFS) was 4.6 months [95% confidence interval (CI): 3.700-5.800], and the median overall survival (OS) was 6.5 months (95%CI: 5.700-8.200). Multivariate analysis helped identify meaningful clinical differences in PFS and OS across subgroups, including factors such as Eastern Cooperative Oncology Group performance status, prognostic nutritional index, and triglyceride levels. Univariate analysis showed that factors such as the location of primary PC, carbohydrate antigen 199 levels, systemic immune-inflammation, neutrophil-to-lymphocyte ratio, and the combination therapy comprising PD-1 inhibitors and radiotherapy are of significant clinical relevance to both PFS and OS. CONCLUSION: The treatment of advanced PC with PD-1 inhibitors presented several potential independent clinical predictive indicators of survival outcomes in older patients. This study highlighted the importance of pre-treatment clinical characteristics and hematological variables for predicting treatment outcomes in older patients with PC.
Risk prediction for chronic atrophic gastritis using a random forest model: A multicenter study.
Cao H, Han JL, Wu H … +12 more , Si SP, Ding LJ, Ji L, Zhang HZ, Yin J, Zhou ZY, Zhang YN, Lv ZF, Tian WY, Zhan Q, Wang H, An FM
World J Gastrointest Oncol · 2026 Feb · PMID 41695920 · Full text
BACKGROUND: Chronic atrophic gastritis (CAG) is a significant precancerous condition of gastric cancer (GC). CAG often lacks typical symptoms in its early stages, and clinical diagnosis relies on gastroscopy and patholog...
BACKGROUND: Chronic atrophic gastritis (CAG) is a significant precancerous condition of gastric cancer (GC). CAG often lacks typical symptoms in its early stages, and clinical diagnosis relies on gastroscopy and pathological examination, which are invasive and have limitations such as poor patient compliance. Therefore, developing a noninvasive, simple, and generalizable prediction tool is crucial for the early identification of CAG. AIM: To construct and validate a CAG risk prediction model to achieve noninvasive and accurate identification of high-risk patients. METHODS: This study included 1268 subjects from a GC screening program. Multimodal data, including serological marker, demographic, lifestyle, and family history data, were collected. Subjects were grouped by pathological biopsy results. Least absolute shrinkage and selection operator regression was used for feature selection. A model was constructed using the random forest algorithm, evaluated with metrics such as the area under the curve (AUC), and interpreted using the SHapley Additive exPlanation (SHAP) method. The model was validated in an independent external cohort, and a web-based prediction platform was developed using Shiny. RESULTS: Six key features were ultimately included: Age, () infection status, pepsinogen I/II ratio (PGR), smoking history, alcohol consumption history, and family history of GC. The model achieved AUCs of 0.8542 and 0.8073 in the training and testing sets, respectively, and an AUC of 0.8505 in the external validation cohort, demonstrating good generalizability and stability. SHAP analysis indicated that infection, age, and PGR were the most important variables influencing CAG risk. The final model was successfully embedded into a web-based platform for convenient clinical application. CONCLUSION: The random forest-based CAG prediction model is a highly accurate and interpretable tool with significant clinical utility in early screening and identifying high-risk patients.
Deep learning in lower gastrointestinal cancer detection: Advances in endoscopic, radiologic, and histopathologic diagnostics.
Sehgal T, Joshi T, Chowdhary R … +6 more , Goyal O, Kalra S, Goyal R, Taranikanti V, Vuthaluru AR, Goyal MK
World J Gastrointest Oncol · 2026 Feb · PMID 41695919 · Full text
Gastrointestinal (GI) cancers, particularly colorectal cancer, continue to be a major contributor to global cancer-related morbidity and mortality. Despite significant advancements in screening protocols and treatment st...
Gastrointestinal (GI) cancers, particularly colorectal cancer, continue to be a major contributor to global cancer-related morbidity and mortality. Despite significant advancements in screening protocols and treatment strategies, early detection remains a clinical challenge due to the limitations of conventional diagnostic tools, which often suffer from inter-observer variability, limited sensitivity, and time-intensive procedures. In recent years the integration of artificial intelligence (AI), especially deep learning (DL) techniques, into medical diagnostics has opened new frontiers for enhancing detection accuracy, speed, and consistency across clinical domains. This review explores the transformative impact of DL-based AI models in detecting lower GI cancers, focusing on three key diagnostic modalities: Endoscopy; radiology; and histopathology. In endoscopic practice convolutional neural networks are used to detect and classify colorectal polyps in real-time, significantly reducing miss rates and aiding non-specialist endoscopists in decision-making. In radiology DL algorithms trained on computed tomography and magnetic resonance imaging data are valuable for automated lesion detection, segmentation, and staging, often outperforming conventional imaging. Histopathological analysis, traditionally reliant on manual examination, is now accelerated by DL models capable of processing whole-slide images to identify architectural distortions and cellular anomalies with high reproducibility and diagnostic accuracy. This review evaluates DL model performance, including sensitivity, specificity, and area under the curve and addresses technical and ethical challenges, including dataset diversity, interpretability, and integration into healthcare workflows. Ultimately, the convergence of AI and clinical medicine has the potential to improve diagnostic outcomes and personalized care for patients with lower GI cancers.
