Pancreatic surgery is an essential treatment for resectable pancreatic ductal adenocarcinoma (PDAC). However, perioperative morbidity and mortality are higher, and postoperative hospital stays are longer, than those for other gastrointestinal malignancies. Meanwhile, the quality of the perioperative surgical course affects both short- and long-term oncological outcomes in various malignancies.Recently, the concepts of textbook outcome (TO) and textbook oncological outcome (TOO) have been developed to evaluate the quality of perioperative surgical care. TO and TOO incorporate multiple perioperative elements and have been applied across various malignancies. In PDAC surgery, TO was defined in 2020 and consists of six short-term surgical outcomes: absence of postoperative pancreatic fistula, bile leak, post-pancreatectomy hemorrhage, severe complications (Clavien-Dindo grade ≥III), readmission, and in-hospital mortality.Previous studies have demonstrated that achieving TO or TOO is associated with improved survival after pancreatic surgery for PDAC. To optimize pancreatic surgery for resectable PDAC, it is essential to understand the characteristics and limitations of existing studies conducted prior to the widespread adoption of TO and TOO. This review summarizes the background, current status, and future perspectives of TO and TOO in pancreatic surgery.

Background/Aim: We evaluated the clinical impact of textbook outcome (TO) in patients with stage I gastric cancer (GC) who underwent minimally invasive surgery (MIS). Moreover, we identified the risk factors associated with achieving TO in these patients. Patients and Methods: Patients were selected from the database of the Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital between 2005 and 2025. Our definition of TO comprised 10 items: complete (potentially curative) resection, R0 resection, retrieval of more than 16 lymph nodes, no intraoperative complications, no severe postoperative complications (Clavien-Dindo grade III or higher), no reintervention after surgery, no unplanned ICU/HCU admission, no readmission within 30 days after discharge, no prolonged hospital stay (defined as more than 21 days after surgery), and no mortality within 30 days after surgery. Results: We analyzed 889 patients who underwent MIS and were pathologically diagnosed with stage I GC. Among them, 621 patients (69.8%) achieved TO, whereas 268 patients (30.2%) did not. The most frequent reason for failure to achieve TO was prolonged hospital stay (>21 days after surgery) (17.5%), followed by postoperative surgical complications (15.4%). In the multivariate analysis, age [odds ratio (OR)=1.619), BMI (OR=1.849), and type of gastrectomy (OR=1.674) were identified as independent risk factors for failure to achieve TO. The 5-year overall survival (OS) rate was 97.5% in patients who achieved TO and 94.7% in those who did not, showing a significant difference between the two groups (p=0.041). Conclusion: The TO achievement rate was approximately 70%, and failure to achieve TO was associated with age, preoperative BMI, and type of gastrectomy. Achievement of TO was associated not only with favorable short-term outcomes but also with improved long-term oncological outcomes.

Background/Aim: The incidence of positive microscopic margins after gastrectomy for gastric cancer (GC) has been reported between 1% to 5% . The aim of the present study was to identify risk factors associated with positive microscopic resection margin in GC patients undergoing gastrectomy, and to assess the survival outcomes and prognostic factors in these patients. Patients and Methods: The patients were selected from the consecutive database of Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Department of Gastric Surgery, according to the following criteria: (i) histologically proven gastric adenocarcinoma (ii) patients who underwent curative gastrectomy for gastric cancer as a primary treatment and archived R0 or R1 resection between 2005 and 2025. Positive microscopic resection margin was defined as disease present at the line of luminal transaction in mucosa, submucosa, or serosa on final pathology. Univariate and multivariate logistic regression analyses were performed to identify risk factors for resection margin positivity. Results: A total of 1,996 patients were eligible for the present study. Among these patients, 35 patients (1.8%) had positive microscopic resection margin. Pathological type, macroscopic tumor type, and tumor size were identified as independent risk factors for positive resection margin in multivariate analysis. Moreover, positive peritoneal lavage cytology was identified as an independent predictor of poor overall survival prognostic factor in margin-positive GC patients. Conclusion: Microscopic resection margin positivity after gastrectomy for GC was linked to specific tumor characteristics, while positive peritoneal lavage cytology independently predicted poorer survival. To minimize the occurrence of resection margin-positive GC after gastrectomy, it is essential to identify risk factors during perioperative evaluation. Furthermore, treatment strategies based on lavage cytology status could improve prognosis in high-risk patients.

