World Journal Of Gastrointestinal Oncology[JOURNAL]
Sun
200 papers
Clinical value of geriatric nutritional risk index and pan-immune-inflammation value in locally advanced gastric cancer receiving neoadjuvant chemotherapy.
Zhong WT, Ding SK, Li RY … +3 more , Liu CY, Huang HY, Yu JC
World J Gastrointest Oncol · 2026 Feb · PMID 41695941 · Full text
BACKGROUND: Metabolism and nutrition status play an important role in the development of cancer. However, whether inflammation and malnutrition related indicators can predict the efficacy of neoadjuvant chemotherapy (NAC...
BACKGROUND: Metabolism and nutrition status play an important role in the development of cancer. However, whether inflammation and malnutrition related indicators can predict the efficacy of neoadjuvant chemotherapy (NACT) and the prognosis of gastric cancer has not been addressed. AIM: To evaluate the predictive value of malnutrition as determined by the geriatric nutritional risk index (GNRI) and inflammation represented by the pan-immune-inflammation value (PIV) for the response to NACT patients' prognosis in locally advanced gastric cancer (LAGC). METHODS: We retrospectively analyzed 147 LAGC patients who underwent radical resection after NACT. The PIV, and GNRI were compared according to whether receiving nutritional intervention during NACT. The prognostic values of GNRI and PIV were assessed using time-dependent receiver operating characteristic curve analysis, log-rank tests, and Cox regression analysis. RESULTS: Nutritional intervention could improve nutrition status and reduce inflammation during NACT in LAGC patients. Multivariate analysis showed that GNRI (hazard ratio = 0.956, 95% confidence interval: 0.923-0.991, = 0.013), PIV (hazard ratio = 1.002, 95% confidence interval: 1-1.005, = 0.041) were independent predictors for OS. Significant differences of overall survival and disease-free survival according to GNRI ( < 0.001) and PIV ( < 0.001) were observed between the low and high groups. The GNRI-PIV score constructed with GNRI and PIV had a higher area under the curve and was significantly associated with pathological tumor regression response. CONCLUSION: GNRI and PIV are useful predictive biomarkers in patients with LAGC receiving NACT, and nutritional supplement can improve patients' status. The GNRI-PIV score may contribute to a more personalized and holistic approach for LAGC patients underwent NACT.
Recent advances in spasmolytic polypeptide expressing metaplasia research.
Yang RR, Yan YR, Li YF
World J Gastrointest Oncol · 2026 Feb · PMID 41695940 · Full text
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, spasm...
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.
Increasing expression of presenilin 1, β-catenin, and p-PTEN and its regulatory roles on cell invasion in gastric cancer.
Lin X, Lin GF, Gu FT … +1 more , Li YL
World J Gastrointest Oncol · 2026 Feb · PMID 41695939 · Full text
BACKGROUND: Presenilin-1 (PS-1), a part of the gamma-secretase complex, has been implicated as a tumor promoter in various cancers. PS-1 binds to β-catenin through a large hydrophilic loop region that could lead to gastr...
BACKGROUND: Presenilin-1 (PS-1), a part of the gamma-secretase complex, has been implicated as a tumor promoter in various cancers. PS-1 binds to β-catenin through a large hydrophilic loop region that could lead to gastric tumorigenesis by the phosphatidylinositol 3-kinase/protein kinase B/mechanistic target of rapamycin pathway, which is known to inhibit phosphatase and tensin homolog deleted on chromosome ten (PTEN). However, little is known about the mechanisms of PS-1, β-catenin, and PTEN in gastric cancer (GC) tumorigenesis. AIM: To determine the regulatory correlation among PS-1, β-catenin, and phosphorylation of PTEN (p-PTEN) in GC tumorigenesis . METHODS: Tissue samples from 116 patients with GC were analyzed by immunohistochemistry. Cell lysates from MGC-803 were used to detect protein levels by western blot. Cell invasion ability and metastatic ability were examined by Transwell invasion and tail vein injection, respectively. RESULTS: The high expression rates of PS-1, β-catenin, and p-PTEN in GC were 60.3% (70/116), 56.9% (66/116), and 47.4% (55/116), respectively, correlating with advanced tumor stages based on tumor invasion, lymph node metastasis, and 5-year survival. PS-1 expression was positively correlated with expression of β-catenin and p-PTEN in patients with GC. PS-1 regulated PTEN phosphorylation and cytoplasmic localization through β-catenin. PS-1 enhanced GC cell invasion β-catenin. CONCLUSION: The expression of PS-1 was positively correlated with that of both β-catenin and p-PTEN in GC. The regulation of PTEN phosphorylation and cytoplasmic localization by PS-1 through β-catenin could be considered potential therapeutic targets to prevent GC tumorigenesis.