Microbiota-metabolite signatures in metastatic colorectal cancer: Promise, pitfalls, and the path forward.
Zhang TT, Yao J, Zhang HM
World J Gastrointest Oncol · 2026 Feb · PMID 41695918 · Full text
This letter evaluates Deng study examining the gut microbiota and metabolite changes in metastatic colorectal cancer (CRC). The research used 16S rRNA sequencing and liquid chromatography-mass spectrometry metabolomics...
This letter evaluates Deng study examining the gut microbiota and metabolite changes in metastatic colorectal cancer (CRC). The research used 16S rRNA sequencing and liquid chromatography-mass spectrometry metabolomics to investigate microbial and metabolic shifts in patients with metastatic non-metastatic CRC. The study reveals that CRC patients with metastasis exhibit significant differences in their gut microbiota and metabolites compared to non-metastatic patients. However, the study's reliance on 16S rRNA sequencing presents inherent limitations, particularly with respect to species-level resolution. The sequencing depth may not have been sufficient to capture all relevant low-abundance taxa, as indicated by the rarefaction curves which did not fully plateau, potentially affecting the identification of differential species. It also identifies 91 differential metabolites, particularly those involved in nucleic acid, alkaloid, and lipid metabolism, which may contribute to metastasis progression. The findings suggest that microbiota and their metabolites play a critical role in CRC metastasis, offering potential targets for diagnosis and treatment. However, several limitations exist, including small sample size, single-center data, and a cross-sectional design that prevents causal conclusions. Additionally, the study lacks integration of key clinical factors such as dietary patterns and medication use, which could confound the results. Future research should expand these findings through multi-center studies with longer follow-up periods, incorporating more comprehensive clinical data and advanced analytical techniques to validate and refine the role of microbiota and metabolites in CRC metastasis. Despite its limitations, this study provides valuable insights into the microbiota-metabolite axis in CRC metastasis and opens potential avenues for future research. However, it is crucial to note that the metabolite identification was based on database matching rather than chemical standard validation. As such, these results should be considered putative annotations, with their accuracy requiring further confirmation through targeted analyses.
Predicting the magnitude of risk for non-curative endoscopic submucosal dissection in superficial esophageal cancer using explainable artificial intelligence.
Luo ZC, Guo HY, Tang X … +9 more , Chen XR, Zhang CY, Cui YT, Zuo J, Li HR, Hou XM, Chen H, Song SB, Wang XF
World J Gastrointest Oncol · 2026 Feb · PMID 41695917 · Full text
BACKGROUND: 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 unfavorab...
BACKGROUND: 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. AIM: To develop and validate a machine learning-based prediction model for accurate preoperative assessment of the risk of non-curative ESD resection. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Efficacy and safety of integrated Chinese and Western medicine in advanced pancreatic cancer: A double-center retrospective cohort study.
Wang YR, Wang JQ, Chen XJ … +7 more , Yan Y, Zhang Y, Li MY, Wang W, Fan TY, Jiao PF, Zhou CF
World J Gastrointest Oncol · 2026 Feb · PMID 41695916 · Full text
BACKGROUND: Advanced pancreatic cancer (PC) is associated with a poor prognosis. The integration of Chinese and Western medicine (ICWM) has shown promising clinical efficacy. Nonetheless, the existing body of research as...
