International Journal of Clinical Oncology最新文献

{"title":"Burden and trajectories of biliary tract malignancies in Taiwan from 1998 to 2022.","authors":"Chung-Hsin Tsai, I-Hung Chien, Shih-Ping Cheng","doi":"10.1007/s10147-025-02841-y","DOIUrl":"10.1007/s10147-025-02841-y","url":null,"abstract":"<p><strong>Background: </strong>Biliary tract cancers, though relatively rare, exhibit wide variations in incidence rates across countries. We conducted a population-based cohort study to delineate the epidemiological trends over 25 years in Taiwan.</p><p><strong>Methods: </strong>Age-standardized incidence and mortality rates of biliary tract cancers were obtained from the Taiwan Cancer Registry. These cancers were identified using the International Classification of Diseases for Oncology codes C23-C24, which include those originating in the gallbladder and extrahepatic bile ducts while excluding intrahepatic cholangiocarcinomas. The annual percent change (APC) was calculated using joinpoint regression models.</p><p><strong>Results: </strong>Male patients experienced an increasing incidence from 1998 to 2009 (APC = 1.54%) and remained stable thereafter. In contrast, female patients had stable incidence rates from 1998 to 2009, followed by a decrease from 2009 to 2022 (APC = - 1.30%). Age-specific analyses showed that younger generations exhibited a decreasing trend, while the elderly had stable or increasing incidence rates. The proportion of patients receiving surgical treatment declined during the study period, while those undergoing chemotherapy and radiotherapy significantly increased. Mortality rates decreased after 2007.</p><p><strong>Conclusion: </strong>Considerable gender disparities and cohort effects exist in the incidence trends of biliary tract cancers. In addition to surgery, chemotherapy with or without radiation therapy has become an important component of multimodal treatment.</p>","PeriodicalId":13869,"journal":{"name":"International Journal of Clinical Oncology","volume":" ","pages":"2072-2078"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival impact and recurrence prediction using oncologic resectability classification in hepatocellular carcinoma following hepatic resection: a Japanese multi-center study.","authors":"Norifumi Iseda, Shinji Itoh, Mizuki Ninomiya, Hiroto Kayashima, Takashi Motomura, Takuma Izumi, Takeo Toshima, Shohei Yoshiya, Yo-Ichi Yamashita, Kengo Fukuzawa, Toru Utsunomiya, Shoichi Inokuchi, Takashi Maeda, Eiji Tsujita, Kazutoyo Morita, Hidefumi Higashi, Keishi Sugimachi, Takahiro Tomino, Ryosuke Minagawa, Koichi Kimura, Hideaki Uchiyama, Noboru Harada, Tomoharu Yoshizumi","doi":"10.1007/s10147-025-02840-z","DOIUrl":"10.1007/s10147-025-02840-z","url":null,"abstract":"<p><strong>Background: </strong>The oncological criteria of resectability for HCC were reported by the Japanese Expert Consensus 2023. The relationship between classification at recurrence and prognosis is unclear in cases with surgical resection in the initial treatment. Factors that predict recurrence patterns are also unknown.</p><p><strong>Methods: </strong>Data were analyzed retrospectively from 937 patients who underwent hepatic resection for primary HCC at 10 facilities. Kaplan-Meier analyses of overall survival (OS) and recurrence-free survival (RFS) after hepatic resection defined according to resectability classification, resectable (R), borderline resectable (BR) 1, and BR2, were performed. In patients who underwent curative resection for R-HCC, we examined the classification and prognosis at the time of recurrence, as well as the factors associated with BR1 or BR2 recurrence.</p><p><strong>Results: </strong>RFS and OS rates were significantly better in the R group than in the BR1 and BR2 groups (P < 0.01). Prognosis was worse in patients whose initial HCC was resected with R and whose recurrence was BR1 or BR2 (P < 0.01). Male sex, α-fetoprotein > 12 ng/dL, Des-γ-carboxy prothrombin > 150 mAU/mL, tumor size > 5 cm, poor differentiation, and microscopic vascular invasion were predictors of BR1 or BR2 recurrence within 2 years after curative resection for R-HCC. We developed a scoring system based on these six factors, which stratified not only prognosis but also recurrence pattern.</p><p><strong>Conclusions: </strong>Our results extend this framework by demonstrating the prognostic significance at the time of recurrence and provide factors to predict high-risk recurrence.