Advancing precision medicine in human epidermal growth factor receptor 2 negative gastric cancer: Insights from a novel nomogram for immunochemotherapy prognosis.
Nayak A, Sahoo G, Nishank SS
World J Gastrointest Oncol · 2026 Feb · PMID 41695938 · Full text
Gastric cancer poses a significant global health burden, particularly in advanced human epidermal growth factor receptor 2-negative cases where prognosis remains poor despite advances in immunochemotherapy. The recent st...
Gastric cancer poses a significant global health burden, particularly in advanced human epidermal growth factor receptor 2-negative cases where prognosis remains poor despite advances in immunochemotherapy. The recent study by Yao introduces a nomogram model integrating programmed death ligand 1 expression, microsatellite status, tumor-node-metastasis stage, tumor differentiation, neutrophil-to-lymphocyte ratio, and C-reactive protein-albumin-lymphocyte index to predict progression-free and overall survival. This letter discusses the model's strengths, limitations, and its alignment with recent developments in biomarkers and therapies, emphasizing its potential for personalized medicine.
Impact of liver metastasis on the efficacy of immune checkpoint inhibitors for advanced colorectal cancer.
Xiang MY, Tuo ZM, Sa XK … +3 more , Wang P, Bian JW, Zhang XM
World J Gastrointest Oncol · 2026 Feb · PMID 41695937 · Full text
BACKGROUND: Liver metastasis is common in advanced colorectal cancer (CRC) and may influence the response to immune checkpoint inhibitors (ICIs). However, the prognostic impact of liver metastasis on ICI efficacy remains...
BACKGROUND: Liver metastasis is common in advanced colorectal cancer (CRC) and may influence the response to immune checkpoint inhibitors (ICIs). However, the prognostic impact of liver metastasis on ICI efficacy remains uncertain. AIM: To evaluate the association between liver metastasis and survival outcomes in patients with metastatic CRC (mCRC) treated with ICIs in a meta-analysis. METHODS: We systematically searched PubMed, EMBASE, and Web of Science up to May 14, 2025, for studies comparing survival outcomes in patients with mCRC with without liver metastasis receiving ICIs. Hazard ratios (HRs) for overall survival (OS) and/or progression-free survival (PFS) were extracted and pooled using random-effects models. Subgroup and sensitivity analyses were conducted to explore heterogeneity and result stability. RESULTS: Sixteen studies comprising 1203 patients were included. Liver metastasis was associated with significantly worse PFS [HR = 1.94, 95% confidence interval (95%CI): 1.56-2.41, < 0.001; = 38%] and OS (HR = 2.10, 95%CI: 1.66-2.65, < 0.001; = 23%) among patients with mCRC treated with ICIs. Subgroup analyses showed consistent results across study design, microsatellite status, age, follow-up duration, and statistical adjustment ( for subgroup difference all > 0.05). Sensitivity analyses performed by excluding one study at a time showed consistent results, which further confirmed the robustness of the findings. CONCLUSION: Liver metastasis is associated with worse survival outcomes in patients with mCRC receiving ICIs. These results suggest that liver metastasis may serve as a negative prognostic factor in the context of immunotherapy for mCRC.
