Japanese journal of clinical oncology最新文献

{"title":"Utility of AMOY polymerase chain reaction panel in detecting non-small cell lung cancer using pleural cell block.","authors":"Shuji Murakami, Kanako Shinada, Yuka Otsuzumi, Shinya Sato, Fumiko Komine, Yuan Yuan, Junko Nakamura, Seigo Katakura, Tetsuro Kondo, Tomoyuki Yokose, Haruhiro Saito","doi":"10.1093/jjco/hyag003","DOIUrl":"10.1093/jjco/hyag003","url":null,"abstract":"<p><strong>Background: </strong>Comprehensive biomarker testing is mandatory for advanced non-small cell lung cancer (NSCLC). Pleural effusion cell blocks are a minimally invasive alternative to biopsy. The AmoyDx pan lung cancer (PLC) polymerase chain reaction panel is a sensitive multiplex assay; however, its performance using pleural cell-block specimens with low tumor-cell content remains largely unexplored.</p><p><strong>Methods: </strong>We conducted a retrospective study of 30 patients with advanced NSCLC and having known driver mutations, whose pleural effusion cell blocks were tested using the AmoyDx PLC panel at Kanagawa Cancer Center between 2021 and 2023. Tumor content was quantified using thyroid transcription factor 1 immunohistochemistry. DNA and RNA quality were assessed, and the panel results were compared with those of other molecular assays.</p><p><strong>Results: </strong>The AmoyDx PLC panel achieved a detection success rate of 96.7% (29/30), with a sole discordant case owing to the absence of malignant cells. The concordance in confirmed malignant cases was 100%. Notably, the panel detected target mutations in specimens with tumor contents well below the recommended threshold. High detection performance was observed even when the nucleic acid concentrations were suboptimal or the purity levels were outside the reference range. The median tumor content was 8.5% (range, 0.2%-88.2%), with 74% samples below the 20% threshold.</p><p><strong>Conclusions: </strong>Pleural effusion cell blocks are a practical and reliable alternative for molecular testing of advanced NSCLC when biopsy is not feasible. The high sensitivity of the AmoyDx PLC panel even for specimens with low tumor cell content underscores its potential clinical utility.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":"605-611"},"PeriodicalIF":2.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world efficacy of enfortumab vedotin in Japanese patients with metastatic urothelial carcinoma stratified by EV-301 trial eligibility: a multicenter Bayesian restricted mean survival time analysis.","authors":"Shugo Yajima, Soichiro Yoshida, Wei Chen, Hiroyuki Sato, Akihiro Hirakawa, Hiroshi Fukushima, Yuki Nakamura, Hajime Tanaka, Masaharu Inoue, Noboru Numao, Atsushi Yoshinaga, Naoko Kawamura, Ichiro Yonese, Keita Izumi, Takanobu Yamamoto, Sho Uehara, Kotaro Suzuki, Masahiro Toide, Ryoji Takazawa, Saori Araki, Hitoshi Masuda, Yasuhisa Fujii","doi":"10.1093/jjco/hyag012","DOIUrl":"10.1093/jjco/hyag012","url":null,"abstract":"<p><strong>Background: </strong>Enfortumab vedotin (EV) exhibited superior efficacy in the EV-301 trial; however, real-world outcomes stratified by trial eligibility criteria remain unclear. We evaluated the real-world efficacy of EV in Japanese patients with metastatic urothelial carcinoma (mUC) via EV-301 eligibility stratification and restricted mean survival time (RMST) analysis.</p><p><strong>Methods: </strong>This multicenter retrospective study analyzed 115 Japanese mUC patients treated with EV following platinum-based chemotherapy and immune checkpoint inhibitors. Patients were categorized as eligible (n = 81, 70.4%) or ineligible (n = 34, 29.6%) based on EV-301 criteria. The primary endpoint was overall survival (OS) evaluated via RMST at multiple time points. Reconstructed individual patient data from EV-301 enabled comparative analysis, with Bayesian power prior methodology integrating evidence sources.</p><p><strong>Results: </strong>Eligible patients exhibited significantly higher OS than ineligible ones (HR 2.19, 95% CI 1.24-3.89, P = .009). RMST analysis at 12 months revealed OS of 9.65 months (95% CI 8.67-10.63) and 7.11 months (4.79-9.44) in eligible and ineligible patients, respectively. Significant RMST differences were observed between the eligible and ineligible groups at 6 months (1.18 months, P = .017) and 12 months (2.54 months, P = .049). Bayesian analysis with moderate borrowing (α = 0.5) revealed posterior RMST of 9.40 months (95% credible intervals 8.80-9.98) at 12 months. Eligible patients showed comparable RMST outcomes to EV-301 trial participants, with no significant differences.