BACKGROUND: Advanced pancreatic cancer (PC) is associated with a poor prognosis. The integration of Chinese and Western medicine (ICWM) has shown promising clinical efficacy. Nonetheless, the existing body of research assessing the efficacy and safety of this integrative approach is limited, hindering the provision of robust evidence-based support for clinical decision-making. AIM: To assess the short-term and long-term efficacy and safety of ICWM compared with Western medicine (WM) as a standalone treatment for advanced PC. METHODS: We enrolled 136 patients with advanced PC admitted to Henan Provincial Hospital of Traditional Chinese Medicine and Henan Provincial People's Hospital from 2019 to 2024. Patients were randomly assigned to the ICWM or WM group ( = 66 or = 70, respectively) according to treatment modality. The long-term efficacy was evaluated using survival analyses. Short-term efficacy was assessed by analyzing the tumor response, serum tumor markers, and immune function before and after treatment. Treatment safety was assessed by monitoring bone marrow suppression and hepatic and renal function impairment. RESULTS: The median overall survival was 12.91 months and 10.64 months in the ICWM and WM groups, while the median progression-free survival was 5.12 months and 3.55 months, respectively. The disease control rate was significantly higher in the ICWM group than that in the the WM group, while the myelosuppression was significantly milder. The serum tumor markers carbohydrate antigen (CA) 19-9 and CA125 showed a significant downward trend before and after treatment in the ICWM group, whereas only CA19-9 showed a significant decrease in the WM group. Post-treatment, both groups showed an upward trend in natural killer cells and CD3+, CD4+, and CD4+/CD8+ lymphocytes compared with pre-treatment, with the ICWM group exhibiting a more pronounced increase. The two groups showed no significant differences in hepatic and renal function impairment. CONCLUSION: ICWM extended survival in patients with advanced PC, improved long-term efficacy, controlled local lesions, reduced serum tumor markers, enhanced immune function, and improved short-term outcomes, with a favorable safety profile.
Detection rate and risk factors of colorectal adenoma in high-altitude population: A cross-sectional study.
Zhao XL, Chen WY, Liu YM … +6 more , Danzeng SL, Pingcuo QZ, Yu Z, Chen HD, Ciren YJ, Wu D
World J Gastrointest Oncol · 2026 Feb · PMID 41695915 · Full text
BACKGROUND: The epidemiology of colorectal cancer (CRC) varies significantly, with an increasing incidence in China. The Xizang Autonomous Region has the lowest CRC mortality nationally, offering a unique natural experim...
BACKGROUND: The epidemiology of colorectal cancer (CRC) varies significantly, with an increasing incidence in China. The Xizang Autonomous Region has the lowest CRC mortality nationally, offering a unique natural experiment to investigate carcinogenesis. As most CRCs develop the adenoma-carcinoma sequence, characterizing the prevalence of its precursor lesion, colorectal adenoma (CRA), is essential for understanding this disparity. AIM: To characterize the detection rates and risk factors for colorectal lesions in the high-altitude population of Xizang Autonomous Region. METHODS: In this cross-sectional study, 1154 Tibetans undergoing high-definition colonoscopy were enrolled. Univariate and multivariate logistic regression were conducted to analyze the risk factors for CRA. Data were collected questionnaire, and the China Sporadic Colorectal Cancer Risk Score and Asia-Pacific Colorectal Screening (APCS) score were calculated. A control group from low altitude was established using a 1:2 case-control matching protocol based on age, sex, body mass index (BMI), and first-degree family history of CRC, and detection rates were compared. RESULTS: The detection rates in the Xizang Autonomous Region cohort were 7.7% for CRA ( = 89) and 1.6% for CRC ( = 18). Univariate analysis showed that CRA was associated with advanced age, male sex, higher BMI, and higher risk tiers on both the China and APCS scores. However, multivariate logistic regression confirmed only advanced age (OR = 1.035, 95%CI: 1.019-1.052, < 0.001) and male sex (OR = 2.161, 95%CI: 1.337-3.492, = 0.002) as independent risk factors. In the comparative analysis, the Xizang CRA detection rate was significantly lower than that in the matched Beijing cohort (7.7% 22.8%, < 0.001). No significant difference was found in CRC detection rates (1.6% 1.3%, = 0.626). CONCLUSION: The prevalence of CRA in the high-altitude population was significantly lower. Advanced age and male sex remain independent risk factors for CRA in Xizang Autonomous Region.
Rectal follicular thyroid-like carcinoma: A case report and review of literature.
Li JL, Cheng C, Zhang P … +5 more , Fan J, Zhang L, Zhu LR, Tao KX, Cai M
World J Gastrointest Oncol · 2026 Feb · PMID 41695914 · Full text
BACKGROUND: Follicular thyroid carcinoma (FTC) is the second most common subtype of thyroid malignancy, with distant metastases most often to the bones, lungs, brain, and liver, and only rarely to other sites. Rectal fol...