Background/Aim: This study aimed to clarify the prognostic and predictive factors of patients with gastric cancer (GC) who are peritoneal lavage cytology positive and negative for other distant metastasis. Patients and Methods: Consecutive patients were selected from the database of Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Department of Gastric Surgery, Tokyo, Japan, according to the following criteria: i) histologically-proven gastric adenocarcinoma; ii) patients who underwent macroscopically curative gastrectomy for gastric cancer as a primary treatment; and iii) a diagnosis of peritoneal washing cytology positive (CY1) disease with no distant metastasis between 2005 and 2025. Results: A total of 89 patients were eligible for the present study. One-, three- and five-years overall survival (OS) rates of the whole cohort were 68.6%, 41.2%, and 21.3%. Medina survival time was 22.2 months (range=11.3-33.1 months). In the prognostic analysis for OS in the CY positive patients with GC who were negative for other distant metastasis, postoperative chemotherapy status was one of the independent prognostic factors [hazard ratio (HR)=2.228, 95% confidence interval (CI)=1.330-3.734]. One-, three- and five-years OS rates of the patients with postoperative adjuvant chemotherapy were 81.1%, 46.3%, and 33.9%, while that of patients without postoperative chemotherapy were 47.6%, 32.9%, and 4.7% (p=0.001). In addition, the prognostic analysis for OS in the CY positive patients GC who were negative for other distant metastasis and received postoperative chemotherapy, lymph node metastasis status was an independent significant prognostic factor in multivariate analysis (HR=6.312, 95% CI=1.476-26.996, p=0.013). Conclusion: Postoperative chemotherapy improved the survival of CY positive patients with GC who were negative for other distant metastasis. In addition, lymph node metastasis status was an independent prognostic factor for CY positive patients with GC who were negative for other distant metastasis and received postoperative chemotherapy.

BACKGROUND/AIM:This study investigated whether postoperative complications (POCs) have a direct negative impact on survival or indirectly worsen survival outcomes by impairing the administration of adjuvant chemotherapy in patients with stage II/III gastric cancer (GC). PATIENTS AND METHODS:Patients were retrospectively selected from the database of the Department of Gastric Surgery at the Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital (Tokyo, Japan). POCs were defined as postoperative complications of Clavien-Dindo grade II-V. Patients were categorized into two groups: those with POCs (C group) and those without POCs (NC group). RESULTS:A total of 465 patients were included in this study, and POCs occurred in 134 patients (28.8%). The 3- and 5-year overall survival (OS) rates were 71.0% and 59.5% in the C group, and 77.7% and 71.2% in the NC group, respectively. The differences between the two groups were statistically significant (p=0.009). Multivariate analysis identified POCs as an independent prognostic factor for OS [hazard ratio (HR)=1.711; 95% confidence interval (CI)=1.182-2.476; p=0.004]. Regarding the postoperative course of adjuvant therapy, significant differences were observed between the C and NC groups in the rate of initiation of adjuvant chemotherapy (62.0% vs. 72.8%, p=0.021) and in the time to initiation after surgery (64 days vs. 48 days, p<0.001). CONCLUSION:POCs were associated with poorer survival and adversely affected the administration of adjuvant chemotherapy after gastric cancer surgery. These findings suggest that POCs not only have a direct negative impact on survival but also indirectly worsen prognosis by compromising the delivery of postoperative adjuvant chemotherapy.