Computed tomography with carcinoembryonic antigen and carbohydrate antigen 19-9 in diagnosing lymph node metastasis of early gastric cancer.
Chen HZ, Zhang P, Ma J
World J Gastrointest Oncol · 2026 Feb · PMID 41695936 · Full text
BACKGROUND: Gastric cancer (GC) is the fifth most prevalent and fourth most lethal malignancy globally. China bears a disproportionately high burden, accounting for 44.0% of new cases and 48.6% of deaths worldwide. In ea...
BACKGROUND: Gastric cancer (GC) is the fifth most prevalent and fourth most lethal malignancy globally. China bears a disproportionately high burden, accounting for 44.0% of new cases and 48.6% of deaths worldwide. In early GC (EGC), the presence of lymph node metastasis (LNM) is a critical prognostic determinant that directly guides therapeutic strategy. While multi-detector computed tomography (CT) and serum biomarkers carcinoembryonic antigen (CEA)/carbohydrate antigen 19-9 (CA19-9) are established diagnostic tools, each demonstrates limited efficacy when used independently. This study therefore aims to verify whether a combined diagnostic approach integrating multi-detector CT (MDCT) with serum CEA/CA19-9 can significantly improve the accuracy of LNM detection in EGC patients. AIM: To investigate the diagnostic value of CT combined with CEA or CA19-9 for detecting LNM in EGC. METHODS: This retrospective study included 120 patients with EGC confirmed by gastroscopic biopsy at our institution (Huai'an Hospital of Huai'an City) between February 2024 and August 2024. Based on postoperative pathological findings, participants were categorized into a LNM group ( = 60) and a non-metastasis group ( = 60). All patients underwent MDCT scanning and serum CEA and CA19-9 level measurements. The diagnostic efficacy of CT, CEA, and CA19-9 alone and in combination was evaluated using receiver operating characteristic (ROC) curve and Kappa consistency analysis. RESULTS: Serum analysis showed significantly elevated CEA and CA19-9 levels and higher positivity rates in the metastasis group ( < 0.0001). ROC analysis yielded area under the curves of 0.9443 (CEA) and 0.9292 (CA19-9), with Kappa values of 0.683 and 0.650, respectively. CT revealed significantly greater short-axis diameter, CT attenuation, blood volume, and permeability in metastatic nodes ( < 0.05), whereas blood flow and mean transit time showed no significant differences. CT alone demonstrated 85.00% sensitivity and 95.00% specificity (Kappa = 0.800). Combined diagnosis improved sensitivity to 91.67% (CT + CEA) and 90.00% (CT + CA19-9), with specificities of 90.00% and 88.33%, respectively. CONCLUSION: The combination of CT with CEA or CA19-9 improves sensitivity for detecting LNM in EGC, supporting personalized treatment planning and demonstrating clinical value.
Pioneering efficient deep learning architectures for enhanced hepatocellular carcinoma prediction and clinical translation.
Akbulut S, Colak C
World J Gastrointest Oncol · 2026 Feb · PMID 41695935 · Full text
BACKGROUND: Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality worldwide and is often diagnosed at advanced stages, reducing opportunities for curative treatment. Current screening tools, includi...