BACKGROUND: Follicular thyroid carcinoma (FTC) is the second most common subtype of thyroid malignancy, with distant metastases most often to the bones, lungs, brain, and liver, and only rarely to other sites. Rectal follicular thyroid-like carcinoma is a rare condition characterized by infiltration of FTC within the rectal wall. There are almost no literature reports. CASE SUMMARY: We report a case of rectal thyroid-like follicular carcinoma in a 61-year-old woman. The patient presented with intermittent rectal bleeding, and a colonoscopy revealed a mass in the mid-rectum. She underwent laparoscopic resection of the lesion, and was diagnosed with rectal thyroid-like follicular carcinoma by postoperative pathology. After a laparoscopic partial rectal resection, she was discharged on postoperative day 7. At 6 months postoperatively, the patient was still alive. CONCLUSION: Rectal follicular thyroid-like carcinoma may arise from malignant struma ovarii, highlighting the need to consider ovarian origins in atypical metastases of FTC.
Clinical efficacy of Fuzheng Jiedu Xiaoyong granules in advanced colorectal cancer (spleen deficiency and stasis toxin syndrome).
Qin HY, Li Z, Cong PW … +4 more , Mi D, Li FZ, Hu X, Li GX
World J Gastrointest Oncol · 2026 Feb · PMID 41695913 · Full text
BACKGROUND: The management of advanced colorectal cancer (CRC) is challenging due to limited treatment efficacy and the significant toxicities and resistance associated with chemotherapy. Traditional Chinese medicine off...
BACKGROUND: The management of advanced colorectal cancer (CRC) is challenging due to limited treatment efficacy and the significant toxicities and resistance associated with chemotherapy. Traditional Chinese medicine offers potential therapeutic benefits through mechanisms such as inhibiting tumor proliferation, modulating immunity, and preventing angiogenesis. Fuzheng Jiedu Xiaoyong granules (FZJDXYG) has shown promising clinical results, including enhanced immune function and reduced chemotherapy-related toxicities. AIM: To validate the efficacy and safety of FZJDXYG and determine its effects on immune function in patients with advanced CRC. METHODS: In this multi-center, double-blind, randomized, placebo-controlled trial, 78 eligible patients were randomly assigned at a ratio of 1:1 to the treatment group (receiving FZJDXYG plus standard care) or the control group (receiving placebo plus standard care) for 12 weeks. RESULTS: The treatment group experienced significant reductions in carcinoembryonic antigen and carbohydrate antigen 19-9 levels (both < 0.05), with significantly greater reductions in these two markers compared to the control group (both < 0.05). Immunologically, the treatment group exhibited significant increases in CD3+ and CD4+ cell counts and CD4+/CD8+ ratio, and decreased CD8+ levels, with all changes superior to those in the control group (all < 0.05). The Karnofsky Performance Status score was also significantly higher in the treatment group ( < 0.05). Crucially, the incidence of adverse events was significantly lower in the treatment group than in the control group ( < 0.05). CONCLUSION: FZJDXYG effectively ameliorates clinical symptoms, enhances immune function, and reduces chemotherapy-induced toxicities in patients with advanced CRC with spleen deficiency and stasis toxin syndrome.
Relationship between preoperative modified frailty index, immune-inflammation index, and outcomes of colorectal cancer surgery in older patients.
Qi XS, Xie J, Liu NL … +1 more , Yang L
World J Gastrointest Oncol · 2026 Feb · PMID 41695912 · Full text
BACKGROUND: 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 postope...
BACKGROUND: 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. AIM: To assess modified frailty index (mFI) and systemic immune-inflammation index (SII) for predicting postoperative prognosis in older patients with CRC. METHODS: 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. RESULTS: 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 ( < 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, < 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, < 0.001). CONCLUSION: 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.
Efficacy and safety of nivolumab plus chemotherapy in patients with advanced gastric cancer with massive ascites.
Matsumoto T, Sugimoto S, Omori R … +7 more , Makiyama C, Nakasya A, Nagai H, Yasui H, Higashi R, Sasamoto A, Satake H
World J Gastrointest Oncol · 2026 Jan · PMID 41607769 · Full text
BACKGROUND: Chemotherapy with an immune checkpoint inhibitor is one of the standard regimens for treating advanced gastric cancer (AGC). Ascites and peritoneal dissemination are common complications and poor prognostic f...