</p>","PeriodicalId":13869,"journal":{"name":"International Journal of Clinical Oncology","volume":" ","pages":"2063-2071"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting miRNAs in renal cell carcinoma: emerging therapeutic strategies.","authors":"Rabab S Hamad, Ghadir A Sayed, Mai A Abd-Elmawla, Sherif S Abdel Mageed, Ahmed I Abulsoud, Mohamed Bakr Zaki, Osama A Mohammed, Shereen Saeid Elshaere, Ahmed E Elesawy, Samy Y Elkhawaga, Walaa A El-Dakroury, Mustafa Ahmed Abdel-Reheim, Abdullah Ayed, Ahmed S Doghish","doi":"10.1007/s10147-025-02856-5","DOIUrl":"10.1007/s10147-025-02856-5","url":null,"abstract":"<p><p>About one-third of renal cell carcinoma (RCC) patients present with metastatic disease upon diagnosis because of the retroperitoneal location of the kidneys, which causes many tumors to stay asymptomatic. Besides, shortly after 5 years following successful curative surgery, nearly 30% of individuals develop distant cancer metastases and recurrences. This is mostly attributable to the complex and diverse characteristics of the tumor microenvironment. Although targeted treatments and immunotherapies can extend the survival of patients, they are linked to the swift emergence of resistance, constraining the therapeutic alternatives for RCC patients and drawing attention to the critical requirement for improved targeted treatments. Along the same vein, there is an urgent demand for novel biomarkers capable of detecting early RCC with significant sensitivity and specificity. Additionally, prognostic indicators are required for the stratification of RCC patients. MicroRNAs (miRNAs) are crucial regulators of mRNA and subsequent protein production in both healthy and malignant tissues. The malignant pathophysiology of RCC has been associated with miRNA dysregulation, which impacts numerous cellular processes and has been found to increase the likelihood of proliferative and invasive processes, promote angiogenesis, alter cell cycle dynamics, evade cell death, facilitate metastasis, and make cancer cells less responsive to certain treatments. Therefore, in this review, we will go over the latest findings regarding the functions of oncogenic and tumor suppressor miRNAs in RCC, how they could be used as diagnostic and prognostic indicators for RCC, and the role they play in the development of RCC and its resistance to cancer-fighting therapies.</p>","PeriodicalId":13869,"journal":{"name":"International Journal of Clinical Oncology","volume":" ","pages":"1925-1945"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Policy recommendations for promoting nuclear medicine therapy in Japan 2025, from the Working Group for promoting nuclear medicine therapy of the Japan Society of Clinical Oncology.","authors":"Kotaro Suzuki, Hideaki Miyake, Anri Inaki, Shoko Takano, Yasutoshi Kuboki, Takashi Mizowaki, Katsumasa Nakamura, Makoto Ueno, Shigemi Matsumoto, Daisuke Obinata, Tohru Nakagawa, Masato Murakami, Yoshiyuki Majima, Megumu Yokono, Masao Namba, Takayuki Yoshino","doi":"10.1007/s10147-025-02858-3","DOIUrl":"https://doi.org/10.1007/s10147-025-02858-3","url":null,"abstract":"<p><p>With the increasing importance of nuclear medicine therapy in overall cancer care and the introduction of ¹⁷⁷Lu-PSMA-617 to Japan being imminent, the Policy Recommendations for Promoting Nuclear Medicine Therapy in Japan from the Working Group for Promoting Nuclear Medicine Therapy of the Japan Society of Clinical Oncology (JSCO) aim to identify issues related to nuclear medicine therapy and propose measures to address them, in order to further advance nuclear medicine therapy in Japan. It is necessary to create an environment in which each medical institution can proactively introduce nuclear medicine therapy by taking measures that target discharge criteria, medical fees, and human resource development and link them organically. The Working Group believes that it is necessary to continue examining long-term issues taking into account the changes that have occurred since the introduction of ¹⁷⁷Lu-PSMA-617, as well as trends in nuclear medicine therapy other than ¹⁷⁷Lu-PSMA-617 that are expected to be introduced in the future. In addition, as the \"Action Plans for Promoting the Production and Use of Medical Radioisotopes\" have been formulated and the advancement of nuclear medicine therapy has become one of the nation's major policy priorities, JSCO will continue to actively work with relevant ministries and local governments to resolve the various issues of nuclear medicine therapy, including the smooth introduction of ¹⁷⁷Lu-PSMA-617.</p>","PeriodicalId":13869,"journal":{"name":"International Journal of Clinical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lymph node metastasis risk in submucosal invasive gastric cancer based on C-reactive protein gene polymorphism analysis.","authors":"Kotaro Honda, Kohei Taniguchi, Kazumasa Komura, Tomohito Tanaka, Hidero Yoshimoto, Kentaro Matsuo, Yoshiro Imai, Ryo Tanaka, Mitsuaki Ishida, Yoshinobu Hirose, Satoru Motoyama, Sang-Woong Lee","doi":"10.1007/s10147-025-02884-1","DOIUrl":"https://doi.org/10.1007/s10147-025-02884-1","url":null,"abstract":"<p><strong>Background: </strong>The 1846C > T polymorphism of the C-reactive protein (CRP) gene is associated with an increased risk of lymph node metastasis in various cancers. This study aimed to examine its association with lymph node metastasis in gastric cancer.