World Journal Of Gastrointestinal Oncology[JOURNAL]
Sun
200 papers
Tumor-resident microorganisms as clinical biomarkers in primary liver cancer: A systematic review of current evidence.
Song S, Xu LS, Wang LQ … +3 more , Zhou X, Jiang X, Li CP
World J Gastrointest Oncol · 2025 Dec · PMID 41480207 · Full text
BACKGROUND: Hepatic malignancies represent the sixth most prevalent cancer globally, with emerging evidence revealing that intratumoral microbes actively modulate carcinogenesis through immunomodulation and metabolic rep...
BACKGROUND: Hepatic malignancies represent the sixth most prevalent cancer globally, with emerging evidence revealing that intratumoral microbes actively modulate carcinogenesis through immunomodulation and metabolic reprogramming. Recent high-throughput sequencing technologies have identified taxonomically diverse microbial communities within tumor tissues, challenging traditional sterility paradigms. Germ-free mouse models have established causal relationships between gut microbiota and hepatocarcinogenesis. However, comprehensive evaluation of intratumoral microbiota as clinical biomarkers remains limited, necessitating systematic analysis of their diagnostic, prognostic, and therapeutic applications in hepatic malignancies. AIM: To systematically analyze intratumoral microbes as biomarkers for hepatic malignancies diagnosis, prognosis, and treatment response. METHODS: We conducted a systematic literature search in PubMed from inception to July 2025 using keywords combining hepatic malignancies, intratumoral microbiota, and biomarkers. Inclusion criteria encompassed human studies examining intratumoral microbial communities with biomarker applications. Exclusion criteria included animal-only studies, reviews, and research focusing solely on gut microbiota. Data extraction focused on diagnostic accuracy, prognostic significance, therapeutic predictions, and underlying mechanisms. Study quality was assessed using Newcastle-Ottawa Scale, with scores ≥ 7 indicating high quality. RESULTS: Twenty studies (sample sizes: 18-925 patients) examining hepatocellular carcinoma (80%) and intrahepatic cholangiocarcinoma (20%) were included. All studies achieved Newcastle-Ottawa Scale scores ≥ 6, with 60% scoring the maximum 9 points, indicating moderate-to-high quality. Studies predominantly employed 16S rRNA sequencing (100%) targeting V3-V4 regions, with complementary validation techniques including fluorescence hybridization, quantitative PCR, and immunohistochemistry. Specific bacterial taxa demonstrated exceptional diagnostic accuracy [area under the curve (AUC) > 0.9] for tumor discrimination. Notably, Bacilli showed AUC = 0.943 in validation cohorts. Microbial diversity and specific genera (, , ) showed consistent prognostic associations with survival outcomes, though relationships varied across cancer subtypes. Advanced risk stratification models incorporating multiple bacterial biomarkers showed independent predictive capacity through multivariable Cox regression. Mechanistic investigations revealed microbe-mediated oncogenic pathway activation, particularly NF-κB signaling, immune modulation through M2 macrophage polarization, and drug resistance mechanisms autophagy regulation. Germ-free mouse models established causal relationships, demonstrating that specific bacterial communities, particularly , can autonomously initiate hepatocarcinogenesis through TLR4-dependent pathways. CONCLUSION: Intratumoral microbes represent promising clinical biomarkers for hepatic malignancies across diagnostic, prognostic, and therapeutic applications. While standardization and multicenter validation remain essential prerequisites, mechanistic evidence from human and experimental studies positions microbiome-based biomarkers at the threshold of clinical translation.
Interlaced roles of mitochondrial DNA in colorectal cancer: Liquid-biopsy biomarkers, nuclear mtDNA-driven genomic instability, and mito-encoded micro peptide signaling.
Koo TH, Leong XB, Lee YL … +2 more , Hayati F, Zakaria AD
World J Gastrointest Oncol · 2025 Dec · PMID 41480206 · Full text
Colorectal cancer (CRC) is a widely occurring malignancy with significant mortality on a global scale, making up close to 10% of all diagnosed cancers in 2020. While traditional CRC diagnostics and research have focused...
Colorectal cancer (CRC) is a widely occurring malignancy with significant mortality on a global scale, making up close to 10% of all diagnosed cancers in 2020. While traditional CRC diagnostics and research have focused on nuclear genomic alterations, emerging evidence has highlighted the multifaceted roles of mitochondrial DNA (mtDNA) in the pathogenesis and clinical management of CRC. In this review, we examine three interlaced aspects of mtDNA in CRC: (1) Liquid biopsy biomarkers: Cell-free mtDNA circulating in the blood serving as a minimally invasive diagnostic and monitoring tool; (2) Nuclear mtDNA (NUMT)-driven genomic instability: The somatic nuclear incorporation of mtDNA (NUMT segments, or NUMT), contributing to mutational burden and chromosomal disruption in tumours; and (3) Mitochondria-encoded micropeptide signaling - small peptides encoded by the mtDNA that modulate cellular pathways and tumour behaviour. Recent high-impact studies have demonstrated that tumour-derived mtDNA in biofluids can augment cancer detection sensitivity, although technical challenges remain due to mtDNA fragmentation and background noise. Meanwhile, genomic analyses have uncovered a significant increase in NUMT insertion events in CRC cells, linking mitochondrial genome escape to nuclear genome instability and identifying potential numtogenesis suppressor genes. A novel dimension of mito-nuclear interactions in cancer was discovered in mitochondrial microproteins, such as humanin and mitochondrial open reading frame of the 12S rRNA type-c. Humanin exhibits both tumour-promoting and cytoprotective properties under specific conditions, while mitochondrial open reading frame of the 12S rRNA type-c possesses tumour-suppressive activities under other conditions. The outcomes of clinical, mechanistic, and translational research, revealing how mtDNA-based biomarkers and involvement contribute towards early detection, prognostication, and treatment of CRC, are presented.