BACKGROUND: Chemotherapy with an immune checkpoint inhibitor is one of the standard regimens for treating advanced gastric cancer (AGC). Ascites and peritoneal dissemination are common complications and poor prognostic factors of AGC; however, reports regarding its efficacy and safety in patients with AGC and massive ascites are limited. AIM: To evaluate the safety and efficacy of nivolumab combined with chemotherapy in patients with AGC and ascites. METHODS: We retrospectively collected clinical data from 124 patients with AGC who received chemotherapy plus nivolumab as first-line treatment from July 2017 to December 2024. Based on computed tomography scans, massive or moderate ascites were classified as high ascites burden (HAB), whereas mild or no ascites were classified as low ascites burden. RESULTS: Ascites was detected in 47 patients (38%); 26 (21%) were classified into the HAB group. Patients in the HAB group exhibited a significantly poorer performance status, a higher prevalence of diffuse-type histology, and lower programmed cell death ligand 1 (PD-L1) expression. Combination therapy with FOLFOX and neutropenia was significantly more common in the HAB group. Progression-free survival (PFS) (4.4 months 9.3 months, = 0.0012) and overall survival (OS) (7.3 months 21.2 months, < 0.0001) were significantly poorer in the HAB group. However, an improvement in ascites was observed in 61.5% of patients in the HAB group. PD-L1 expression did not correlate with either PFS or OS in the HAB group. CONCLUSION: Nivolumab plus chemotherapy demonstrated modest efficacy and acceptable toxicity in patients with AGC and HAB.
Correction to "Prognostic value of preoperative fibrinogen, neutrophil-to-lymphocyte ratio, serum alpha-fetoprotein, and prealbumin for patients with primary liver cancer undergoing transarterial chemoembolization".
Liu QQ, Li YD, Chen JX … +4 more , Zhang LL, Guan RC, Zhao W, Meng LY
World J Gastrointest Oncol · 2026 Jan · PMID 41607768 · Full text
[This corrects the article on p. 103198 in vol. 17, PMID: 40547171.].
[This corrects the article on p. 103198 in vol. 17, PMID: 40547171.].
Impact of visceral obesity on postoperative complications and oncological outcomes in elderly patients with colorectal cancer.
Zhou J, Wang BP, Su RN … +2 more , Zhang S, Gao YW
World J Gastrointest Oncol · 2026 Jan · PMID 41607767 · Full text
BACKGROUND: Elderly patients with colorectal cancer (CRC) can judge the risk of postoperative complications and oncological outcomes due to visceral obesity, which can provide data reference for the early prediction of p...
BACKGROUND: Elderly patients with colorectal cancer (CRC) can judge the risk of postoperative complications and oncological outcomes due to visceral obesity, which can provide data reference for the early prediction of prognosis. AIM: To explore the effect of visceral obesity on postoperative complications and oncological outcomes in elderly patients with CRC. METHODS: A total of 150 elderly patients who underwent radical surgery for CRC at Inner Mongolia Medical University and Inner Mongolia Autonomous Region People's Hospital from January 2021 to June 2024 were retrospectively analyzed. Patients were divided into the abdominal [visceral fat area (VFA) ≥ 100.00 cm, = 80] and non-abdominal (VFA < 100.00 cm, = 70) obesity groups according to the VFA measured by preoperative computed tomography. The two groups showed no significant differences in age, sex, tumor location, tumor-node-metastasis stage, and underlying disease ( > 0.05). All patients underwent standardized laparoscopic assisted surgery and received unified perioperative management. Complications, nutritional status, changes in biochemical indicators, and tumor recurrence and metastasis were evaluated postoperatively. RESULTS: The overall incidence of postoperative complications was significantly higher in the abdominal obesity group than in the non-abdominal obesity group ( < 0.05). The pulmonary infection on postoperative day (POD) 3 ( = 0.038), anastomotic leakage on POD 7 ( = 0.042), and moderate-to-severe complications (Clavien-Dindo class III, = 0.03) were significantly different. With respect to biochemical indicators, the white blood cell count, neutrophil percentage, and C-reactive protein level in the abdominal obesity group continuously increased after surgery ( < 0.05); the albumin level on POD 1 was even lower ( = 0.024). Regarding tumor markers, carcinoembryonic antigen ( = 0.039) and carbohydrate antigen 19-9 ( = 0.048) levels were significantly higher in the abdominal obesity group at 3 months after surgery, and local recurrence rates were higher than those in the non-abdominal obesity group at 30 days and 3 months after surgery ( < 0.05). Abdominal obesity was an independent risk factor for postoperative complications (odds ratio: 3.843, = 0.001), overall survival [hazard ratio (HR): 1.937, = 0.011], and disease-free survival (HR: 1.769, = 0.018). CONCLUSION: Visceral obesity significantly increases the risk of postoperative complications in elderly patients with CRC and may adversely affect short-term tumor prognosis. Preoperative risk identification and interventions for abdominal obesity should be strengthened to improve perioperative safety and postoperative rehabilitation quality.