</p><p><strong>Methods: </strong>A retrospective analysis of the 1846C > T CRP polymorphism was conducted in patients with submucosal (SM) gastric cancer from April 2011 to March 2022. Genotyping was performed using polymerase chain reaction fragment length polymorphisms. Patients were categorized into differentiated and undifferentiated groups and then subdivided into C/C + C/T and T/T genotypes. We assessed correlations between polymorphisms, lymph node metastasis, and lymphatic and venous invasion. Two sub-analyses were conducted in the differentiated gastric cancer group.</p><p><strong>Results: </strong>Among 111 patients with SM gastric cancer, 81 had differentiated tumors, whereas 30 had undifferentiated tumors. In the differentiated group, 4.5% of C/C and C/T genotypes and 18.9% of T/T genotypes exhibited lymph node metastasis, with a 95% negative predictive value. Excluding pT1b1 and tumors ≤ 3 cm, lymph node metastasis occurred in 5.3% of C/C and C/T genotypes and 20.6% of T/T genotypes, with a negative predictive value of 94.7%. For cT1bN0 cases, lymph node metastasis was 0% in C/C and C/T genotypes and 15.8% in T/T genotypes, with a negative predictive value of 100%.</p><p><strong>Conclusions: </strong>In this exploratory study, the 1846C > T CRP polymorphism suggests that patients with differentiated SM gastric cancer carrying the C/C or C/T genotype have reduced risk of lymph node metastasis, potentially minimizing the need for additional surgery after endoscopic submucosal dissection.</p>","PeriodicalId":13869,"journal":{"name":"International Journal of Clinical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic implications of morphological subtypes in a surgical cohort of perihilar cholangiocarcinoma: the overriding impact of nodal status.","authors":"Poowanai Sarkhampee, Weeris Ouransatien, Satsawat Chansitthichok, Nithi Lertsawatvicha, Paiwan Wattanarath","doi":"10.1007/s10147-025-02891-2","DOIUrl":"https://doi.org/10.1007/s10147-025-02891-2","url":null,"abstract":"<p><strong>Background: </strong>The morphological classification of perihilar cholangiocarcinoma (pCCA) may influence survival outcomes following curative resection. This study aimed to evaluate the impact of different morphological subtypes on long-term survival.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 167 patients with pCCA who underwent curative resection between 2013 and 2018. Patients were classified into three morphological subtypes: intraductal growth (IG-type), periductal infiltrating (PI-type), and mass-forming/mixed (MF-type).</p><p><strong>Results: </strong>Among the 167 resected patients, the PI-type was most prevalent (53.3%), followed by the IG-type (25.7%) and MF-type (21.0%). Within this surgical cohort, the IG-type was associated with the most favorable prognosis, exhibiting a significantly longer median OS (21.0 months) compared to the PI-type (15.9 months) and MF-type (14.5 months). Multivariable analysis identified positive RM and LNM as the independent predictors of both poor OS and RFS. A critical interaction was observed: in LNM-negative patients, achieving an R0 resection conferred a significant survival benefit across all morphological subtypes. However, in LNM-positive patients, survival was uniformly poor, and the prognostic impact of RM status was completely attenuated.</p><p><strong>Conclusion: </strong>Among patients with resectable pCCA, morphological subtype is associated with distinct prognostic profiles. However, the ultimate determinants of survival outcome are the RM status and the status of LNM. Achieving an R0 resection is paramount in LNM-negative disease, whereas LNM positivity dictates a poor prognosis regardless of margin status. This underscores the dominant roles of margin status and nodal involvement in risk stratification and in guiding decisions for adjuvant therapy.</p>","PeriodicalId":13869,"journal":{"name":"International Journal of Clinical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: \"Comparative neurological safety of novel hormonal therapies in advanced prostate cancer: a Bayesian network meta-analysis of randomized trials\".","authors":"Yuekun Fang, Shengyi Chen, Bin Cheng","doi":"10.1007/s10147-025-02883-2","DOIUrl":"https://doi.org/10.1007/s10147-025-02883-2","url":null,"abstract":"","PeriodicalId":13869,"journal":{"name":"International Journal of Clinical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma CAF22 and NfL reflect neuromuscular decline during cisplatin-based chemotherapy and radical cystectomy in muscle-invasive bladder cancer.","authors":"Rizwan Qaisar, Shah Hussain, Firdos Ahmad, Asima Karim","doi":"10.1007/s10147-025-02890-3","DOIUrl":"https://doi.org/10.1007/s10147-025-02890-3","url":null,"abstract":"<p><strong>Background: </strong>Cisplatin-based chemotherapy and radical cystectomy are standard treatments for muscle-invasive bladder cancer (MIBC), but their impact on neuromuscular integrity and functional capacity remains elusive. We investigated plasma biomarkers of neuromuscular junction degradation (c-terminal agrin-fragment-22; CAF22) and neuronal injury (Neurofilament light-chain; NfL) in relation to physical capacity in MIBC patients.