Pancreatic neuroendocrine microtumors in the elderly: A retrospective study using cadaveric pancreatic tissue.
Yang T, Ren K, Chen XQ … +6 more , Toriumi T, Natsuyama Y, Li J, Sukeda A, Nagao T, Yi SQ
World J Gastrointest Oncol · 2025 Dec · PMID 41480205 · Full text
BACKGROUND: Pancreatic neuroendocrine microtumors (PNEMTs) are small (< 5 mm), non-functioning, well-differentiated neuroendocrine neoplasms. Although they are rare, they are not invariably benign. PNEMTs are typically d...
BACKGROUND: Pancreatic neuroendocrine microtumors (PNEMTs) are small (< 5 mm), non-functioning, well-differentiated neuroendocrine neoplasms. Although they are rare, they are not invariably benign. PNEMTs are typically discovered incidentally during autopsy. However, data regarding the occurrence of PNEMTs in the elderly population, particularly those identified incidentally in cadaveric studies, remain limited. AIM: To investigate the prevalence and histopathological characteristics of PNEMTs in elderly individuals by analyzing cadaveric pancreatic tissues. METHODS: We conducted a retrospective analysis of 85 pancreatic specimens (age range: 58-109 years) obtained from cadavers for anatomical education and research at the Department of Life Dentistry, Nippon Dental University. Paraffin sections of the pancreatic head, body, and tail were prepared for histological and immunohistochemical analysis. RESULTS: Five cases with PNEMTs (5/85, 5.9%; male, = 33; female, = 52; mean age: 85.8 ± 12.1 years) were identified. The tumors were solitary, well circumscribed, and located within the pancreatic parenchyma (body: = 4; tail: = 1), and all were < 5 mm (range: 0.54-2.20 mm) in size. All tumors showed strong chromogranin A and synaptophysin positivity, and were predominantly glucagon (GLU)-positive. Ki-67 immunostaining indicated minimal proliferative activity; therefore, these tumors were considered non-functioning, GLU-producing, well-differentiated grade 1 PNEMTs. CONCLUSION: Small, predominantly low-grade, GLU-secreting PNEMTs were present in 5.9% of elderly individuals, highlighting the prevalence of subclinical PNEMTs and the need for careful follow-up.
Beyond the blank page: Frequentist and Bayesian perspectives on risk prediction algorithms.
Tustumi F, Maegawa FAB, Serrano Uson Junior PL
World J Gastrointest Oncol · 2025 Dec · PMID 41480204 · Full text
Risk prediction has long been a cornerstone of surgical oncology, enabling surgeons to anticipate complications, tailor perioperative care, and improve outcomes. With the rise of artificial intelligence, machine learning...
Risk prediction has long been a cornerstone of surgical oncology, enabling surgeons to anticipate complications, tailor perioperative care, and improve outcomes. With the rise of artificial intelligence, machine learning (ML) models are increasingly being applied to predict outcomes, highlighting the growing significance of data-driven methods for clinical decision-making. Currently, frequentist approaches dominate prediction models, including most ML algorithms; these rely exclusively on observed datasets and risk overlooking the cumulative value of prior clinical knowledge. In contrast, Bayesian reasoning formally integrates existing evidence with new data. In this letter, we examine the strengths of frequentist-based prediction models, discuss how Bayesian methods may improve predictive accuracy, and argue that combining both approaches offers a promising path toward more robust, interpretable, and clinically useful prediction tools in surgery. This integration can yield robust, interpretable, and clinically relevant tools that advance personalized surgical care.
Neutrophil-albumin ratio and multi-phase computed tomography for lymph node metastasis in pancreatic cancer.
Wang H, Fu TY, Zhang F … +2 more , Kang FC, Sun ZW
World J Gastrointest Oncol · 2025 Dec · PMID 41480203 · Full text
BACKGROUND: Reliable preoperative detection of lymph node metastasis (LNM) in pancreatic cancer remains elusive: Conventional computed tomography (CT) underestimates micrometastases, and carbohydrate antigen 19-9 is hamp...
