Aggressive progression in esophageal cancer: residual disease post-CROSS (ypT+ or ypN+ at...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-ESOPH-TRANSFORMATION-PROGRESSION`
Type	Red flag
Status	reviewed 2026-04-26 \| pending_clinical_signoff
Diseases	`DIS-ESOPHAGEAL`
Sources	`SRC-ESMO-ESOPHAGEAL-2024` `SRC-NCCN-ESOPHAGEAL-2025`

Red Flag Origin

Definition	Aggressive progression in esophageal cancer: residual disease post-CROSS (ypT+ or ypN+ at esophagectomy — adjuvant nivolumab CheckMate-577 indication), peritoneal carcinomatosis with malignant ascites, OR rapid clinical decline on first cycle.
Clinical direction	intensify
Category	transformation-progression

Trigger Logic

{
  "any_of": [
    {
      "finding": "post_cross_pcr_negative",
      "value": true
    },
    {
      "finding": "peritoneal_carcinomatosis_with_ascites",
      "value": true
    },
    {
      "finding": "rapid_decline_first_cycle",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

CheckMate-577: adjuvant nivolumab × 1 year for residual ypT+/ypN+ post-CROSS — DFS doubled (22 vs 11 mo). Treatment-defining for this ~30% of CROSS patients without pCR.

Used By

No reverse references found in the YAML corpus.