Multimodal clinical parameters-based immune status associated with the prognosis in patients with hepatocellular carcinoma.
Zhang YZ, Tang YZ, He YX … +4 more , Pan ST, Dai HC, Liu Y, Zhou HF
World J Gastrointest Oncol · 2026 Jan · PMID 41607766 · Full text
Hepatocellular carcinoma presents with three distinct immune phenotypes, including immune-desert, immune-excluded, and immune-inflamed, indicating various treatment responses and prognostic outcomes. The clinical applica...
Hepatocellular carcinoma presents with three distinct immune phenotypes, including immune-desert, immune-excluded, and immune-inflamed, indicating various treatment responses and prognostic outcomes. The clinical application of multi-omics parameters is still restricted by the expensive and less accessible assays, although they accurately reflect immune status. A comprehensive evaluation framework based on "easy-to-obtain" multi-model clinical parameters is urgently required, incorporating clinical features to establish baseline patient profiles and disease staging; routine blood tests assessing systemic metabolic and functional status; immune cell subsets quantifying subcluster dynamics; imaging features delineating tumor morphology, spatial configuration, and perilesional anatomical relationships; immunohistochemical markers positioning qualitative and quantitative detection of tumor antigens from the cellular and molecular level. This integrated phenomic approach aims to improve prognostic stratification and clinical decision-making in hepatocellular carcinoma management conveniently and practically.
Tumor microenvironment-driven microRNA dysregulation: Key interactions in colorectal cancer progression.
Quiroz-Reyes AG, Delgado-Gonzalez P, Islas JF … +6 more , Loaiza-Gutierrez VL, Santoyo-Suarez MG, Garcia-Loredo JA, Gonzalez-Villarreal CA, Ramirez-Fernandez F, Garza-Treviño EN
World J Gastrointest Oncol · 2026 Jan · PMID 41607765 · Full text
Colorectal cancer remains one of the leading causes of morbidity and mortality worldwide. Despite notable advances in early detection and therapeutic strategies, the molecular mechanisms underlying tumor survival, chemot...
Colorectal cancer remains one of the leading causes of morbidity and mortality worldwide. Despite notable advances in early detection and therapeutic strategies, the molecular mechanisms underlying tumor survival, chemotherapy resistance, and metastasis are not yet fully understood. MicroRNAs (miRNAs) have emerged as pivotal regulators of cancer development, as they modulate gene expression and orchestrate key signaling pathways. However, the epigenetic mechanisms that control miRNA expression and their downstream gene targets remain largely unclear. In this review, we highlight the critical role of the colorectal cancer microenvironment in influencing miRNA expression and discuss how this regulation contributes to tumorigenesis. A better understanding of these processes may lead to the identification of novel therapeutic targets and strategies to prevent recurrence.
Efficacy and safety of immune checkpoint inhibitors plus chemotherapy in esophageal cancer patients with liver metastases.
Dai EH, Que SH, Xu H … +7 more , Zhong GQ, Zhang Z, Liang X, Zhai SW, Li YT, Wang JJ, Feng W
World J Gastrointest Oncol · 2026 Jan · PMID 41607764 · Full text
BACKGROUND: The liver represents a common site of distant metastasis in patients with esophageal cancer (EC). Conventional chemotherapy (CMT) presents limited efficacy for EC, and EC patients with liver metastases typica...
BACKGROUND: The liver represents a common site of distant metastasis in patients with esophageal cancer (EC). Conventional chemotherapy (CMT) presents limited efficacy for EC, and EC patients with liver metastases typically experience a poor prognosis, highlighting an urgent need to explore novel treatment approaches. This study evaluated the overall efficacy and safety of CMT CMT combined with immune checkpoint inhibitors (ICIs) in the treatment of EC patients with liver metastases. Furthermore, prognostic factors influencing outcomes in this patient population were identified. AIM: To evaluate the efficacy and safety of first-line chemoimmunotherapy for EC patients with liver metastases and to analyze prognostic factors. METHODS: This retrospective study included 126 EC patients with liver metastases at Zhejiang Cancer Hospital between 2014 and 2024. Patients receiving CMT were compared with those receiving CMT + ICI. Analyzed variables included clinicopathological features, treatment history, characteristics of metastasis, systemic and local treatments, overall survival (OS), and treatment-related adverse events (TRAEs). Prognostic factors were evaluated using univariate and multivariate Cox proportional-hazards regression models. Finally, efficacy outcomes and TRAE profiles were compared between the two groups. RESULTS: A significant difference in median OS was identified between the two groups (10.8 months in the CMT group 20.8 months in the CMT + ICI group, = 0.004). The CMT + ICI group also demonstrated a significantly longer median progression-free survival of 11.7 months ( < 0.001). Patients receiving combination therapy exhibited significantly improved systemic objective response rate and disease control rate. Multivariate analysis identified key factors significantly influencing OS in EC patients with liver metastases: Karnofsky Performance Status score ≥ 70, receipt of local therapy for liver metastases, and the number of cycles of CMT and immunotherapy received. Furthermore, the incidence of TRAEs did not significantly differ between the CMT + ICI and CMT groups. CONCLUSION: For EC patients with liver metastases, the combination of CMT and ICIs demonstrates significantly superior efficacy compared with CMT alone, while maintaining manageable TRAEs.