BACKGROUND: Reliable preoperative detection of lymph node metastasis (LNM) in pancreatic cancer remains elusive: Conventional computed tomography (CT) underestimates micrometastases, and carbohydrate antigen 19-9 is hampered by low specificity. The neutrophil-albumin ratio (NAR) simultaneously reflects systemic inflammation and nutritional depletion, but its contribution to LNM prediction in pancreatic cancer is unexplored. We hypothesised that integrating NAR with multi-phase CT findings would significantly improve the accuracy of preoperative LNM assessment in patients undergoing curative-intent resection. AIM: To determine whether preoperative NAR plus multi-phase CT reliably predicts nodal metastasis in pancreatic cancer. METHODS: In this single-centre retrospective cohort study (February 2022 to February 2025, Ordos Central Hospital, China), 129 consecutive patients undergoing curative pancreatic resection were histologically classified as LNM ( = 61) and LNM ( = 68). Preoperative NAR and platelet-albumin ratio (PAR) were calculated; optimal cut-offs were determined with X-tile. Multi-phase CT images were re-reviewed by two blinded radiologists. Independent predictors of nodal metastasis were identified by multivariate logistic regression, and model performance was evaluated with receiver operating characteristic (ROC) analysis. RESULTS: Between the two cohorts, univariate comparison revealed significant divergence in age, tumour diameter, concomitant hemangioma thrombosis, PAR, NAR, and CT-detected nodal status ( < 0.05). Subsequent multivariate modelling identified hemangioma thrombosis, PAR above 6.35, NAR exceeding 0.13, and radiologically positive lymph nodes as independent predictors of nodal metastasis ( < 0.05). ROC evaluation indicated that the NAR-plus-CT-nodes model (model 1) reached an area under the curve (AUC) of 0.758, whereas the four-variable composite (model 3) achieved the best performance with an AUC of 0.830 (95%CI: 0.753-0.890), sensitivity 83.61%, and specificity 67.65%. CONCLUSION: The model 3 (NAR > 0.13, PAR > 6.35, CT nodal positivity, hemangioma thrombosis) provides robust, clinically actionable preoperative identification of pancreatic cancer patients at high risk of LNM.
Lymphocyte to C-reactive protein ratio as a novel inflammatory biomarker: Validation and clinical relevance as an independent prognostic factor in cholangiocarcinoma.
Xiao F, Zhou DH, Liu GW … +5 more , Lin CW, Wu ZY, Yu H, Gong W, Tan WF
World J Gastrointest Oncol · 2025 Dec · PMID 41480202 · Full text
BACKGROUND: Inflammatory cytokines are associated with cancer prognosis, but their specific role in cholangiocarcinoma remains poorly understood. The lymphocyte to C-reactive protein ratio (LCR), a novel inflammatory-nut...
BACKGROUND: Inflammatory cytokines are associated with cancer prognosis, but their specific role in cholangiocarcinoma remains poorly understood. The lymphocyte to C-reactive protein ratio (LCR), a novel inflammatory-nutritional biomarker, has demonstrated predictive value in gastrointestinal cancers; however, its clinical relevance in cholangiocarcinoma has not been investigated. AIM: To validate the LCR as an independent prognostic factor for overall survival (OS), surgical site infection (SSI), and length of hospital stay in patients with resectable cholangiocarcinoma. METHODS: We conducted a retrospective analysis of 76 patients with cholangiocarcinoma who underwent radical surgery between 2008 and 2013. The preoperative LCR was calculated as the lymphocyte count divided by C-reactive protein level, using a cutoff value of 180. Univariate and multivariate logistic regression analyses were performed to evaluate factors associated with SSI and hospitalization duration, while Kaplan-Meier survival curves and Cox proportional hazards models were used to assess predictors of OS. RESULTS: Patients in the low LCR group was significantly associated with several adverse clinical outcomes: A shorter median OS (14.93 months 46.67 months; = 0.022); a 4.5-fold increased risk of prolonged hospitalization ( = 0.007); and a higher incidence of SSI (odds ratio = 4.41, = 0.045). Multivariate analysis confirmed that LCR was an independent predictor of OS [hazard ratio (HR) = 3.204, = 0.002], SSI, and hospitalization duration. Additionally, R0 resection (HR = 3.546, = 0.002) and advanced tumor-node-metastasis stage (HR = 2.016, = 0.035) were identified as independent prognostic factors for OS. CONCLUSION: In this retrospective study, preoperative LCR is a cost-effective and practical biomarker that independently predicts OS, postoperative complications, and hospitalization duration in patients with resectable cholangiocarcinoma, thereby facilitating more precise patient stratification.
Long-term survival after treatment of gastric cancer with S-1 plus oxaliplatin regimen and sintilimab: A case report.
Pan J, Li P, Zhou YH … +3 more , Pan TT, Chen YT, Chu XY
World J Gastrointest Oncol · 2025 Dec · PMID 41480201 · Full text
BACKGROUND: Treatment of metastatic gastric cancer (mGC) relies primarily on chemotherapy, which can be effectively combined with immunotherapy. Despite these interventions, overall survival remains suboptimal. CASE SUMM...
BACKGROUND: Treatment of metastatic gastric cancer (mGC) relies primarily on chemotherapy, which can be effectively combined with immunotherapy. Despite these interventions, overall survival remains suboptimal. CASE SUMMARY: We report a patient with mGC who received S-1 plus oxaliplatin with sintilimab as first-line therapy, followed by maintenance therapy with S-1 and sintilimab. After 6 months, a partial response was observed, with a 71.7% reduction in the target lesion. After 13 months, the reduction reached 76.3%. Treatment was temporarily paused for 6 months due to a pulmonary infection. Upon re-evaluation 6 months later, the tumor continued to regress, with a 79.4% reduction in the target lesion. The original regimen was then resumed. From diagnosis to date, progression-free survival has reached 23 months. CONCLUSION: Sintilimab combined with chemotherapy demonstrated improved progression-free survival and warrants further investigation in mGC.
Tumor calcification and sustained complete response after chemoembolization in hepatocellular carcinoma: Two case reports and review of literature.
Alharbi SR
World J Gastrointest Oncol · 2025 Dec · PMID 41480200 · Full text
BACKGROUND: Transarterial chemoembolization (TACE) is a widely accepted palliative therapy modality for unresectable hepatocellular carcinoma (HCC). Although it is rarely curative, complete radiological response can be a...