BACKGROUND/AIM:This study aimed to evaluate the preventive effect of anti-adhesive materials (AAMs) on the incidence of small bowel obstruction (SBO) and to investigate the risk factors for SBO within five years after gastrectomy for gastric cancer. PATIENTS AND METHODS:This multicenter cohort study included 2,077 patients with gastric cancer who underwent total gastrectomy (TG) or distal gastrectomy (DG). Patients were followed for five years after surgery. Clinical characteristics associated with AAM use and risk factors for postoperative SBO were analyzed. RESULTS:Among the included patients, 959 received AAMs and 1,118 did not. Intraoperative blood loss and operative time were greater in the AAM group. Open surgery and drain placement were more frequently performed in the AAM group. SBO occurred in 4.8% of patients in the AAM group and 4.7% in the non-AAM group. A higher incidence of postoperative intra-abdominal abscess was observed in the AAM group than in the non-AAM group (6.6% vs. 3.7%, p=0.003). Multivariate analysis identified TG [odds ratio (OR)=1.81, p=0.004], postoperative ileus (OR=2.61, p=0.043), and reoperation (OR=4.88, p<0.001) as independent risk factors for SBO within five years after gastrectomy. CONCLUSION:The use of AAMs did not demonstrate a significant preventive effect on postoperative SBO after radical gastrectomy for gastric cancer and may be associated with an increased risk of postoperative intra-abdominal abscess.

Tissue factor (TF), a key initiator of the coagulation cascade, is frequently overexpressed in pancreatic cancer and linked to tumor progression and thrombosis. While TF has been recognized as a prognostic biomarker, its clinical relevance in surgically treated patients remains unclear. We retrospectively analyzed TF expression in resected pancreatic cancer specimens from 265 patients, including those with and without preoperative therapy, using immunohistochemistry. Tissue factor expression was semiquantitatively classified as negative, low, or high. Associations with clinicopathological features, treatment response, and survival were evaluated. High TF expression was observed in 17.4

BACKGROUND/AIM:Remnant gastric cancer (RGC) is technically difficult for surgery due to adhesion of remnant stomach to surrounding organs. To optimize RGC treatment, it is necessary to clarify the clinical features and prognostic factors of RGC. Therefore, we aimed to clarify the clinical features and prognostic factors of RGC. PATIENTS AND METHODS:The patients were selected from the consecutive database of the Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Department of Gastric Surgery, according to the following criteria: (i) histologically-proven gastric adenocarcinoma, (ii) patients who underwent curative gastrectomy for gastric cancer as a primary treatment and archived R0 resection between 2005 and 2025. RGC is defined as GC develops at the remnant stomach after gastrectomy for benign or malignant disease. RESULTS:A total of 2,013 patients were eligible for the present study. In the present study, 45 patients were categorized as the RGC group, and 1,968 patients were in the non-RGC group. When comparing the patient background between RGC group and non-RGC group, significant differences were observed in median age (72 years vs. 69 years, p=0.042), preoperative body mass index (BMI) (21.3 vs. 22.5, p=0.004), and clinical lymph node metastasis (11.1% vs. 29.4%, p=0.007). Three- and five-year OS were 83.4% and 78.5% in RGC group, 85.3% and 81.0% in non-RGC group, respectively. No significant differences were found (p=0.529). In the prognostic analysis of RGC, lymphatic invasion was an independent prognostic factors for OS [hazard ratio (HR)=10.245, 95% confidence interval (CI)=1.150-91.281, p=0.037]. CONCLUSION:Although there are surgical, perioperative diagnosis, and tumor evaluation difficulties in RGC treatment, the survival of RGC patients was almost similar to non-RGC patients. RGC patients with lymphatic invasion were poorer than those without lymphatic invasion.