</p><p><strong>Conclusions: </strong>EV exhibited real-world efficacy in Japanese mUC patients comparable to the eligible patients' outcomes in the EV-301 trial. Ineligible patients showed statistically inferior outcomes.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":"636-645"},"PeriodicalIF":2.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146063617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pembrolizumab-induced pan-airway mucositis with a cobblestone-like appearance: a case report.","authors":"Ryo Ikeda, Takeshi Takahashi, Kosuke Ichikawa, Hazuki Kazama, Arata Horii","doi":"10.1093/jjco/hyag016","DOIUrl":"10.1093/jjco/hyag016","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICIs) can induce diverse immune-related adverse events (irAEs), but pan-airway mucosal involvement is rare and may mimic common infectious laryngopharyngitis. A 76-year-old woman receiving long-term pembrolizumab for lung squamous cell carcinoma developed asthma-like symptoms ~1 year after treatment initiation, which were partially controlled with inhaled corticosteroid. Approximately 3 years after pembrolizumab initiation, she presented with persistent hoarseness and sore throat. Laryngoscopy showed diffuse erythema and a characteristic cobblestone-like appearance of the pharyngeal and laryngeal mucosa, and chest computed tomography revealed diffuse thickening of the tracheal and bronchial walls. Bronchoscopy demonstrated continuous mucosal inflammation extending from the bronchi to the larynx. Biopsies from both the larynx and trachea revealed identical dense CD8-positive T-cell infiltration without granulomatous changes, consistent with ICI-induced mucositis. Her symptoms and endoscopic and radiologic abnormalities resolved after discontinuation of pembrolizumab and initiation of oral prednisolone, and steroids were successfully tapered without recurrence. This case highlights a rare but clinically important pattern of ICI-induced pan-airway mucositis, in which lower-airway inflammation may be initially attenuated by inhaled steroids and later become evident after extension to the upper airway; such airway irAEs should be considered in ICI-treated patients presenting with persistent or atypical upper-airway symptoms.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":"654-658"},"PeriodicalIF":2.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in antisense oligonucleotide treatment for cancer.","authors":"Lu Zhu, Pariha Muhtar, Susumu Goyama, Akihide Yoshimi","doi":"10.1093/jjco/hyag017","DOIUrl":"10.1093/jjco/hyag017","url":null,"abstract":"<p><p>RNA therapeutics, including antisense oligonucleotides (ASOs), have emerged as a promising class of drugs, with several already approved for clinical use. To date, most approved ASO-based RNA therapies target non-malignant disorders such as neurodegenerative diseases, and only a single therapy in this class has been approved for cancer. Notably, nearly half of existing RNA therapeutics act by modulating RNA splicing. Given the growing evidence implicating aberrant RNA splicing in cancer pathogenesis, the development of ASO-based therapeutics for oncologic indications is expected to accelerate. More than 250 clinical trials have evaluated oligonucleotide agents targeting diverse cancer-associated molecules, with several showing encouraging early results. In this review, we summarize recent advances in understanding cancer biology relevant to ASO-based therapies and highlight ongoing progress in the development of RNA-targeted approaches for cancer treatment.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":"503-517"},"PeriodicalIF":2.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13149323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical utility of the Geriatric-8 in the functional assessment of patients with gynecological cancer aged 75 and older: a retrospective study.","authors":"Miwa Yasaka, Yumi Kawaguchi, Chinami Makinoda, Takatoshi Manabe, Arata Kobayashi, Hiroko Machida, Takeshi Hirasawa, Hiroyuki Nomura","doi":"10.1093/jjco/hyag020","DOIUrl":"10.1093/jjco/hyag020","url":null,"abstract":"<p><strong>Background: </strong>The Geriatric-8 (G8) is used for the functional status of older adult patients with cancer. However, its role in treatment decision-making for gynecological malignancies has not been established.</p><p><strong>Methods: </strong>We retrospectively analyzed the data of 180 women aged ≥75 years with gynecological malignancies who underwent initial treatment at our institution between January 2019 and December 2023. Pre-treatment G8 scores were assessed and patients were categorized as fit (G8 > 14) or frail (G8 ≤ 14). Associations between the G8 score and patient background, disease characteristics, treatment options, and treatment tolerability were examined.