BACKGROUND: Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality worldwide and is often diagnosed at advanced stages, reducing opportunities for curative treatment. Current screening tools, including ultrasonography with or without alpha-fetoprotein, lack sufficient sensitivity for early detection. Deep learning (DL) has emerged as a transformative approach, capable of detecting subtle, high-dimensional patterns in ultrasonography, computed tomography, magnetic resonance imaging, histopathological whole-slide images, and electronic health records. Convolutional neural networks, recurrent neural networks, and Transformer-based models have achieved strong performance in classification, segmentation, and risk prediction tasks, with sensitivities and specificities frequently above 89% and 90%. In some applications, DL has matched or even exceeded expert interpretation. However, the high computational cost and limited feasibility in real-time, resource-constrained settings remain major barriers to adoption. AIM: To overcome these challenges, recent studies emphasize efficiency-oriented strategies. METHODS: Lightweight architectures such as MobileNet and EfficientNet, model compression through pruning and quantization, and data-efficient methods like self-supervised pretraining and targeted augmentation enable smaller and faster models without major loss of accuracy. Hybrid or pseudo-3D approaches that summarize volumetric information from sequential slices further reduce computational load, while multimodal fusion of imaging, clinical, and omics data extends applications beyond detection toward personalized prognostication and treatment guidance. These developments highlight that efficiency is essential for real-world deployment, not merely a technical refinement. Nonetheless, significant gaps remain. RESULTS: Most studies are retrospective, single-center, and limited in sample size, underscoring the need for rigorous external validation across multicenter cohorts and prospective trials assessing patient-relevant outcomes. Bias and fairness audits are critical to ensure equitable performance across demographic and etiological groups, while privacy-preserving strategies such as federated learning are required to harness diverse datasets securely. Seamless integration into hospital workflows, including Picture Archiving and Communication Systems and Electronic Medical Records using standards such as substitutable medical applications reusable technologies on fast healthcare interoperability resources, together with clear regulatory frameworks and post-market monitoring, will be essential for safe and scalable clinical translation. In conclusion, efficient and explainable DL offers a promising path to earlier detection and more personalized therapy in HCC. Achieving this potential will require not only technical innovation but also disciplined validation, thoughtful design for resource-limited contexts, and strong collaboration between clinicians, engineers, and regulators. CONCLUSION: This review synthesizes current advances, identifies persistent challenges, and provides guidance for developing efficient DL systems that are both clinically relevant and broadly deployable.
Application value of multiphase contrast-enhanced computed tomography radiomics in preoperative evaluation of peritoneal metastasis in gastric cancer.
Mu XD, Ji DX, Kang DQ
World J Gastrointest Oncol · 2026 Feb · PMID 41695934 · Full text
BACKGROUND: Peritoneal metastasis occurs in 10%-45% of gastric cancer patients and significantly impacts prognosis and treatment decisions. Traditional computed tomography (CT) imaging has limited sensitivity (60%-80%) f...
BACKGROUND: Peritoneal metastasis occurs in 10%-45% of gastric cancer patients and significantly impacts prognosis and treatment decisions. Traditional computed tomography (CT) imaging has limited sensitivity (60%-80%) for detecting early peritoneal metastases, while laparoscopic exploration is invasive. Multiphase contrast-enhanced CT radiomics offers a non-invasive approach to improve preoperative prediction, yet most existing studies rely on single-phase analysis without fully exploiting multiphase data advantages. AIM: To construct a preoperative prediction model for gastric cancer peritoneal metastasis based on multiphase contrast-enhanced CT radiomics, compare the diagnostic efficacy between multiphase combined and single-phase analysis, and evaluate its clinical application value. METHODS: A retrospective analysis was conducted on 200 pathologically confirmed gastric cancer patients from January 2020 to December 2024, all of whom underwent preoperative multiphase contrast-enhanced CT examination. Patients were randomly divided into training set ( = 140) and validation set ( = 60) at a 7:3 ratio. PyRadiomics was used to extract 3920 radiomics features from arterial phase, venous phase, and delayed phase images. Synthetic minority oversampling technique was applied to handle class imbalance. Feature selection was performed through -score standardization, univariate screening, collinearity testing, and least absolute shrinkage and selection operator regression. Single-phase and multiphase combined radiomics models were constructed using logistic regression, support vector machine, and random forest algorithms. Model performance was evaluated through receiver operating characteristic curves. RESULTS: The multiphase combined model achieved an area under the curve (AUC) of 0.876 (95% confidence interval: 0.783-0.941) in the validation set, with sensitivity of 81.0%, specificity of 84.6%, and accuracy of 83.3%, significantly superior to all single-phase models ( < 0.05). Among single-phase models, the venous phase model performed best (AUC = 0.834). Hosmer-Lemeshow test showed good model calibration ( = 0.765). Decision curve analysis demonstrated that at a threshold probability of 0.35, the multiphase combined model could avoid 33.7% of unnecessary exploratory surgeries. CONCLUSION: The multiphase combined model based on multiphase contrast-enhanced CT radiomics can effectively predict gastric cancer peritoneal metastasis, with diagnostic performance significantly superior to single-phase models, providing a new non-invasive technical approach for individualized preoperative assessment of gastric cancer patients.
