Background: Endoscopic resection has become a standard curative treatment for superficial esophageal cancer. However, limited data are available regarding long-term outcomes and causes of death after curative endoscopic treatment, particularly deaths unrelated to the primary esophageal cancer. This study aimed to clarify post-treatment prognosis and to identify factors associated with mortality in patients with superficial esophageal cancer who underwent curative endoscopic resection. Methods: We conducted a multicenter cohort study in Japan to evaluate survival outcomes, causes of death, and prognostic factors in patients with superficial esophageal cancer who achieved curative resection by endoscopic treatment. Patients were stratified according to endoscopic treatment indication categories (absolute, relative, and beyond indication). Five-year overall survival and disease-specific survival were analyzed, along with risk factors for all-cause and cause-specific mortality. Results: No disease-specific deaths were observed in patients with absolute or relative indication lesions, whereas the disease-specific 5-year survival rate was 81% in patients with beyond-indication lesions. When overall mortality, including deaths from other diseases and other malignancies, was evaluated, the 5-year survival rates were 92% for absolute indication cases, 85% for relative indication cases, and 69% for beyond-indication cases. Multivariate analysis identified low body mass index (BMI) and advanced age as independent risk factors for mortality. Notably, low BMI was significantly associated with non-cancer-related death. Conclusions: Even among patients who achieve curative endoscopic treatment for superficial esophageal cancer, long-term survival is limited by deaths from other malignancies and non-cancer-related causes. Low BMI represents a clinically important prognostic factor, underscoring the need for comprehensive post-treatment surveillance and supportive care beyond cancer control.
The optimal timing of immune checkpoint inhibitor (ICI) initiation in advanced gastric cancer (GC) remains unclear. In this study, we evaluated the association between ICI initiation timing, tumor response, and survival outcomes in a real-world setting for GC. We conducted a multicenter retrospective study of patients with unresectable or recurrent GC who initiated first-line chemotherapy between January 2015 and September 2025. To adjust for immortal time bias, a clone-censor-weight (CCW) approach was applied to evaluate overall survival (OS) among the patients who received ICIs. Tumor response was assessed in patients treated with first-line S-1 plus oxaliplatin (SOX) or capecitabine plus oxaliplatin (CapeOX), with logistic regression analysis performed to identify factors associated with response. A total of 359 GC patients were included, of whom 219 received ICIs and were included in the CCW analysis. The ICI initiation timing was not significantly associated with OS (hazard ratio 1.03, 95
BACKGROUND:Convulsive status epilepticus (CSE) is a type of severe seizure associated with significant neurological sequelae. However, the extent to which CSE causes novel-onset neurological disorders in children remains unclear. This retrospective study aimed to assess long-term neurological outcomes after pediatric CSE, determine the incidence ratios of new-onset neurological conditions, and identify prognostic factors. METHODS:This study enrolled patients with CSE onset between 2006 and 2009 in any of nine hospitals in Tottori Prefecture, Japan, that potentially treated the condition in this area. We collected clinical data from the medical records, analyzed the incidence ratios of CSE, etiologies, and incidences of new-onset neurological diseases/conditions after CSE, and statistically analyzed the prognostic factors. RESULTS:A total of 140 pediatric patients developed new-onset CSE during the study period. The study found an CSE incidence ratio of 43.4 per 100,000 child-years. Febrile CSE was the most common cause. The incidence rates of new-onset neurological diseases/conditions after CSE were 8.6 per 100,000 child-years for epilepsy, 3.4 for intellectual disabilities, 2.8 for motor disabilities and 1.2 for acute mortality per 100,000 child-years. Multivariate analyses revealed that a history of afebrile seizures (p = 0.014), pre-existing structural brain abnormalities (p < 0.001) and acute symptomatic etiology (p = 0.032) were risk factors for new-onset intellectual disability, whereas pre-existing developmental/intellectual delay (p < 0.001) was risk factors for new-onset epilepsy. CONCLUSIONS:In this study, we determined the incidence of new-onset neurological problems due to CSE in children. These results may help to enhance the efficacy of CSE management strategies and improve prognosis.
The clinical value of the C-reactive protein–albumin–lymphocyte (CALLY) index, an inflammation- and nutrition-based biomarker, in unresectable or recurrent gastric cancer (URGC) remains unclear. This study evaluated its prognostic significance in patients receiving first-line fluoropyrimidine-based chemotherapy. This multicenter retrospective study included 201 URGC patients treated with fluoropyrimidine-based combination chemotherapy between 2017 and 2023. Patients with HER2-positive tumors, monotherapy, or non-fluoropyrimidine regimens were excluded from the analysis. The CALLY index was calculated using pretreatment laboratory values, and the optimal cutoff was calculated by receiver operating characteristic (ROC) analysis. We compared the survival outcomes and clinical characteristics between the high- and low-CALLY groups. The optimal CALLY index cutoff was 1.7, indicating the highest prognostic performance. The low-CALLY group had higher rates of unresectable primary tumors and Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥ 1. Despite a comparable incidence of grade ≥ 3 adverse events, third-line therapy was administered more frequently in the high-CALLY group. Median overall survival was significantly shorter in the low-CALLY group (11.4 vs. 20.5 months, respectively; p < 0.001). On multivariate analysis, a low CALLY index (hazard ratio [HR] 1.591, p = 0.004), ECOG PS ≥ 1 (HR 1.648, p = 0.002), and peritoneal dissemination (HR 1.530, p = 0.042) were independent predictors of poor survival. The CALLY index is a strong independent prognostic biomarker for URGC patients treated with first-line fluoropyrimidine–based chemotherapy. It reflects tumor-induced inflammation and host immune–nutritional status, providing a simple, objective tool for pretreatment risk stratification.
BACKGROUND/AIM:Remnant gastric cancer (RGC) after distal gastrectomy (DG) is a rare entity, and its prognostic determinants have not been fully clarified. Although current staging systems and treatment strategies for gastric cancer are well established, they are largely based on the primary disease, and their applicability to RGC remains uncertain. This study aimed to evaluate the clinicopathological characteristics and survival outcomes of patients with RGC after DG, focusing on tumor depth and lymph node status. PATIENTS AND METHODS:This multicenter retrospective study evaluated patients who underwent curative resection for RGC arising in the upper stomach after DG at 10 institutions in Japan between January 2000 and December 2016. Clinicopathological factors, such as tumor depth and lymph node status, recurrence patterns, and overall survival (OS) were analyzed. RESULTS:A total of 119 patients were included in the analysis. The 5-year OS rates for pathological stages I, II, and III were 77.5%, 52.9%, and 26.7%, respectively. On multivariate analysis, tumor invasion depth of T3 or deeper was an independent predictor of poor OS, while lymph node metastasis was not. Regarding T3 disease, patients with T3N0 tumors tended to have poorer survival than those with nodal metastasis. Hematogenous recurrence was more frequent in the T3N0 group, and none of the patients in that group received adjuvant chemotherapy. CONCLUSION:Tumor invasion depth was the most significant prognostic factor for RGC after DG. Patients with T3N0 RGC may represent a distinct subgroup with unfavorable outcomes, warranting further investigation into postoperative treatment strategies.