</p><p><strong>Results: </strong>Of the 180 women, 53 (29.4%) were classified as fit and 127 (70.6%) as frail. Frail patients required long-term care (P = .008) and used anticoagulants more frequently than fit patients (P = .019). Median G8 scores were highest in endometrial cancer (14) and lowest in vulvar cancer (10). Best supportive care (8) and neoadjuvant chemotherapy (10) had lower G8 scores than surgery and concurrent chemoradiotherapy (14) (P < .001). Postoperative complications occurred in 10/96 surgical cases; these cases had lower scores than those without complications (12 vs. 14, P = .044). During chemotherapy, median scores were lower in women with ≥ grade 3 (12 vs. 14, P = .008) and grade ≥ 4 adverse events (10 vs. 14, P = .002).</p><p><strong>Conclusions: </strong>The G8 score is associated with patient background, cancer type, and treatment options, and is associated with treatment tolerability in women aged ≥75 years with gynecological malignancies.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":"563-568"},"PeriodicalIF":2.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumor cell invasion of blood vessels predicts poor survival in upper tract urothelial carcinoma following radical nephroureterectomy.","authors":"Miyaka Umemori, Shun Sato, Fumihiko Urabe, Hirotaka Kondo, Juria Nakano, Kentaro Yoshihara, Yuya Iwamoto, Wataru Fukuokaya, Shuhei Hara, Yuzo Inaba, Kosuke Iwatani, Yu Imai, Mahito Atsuta, Masaya Murakami, Kojiro Tashiro, Shunsuke Tsuzuki, Jun Miki, Hiroyuki Takahashi, Masayuki Shimoda, Takahiro Kimura","doi":"10.1093/jjco/hyag002","DOIUrl":"10.1093/jjco/hyag002","url":null,"abstract":"<p><strong>Objectives: </strong>Lymphovascular invasion (LVI) is an established adverse prognostic factor in urothelial carcinoma; however, prior studies have rarely distinguished lymphatic vessel invasion (LymVI) from blood vessel invasion (BVI). We investigated the prevalence and prognostic significance of LymVI and BVI in upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNUx), and assessed their associations with clinicopathological characteristics and metastatic patterns.</p><p><strong>Methods: </strong>We retrospectively analyzed 455 patients who underwent RNUx at Jikei University Hospital and six affiliated centers between 2012 and 2021. LVI subtype was assessed using hematoxylin-eosin staining, supplemented by D2-40, CD31, and Elastica van Gieson staining when required. Patients were categorized into four groups: no LVI, LymVI only, BVI only, and combined LymVI+BVI. Outcomes included non-urothelial tract recurrence-free survival (NUTRFS), cancer-specific survival (CSS), and overall survival (OS). Kaplan-Meier methods and Cox regression analyses were used to evaluate prognostic associations.</p><p><strong>Results: </strong>LVI subtypes were distributed as follows: no LVI (65.1%), LymVI only (9.9%), BVI only (7.7%), and combined LymVI+BVI (17.4%). Higher pathological T and N stages were observed progressively across these groups (P < 0.001). BVI only and combined LymVI+BVI were independent predictors of inferior NUTRFS (HR 4.52 and 5.01), OS (HR 2.46 and 2.73), and CSS (HR 2.85 and 4.06), whereas isolated LymVI did not significantly affect outcomes. Hematogenous metastases to the lung, liver, and bone were significantly more frequent in patients with BVI or combined LVI.</p><p><strong>Conclusions: </strong>Distinguishing BVI from LymVI provides refined prognostic stratification in UTUC. BVI, alone or combined with LymVI, is strongly associated with adverse survival and increased hematogenous dissemination, while isolated LymVI has limited prognostic impact. Routine pathological subclassification of vascular invasion may improve postoperative risk assessment and guide adjuvant treatment decisions.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":"612-619"},"PeriodicalIF":2.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcome of 50 patients treated with eribulin for soft tissue sarcoma: a single-institute retrospective study.","authors":"Yudai Murayama, Rumi Nakagawa, Yasutaka Sukawa, Masanobu Takahashi, Hiroyuki Kawashima, Kazutaka Kikuta","doi":"10.1093/jjco/hyag001","DOIUrl":"10.1093/jjco/hyag001","url":null,"abstract":"<p><strong>Background: </strong>Eribulin is an approved treatment option for soft tissue sarcomas (STSs) in Japan; however, real-world data regarding its safety, efficacy, and optimal dosing strategies across heterogeneous patient populations remain limited. Thus, this study aimed to evaluate clinical outcomes, treatment tolerability, and prognostic factors in patients with STS treated with eribulin.