Efficacy of regorafenib in the treatment of advanced hepatocellular carcinoma: A systematic review and meta-analysis.
Cheng Z, Yue AM
World J Gastrointest Oncol · 2026 Jan · PMID 41607763 · Full text
BACKGROUND: Regorafenib is approved as a second-line treatment for advanced hepatocellular carcinoma (HCC), but its comparative efficacy remains under evaluation. AIM: To evaluate the efficacy and safety of regorafenib...
BACKGROUND: Regorafenib is approved as a second-line treatment for advanced hepatocellular carcinoma (HCC), but its comparative efficacy remains under evaluation. AIM: To evaluate the efficacy and safety of regorafenib other second-line therapies in advanced HCC. METHODS: This systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed, EMBASE, Web of Science, and the Cochrane Library was performed on June 6, 2025. Studies were included if they reported at least one relevant clinical outcome: Overall survival, progression-free survival, objective response rate, or disease control rate. Data was extracted independently by two reviewers. Quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies. Pooled effect estimates were calculated using random- or fixed-effects models depending on the degree of heterogeneity. Sensitivity analyses and Egger's test were performed to evaluate the robustness of the results and potential publication bias. RESULTS: Nine studies met inclusion criteria. Regorafenib significantly improved overall survival compared to controls [weighted mean difference = 2.54 months; 95% confidence interval (CI): 0.26-4.81; < 0.05], but no significant benefit was observed for progression-free survival (weighted mean difference = 1.04; 95%CI: -1.27 to 3.36). The pooled objective response rate showed no overall difference, though regorafenib was inferior to nivolumab in subgroup analysis (odds ratio = 0.34; 95%CI: 0.20-0.58). Disease control rate did not differ significantly. No publication bias was detected. CONCLUSION: Regorafenib offers a survival advantage in advanced HCC but does not significantly improve tumor response rates compared to alternative therapies.
Right patient approach to experimental stromal cell therapies for gastrointestinal tumors.
Vescio F, Curcio S, Aquila I … +2 more , Ammendola M, Tarallo AP
World J Gastrointest Oncol · 2026 Jan · PMID 41607762 · Full text
Experimental therapies targeting immune and stromal cells, such as mast cells, cancer-associated fibroblasts, dendritic cells, and tumor endothelial cells, in the treatment of gastrointestinal solid tumors pose new and c...
Experimental therapies targeting immune and stromal cells, such as mast cells, cancer-associated fibroblasts, dendritic cells, and tumor endothelial cells, in the treatment of gastrointestinal solid tumors pose new and complex surgical and medico-legal challenges. These innovative treatments require that informed consent not be limited to simple acceptance of the medical procedure, but instead reflect a true relational and cognitive process grounded in understanding, free choice, and the ability to revoke consent at any time. In particular, it is essential that the patient understands the experimental nature of the therapy, its development stage, potential benefits and risks, as well as the implications for their health and personal dignity. In the case of stromal cell-based treatments, which may exert complex immunomodulatory effects or activate angiogenic pathways that are not yet fully understood, patients must be made fully aware that they are participating in a non-standardized therapy whose outcomes, whether beneficial or harmful, cannot yet be predicted with certainty. This requires particularly careful medical communication, using simple yet scientifically accurate explanations delivered in appropriate language, along with a final verification of the patient's actual understanding.
Adult liver rhabdomyosarcoma complicated with sarcomatoid carcinoma: A case report.