BACKGROUND: Transarterial chemoembolization (TACE) is a widely accepted palliative therapy modality for unresectable hepatocellular carcinoma (HCC). Although it is rarely curative, complete radiological response can be achieved in selected patients, leading to prolonged survival. Post-treatment tumoral calcification is an uncommon imaging finding in HCC and is rarely reported after drug-eluting beads TACE (DEB-TACE). CASE SUMMARY: Two patients with large, solitary HCCs (> 5 cm) were treated with DEB-TACE, and both achieved complete radiological response after two treatment sessions. Approximately 1 year after DEB-TACE, imaging demonstrated progressive peripheral tumoral calcification. Over 6 years of follow-up, both patients remained in remission with preserved liver function. CONCLUSION: These two cases highlight the potential for complete remission and long-term survival in selected patients with large HCC following DEB-TACE. The appearance of peripheral calcification may represent a late imaging marker of effective tumor necrosis and durable treatment response although prospective studies are warranted to clarify its prognostic value.
Clinical characteristics and prognostic analysis of three hundred and nineteen cases of primary gastrointestinal diffuse large B-cell lymphoma.
Ma JJ, Zhang H, Wang CC … +3 more , Ji WL, Zhao Y, Li XX
World J Gastrointest Oncol · 2025 Dec · PMID 41480199 · Full text
BACKGROUND: Primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL), the most prevalent extranodal non-Hodgkin lymphoma, poses significant diagnostic and therapeutic challenges due to its non-specific symptoms...
BACKGROUND: Primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL), the most prevalent extranodal non-Hodgkin lymphoma, poses significant diagnostic and therapeutic challenges due to its non-specific symptoms and poor prognosis. AIM: To develop and validate a risk model for the early identification of PGI-DLBCL using Least Absolute Shrinkage and Selection-Cox regression, with the aim of guiding clinical decision-making. METHODS: The clinical data of patients diagnosed with PGI-DLBCL at the Tumor Hospital Affiliated to Xinjiang Medical University were analyzed retrospectively from January 2010 to April 2022. RESULTS: A total of 319 patients with PGI-DLBCL were included and divided into training ( = 223) and validation ( = 96) cohorts. The median age was 55 years, with 48.9% male and 51.1% female patients. Key clinical features included Eastern Cooperative Oncology Group performance status ≥ 2 (40.8%), advanced-stage disease (stage IV: 27.6%), extranodal involvement ≥ 2 sites (47%), tumor > 5 cm (46.1%), elevated beta-2 microglobulin (50.5%), elevated lactate dehydrogenase (27%), high International Prognostic Index (3-5: 69.9%), non-germinal center B-cell-like subtype (59.9%), and B symptoms (55.8%). Immunohistochemical analysis showed frequent expression of CD10 (51.1%), B-cell lymphoma 6 (53.3%), multiple myeloma oncogene 1 (40.1%), B-cell lymphoma 2 (49.2%), myelocytomatosis viral oncogene homolog (48.3%), Ki-67 (67.1%), and CD5 (42.6%); Epstein-Barr virus-encoded RNA was positive in 3.1%. Based on Least Absolute Shrinkage and Selection regression and subsequent univariate and multivariate Cox regression analyses, extranodal sites ≥ 2, B symptoms, mixed lesion type, and negative multiple myeloma oncogene 1 expression were identified as independent risk factors for PGI-DLBCL. The risk model stratified patients into high- and low-risk groups with significantly different overall survival ( < 0.05). Area under the curve values for 1-, 3-, and 5-year overall survival were 0.625, 0.663, and 0.723 in the training cohort, with consistent performance in the validation cohort. Decision curve analysis indicated favorable clinical utility. CONCLUSION: PGI-DLBCL in our cohort showed distinctive clinical features and a predominance of the non-germinal center B-cell-like subtype. Decision curve analysis confirmed the clinical applicability of our prognostic model. Although molecular biomarkers will be needed to improve predictive precision, our model offers a practical tool for early risk identification and individualized management in clinical practice.
Preliminary exploration of programmed death 1 inhibitor combined with fruquintinib and docetaxel for advanced colorectal cancer.
Meng XY, Cai YM, Sun NN … +7 more , Zhang WH, Cui RX, Zhang L, Zheng CC, Sun Z, Luo WX, Wang FW
World J Gastrointest Oncol · 2025 Dec · PMID 41480198 · Full text
BACKGROUND: Immune checkpoint inhibitors have demonstrated significant efficacy in colorectal cancer (CRC) patients with microsatellite instability-high or deficient mismatch repair. However, their efficacy as monotherap...
BACKGROUND: Immune checkpoint inhibitors have demonstrated significant efficacy in colorectal cancer (CRC) patients with microsatellite instability-high or deficient mismatch repair. However, their efficacy as monotherapy is limited in microsatellite stable/proficient mismatch repair (MSS/pMMR) subtypes. AIM: To provide an evidence-based rationale for optimizing later-line therapeutic strategies in advanced MSS/pMMR CRC. METHODS: This study conducted a systematic retrospective analysis to evaluate the efficacy and safety of a triple-combination regimen comprising programmed death 1 inhibitors, fruquintinib and docetaxel administered as third-line therapy in 13 patients with advanced MSS/pMMR CRC. RESULTS: Primary endpoints included progression-free survival and disease control rate. Intention-to-treat analysis showed median progression-free survival 7.0 months, median overall survival 18.5 months, disease control rate 61.5%, with manageable toxicity. CONCLUSION: Although this is a small-sample retrospective study, it preliminarily validates the synergistic effect of programmed death 1 inhibitors combined with fruquintinib and docetaxel in MSS/pMMR CRC, providing a novel strategy with translational significance for later-line treatment in advanced patients.