</p><p><strong>Methods: </strong>We retrospectively reviewed 50 patients with STS who received eribulin at a single institution between 2018 and 2024. Clinical variables, dosing schedules, tumor responses, survival outcomes, and adverse events (AEs) were analyzed. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method; group comparisons were performed with the log-rank test.</p><p><strong>Results: </strong>The cohort had a median age of 66 years, and eribulin was administered as first-line therapy in 24 patients. The disease control rate was 62%; one patient achieved complete response and one achieved partial response. Median PFS and OS were 4 and 19 months, respectively. Hematologic toxicities were the most common Grade ≥ 3 AEs, with no treatment-related cardiac events observed. Dose modifications included a bi-weekly schedule or a regimen consisting of two administrations followed by a 2-week rest period with pegfilgrastim support. No treatment discontinuations due to AEs occurred in either reduced-intensity schedule; the latter regimen demonstrated the longest treatment duration. Survival outcomes were comparable across age groups, treatment lines, histological subtypes, and tumor locations. Patients aged ≥70 years achieved a median OS of 16 months, generally consistent with previously reported outcomes in elderly sarcoma populations.</p><p><strong>Conclusions: </strong>Eribulin demonstrated favorable tolerability and durable disease control across diverse patient subgroups, including elderly and comorbid patients who are often ineligible for anthracycline therapy. Although no significant prognostic factors were identified, bi-weekly dosing and two-administration/2-week rest schedules were feasible, with the latter offering the advantage of pegfilgrastim support. These findings support the integration of eribulin into individualized treatment strategies for advanced STS and highlight the need for prospective studies to refine patient selection and optimize dosing approaches.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":"569-576"},"PeriodicalIF":2.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between bevacizumab administration and delayed wound healing complications before and after central venous port placement in patients with colorectal cancer.","authors":"Kohei Takura, Miyuki Sone, Hidekazu Hirano, Ken Kato, Sho Murakami, Tomoya Tanishima, Rakuhei Nakama, Mizuki Ozawa, Takumi Oshima, Shintaro Kimura, Chihiro Itou, Shunsuke Sugawara, Yoshiyuki Matsui, Yukihide Kanemitsu, Masahiko Kusumoto","doi":"10.1093/jjco/hyag006","DOIUrl":"10.1093/jjco/hyag006","url":null,"abstract":"<p><strong>Background: </strong>Bevacizumab (BEV) is commonly used to treat unresectable or metastatic colorectal cancer; however, it is associated with delayed wound healing. This study aimed to assess whether administration of BEV within 14 days after central venous (CV) port placement was associated with an increased incidence of delayed wound healing complications.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with unresectable or metastatic colorectal cancer who underwent CV port placement between January 2017 and January 2023. The primary outcome was the incidence of wound-healing complications within 90 days. The incidence of complications was examined in 29 patients who received BEV within 8 weeks prior to CV port placement.</p><p><strong>Results: </strong>Data on 264 matched patient pairs, selected from 778 eligible patients, were included in the analysis. Wound healing complications occurred in 4/264 patients (1.5%; 95% confidence interval [CI], 0.4%-4.0%) in the BEV group and 3/264 patients (1.1%; 95% CI, 0.2%-3.4%) in the non-BEV group, a nonsignificant difference (P > .99). Additionally, no wound-healing events were observed among the 29 patients who received BEV before CV port placement; however, this finding should be interpreted with caution because of the limited sample size.</p><p><strong>Conclusions: </strong>Administration of BEV before and after CV port placement does not significantly increase the risk of delayed wound healing complications. These findings suggest that the risk of delayed wound healing associated with peri-CV port administration of BEV appears to be low in this specific clinical setting; however, this should be interpreted with caution and does not constitute definitive proof of safety.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":"546-552"},"PeriodicalIF":2.