BACKGROUND/AIM:The albumin-bilirubin (ALBI) score, which evaluates pretreatment liver function, has been reported as a prognostic factor in several malignancies. We conducted a retrospective study to clarify the prognostic impact of the ALBI score in patients with recurrent esophageal cancer. PATIENTS AND METHODS:We retrospectively reviewed the medical records and data of consecutive patients with recurrent esophageal cancer who received treatment, including best supportive care, at Yokohama City University from 2005 to 2022. The primary endpoint of the present study was overall survival (OS) after recurrence. The secondary endpoint was the association between the ALBI score and the treatment course after recurrence. RESULTS:Ninety patients were eligible for the present study. The median overall survival was 10.4 months (95% confidence interval=4.9-15.8 months). Based on previous studies and exploratory analyses of 1- and 3-year OS, the ALBI score cut-off was set at -2.80. The 90 patients were divided into the ALBI-low (ALBI score <-2.80, n=29) and ALBI-high (ALBI score ≥-2.80, n=61) groups. The 1- and 3-year OS rates were 70.9% and 40.8% in the ALBI-low group and 35.5% and 13.7% in the ALBI-high group, respectively (p=0.007). In the multivariate analysis, the ALBI score was an independent prognostic factor for OS (hazard ratio=2.046, 95% confidence interval=1.164-3.594, p=0.013). The first-line treatment rate tended to be higher in the ALBI-low group than in the ALBI-high group [89.7% (26/29) vs. 73.8% (45/61), p=0.084]. CONCLUSION:The ALBI score may be a promising prognostic factor for patients with recurrent esophageal cancer.

BACKGROUND/AIM:This study retrospectively evaluated the clinical impact of perioperative antiplatelet and/or anticoagulation therapy (hereafter: antiplatelet/anticoagulation therapy) in more than 2,000 patients with gastric cancer (GC) who underwent gastrectomy. PATIENTS AND METHODS:Patients were selected from the consecutive database of Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Department of Gastric Surgery, between 2005 and 2025. Grade 2-5 postoperative complications (according to the Clavien-Dindo classification) were retrospectively determined from the patients' records. RESULTS:We analyzed 2,023 patients who underwent gastrectomy for GC. Among the 2,023 patients, 229 (11.3%) received antiplatelet and/or anticoagulation therapy. The rates of postoperative surgical complications and postoperative bleeding were significantly higher in the antiplatelet/anticoagulation therapy group than in the non-antiplatelet/anticoagulation therapy group (34.1% vs. 21.7%, p<0.001) (1.7% vs. 0.5%, p=0.026). Risk factors for postoperative surgical complications and bleeding were analyzed based on perioperative factors using logistic regression analysis. Preoperative antiplatelet/anticoagulation therapy was identified as a significant independent risk factor for postoperative surgical complications [odds ratio (OR)=1.651; p=0.002) and postoperative bleeding in both univariate and multivariate analyses (OR=3.328; p=0.049). CONCLUSION:Patients with gastric cancer treated with perioperative antiplatelet and/or anticoagulation treatment require careful attention for postoperative surgical complications, including postoperative bleeding after gastrectomy.

BACKGROUND/AIM:The albumin-to-globulin ratio (AGR) is a promising biomarker reflecting both the nutritional and inflammatory status in patients with gastrointestinal malignancies. However, the clinical significance of AGR in patients with recurrent esophageal cancer (EC) remains unclear. The aim of the present study was to evaluate the prognostic and predictive impact of AGR in patients with recurrent EC after esophagectomy. PATIENTS AND METHODS:We retrospectively reviewed data for 91 patients with recurrent EC who received any treatment, including best supportive care, after recurrence at Yokohama City University between 2005 and 2022. The cut-off value of AGR was set at 1.4 based on previous studies and survival outcomes. Overall survival (OS) and treatment responses were compared between the AGR-low (<1.4) and AGR-high (≥1.4) groups. RESULTS:Fifty-three patients were categorized into the AGR-low group and 38 into the AGR-high group. The 1-, 3-, and 5-year OS rates were 28.6%, 12.8% and 12.8%, and 80.3%, 42.0% and 36.7%, respectively. In multivariate analysis, age ≥75 years [hazard ratio (HR)=1.808, 95% confidence interval (CI)=1.028-3.179, p=0.040] and low AGR (HR=3.573, 95% CI=2.043-6.249, p<0.001) were identified as independent prognostic factors for poorer OS. The initiation rate of first-line chemotherapy was significantly lower in the AGR-low group than in the AGR-high group (62.2% vs. 89.5%, p=0.004). Furthermore, treatment response was significantly poorer for the AGR-low group, and low AGR was an independent predictive factor for poor treatment response (odds ratio=2.990, 95% CI=1.055-8.479, p=0.039). CONCLUSION:AGR was an independent prognostic and predictive biomarker in patients with recurrent EC. AGR may serve as a simple and clinically useful biomarker for predicting prognosis and guiding treatment strategies in patients with recurrent EC.

