Japanese journal of clinical oncology最新文献

{"title":"Metastasis-directed radiotherapy for oligoprogressive castration-resistant prostate cancer: clinical outcomes and factors associated with durable disease control.","authors":"Yuichiro Nakamura, Shu Okamoto, Yujiro Hayashi, Kensuke Mitsunari, Norihiko Kawamura, Akira Nagahara, Yasutomo Nakai, Koji Konishi, Masahiro Morimoto, Naoyuki Kanayama, Ryoichi Imamura, Masashi Nakayama, Kazuo Nishimura","doi":"10.1093/jjco/hyag192","DOIUrl":"https://doi.org/10.1093/jjco/hyag192","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to evaluate clinical outcomes after metastasis-directed radiotherapy (MDRT) in patients with oligoprogressive castration-resistant prostate cancer (CRPC) and to identify factors associated with durable disease control.</p><p><strong>Methods: </strong>We retrospectively analyzed 43 patients with oligoprogressive CRPC who underwent MDRT between 2020 and 2024 at a single institution. The primary endpoint was progression-free survival (PFS), defined using composite criteria from the Prostate Cancer Working Group 3 and Response Evaluation Criteria in Solid Tumors. Secondary endpoints included prostate-specific antigen (PSA) response and secondary PFS (PFS2) in patients who underwent repeat MDRT. Clinical factors associated with PFS were assessed by Cox proportional hazards regression.</p><p><strong>Results: </strong>The median PFS after initial MDRT was 9.0 months (95% confidence interval [CI], 7.0-11.0). A PSA decline of ≥50% was achieved in 53% of patients, including a ≥ 90% decline in 21%. Thirteen patients (30%) underwent repeat MDRT for recurrent oligoprogression, with a median PFS2 of 14.0 months (95% CI, 10.0-25.0). In multivariable analysis, prior androgen receptor signaling inhibitor (ARSI) exposure for CRPC (hazard ratio [HR], 4.53; 95% CI, 1.75-11.73) and PSA doubling time ≤ 2.4 months (HR, 3.24; 95% CI, 1.29-8.15) were independently associated with shorter PFS. No grade ≥ 3 treatment-related adverse events were observed.</p><p><strong>Conclusions: </strong>MDRT was followed by clinically meaningful disease control in patients with oligoprogressive CRPC. Prior ARSI exposure for CRPC and a shorter PSA doubling time were associated with earlier progression. These findings are exploratory and warrant validation in prospective studies.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149333923","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":"Northward shift in cancer mortality inequality across Japanese prefectures, 1995-2023, a nationwide ecological study.","authors":"Hasan Jamil, Aminu Kende Abubakar, Hirokazu Tanaka, Kota Katanoda","doi":"10.1093/jjco/hyag190","DOIUrl":"https://doi.org/10.1093/jjco/hyag190","url":null,"abstract":"<p><strong>Background: </strong>Cancer has been the leading cause of death in Japan since the 1980s, with known variation across prefectures, but evidence on how this pattern has changed over time is limited.</p><p><strong>Methods: </strong>We analysed age-standardized cancer mortality across all 47 Japanese prefectures in 1995 and 2023 using vital statistics data. For each prefecture, excess mortality was calculated relative to a leave-one-out national reference and standardized to the 1995 national population. Excess mortality was decomposed by cancer site. We also compared prefectures' age-standardized mortality rates (ASMRs) between the two years.</p><p><strong>Results: </strong>All-cancer ASMR declined in every prefecture. In 2023, excess mortality ranged from 32·6 per 100 000 (95% CI 26·8 to 38·4) in Aomori to -22·4 (-26·1 to -18·6) in Nagano, a gap of 55·0 deaths per 100 000, with 30 prefectures differing significantly from the national reference. The geographic pattern shifted between 1995 and 2023. In 1995, excess mortality was concentrated in western Japan, particularly Osaka and Fukuoka, and was largely driven by liver cancer. By 2023, excess mortality had shifted to northern prefectures, led by Aomori and Hokkaido, and was distributed across multiple cancer types, including colorectal, lung, and stomach cancer. The overall gap narrowed from 69·6 to 55·0 per 100 000.</p><p><strong>Conclusions: </strong>Geographic inequality in cancer mortality persisted in Japan, but its pattern changed substantially. The findings suggest that national cancer control should monitor subnational inequality directly and support regionally targeted strategies.