Ma JQ, Wang C, Li SN … +4 more , Zheng Q, Bai J, Ding CX, Zhang YB
World J Gastrointest Oncol · 2026 Jan · PMID 41607761 · Full text
BACKGROUND: Rhabdomyosarcoma (RMS) is a type of malignant tumor originating from rhabdomyocytes or mesenchymal cells differentiating into rhabdomyocytes. Hepatic pleomorphic RMS is a rare malignant liver tumor. Hepatic s...
BACKGROUND: Rhabdomyosarcoma (RMS) is a type of malignant tumor originating from rhabdomyocytes or mesenchymal cells differentiating into rhabdomyocytes. Hepatic pleomorphic RMS is a rare malignant liver tumor. Hepatic sarcomatoid carcinoma is also a rare epithelial malignant tumor originating from the liver; it is characterized by the coexistence of both carcinomatous and sarcomatoid spindle cell components. CASE SUMMARY: This paper reports a special case of an elderly woman whose initial liver puncture biopsy showed pleomorphic RMS. After chemotherapy with the vincristine + doxorubicin + cyclophosphamide regimen, the alpha-fetoprotein level increased significantly. Therefore, a second liver puncture was performed, the pathological result of which was hepatic sarcomatoid carcinoma. Next-generation sequencing revealed gene amplification with an average copy number of 9 in the tumor tissue; however, both fluorescence hybridization and immunohistochemical tests were negative for MET amplification. The treatment regimen was adjusted to chemotherapy combined with immunotherapy; however, the disease progressed rapidly, and the overall survival was only 6 months. CONCLUSION: By sharing the diagnosis and treatment process of this patient and reviewing the relevant literature, we aim to help clinicians enhance their understanding of two rare diseases, namely pleomorphic RMS and sarcomatoid carcinoma of the liver.
Molecular mosaic of colorectal cancer: Why one classification system is no longer enough?
Ahlawat S, Das S
World J Gastrointest Oncol · 2026 Jan · PMID 41607760 · Full text
Colorectal cancer (CRC) is one of the most molecularly heterogeneous malignancies, with complexity that extends far beyond traditional histopathological classifications. The consensus molecular subtypes (CMS) established...
Colorectal cancer (CRC) is one of the most molecularly heterogeneous malignancies, with complexity that extends far beyond traditional histopathological classifications. The consensus molecular subtypes (CMS) established in 2015 brought a marked advancement in the taxonomy of CRC, consolidating six classification systems into four novel subtypes, which focus on vital gene expression patterns and clinical and prognostic outcomes. However, nearly a decade of clinical experience with CMS classification has revealed fundamental limitations that underscore the inadequacy of any single classification system for capturing the full spectrum of CRC biology. The inherent challenges of the current paradigm are multifaceted. In the CMS classification, mixed phenotypes that remain unclassifiable constitute 13% of CRC cases. This reflects the remarkable heterogeneity that CRC shows. The tumor budding regions reflect the molecular shift due to CMS 2 to CMS 4 switching, causing further heterogeneity. Moreover, the reliance on bulk RNA sequencing fails to capture the spatial organization of molecular signatures within tumors and the critical contributions of the tumor microenvironment. Recent technological advances in spatial transcriptomics, single-cell RNA sequencing, and multi-omic integration have revealed the limitations of transcriptome-only classifications. The emergence of CRC intrinsic subtypes that attempt to remove microenvironmental contributions, pathway-derived subtypes, and stem cell-based classifications demonstrates the field's recognition that multiple complementary classification systems are necessary. These newer molecular subtypes are not discrete categories but biological continua, thus highlighting that the vast molecular landscape is a tapestry of interlinked features, not rigid subtypes. Multiple technical hurdles cause difficulty in implementing the clinical translation of these newer molecular subtypes, including gene signature complexity, platform-dependent variations, and the difficulty of getting and preserving fresh frozen tissue. CMS 4 shows a poor prognostic outcome among the CMS subtypes, while CMS 1 is associated with poor survival in metastatic cases. However, the predictive value for definitive therapy remains subdued. Looking forward, the integration of artificial intelligence, liquid biopsy approaches, and real-time molecular monitoring promises to enable dynamic, multi-dimensional tumor characterization. The temporal and spatial complexity can only be captured by complementary molecular taxonomies rather than a single, unified system of CRC classification. Such an approach recognizes that different clinical questions - prognosis, treatment selection, resistance prediction - may require different molecular lenses, each optimized for specific clinical applications. This editorial advocates for a revolutionary change from pursuing a single "best" classification system toward a diverse approach that welcomes the molecular mosaic of CRC. Only through such comprehensive molecular characterization can we hope to achieve the promise of precision oncology for the diverse spectrum of patients with CRC.
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