Cost clinical utility on application of large language models in clinical practice: A double-edged sword.
Au SCL
World J Gastrointest Oncol · 2025 Dec · PMID 41480197 · Full text
As large language models increasingly permeate medical workflows, a recent study evaluating ChatGPT 4.0's performance in addressing patient queries about endoscopic submucosal dissection and endoscopic mucosal resection...
As large language models increasingly permeate medical workflows, a recent study evaluating ChatGPT 4.0's performance in addressing patient queries about endoscopic submucosal dissection and endoscopic mucosal resection offers critical insights into three domains: Performance parity, cost democratization, and clinical readiness. The findings highlight ChatGPT's high accuracy, completeness, and comprehensibility, suggesting potential cost efficiency in patient education. Yet, cost-effectiveness alone does not ensure clinical utility. Notably, the study relied exclusively on text-based prompts, omitting multimodal data such as photographs or endoscopic scans. This is a significant limitation in a visually driven field like endoscopy, where large language model performance may drop precipitously without image context. Without multimodal integration, artificial intelligence tools risk failing to capture key diagnostic signals, underscoring the need for cautious adoption and robust validation in clinical practice.
miR-136: A biomarker in the inflammation-cancer transformation of gastric cancer.
Lyu H, Chen JS, Tang JF … +1 more , Zhou CF
World J Gastrointest Oncol · 2025 Dec · PMID 41480196 · Full text
The study by Chen found that miR-136 plays an indispensable role in the inflammation-cancer transformation in gastric cancer (GC). The authors conducted and experiments and verified them in conjunction with functional...
The study by Chen found that miR-136 plays an indispensable role in the inflammation-cancer transformation in gastric cancer (GC). The authors conducted and experiments and verified them in conjunction with functional and molecular mechanisms. Their key findings indicate that () activated NF-κB/miR-136/PDCD11 axis to induce the growth of -positive GC tumors. And miR-136 is markedly associated with characteristics related to the gastric mucosal histopathological, supporting its use as a diagnostic biomarker and a therapeutic target for early -induced GC. Chronic inflammation is one of the important precancerous lesions. With the development of emerging technologies such as multi-omics technology, the pathways linking chronic inflammation to cancer have been extensively elucidated. In this letter, we focus on introducing the molecular mechanisms of chronic inflammation in the development of GC, which will provide new insights for early diagnosis, personalized treatment, and prognosis assessment of GC.
Survival prognosis in advanced HER-2 negative gastric cancer treated with immunochemotherapy: A novel model.
Yao ZY, Bao G, Li GC … +6 more , Hao QL, Ma LJ, Rao YX, Xu K, Ma X, Han ZX
World J Gastrointest Oncol · 2025 Nov · PMID 41281500 · Full text
BACKGROUND: Gastric cancer is one of the most common malignant tumors of the digestive system globally, with a generally poor prognosis for patients with advanced disease. In recent years, immune checkpoint inhibitors ha...
BACKGROUND: Gastric cancer is one of the most common malignant tumors of the digestive system globally, with a generally poor prognosis for patients with advanced disease. In recent years, immune checkpoint inhibitors have made significant advancements in gastric cancer treatment, with some HER-2 negative advanced gastric cancer patients benefiting from the combination of immunotherapy and chemotherapy. However, significant biological heterogeneity exists among patients, resulting in a lack of effective tools to predict the benefits of immunotherapy and survival outcomes. Therefore, there is an urgent need to develop a scientific and precise survival prediction model to provide robust support for personalized treatment decisions. AIM: To develop and validate a novel survival prediction model for assessing the survival risk of advanced HER-2 negative gastric cancer patients receiving immunotherapy combined with chemotherapy, thereby enhancing the accuracy of prognostic evaluation and its clinical guidance value. METHODS: This retrospective study included 200 advanced HER-2 negative gastric cancer patients who received programmed cell death protein 1 inhibitors combined with chemotherapy. Independent prognostic factors for progression-free survival (PFS) and overall survival (OS) were identified using multivariable Cox regression analysis, and a nomogram model was constructed based on these factors. The variables included in the regression analysis were selected based on their clinical relevance, routine application in gastric cancer evaluation, and availability within our dataset. The model's discrimination and calibration were assessed using the concordance index (C-index), the area under the receiver operating characteristic curve (AUC), and calibration plots. RESULTS: Among the 200 advanced HER-2 negative gastric cancer patients, multivariable Cox regression analysis identified programmed death-ligand 1 expression level, microsatellite status, tumor-node-metastasis stage, tumor differentiation, neutrophil-to-lymphocyte ratio, and C-reactive protein-albumin-lymphocyte index as independent prognostic factors for PFS and OS (all values < 0.05). Based on these variables, nomogram models for PFS and OS were constructed. In the training set, the C-index for the PFS model was 0.82 [95% confidence interval (CI): 0.77-0.87], and in the internal validation set, it was 0.78 (95%CI: 0.70-0.87), indicating good discrimination ability. For AUC evaluation, the PFS model's 3-month and 6-month prediction AUCs in the training set were 0.79 (95%CI: 0.65-0.92) and 0.89 (95%CI: 0.83-0.94), respectively. In the validation set, they were 0.82 (95%CI: 0.68-0.97) and 0.80 (95%CI: 0.68-0.92), respectively. For OS prediction, the C-index in the training set and validation set were 0.81 (95%CI: 0.76-0.86) and 0.78 (95%CI: 0.69-0.87), respectively. The nomogram also showed high accuracy in predicting OS at 12, 15, and 18 months. In the training set, the AUCs were 0.82 (95%CI: 0.75-0.89), 0.91 (95%CI: 0.86-0.97), and 0.89 (95%CI: 0.83-0.95), respectively. In the validation set, they were 0.79 (95%CI: 0.66-0.91), 0.84 (95%CI: 0.73-0.96), and 0.81 (95%CI: 0.69-0.93), respectively. Furthermore, calibration curves demonstrated that the predicted probabilities of the model were highly consistent with the actual observed values at different time points, suggesting that the model has good reliability and adaptability for clinical application. CONCLUSION: The nomogram model developed in this study effectively predicts the survival outcomes of advanced HER-2 negative gastric cancer patients receiving immunotherapy combined with chemotherapy, demonstrating good discrimination and consistency, and providing robust support for personalized clinical treatment decisions.