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149333924","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 first-line treatment strategies for metastatic hormone-sensitive prostate cancer in Japanese clinical practice since 2020: a multicenter registry study.","authors":"Takashi Ueda, Keita Hayakawa, Yuki Ota, Junki Murashita, Hikaru Takahashi, Yumiko Saito, Masatsugu Miyashita, Takumi Shiraishi, Atsuko Fujihara, Masayoshi Okumi, Yuta Asakawa, Yuki Harada, Takeshi Yamada, Osamu Ukimura","doi":"10.1093/jjco/hyag184","DOIUrl":"https://doi.org/10.1093/jjco/hyag184","url":null,"abstract":"<p><strong>Background: </strong>Though randomized trials established androgen-receptor signaling inhibitor (ARSI) doublets and darolutamide-docetaxel triplet therapy (TRI) for metastatic hormone-sensitive prostate cancer, combined androgen blockade (CAB) remains widely used in Japan and these strategies have not been compared directly.</p><p><strong>Methods: </strong>We retrospectively analysed 643 men with M1 disease who began androgen-deprivation therapy during 2020-2026 at 23 Japanese institutions: CAB (113), abiraterone (139), enzalutamide (166), apalutamide (APA; 116), or TRI (109). The primary endpoint was castration-resistance-free survival (PFS1). Groups were compared by Kaplan-Meier analysis and multivariable Cox regression, with inverse-probability-of-treatment weighting, restriction to 2023-2026, and propensity-score matching as sensitivity analyses.</p><p><strong>Results: </strong>Median PFS1 was 16.1, 37.5, 54.9, and 52.9 months, respectively, and was not reached with TRI (P < .001). Adjusted hazard ratios versus CAB were 0.50 (95% CI 0.34-0.72), 0.43 (0.28-0.66), 0.42 (0.26-0.66), and 0.20 (0.10-0.41); triplet versus pooled ARSI doublets was 0.45 (0.24-0.85), exploratory and resting on 12 events. The ordering was preserved in all sensitivity analyses. Prostate-specific antigen 90 (PSA90) rates were similar (94.7%-95.8%), whereas a PSA nadir ≤0.2 ng/ml rose from 43.4% (CAB) to 68.9% (triplet; P < .001). Overall survival was immature (141 deaths). Discontinuation for toxicity was most frequent with APA (19.8%); 54.1% of triplet-treated patients completed six docetaxel cycles.</p><p><strong>Conclusions: </strong>Intensified first-line treatment was associated with a substantially lower hazard of castration resistance than CAB. The further reduction with TRI rests on few events and is exploratory. Discontinuation for toxicity was most frequent with APA, but ascertainment differed between the registry streams, so safety comparisons are hypothesis-generating.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149321198","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":"Impact of caseload-threshold centralization of intensity-modulated radiotherapy on cancer care regions in Japan: a nationwide ecological geospatial study.","authors":"Yuki Egashira, Ryo Watanabe","doi":"10.1093/jjco/hyag186","DOIUrl":"https://doi.org/10.1093/jjco/hyag186","url":null,"abstract":"<p><strong>Background: </strong>In Japan, a national expert panel has designated intensity-modulated radiotherapy (IMRT) for centralization at the level of single or multiple cancer care areas to improve outcomes and sustain the delivery system, projecting demand growth through 2040. Radiotherapy requires repeated visits; thus, centralization trades off quality for geographic access. However, the impact of the geographic unit of centralization has not been quantified before implementation. We evaluated the impact of caseload-based centralization of IMRT facilities on patient access by centralization unit (prefecture versus secondary medical area [SMA]) and demand year (2025 and 2040).</p><p><strong>Methods: </strong>We identified 611 IMRT-providing facilities from the FY2025 Bed Function Reports and derived a centralization threshold of 98 treatments annually using equipercentile correspondence. Accessibility was computed using an enhanced two-step floating catchment area method with 500-m mesh utilization-adjusted demand, comparing two scenarios reallocating the caseloads of withdrawing facilities to the nearest remaining facility. Outcomes were coverage (mesh- and demand-based), SMA accessibility score median (ASM), Gini coefficients, and cluster-based typology.</p><p><strong>Results: </strong>Overall, 166 facilities (27.2%) were designated for centralization. Prefecture-level centralization increased the share of demand beyond 60 minutes from 4.46% to 5.67% and resulted in loss of accessibility in 19 SMAs. Restricting centralization to SMAs limited withdrawals to 125 facilities, limited the increase in demand beyond 60 minutes to 0.14 percentage points, and loss of accessibility to three SMAs.</p><p><strong>Conclusions: </strong>Changes in accessibility depend not only on the caseload criterion but also on the geographic unit of centralization. Cancer centralization requires explicit consideration of geographic accessibility.