{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T08:43:31Z","timestamp":1782809011702,"version":"3.54.5"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["NSTC 114-2314-B-006-015"],"award-info":[{"award-number":["NSTC 114-2314-B-006-015"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Esophagus"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The indication of feeding-stoma creation (gastrostomy\/jejunostomy) in esophageal squamous cell carcinoma (ESCC) patients and its impact on survival remain unclear. We aimed to identify patient subgroups who benefit from feeding-stoma placement before concurrent chemoradiation therapy (CCRT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We did a secondary analysis of prospective cohort. A total of 260 patients with advanced ESCC who underwent CCRT between April 2008 and March 2024 were included. Tumor-occupying proportion (tumor area\/total lumen area) and other tumor characteristics were measured from standardized endoscopic images. Characteristics that predict post-CCRT cachexia was identified and validated as indications of feeding-stoma creation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Post-CCRT cachexia developed in 60.7% of patients. Independent predictors of cachexia included longer tumor length and bigger tumor-occupying proportion. ROC curve found tumor length\u2009\u2265\u20096\u00a0cm (area under ROC (AUC): 0.760,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) and tumor-occupying proportion\u2009\u2265\u200970% are optimal to predict post-CCRT cachexia (AUC: 0.620,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.001). Sixty-two patients (23.8%) underwent pretreatment feeding-stoma creation. In the overall cohort, feeding-stoma creation was not associated with a longer progression-free survival (PFS) or overall survival (OS). In patients with tumor-occupying proportion\u2009\u2265\u200970%, feeding-stoma creation was associated with reduced cachexia incidence, better treatment response (OR: 2.78,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.028), longer median PFS (6 vs. 4 months,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.012) and OS (11 vs. 9 months,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.009). In contrast, feeding-stoma creation was not associated with an improved treatment response or survival in patients with tumor-occupying proportion\u2009&lt;\u200970% or in patients with different tumor length.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tumor-occupying proportion is a novel metric that predicts cachexia and survival in advanced ESCC. Pretreatment feeding-stoma creation was associated with a better treatment response and longer survival only in patients with tumor-occupying proportion\u2009\u2265\u200970%, supporting its use as a selection criterion for this invasive procedure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10388-026-01210-6","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T06:58:12Z","timestamp":1779346692000},"page":"475-485","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pretreatment feeding\u2011stoma placement in advanced esophageal cancer: defining optimal patient selection criteria"],"prefix":"10.1007","volume":"23","author":[{"given":"Hsueh-Chien","family":"Chiang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chien-Ming","family":"Chiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying-Yuan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shang-Yin","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Forn-Chia","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzu-Hui","family":"Pao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ta-Jung","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bor-Shyang","family":"Sheu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0238-527X","authenticated-orcid":false,"given":"Wei-Lun","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"1210_CR1","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1016\/S2468-1253(20)30007-8","volume":"5","author":"GBDOC Collaborators","year":"2020","unstructured":"Collaborators GBDOC. 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This study adheres to the STROBE Statement.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"This study was approved by the Institutional Review Board of the National Cheng Kung University Hospital (B-BR-106-082).","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Institutional Review Board Statement"}}]}}