Total neoadjuvant therapy in rectal cancer: Challenging traditions without compromising surgical safety.
Karmakar R, Kandalkar A, Mukundan A
World J Gastrointest Oncol · 2026 Feb · PMID 41695933 · Full text
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...
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 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 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.
Ethnic genomic diversity in esophageal squamous cell carcinoma.
Li WM, Jiao Y, Liu SQ … +2 more , Wang CX, He M
World J Gastrointest Oncol · 2026 Feb · PMID 41695932 · Full text
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 t...
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.
Frequency and characteristics of synchronous gastric cancers: Need for improved awareness and better detection.
Dutta AK, Rao NV, Bharadwaj PK … +1 more , Benny S
World J Gastrointest Oncol · 2026 Feb · PMID 41695931 · Full text
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 a...
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.
Radiomics-based model for predicting neoadjuvant therapy response in esophageal cancer: Limitations and suggestions.
Zhao ZX
World J Gastrointest Oncol · 2026 Feb · PMID 41695930 · Full text
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 reported a predictive model for NAT response in EC,...
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 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 , identifies its limitations, and puts forward in-depth suggestions to further optimize the model.
Metallic elements and their molecular roles in gastric cancer: Pathogenic mechanisms and therapeutic implications.
Jing LB, Liu J, Yang ZH … +3 more , Yang FF, Wang DG, Li YM
World J Gastrointest Oncol · 2026 Feb · PMID 41695929 · Full text
Gastric cancer (GC) remains among the leading causes of cancer-related mortality globally. Increasing evidence indicates that metallic elements such as iron, copper (Cu), zinc, and calcium (Ca) play crucial roles in GC p...
Gastric cancer (GC) remains among the leading causes of cancer-related mortality globally. Increasing evidence indicates that metallic elements such as iron, copper (Cu), zinc, and calcium (Ca) play crucial roles in GC pathogenesis, diagnosis, and treatment through diverse molecular mechanisms. This review systematically summarizes recent advances in the application of metallomics in GC. Relevant studies published up to 2024 were retrieved from PubMed, Web of Science, and Scopus using keywords including "gastric cancer", "metal ions", "metallomics", and "metal-based therapy". After screening and evaluation, representative studies elucidating the roles of metallic elements in GC were analyzed and synthesized. The findings revealed that iron overload induces oxidative stress and immune suppression the Fenton reaction. Further analysis indicated that Cu imbalance triggers mitochondrial dysfunction and cuproptosis, zinc deficiency disrupts transcriptional regulation through zinc finger proteins and metalloproteinases, and Ca dysregulation activates Ca/calmodulin-dependent protein kinase kinase- AMP-activated protein kinase signaling to promote proliferation and chemoresistance. Advances in analytical techniques such as laser ablation inductively coupled plasma mass spectrometry have enabled spatial mapping of metal distributions in tumors, providing novel diagnostic and prognostic insights. Moreover, metal-based anti-cancer drugs and combination regimens involving traditional Chinese medicines exhibit promising therapeutic potential. Understanding the molecular crosstalk of metal metabolism offers new perspectives for precision diagnosis and targeted treatment in GC.
Serum protein induced by vitamin K absence or antagonist-II predicts aggressive tumor biology in alpha-fetoprotein-normal hepatocellular carcinoma.