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149321199","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 incidence of interstitial lung disease with enfortumab vedotin plus pembrolizumab or enfortumab vedotin monotherapy in metastatic urothelial carcinoma: a multicenter retrospective study in Japan.","authors":"Yuki Kobari, Nao Nakajima, Akira Saito, Nanaka Katsurayama, Toru Inakawa, Takanori Endo, Yuki Nemoto, Kazutaka Nakamura, Koichi Nishimura, Maki Yoshino, Hiroki Ishihara, Hironori Fukuda, Kazuhiko Yoshida, Hiroaki Shimmura, Yasunobu Hashimoto, Tsunenori Kondo, Hiroshi Kobayashi, Toshio Takagi","doi":"10.1093/jjco/hyag183","DOIUrl":"https://doi.org/10.1093/jjco/hyag183","url":null,"abstract":"<p><strong>Background: </strong>Enfortumab vedotin (EV) plus pembrolizumab is a standard first-line therapy for locally advanced or metastatic urothelial carcinoma. Interstitial lung disease (ILD) is a potentially serious adverse event (AE) associated with these therapies. We compared the incidence of ILD between EV monotherapy and enfortumab vedotin plus pembrolizumab in Japanese clinical practice.</p><p><strong>Methods: </strong>This multicenter retrospective study included patients with locally advanced or metastatic urothelial carcinoma treated with EV or EV plus pembrolizumab at five Japanese institutions. AEs, particularly ILD, were compared between the two groups. Factors associated with ILD development were evaluated using Firth penalized logistic regression.</p><p><strong>Results: </strong>Among 141 patients, 81 received EV and 60 received EV plus pembrolizumab. Grade ≥ 3 AEs were more frequent with the combination (27% vs. 10%, P = .0106). ILD occurred significantly more frequently in the combination (12% vs. 2%, P = .0272). Grade ≥3 ILD occurred in 8% versus 2% (P = .11). In Firth penalized logistic regression analysis adjusted for age and Eastern Cooperative Oncology Group performance status, the combination was associated with ILD (adjusted odds ratio, 5.47; 95% confidence interval, 1.32-32.3; P = .0134).</p><p><strong>Conclusions: </strong>In this retrospective Japanese cohort, ILD was observed more frequently in patients receiving enfortumab vedotin plus pembrolizumab than in those receiving enfortumab vedotin monotherapy. Careful monitoring and early recognition of ILD are warranted during combination therapy.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149297470","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":"Longitudinal plasma osimertinib concentrations during treatment in patients with EGFR-mutant NSCLC: a prospective real-world study.","authors":"Reiko Ando Makihara, Yuki Shinno, Yuki Katsuya, Keisuke Ikegami, Yukitaka Shibata, Makoto Maeda, Akiko Tateishi, Tomonori Mizutani, Yusuke Okuma, Tatsuya Yoshida, Hidehito Horinouchi, Noboru Yamamoto, Hironobu Hashimoto, Yasushi Goto","doi":"10.1093/jjco/hyag181","DOIUrl":"https://doi.org/10.1093/jjco/hyag181","url":null,"abstract":"<p><strong>Background: </strong>Osimertinib is used across treatment settings for epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC). Dose reduction is sometimes required for tolerability; however, efficacy is often maintained. We evaluated longitudinal plasma trough concentrations (C_trough) in patients receiving osimertinib.</p><p><strong>Methods: </strong>Patients with EGFR-mutant NSCLC receiving osimertinib who provided informed consent for a prospective observational study between March 2022 and May 2024 were included. Blood samples were obtained at each visit, and plasma concentrations were quantified using a validated assay. Among the patients initiated on 80 mg once daily, the association between the initial C_trough and subsequent dose reduction for toxicity was evaluated. Clinical correlates of exposure were assessed by relating the dose-normalized concentration (C/D ratio) to baseline characteristics.</p><p><strong>Results: </strong>Twenty-five patients were evaluated. Patients requiring dose reduction (n = 6) had a higher initial C_trough on days 6-14 than did those who did not (median, 466.5 versus 224 ng/mL; P = .0094). Among 15 patients treated ≥18 months, long-term therapy was sustained across a wide concentration range. Of the 70 long-term samples, 96% were ≤ 268.5 ng/mL. The C/D ratio was higher in females than males, inversely correlated with body weight and body surface area, and positively correlated with the neutrophil-to-lymphocyte ratio.</p><p><strong>Conclusions: </strong>Higher early osimertinib exposure was observed in patients who subsequently required dose reduction because of toxicity. Plasma concentration measurement may provide complementary information on individual drug exposure when assessing tolerability. Long-term treatment was observed across a broad concentration range following dose modification.