Innovative insights and future research directions in gastric cancer through single-cell RNA sequencing.
Zhao CF, Li QW, Ye SY … +2 more , Chen LW, Xu ZF
World J Gastrointest Oncol · 2025 Nov · PMID 41281499 · Full text
Gastric cancer (GC) remains one of the leading causes of cancer-related morbidity and mortality globally. Although significant progress has been made in treatment options, the survival rates for GC patients continue to b...
Gastric cancer (GC) remains one of the leading causes of cancer-related morbidity and mortality globally. Although significant progress has been made in treatment options, the survival rates for GC patients continue to be low. This is primarily attributed to the intricate and insufficiently understood mechanisms of disease progression, as well as the considerable challenges associated with tumor heterogeneity. The recent study by Tang provides a detailed single-cell RNA sequencing analysis of GC across different stages, revealing dynamic changes in the tumor microenvironment and key immune responses. We aim to offer a comprehensive interpretation of the study's findings and propose several innovative directions for future academic research in gastric cancer. These include exploring advanced multi-omics approaches, leveraging spatial transcriptomics, integrating artificial intelligence for clinical applications, and developing novel immunotherapy strategies. We further emphasize the importance of personalized medicine, early detection, and novel drug discovery techniques in improving GC treatment outcomes.
Personalized prognosis in unresectable hepatocellular carcinoma: Development and validation of a model for transcatheter arterial chemoembolization plus lenvatinib.
Yu JH, Yu J, Yu JX … +5 more , Yang LF, Yan D, Liu Y, Xian JR, Yi PS
World J Gastrointest Oncol · 2025 Nov · PMID 41281498 · Full text
BACKGROUND: Transcatheter arterial chemoembolization (TACE) combined with lenvatinib is an important modality for the treatment of unresectable hepatocellular carcinoma (HCC). To date, no prognostic analysis exists for c...
BACKGROUND: Transcatheter arterial chemoembolization (TACE) combined with lenvatinib is an important modality for the treatment of unresectable hepatocellular carcinoma (HCC). To date, no prognostic analysis exists for clinical predictive models of TACE combined with lenvatinib in treating advanced unresectable HCC. A model was constructed through meta-analysis, and its validation was further enhanced by the collection of external clinical data, thereby providing guidance for clinical practice. AIM: To identify risk factors for unresectable HCC following TACE plus lenvatinib therapy and to construct a clinical prediction model. METHODS: We searched PubMed, Web of Science, EMBASE, and Cochrane Library databases for studies on TACE plus lenvatinib for unresectable HCC. Risk factors from the meta-analysis and sensitivity analyses were used to construct a prediction model. The validation set included clinical data from 106 eligible patients at the Affiliated Hospital of North Sichuan Medical College collected by June 1, 2023. RESULTS: This study included 43 group studies involving 5070 patients. Tumor number, microvascular invasion, Eastern Cooperative Oncology Group performance status, Child-Pugh stage, Barcelona Clinic Liver Cancer stage, extrahepatic metastases, alpha-fetoprotein level, and hepatitis B virus status were risk factors for overall survival and progression-free survival, while triple therapy was a protective factor for both. In the validation set, the overall survival prediction model had area under the curve values of 0.616, 0.643, and 0.706 at 1 year, 2 years, and 3 years, respectively, and the progression-free survival model had area under the curve values of 0.702, 0.696, and 0.670 at the corresponding time points, demonstrating good model performance. Calibration curves, Kaplan-Meier survival analysis, and decision curves further validated the efficacy of the model. CONCLUSION: Models based on nine variables from 43 group studies predicted the efficacy of TACE plus lenvatinib in unresectable HCC, supporting evidence-based clinical decisions and treatment strategies.
Stromal secreted protein acidic and rich in cysteine expression: A potential target for improved prognosis in patients with pancreatic cancer.
Yang HY, Chong JU, Jang M … +4 more , Lee SH, Hwang HK, Lee WJ, Kang CM
World J Gastrointest Oncol · 2025 Nov · PMID 41281497 · Full text
BACKGROUND: Pancreatic cancer tissues mainly consist of fibrotic and dense stroma, which limits their therapeutic efficacy. The stromal fibroblasts of pancreatic tumors frequently express the secreted protein acidic and...