Abbas Z, Gazder DP, Hyder Z … +2 more , Qadeer MA, Abbas M
World J Gastrointest Oncol · 2026 Feb · PMID 41695928 · Full text
BACKGROUND: Patients with hepatocellular carcinoma (HCC) beyond the Milan criteria or with portal vein tumor thrombosis are often excluded from the transplant list owing to aggressive biology and recurrence risk. While h...
BACKGROUND: Patients with hepatocellular carcinoma (HCC) beyond the Milan criteria or with portal vein tumor thrombosis are often excluded from the transplant list owing to aggressive biology and recurrence risk. While high alpha-fetoprotein (AFP) signals aggressiveness, the behavior of normal AFP HCC with elevated protein induced by vitamin K absence/antagonist-II (PIVKA-II) is less defined. AIM: To assess the prognostic value of PIVKA-II in normal AFP HCC. METHODS: Retrospective cohort of 113 patients with normal AFP and normal or elevated PIVKA-II. "Aggressive" tumors were defined as beyond Milan and/or portal vein tumor thrombosis ( = 63); others were non-aggressive ( = 50). Receiver operating characteristic curve analysis identified PIVKA-II cut-offs. RESULTS: This study included 78 men and 35 women; mean age 58.4 ± 11.1 years; 62.8% with decompensated cirrhosis. PIVKA-II was higher in aggressive tumors: Median 2785 mAU/mL (interquartile range: 222-8152) 239 mAU/mL (interquartile range: 55-727), < 0.001. Area under receiver operating characteristic curve 0.756 (95% confidence interval: 0.669-0.844). The Youden-optimized cut-off for aggressive HCC was 1609.5 mAU/mL [sensitivity: 0.54, specificity: 0.94; positive predictive value (PPV): 0.919]. A sensitivity-oriented cut-off of 400 mAU/mL gave sensitivity 0.69 and specificity 0.64 (PPV: 0.71). Regression analysis showed that PIVKA-II > 400 mAU/mL was strongly associated with aggressive tumor phenotype (adjusted odds ratio = 5.16, = 0.001). All the 29 patients with ≥ 4000 mAU/mL were in the aggressive group (PPV: 1.0). All thresholds were dataset-derived. CONCLUSION: In normal AFP HCC, PIVKA-II discriminates aggressive biology. A cut-off of 1609.5 mAU/mL balances sensitivity and specificity; 400 mAU/mL favors sensitivity; ≥ 4000 mAU/mL delineates an ultra-high-risk subgroup. Findings support the incorporation of PIVKA-II into risk stratification.
Role of microRNA-136 in -induced early-stage gastric cancer: Mechanistic insights and future directions.
Chen YX, Zhang YH, Mo SJ
World J Gastrointest Oncol · 2026 Feb · PMID 41695927 · Full text
This commentary critically appraises Chen , who delineate the nuclear factor kappa B (NF-κB)-microRNA-136 (miR-136)-programmed cell death protein 11 (PDCD11) axis in ()-associated gastric carcinogenesis and propose indu...
This commentary critically appraises Chen , who delineate the nuclear factor kappa B (NF-κB)-microRNA-136 (miR-136)-programmed cell death protein 11 (PDCD11) axis in ()-associated gastric carcinogenesis and propose 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, assays, and models - which collectively support a model in which 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 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, 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 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 -associated GC.
Solitary esophageal metastasis ten years after curative resection of stage I rectal adenocarcinoma: A case report.
Zhang Y, Li ZX, Ma DY … +1 more , Liu F
World J Gastrointest Oncol · 2026 Feb · PMID 41695926 · Full text
BACKGROUND: We report an exceptionally rare case of a solitary esophageal metastasis occurring in the tenth year after curative resection of stage I (pT2N0M0) rectal adenocarcinoma. This represents one of the longest rep...