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146063585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of long-term outcomes between proximal gastrectomy and total gastrectomy for advanced gastric cancer in the upper third of the stomach: a propensity score-matched analysis.","authors":"Yosuke Kano, Hiroshi Ichikawa, Yusuke Muneoka, Kazuaki Kobayashi, Shirou Kuwabara, Shigeto Makino, Yasuyuki Kawachi, Masaki Aizawa, Satoru Nakagawa, Takaaki Hanyu, Tomoyuki Kakuta, Kenji Usui, Tetsuya Naito, Yoshifumi Shimada, Jun Sakata, Toshifumi Wakai","doi":"10.1093/jjco/hyag010","DOIUrl":"10.1093/jjco/hyag010","url":null,"abstract":"<p><strong>Background: </strong>Total gastrectomy (TG) is commonly performed as the standard treatment for upper third advanced gastric cancer (AGC). Proximal gastrectomy (PG) may be a potential alternative procedure for upper-third AGC. However, its oncologic safety remains uncertain. This study aimed to compare the long-term outcomes of PG and TG for upper-third AGC and to evaluate the oncological safety of PG.</p><p><strong>Methods: </strong>We retrospectively analyzed the data of patients who underwent PG or TG for clinical T2-T4aNanyM0 upper-third gastric cancer at six institutions between 2018 and 2022. To minimize selection bias, propensity score matching (PSM) was performed at a 1:1 ratio. The primary endpoint was overall survival (OS).</p><p><strong>Results: </strong>A total of 208 patients with upper-third AGC were included. After PSM, 104 patients were selected for analysis, with 52 patients in each group. The 3-year OS rates were 81.8% in the PG group and 70.8% in the TG group, with no statistically significant difference between the two groups (P = .167), with a hazard ratio for PG of 0.58 (95% confidence interval, 0.27-1.27; P = .173). Subgroup analysis revealed that the hazard ratio for OS was significantly lower in the PG group than in the TG group among patients with tumor diameters <50 mm.</p><p><strong>Conclusions: </strong>The long-term survival outcomes of PG and TG for upper-third AGC patients are comparable, suggesting that PG may be an oncologically acceptable option in carefully selected patients.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":"553-562"},"PeriodicalIF":2.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk stratification by pathological upstaging and tumor necrosis in clinical T1 clear-cell renal cell carcinoma: evidence from a multi-institutional cohort of 1081 patients.","authors":"Hideto Ueki, Takuto Hara, Taisuke Tobe, Naoto Wakita, Yasuyoshi Okamura, Kotaro Suzuki, Yukari Bando, Tomoaki Terakawa, Akihisa Yao, Koji Chiba, Jun Teishima, Hideaki Miyake","doi":"10.1093/jjco/hyag023","DOIUrl":"10.1093/jjco/hyag023","url":null,"abstract":"<p><strong>Purpose: </strong>To identify independent prognostic factors for recurrence and develop a practical risk stratification system in patients with clinical T1 (cT1) clear-cell renal cell carcinoma (ccRCC) following curative-intent surgery.</p><p><strong>Methods: </strong>This retrospective multi-institutional study analyzed 1081 consecutive patients with cT1N0M0 ccRCC who underwent partial or radical nephrectomy at 14 Japanese tertiary centers (2016-21). We evaluated six established prognostic factors based on prior literature: pathological T3 upstaging, tumor size, nuclear grade, tumor necrosis, surgical approach, and venous invasion. Cox proportional hazards regression was performed to identify independent predictors of recurrence-free survival.</p><p><strong>Results: </strong>During a median follow-up of 48 months, 66 patients (6.1%) developed recurrence. Multivariable Cox regression identified two independent prognostic factors: pathological T3 upstaging (HR 4.67, 95% CI 2.40-9.08, P <.001) and tumor necrosis (HR 2.51, 95% CI 1.22-5.13, P = .012). Tumor size showed borderline significance (HR 1.22 per cm, 95% CI 1.00-1.49, P = .055). Based on the significant factors, patients were stratified into low-risk (91.1%, no upstaging/necrosis) and high-risk (8.9%, upstaging or necrosis present) groups with recurrence rates of 4.3% and 25.0%, respectively (log-rank P <.001). The 5-year recurrence-free survival rates were 95.2% and 73.4% for low- and high-risk groups, respectively.</p><p><strong>Conclusions: </strong>Pathological T3 upstaging and tumor necrosis were identified as the only independent predictors of recurrence in cT1 ccRCC. This simplified two-tier risk stratification effectively distinguishes a small high-risk subset (9% of patients) with 25% recurrence rate from the low-risk majority, enabling tailored surveillance strategies and appropriate selection for adjuvant therapy trials.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":"646-653"},"PeriodicalIF":2.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146163992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}