Esophagectomy is an essential treatment for resectable esophageal cancer. However, perioperative morbidity and mortality are higher and postoperative hospital stay is longer than other gastrointestinal malignancies. However, quality of perioperative surgical course affects both short- and long-term oncological outcomes in various malignancies. Recently, textbook outcome (TO)/textbook oncological outcome (TOO) are developed to evaluate quality of perioperative surgical course. TO/TOO included various perioperative elements and introduced in various malignancies. In esophageal cancer surgery, in 2017, TO for esophageal cancer (EC) defined and included 10 short-term surgical outcomes (curative resection, no intraoperative complications, R0 resection, number of harvest lymph node, no sever postoperative complication, no reintervention, no readmission intensive care unit, no readmission, no prolonged hospital stay, and no mortality). In 2021, TO for EC redefinition was made and included nine revised short-term surgical parameters. Previous studies demonstrated that achieved TO associated with better survival after esophagectomy for EC. To optimize esophagectomy for EC, it is necessary to understand the characteristics of each study before the widespread implementation of TO in clinical practice. This review summarizes the background, current status, and future perspectives of TO for resectable EC.

Pancreatic cancer is the seventh leading cause of cancer-related death worldwide. Surgical resection, such as pancreatoduodenectomy or distal pancreatectomy, is the standard curative treatment for resectable pancreatic cancer. So far, several studies suggested that management of micro metastasis is one of the approaches to improve pancreatic cancer patients. The use of chemotherapy or chemo radiation therapy during perioperative periods is most promising adjuvant treatment. To introduce the adjuvant treatment during perioperative periods for pancreatic cancer, it is necessary to establish the optimal methods, regimen, and timing of adjuvant treatment. To date, many randomized trials have been conducted to examine the efficacy of adjuvant therapies. Since 2000, different evidence has emerged for postoperative adjuvant chemoradiation, postoperative adjuvant chemotherapy, and perioperative adjuvant chemotherapy for resectable pancreatic cancer. This review summarizes the background, current status, and future perspectives of adjuvant therapy for resectable pancreatic cancer.

Trastuzumab deruxtecan (T-DXd) has been approved for the treatment of human epidermal growth factor receptor-2 (HER2)-positive gastric cancer and other indications in several countries and is considered moderately or highly emetogenic. The management of nausea and vomiting associated with T-DXd treatment has not been fully evaluated and the effectiveness of conventional prophylaxis remains unknown. This open-label, randomized, multicenter, phase 2 study aimed to investigate the optimal antiemetic therapy for Japanese patients with gastric cancer undergoing T-DXd treatment. Patients were randomized to a doublet regimen group (dexamethasone and palonosetron) or triplet regimen group (aprepitant, dexamethasone, and palonosetron) at a ratio of one to one, stratified by sex, gastrectomy status, and study institution. Both antiemetic treatments were administered from day 1 before T-DXd administration, and emetic events and nausea were observed for 21 days. The primary endpoint was the antiemetic complete response (CR) rate to assess control for emetic events based on voluntary patient-reported outcomes (PROs) during cycle 1 (1–21 days). Of the 60 enrolled patients, 58 were eligible for inclusion in this analysis (29 patients in each regimen group). The overall CR rates for the doublet and triplet regimens were 41.4