BACKGROUND: We report an exceptionally rare case of a solitary esophageal metastasis occurring in the tenth year after curative resection of stage I (pT2N0M0) rectal adenocarcinoma. This represents one of the longest reported intervals to esophageal metastasis from colorectal cancer, challenging the conventional understanding of metastatic potential of early-stage tumors. CASE SUMMARY: A 42-year-old male underwent curative resection for rectal adenocarcinoma (pT2N0M0, stage I) in 2015. Ten years later (2025), he presented with progressive dysphagia. Imaging and endoscopy revealed a mid-esophageal tumor with mediastinal lymphadenopathy. Initial biopsy suggested primary esophageal adenocarcinoma. After two cycles of neoadjuvant immunochemotherapy, dysphagia worsened. However, a multidisciplinary team re-evaluation, utilizing comparative immunohistochemistry for the esophageal lesions and rectal specimens, confirmed the diagnosis as a solitary esophageal metastasis from rectal adenocarcinoma ( wild-type). The patient received involved-field radiotherapy with concurrent systemic therapy (capecitabine, oxaliplatin and cetuximab). Dysphagia significantly improved one week after radiotherapy initiation. Three-month follow-up imaging after radiotherapy demonstrated a partial response. The patient was on cetuximab maintenance. CONCLUSION: This case underscores the risk of early tumor recurrence or metastasis beyond standard follow-up windows thus long-term follow-up is necessary.
Taurine suppresses gastric intestinal metaplasia in patient-derived organoids and mice.
Liu K, Zhang X, Li FZ … +2 more , Zheng PY, Mi Y
World J Gastrointest Oncol · 2026 Feb · PMID 41695925 · Full text
BACKGROUND: 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...
BACKGROUND: 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. AIM: To investigate the therapeutic effects of taurine on GIM using patient-derived organoids and mouse models. METHODS: Patient-derived GIM organoids ( = 3) and mice, which spontaneously develop GIM, were used as experimental models. Morphological changes were assessed Alcian blue-periodic acid Schiff staining. The expression levels of the gastric epithelial marker mucin 5AC () and GIM-associated markers (caudal type homeobox 2 [], , Trefoil factor family 3 []) were quantified quantitative PCR, Western blotting, and immunohistochemistry. RESULTS: We confirmed that taurine treatment significantly attenuated pathological changes, including glandular hypertrophy and vacuolar dilation, in mice. It also reduced GIM severity compared with that in the untreated model group. Under taurine treatment, expression was significantly increased, whereas the intestinal-specific markers , , and were reduced ( < 0.05). In parallel, in patient-derived GIM organoids, taurine treatment significantly ameliorated GIM features, as evidenced by increased expression and decreased , , and expression. CONCLUSION: This study highlights the potential application of taurine as a therapeutic agent for treating GIM, offering a promising strategy for its clinical management.
Shifting paradigm in locally advanced resectable gastric and gastroesophageal junction cancers.
Ismaili N
World J Gastrointest Oncol · 2026 Feb · PMID 41695924 · Full text
Gastric cancer (GC) is the fifth most common cancer and the fifth leading cause of cancer-related mortality worldwide. The management of resectable locally advanced GC evolved with the introduction of adjuvant chemoradio...
Gastric cancer (GC) is the fifth most common cancer and the fifth leading cause of cancer-related mortality worldwide. The management of resectable locally advanced GC evolved with the introduction of adjuvant chemoradiotherapy in some regions, notably following the INT-0116 trial. A subsequent major advance was perioperative chemotherapy with epirubicin, cisplatin, and fluorouracil, which significantly improved 5-year overall survival compared to surgery alone. More recently, the fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) regimen demonstrated superior outcomes compared to epirubicin, cisplatin, and fluorouracil. Despite this advancement, nearly half of all patients (46%) experience disease recurrence within three years, underscoring a significant unmet need. In a recent real-world study by Wang , which assessed perioperative sintilimab plus oxaliplatin and S-1 chemotherapy chemotherapy alone in non-metastatic GC, the authors reported significantly improved pathological response rates and overall survival with the combination. Additionally, the safety profile showed a lower frequency of high-grade adverse events. However, this study has limitations, including its retrospective design and the use of a chemotherapy backbone (oxaliplatin and S-1) considered less effective than FLOT based on phase III evidence. Recent data from the phase III MATTERHORN trial support the addition of durvalumab to FLOT, showing significant improvements in pathological complete response and event-free survival. Based on the cumulative evidence, adding immunotherapy to perioperative chemotherapy improves outcomes for patients with resected GC and may constitute a new standard of care once confirmatory data mature and regulatory approvals are granted.