BACKGROUND: Pancreatic cancer tissues mainly consist of fibrotic and dense stroma, which limits their therapeutic efficacy. The stromal fibroblasts of pancreatic tumors frequently express the secreted protein acidic and rich in cysteine (SPARC). AIM: To assess the impact of SPARC and its oncological relevance in patients undergoing pancreatic cancer resection. METHODS: Ninety-one pancreatic ductal adenocarcinoma specimens were obtained from patients with curative resection between January 2009 and December 2015 as a retrospective study. SPARC expression patterns were analyzed using immunohistochemistry. Oncological outcomes were analyzed based on SPARC expression patterns. Oncological outcomes, based on SPARC expression, were analyzed in The Cancer Genome Atlas-Pancreatic Adenocarcinoma cohort (retrieved from a public database). RESULTS: Patients with stromal SPARC expression (sSPARC+) had poorer overall survival than that in those without it (sSPARC-) ( = 0.035). However, among patients who received adjuvant treatment, no difference was observed in survival between the sSPARC+ and the sSPARC- groups ( = 0.14). In The Cancer Genome Atlas-Pancreatic Adenocarcinoma samples, the high SPARC expression group exhibited noticeably lower overall survival than that in the low expression group (cutoff: 14.1295, = 0.0222). Furthermore, SPARC expression was strongly correlated with the percentage the CD10+ stromal component ( = 0.804, < 0.001). CONCLUSION: Adjuvant chemotherapy improves survivals in sSPARC+ pancreatic cancer patients, indicating suggesting sSPARC expression as a prognostic biomarker and potential indicator for neoadjuvant treatment planning.
Construction of a prognostic model for colorectal cancer liver metastasis: A retrospective study based on population data.
Xie MJ, Li JJ, Guo YJ … +4 more , Wang Q, Tan ZB, Li YL, Li JP
World J Gastrointest Oncol · 2025 Nov · PMID 41281496 · Full text
BACKGROUND: Colorectal cancer (CRC) is a prevalent gastrointestinal malignancy with a typically unfavorable prognosis following the onset of liver metastases. AIM: To develop and validate a new clinical prediction model...
BACKGROUND: Colorectal cancer (CRC) is a prevalent gastrointestinal malignancy with a typically unfavorable prognosis following the onset of liver metastases. AIM: To develop and validate a new clinical prediction model to accurately forecast overall survival (OS) in CRC patients following surgical treatment for liver metastasis. METHODS: This study included 1059 patients diagnosed with CRC liver metastases (CRLM) at the Xijing Hospital between 2010 and 2022. The patients were randomly divided into training and validation cohorts at a 7:3 ratio. Key clinical predictors were identified using least absolute shrinkage and selection operator (LASSO) regression combined with a Cox proportional hazards model, leading to the establishment of a prediction model and preparation of a nomogram to enhance its clinical utility. Decision curve analysis (DCA) and Kaplan-Meier survival analysis were employed to evaluate the precision and predictive performance of the model. RESULTS: The LASSO-Cox regression analysis revealed multiple pivotal clinical biomarkers significantly linked to CRLM, including gamma-glutamyl transferase levels, blood chloride concentration, activated partial thromboplastin time, N stage, and vascular invasion. The model's receiver operating characteristic curve area under the curve exceeded 0.7 for both the training and validation groups with moderate-to-good predictive accuracy. Furthermore, DCA validated the nomogram's effectiveness for OS prediction. Kaplan-Meier risk stratification demonstrated markedly improved OS among patients classified as low-risk compared to those categorized as high-risk ( < 0.001), highlighting its clinical utility for risk assessment and treatment guidance. CONCLUSION: The nomogram prediction model constructed in this study has good predictive value and can effectively assess the survival rate of patients with CRLM.
MicroRNAs in colorectal cancer: A comparative analysis of circulating and tissue microRNA levels.
Pelisenco IA, Trandafir B, Dobre AM … +7 more , Dragne AD, Herlea V, Niculae AM, Vasilescu C, Hinescu ME, Milanesi E, Dobre M
World J Gastrointest Oncol · 2025 Nov · PMID 41281495 · Full text
BACKGROUND: Colorectal cancer (CRC) is one of the most common cancers worldwide. The gold standard screening methods for early detection and monitoring are colonoscopy and stool-based tests. However, innovative and minim...
BACKGROUND: Colorectal cancer (CRC) is one of the most common cancers worldwide. The gold standard screening methods for early detection and monitoring are colonoscopy and stool-based tests. However, innovative and minimally invasive biomarkers need to be integrated into clinical practice. AIM: To identify circulating microRNAs as potential CRC biomarkers through a comparative analysis of tissue and plasma samples from patients with CRC. METHODS: This case-control study conducted a quantitative real-time polymerase chain reaction analysis of 84 microRNAs in tumoral and peritumoral tissues, and 179 microRNAs in plasma from 19 patients with CRC. A control cohort for the tissue analysis and another control cohort for the plasma analysis have been enrolled. RESULTS: In total, 14 microRNAs were significantly differentially expressed in the tissue and plasma samples. Notably, five microRNAs (miR-26b-5p, miR-101-3p, miR-30d-5p, miR-107, and miR-21-5p) presented the same trend in terms of fold change in both types of biological samples. Significant associations between the circulating levels of miR-21-5p and miR-26b-5p and lymphovascular invasion were found. CONCLUSION: These five microRNAs with significantly altered levels in plasma and tumoral tissue, could be good non-invasive CRC biomarkers candidates, enhancing screening, and supporting precision and individualized patient care.