BACKGROUND/AIM:We retrospectively evaluated the clinical impact of anemia during the perioperative period on both short- and long-term oncological outcomes in patients with resectable esophageal cancer who received curative treatment. PATIENTS AND METHODS:We retrospectively reviewed the medical records and collected data from consecutive patients with esophageal cancer who underwent curative resection at Yokohama City University from 2005 to 2022. RESULTS:A total of 198 patients were included in this study. According to previous studies and the 3- and 5- year overall survival rates, a hemoglobin level of 11 g/dl was selected as the optimal cutoff value in the present study; preoperative hemoglobin of <11 g/dl and >11 g/dl were observed in 34 patients (Hb-low group) and 164 patients (Hb-high group), respectively. The 3- and 5-year OS rates were 39.1% and 34.8%, respectively, in the Hb-low group and 70.3% and 62.1% in the Hb-high group. There were significant differences between the two groups (p=0.003). Univariate and multivariate analyses demonstrated that the preoperative Hb level was as an independent prognostic factor for OS [hazard ratio (HR)=1.809; 95% confidence interval (CI)=1.073-3.050, p=0.026]. Moreover, the 3- and 5-year recurrence-free survival (RFS) rates were 16.6% and 16.6%, respectively, in the Hb-low group and 51.8% and 45.1% in the Hb-high group (p<0.001). In the multivariate analysis, the preoperative Hb status was also selected as an independent prognostic factor for RFS (HR=1.977; 95%CI=1.240-3.151 p=0.004). CONCLUSION:Preoperative anemia is an independent prognostic factor in patients with esophageal cancer. Our results suggest its potential significance in the treatment and management of these patients.

Background/Objectives: This study aimed to assess the efficacy of adjuvant chemotherapy for T1-2 stage III colorectal cancer, a disease with a low recurrence rate. Methods: The efficacies of fluorouracil-based adjuvant chemotherapy (5FU group) and oxaliplatin-based adjuvant chemotherapy (L-OHP group) were assessed and compared with that of surgery alone (surgery group) using data from seven clinical trials conducted by the Japanese Foundation for Multidisciplinary Treatment of Cancer. Propensity score matching was used to compare the three groups. Direct-adjusted survival curves were delineated with consideration of treatment periods. Results: A total of 604 patients with T1-2 stage III colorectal cancer were identified. After adjusting for the patient factors, the hazard ratio of relapse-free survival (RFS) was 0.79 (95% confidence interval (CI): 0.13-4.65, p = 0.79) and 0.64 (95% CI: 0.06-6.40, p = 0.70) in the 5FU and L-OHP groups, respectively. Adjusted 5-year RFS rate was 82.8% (95% CI: 67.2-100%), 86.2% (95% CI: 74.2-100%), and 88.6% (95% CI: 74.0-100%) in the surgery, 5-FU, and L-OHP groups, respectively. Overall and disease-specific survival showed similar trends without significant differences. Conclusions: No significant improvement in prognosis was observed after adjuvant chemotherapy. The potential improvement in the 5-year RFS after adjuvant chemotherapy for resected T1-2 stage III colorectal cancer should be balanced with patient factors and adverse events.

BACKGROUND:Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies with high recurrence and poor survival (5-year survival rate: approximately 10%) despite curative resection. Identifying molecular drivers of PDAC recurrence remains a significant challenge. PDAC is characterized by dense stromal hyperplasia that may influence tumor cell-specific gene expression. We aimed to identify genes associated with early recurrence using patient-derived xenograft (PDX) models, focusing on the calcineurin-nuclear factor of activated T-cells (NFAT) signaling pathway. MATERIALS AND METHODS:Gene expression profiles were analyzed in PDX models derived from PDAC tumors. Differential gene expression (DEG) analysis was conducted to identify pathways linked to early recurrence. Immunohistochemical (IHC) analysis of 165 resected PDAC specimens was performed to evaluate NFAT protein expression. Multivariate Cox regression identified independent prognostic factors for recurrence and survival. Chemoresistance was examined by silencing NFAT1 and NFAT5 in PDAC cell lines and measuring changes in the half-maximal inhibitory concentration (IC50) of chemotherapeutic agents. RESULTS:DEG analysis revealed enrichment of the calcineurin-NFAT signaling cascade. Higher expression of NFAT1 and NFAT5 were significantly associated with early recurrence. IHC revealed NFAT1 expression in 53 (32.1%) samples, NFAT5 in 104 (63.0%), and coexpression in 43 (26.1%). Multivariate analysis identified lymphatic invasion, incomplete resection, and NFAT1/NFAT5 coexpression as independent predictors of poor prognosis. Dual knockdown of NFAT1 and NFAT5 significantly reduced the IC50 of multiple chemotherapeutic agents. CONCLUSIONS:Coexpression of NFAT1 and NFAT5 is associated with early recurrence, poor survival, and chemoresistance in PDAC. Targeting the NFAT signaling pathway may improve treatment outcomes in PDAC.