</p><p><strong>Methods: </strong>In this prospective study, 42 MIBC patients undergoing neoadjuvant cisplatin-gemcitabine chemotherapy and radical cystectomy were assessed before (T1) and after (T2) chemotherapy, and 4-6 weeks post-surgery (T3). Age- and BMI-matched controls (n = 46) were evaluated once. Plasma CAF22 and NfL were measured alongside handgrip strength (HGS), gait speed (GS), appendicular skeletal muscle index (ASMI), and short physical performance battery (SPPB).</p><p><strong>Results: </strong>Plasma CAF22 and NfL were significantly elevated in patients versus controls at all time points. NfL showed more modest increases in post-treatment. HGS declined from 22.3 ± 3.9 kg at T1 to 17.2 ± 3.3 kg at T3 (p < 0.05), along with reductions in ASMI and GS. Cumulative SPPB scores dropped from 9.02 ± 1.02 to 8.24 ± 1.32. Sarcopenia prevalence rose from 28.5% at T1 to 52.4% at T3. CAF22 was significantly associated with lower HGS and SPPB at T1 (β = - 0.58 and - 0.42, p < 0.001). CAF22 changes correlated with HGS (r = - 0.80) and SPPB (r = - 0.75), while NfL showed weaker but significant correlations. Lab results indicated declines in hemoglobin, albumin, and renal function markers consistent with treatment effects.</p><p><strong>Conclusions: </strong>CAF22 showed strong associations with treatment-related decline in skeletal muscle, suggesting its potential as an early biomarker of sarcopenia that warrants validation in larger cohorts.</p>","PeriodicalId":13869,"journal":{"name":"International Journal of Clinical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in the use of Japanese herbal Kampo medicine in inpatients with cancer: a 14-year nationwide analysis.","authors":"Chikako Iwai, Takaaki Konishi, Shotaro Aso, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga","doi":"10.1007/s10147-025-02866-3","DOIUrl":"https://doi.org/10.1007/s10147-025-02866-3","url":null,"abstract":"<p><strong>Background: </strong>Kampo medicine (Japanese herbal medicine) is often used to manage the side effects of cancer treatment and improve quality of life. However, nationwide trends in Kampo use among inpatients with cancer in Japan remain poorly understood. This study aimed to examine the temporal trends and clinical practice patterns of Kampo prescriptions among inpatients with cancer between 2010 and 2023, with a focus on their use in acute or severe conditions.</p><p><strong>Methods: </strong>This retrospective cohort study used the Japanese Diagnosis Procedure Combination database, including over 6.8 million hospitalizations for five major cancer types (breast, colorectal, gastric, lung, and prostate)between July 2010 and March 2023. Kampo use was identified from in-hospital prescription data. Prescription trends and patient characteristics were analyzed.</p><p><strong>Results: </strong>Kampo medicines were prescribed in 13.6% of hospitalizations, more commonly among older adults and patients with colorectal cancer. The overall prescription proportion increased from 2010 to 2017 before plateauing. The top five prescribed Kampo medicines were Dai-ken-chu-to, Gosha-jinki-gan, Rikkunshi-to, Shakuyaku-kanzo-to, and Hange-shashin-to. Prescription patterns varied by age group, cancer type, cancer stage, disease status, and cause of hospitalization. Dai-ken-chu-to use shifted from postoperative to chronic care, while Gosha-jinki-gan prescriptions gradually declined.</p><p><strong>Conclusions: </strong>Kampo prescription patterns among inpatients with cancer have changed over the past fourteen years, reflecting changes in patient demographics and treatment strategies. Kampo medicines appear to be selectively used as supportive care tailored to specific clinical situations. These findings highlight the evolving role of traditional medicine in modern cancer care in Japan.</p>","PeriodicalId":13869,"journal":{"name":"International Journal of Clinical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: significance of preoperative mean corpuscular volume in patients with stage II/III colorectal cancer and anemia.","authors":"Min Zou, Yansheng Zhang, Feng Gao, Zengqiang Yang","doi":"10.1007/s10147-025-02882-3","DOIUrl":"https://doi.org/10.1007/s10147-025-02882-3","url":null,"abstract":"","PeriodicalId":13869,"journal":{"name":"International Journal of Clinical Oncology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}