Tumour chemotherapy sensitivity test may predict clinical outcomes in colorectal cancer patients receiving oxaliplatin and fluoropyrimidine-based regimens.
Li SJ, Lu YX, Zheng FY … +3 more , Bian YC, Miao LY, Huang CR
World J Gastrointest Oncol · 2025 Nov · PMID 41281494 · Full text
BACKGROUND: Chemotherapy is an essential treatment for colorectal cancer (CRC) patients after surgery, but many patients do not benefit from chemotherapy because tumour heterogeneity results in varied responses. AIM: To...
BACKGROUND: Chemotherapy is an essential treatment for colorectal cancer (CRC) patients after surgery, but many patients do not benefit from chemotherapy because tumour heterogeneity results in varied responses. AIM: To study the effectiveness of chemosensitivity tests adenosine triphosphate-based tumour chemotherapy sensitivity test (ATP-TCA) for tailoring postoperative chemotherapy regimens for patients with CRC. METHODS: Between January 2015 to December 2021, a total of 1549 CRC patients underwent surgery and chemosensitivity testing using ATP-TCA. A subset of 405 patients who met the survival assessment criteria were followed to collect data on overall survival (OS) and disease-free survival (DFS). Cox regression analysis revealed independent prognostic factors that affect OS and DFS for those receiving oxaliplatin (L-OPH) and fluoropyrimidine-based regimens, aiding in the development of clinical predictive models. The relationships between the ATP-TCA results and clinical outcomes were analysed using the Kaplan-Meier method. RESULTS: Tumour heterogeneity and resistance to multiple drugs were observed in 1549 patients. The sensitivity to 5-fluorouracil (5-FU) combined with L-OPH was tested among 1474 of these patients, yielding a sensitivity rate of 11.9%. ATP-TCA results were identified as an independent prognostic factor for DFS [ = 0.002, hazard ratio (95% confidence interval): 4.98 (1.81-13.72)] in patients with resectable CRC. Compared with drug-resistant patients, sensitive CRC patients treated with 5-FU and L-OPH had significantly prolonged DFS ( = 0.027). Further Kaplan-Meier analysis indicated that ATP-TCA sensitivity was significantly associated with improved OS ( = 0.048) and DFS ( = 0.003) in patients with stage III CRC. CONCLUSION: The response of CRC patients to the combination regimen of 5-FU and L-OPH is heterogeneous. This study confirmed that the ATP-TCA is a valuable tool for predicting clinical outcomes, such as DFS, in patients with resectable CRC receiving chemotherapy. Although further validation with multicentre data is still necessary, these findings support that the ATP-TCA may function as a guiding tool for personalized chemotherapy administration, thereby optimizing treatment opportunities for patients.
Unraveling the characteristics of early esophageal neuroendocrine carcinoma using multi-model endoscopy: A retrospective study of serial cases.
Jin T, Zhou YW, Sun PS … +3 more , Huang Y, Gao JG, Jin X
World J Gastrointest Oncol · 2025 Nov · PMID 41281493 · Full text
BACKGROUND: Early esophageal neuroendocrine carcinoma (E-NEC) is a rare but aggressive malignancy with poorly understood endoscopic features. Despite advancements in multi-model endoscopy, including white light endoscopy...
BACKGROUND: Early esophageal neuroendocrine carcinoma (E-NEC) is a rare but aggressive malignancy with poorly understood endoscopic features. Despite advancements in multi-model endoscopy, including white light endoscopy, magnifying endoscopy narrow-band imaging (NBI), and endoscopic ultrasonography (EUS), the diagnostic characteristics of early E-NEC remain unclear. Comprehensive evaluation using these techniques can improve early detection and guide clinical management. This study aimed to investigate the endoscopic features of early E-NEC using multiple imaging modalities. We hypothesized that specific endoscopic patterns, such as irregular microvascular morphology or signs of submucosal invasion, could reliably distinguish early E-NEC from other esophageal lesions. AIM: To characterize early E-NEC using multi-model endoscopy and identify diagnostic endoscopic features. METHODS: Clinical data of four patients with esophageal submucosal lesions identified by gastroscopy and pathologically diagnosed as E-NEC in the Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University School of Medicine between January 2020 and August 2024 were retrospectively analyzed, and their manifestations under multi-model endoscopy were observed. Grayscale values of ultrasound images in three patients with E-NEC and eight with esophageal leiomyoma were calculated using Image J software and compared using the Mann-Whitney test. RESULTS: Among the four patients with early E-NEC, two were males and two were females, with ages ranging from 60-70 years. White light endoscopy revealed three patients with mild local ulceration on the lesion surface. NBI images were available in two patients, revealing the intraepithelial papillary capillary loop of B1-B2 and B2 types. EUS was performed in three patients, all showing solitary hypoechoic lesions originating from the muscularis mucosa/mucosal muscular layer or submucosa; peripherally enlarged lymph node was observed in one patient. Average grayscale value of EUS images for early E-NEC ( = 3, 63.79 ± 1.42) was significantly higher than that for esophageal leiomyoma ( = 8, 49.44 ± 11.57; = 0.01). CONCLUSION: Endoscopic features of early E-NEC differ from those of esophageal leiomyoma, including NBI imaging, lymph node metastasis, and a notably higher echo intensity on EUS.
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