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149297462","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":"A randomized phase III study optimizing adjuvant osimertinib for resected EGFR-mutant stage II-III non-squamous non-small cell lung cancer: OASIS trial (JACTOP-01).","authors":"Ken Onodera, Yoshinori Okada, Yujin Kudo, Masaya Yotsukura, Keisuke Asakura, Yasushi Goto, Satoshi Shiono, Shinichi Toyooka, Yoshimasa Maniwa, Toyofumi Fengshi Chen-Yoshikawa, Shun-Ichi Watanabe, Masataka Taguri, Nodoka Seya, Tomonori Mizutani, Hideo Kunitoh, Norihiko Ikeda","doi":"10.1093/jjco/hyag185","DOIUrl":"https://doi.org/10.1093/jjco/hyag185","url":null,"abstract":"<p><p>The OASIS trial [Japan Cancer Treatment Optimization group (JACTOP)-01] is a multicenter, randomized, open-label, phase III study optimizing adjuvant osimertinib therapy for patients with completely resected, epidermal growth factor receptor (EGFR)-mutated (exon 19 deletion or L858R) stage II-III non-squamous non-small cell lung cancer. Based on the ADAURA trial, the standard adjuvant dose of osimertinib is 80 mg/day, which often causes significant adverse events and financial toxicity. This trial evaluates the non-inferiority of a reduced dose of 40 mg/day of osimertinib compared to the standard 80 mg/day. A total of 420 patients will be randomized (1:1) to receive either osimertinib 80 or 40 mg/day orally for 3 years. The primary endpoint is disease-free survival. Secondary endpoints include overall survival, central nervous system disease-free survival, safety, and quality of life. If non-inferiority is confirmed, osimertinib 40 mg/day will establish a new optimal adjuvant strategy, improving patient quality of life and reducing medical economic burdens.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149297478","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":"Author's reply to \"Early progression after immune checkpoint inhibition: aligning assessment with disease distribution\".","authors":"Hiroki Noda, Takuma Makino, Yuto Naoi, Shohei Fujimoto, Mizuo Ando","doi":"10.1093/jjco/hyag180","DOIUrl":"https://doi.org/10.1093/jjco/hyag180","url":null,"abstract":"","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238325","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":"Early progression after immune checkpoint inhibition: aligning assessment with disease distribution.","authors":"Murat Kiracı","doi":"10.1093/jjco/hyag179","DOIUrl":"https://doi.org/10.1093/jjco/hyag179","url":null,"abstract":"","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238347","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":"Efficacy and safety of immunotherapy plus chemotherapy in elderly patients with advanced gastric cancer: a retrospective study.","authors":"Naoya Ishibashi, Takeshi Kawakami, Kunihiro Fushiki, Kotoe Oshima, Satoshi Hamauchi, Takahiro Tsushima, Tomoya Yokota, Yusuke Onozawa, Hirofumi Yasui, Kentaro Yamazaki","doi":"10.1093/jjco/hyag176","DOIUrl":"https://doi.org/10.1093/jjco/hyag176","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the efficacy and safety of immunotherapy plus chemotherapy in elderly patients with human epidermal growth factor receptor 2 (HER2)-negative advanced gastric cancer (AGC).</p><p><strong>Methods: </strong>This single-center retrospective study included patients with HER2-negative AGC who received nivolumab or pembrolizumab plus chemotherapy between November 2021 and October 2025. Patients were classified as non-elderly (<75 years) or elderly (≥75 years). Endpoints included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and safety.</p><p><strong>Results: </strong>A total of 164 patients were selected (117 non-elderly, 47 elderly). The median PFS was 6.4 and 7.4 months (Hazard Ratio (HR) 0.79; 95% confidence interval (CI), 0.52-1.19), and median OS was 14.8 and 15.9 months (HR 0.89; 95% CI 0.57-1.38). Initial dose reduction was significantly more frequent in elderly patients (35.9% vs. 83.0%, P < .001). Any grade AEs occurred in 97.4% and 97.9%, grade 3-4 AEs in 51.3% and 40.4%. Any grade immune-related adverse events (irAEs) in 31.6% and 27.7%, and grade 3-4 irAEs in 6.8% and 6.4% in non-elderly and elderly patients, respectively. Treatment discontinuation due to AEs was observed more frequent in the elderly group (3.4% vs. 17.0%). Fewer elderly patients received subsequent therapy (72.6% vs. 48.5%, P = .01).</p><p><strong>Conclusions: </strong>No clear age-related differences in survival outcomes or safety were observed with first-line immunotherapy plus chemotherapy in this study. However, elderly patients had higher treatment discontinuation and lower subsequent therapy rates, highlighting the importance of individualized dose adjustment and timely disease assessment and close monitoring.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215689","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}