A 61-year-old female presented with dyspnea. CT scan revealed an esophageal tumor with airway stenosis, and she was referred to our hospital. During endoscopy, oxygen desaturation necessitated emergency endotracheal intubation and mechanical ventilation. Following tracheostomy placement, a diagnosis of NEC cStage ⅣB was established. IP chemotherapy was initiated. The patient was successfully weaned from mechanical ventilation on hospital day 14. Follow-up CT demonstrated tumor shrinkage, and she was discharged home on day 52. After that, IP therapy was continued and the tracheotomy tube was removed on an outpatient visit. Although the patient underwent up to fourth-line treatment, she died of the underlying disease 1 year and 2 months after the starts of treatment.

BACKGROUND/AIM:Esophageal cancer (EC) is a malignant tumor with poor prognosis. Prognostic factors that may be used in the treatment and management of EC are important. The purpose of this study was to evaluate the impact of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score on the long-term oncological prognosis of patients with EC who have undergone curative treatment. PATIENTS AND METHODS:Patients with EC who underwent curative resection at Yokohama City University between 2000 and 2020 were included. Clinical data were retrospectively retrieved from medical records and analyzed. The HALP score was determined as follows: HALP=[hemoglobin (g/l)×albumin (g/l)×lymphocytes (/l)]/platelets (/l). Kaplan-Meier method and Cox regression model were used to assess the overall (OS) and recurrence-free survival (RFS) and to evaluate the prognostic value of the HALP score. RESULTS:In total, 180 patients were included in this study. They were classified into the HALP-low (n=110) and HALP-high (n=70) groups using a cutoff value of 40. The 5-year OS rate was 46.9% in the HALP-low group and 66.0% in the HALP-high group (p=0.012). The 5-year RFS rate was 31.1% in the HALP-low group and 51.4% in the HALP-high group (p=0.006). The HALP score was found to be an independent prognostic factor for OS [odds ratio (OR)=1.954, 95% confidence interval (CI)=1.157-3.299, p=0.012] and RFS (OR=1.852, 95% CI=1.197-2.866, p=0.006). CONCLUSION:The HALP score is a factor that predicts the oncological prognosis in patients with EC who have undergone radical resection.

Chemotherapy is a key treatment modality for resectable and unresectable gastrointestinal malignancies. Although systemic chemotherapy has clinical benefits, patients with gastrointestinal malignancies experience chemotherapy-related hematological and nonhematological adverse events. Among the various adverse events, chemotherapy-induced oral mucositis (COM) is a common adverse event associated with chemotherapy used for gastrointestinal malignancies. Previous pivotal phase III studies reported that 20%-80% of patients with gastrointestinal malignancies had COM during chemotherapy treatment periods. Once patients have COM, they experience severe discomfort and an impaired ability to eat, swallow, and talk. In addition, the patients with COM need to suspension of chemotherapy or a dose reduction of chemotherapy. Therefore, it is necessary to manage COM to improve both the short- and long-term oncological outcomes. Recently, promising treatments for COM have been reported in randomized trials of gastrointestinal malignancies. This review summarizes the background, current status, and future perspectives of COM treatment in patients with gastrointestinal malignancies.