Does anesthesia choice shape oncologic destiny in gastric cancer surgery?
Arun O, Arun F
World J Gastrointest Oncol · 2026 Feb · PMID 41695923 · Full text
Anesthetic management in gastric cancer surgery has progressed from a technical necessity to a potential influencer of perioperative immune function and long-term oncologic outcomes. The perioperative period-marked by in...
Anesthetic management in gastric cancer surgery has progressed from a technical necessity to a potential influencer of perioperative immune function and long-term oncologic outcomes. The perioperative period-marked by inflammation, stress responses, and immunosuppression-is increasingly seen as critical to cancer recurrence risk. This has prompted investigations into whether anesthetic agents could shape oncologic trajectories. The recent study by Wang contributes valuable data by comparing sevoflurane inhalation anesthesia and propofol-based total intravenous anesthesia in patients undergoing radical gastrectomy. While no significant differences were observed in survival outcomes, subtle variations in post-operative nausea and intraoperative hemodynamics raise important considerations about anesthetic-specific physiologic effects. This editorial reflects on these findings in the broader context of ongoing efforts to individualize perioperative care in oncology. It also underscores the need for future prospective studies integrating immune, molecular, and clinical endpoints to determine whether anesthetic techniques can play a meaningful role in long-term cancer control. As the field advances, anesthesia should no longer be viewed as a neutral backdrop but as a modifiable component of comprehensive cancer care. Determining when, how, and for whom an anesthetic technique matters remains an open but essential question.
Endoscopic laparoscopic resection for gastric gastrointestinal stromal tumors: Oncological outcomes.
Huang L, Li JT, Zhou WJ … +1 more , Wu QF
World J Gastrointest Oncol · 2026 Feb · PMID 41695922 · Full text
BACKGROUND: 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 resec...
BACKGROUND: 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. AIM: To systematically compare the perioperative outcomes and mid-term oncological efficacy of endoscopic laparoscopic resection for LGISTs, and provide an evidence-based reference for clinical surgical approach selection. METHODS: 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. RESULTS: After matching, the baseline data of the two groups were comparable ( > 0.05). The endoscopic group was superior to the laparoscopic group in terms of operation time [80 minutes (65-100 minutes) 95 minutes (80-120 minutes), = 0.002], intraoperative blood loss [25 mL (15-35 mL) 55 mL (40-90 mL), < 0.001], and postoperative hospital stay [5 days (4-7 days) 7 days (6-9 days), < 0.001]. There were no significant differences in the rates of R0 resection (95.6% 97.8%, = 0.617), intraoperative tumor rupture (2.2% 4.4%, = 1.000), and 30-day postoperative complications (11.1% 22.2%, = 0.152) between the two groups. With a median follow-up of 32 months, the 3-year RFS (93.3% 91.1%, = 0.695) and 3-year OS (97.8% 95.6%, = 1.000) rates were comparable between the two groups. Multivariate analysis showed that tumor size (HR = 1.38, = 0.002), mitotic count (HR = 1.18, = 0.010), and National Institutes of Health risk stratification (intermediate risk low risk: HR = 5.12, = 0.001) were independent risk factors for RFS, while surgical approach was not an independent prognostic factor ( = 0.558). CONCLUSION: 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 time, less blood loss, and faster postoperative recovery. It can therefore be a minimally invasive treatment option for eligible patients, with surgical decision-making based on tumor characteristics and multidisciplinary assessments.
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