Japanese journal of clinical oncology最新文献

{"title":"Conversion surgery for gastric cancer: current status and future perspectives.","authors":"Itaru Yasufuku, Yusuke Okuma, Syunpei Tonomura, Seito Fujibayashi, Wakana Chikaishi, Masahide Endo, Yuji Hatanaka, Masahiro Fukada, Ryuichi Asai, Yuta Sato, Jesse Yu Tajima, Akitaka Makiyama, Yoshihiro Tanaka, Nobuhisa Matsuhashi","doi":"10.1093/jjco/hyag137","DOIUrl":"https://doi.org/10.1093/jjco/hyag137","url":null,"abstract":"<p><p>Conversion surgery, defined as surgical resection with curative intent after a favorable response to systemic chemotherapy in patients with initially unresectable gastric cancer, has attracted considerable attention as a potential treatment strategy for metastatic disease. Observational studies suggest that long-term survival may be achieved when R0 resection is accomplished. However, the therapeutic landscape has changed with advances in systemic treatment, including immune checkpoint inhibitor-based regimens. Recent evidence indicates that some patients who respond well to modern systemic therapies may achieve prolonged survival without surgery. Emerging observational data also suggest that, among patients with profound tumor regression or complete response to chemotherapy, overall survival may not differ substantially between those undergoing surgery and those continuing systemic therapy alone, raising important questions regarding the necessity of conversion surgery in current clinical practice. Accordingly, the Japanese Gastric Cancer Treatment Guidelines 2025 concluded that evidence remains insufficient to make a clear recommendation regarding conversion surgery. This review summarizes the concept and definition of conversion surgery, outlines the resectability classifications proposed by the Japan Clinical Oncology Group, and critically reviews evidence from observational studies and prospective trials, with particular attention to chemotherapy responders treated with or without surgery. In the modern treatment era, conversion surgery remains a promising approach; however, whether it offers a survival advantage over continued systemic chemotherapy has not been established. Clarification of its appropriate role in metastatic gastric cancer requires evidence from prospective randomized trials.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828412","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":"Prognostic significance of the FAN score in patients with advanced urothelial carcinoma treated with enfortumab vedotin monotherapy.","authors":"Hiromu Horitani, Atsunari Kawashima, Yu Ishizuya, Yoshiyuki Yamamoto, Takuji Hayashi, Shunsuke Inoguchi, Yuki Horibe, Nesrine Sassi, Yujiro Hayashi, Takeshi Ujike, Koichi Tsutahara, Mototaka Sato, Yosuke Sekii, Koji Yazawa, Fuki Kondo, Yutaka Kurahashi, Wataru Nakata, Toshihisa Asakura, Takahiro Imanaka, Koichi Okada, Masashi Nakayama, Taigo Kato, Koji Hatano, Norio Nonomura","doi":"10.1093/jjco/hyag141","DOIUrl":"https://doi.org/10.1093/jjco/hyag141","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the prognostic significance of the Fib-4 index, ALBI and NLR (FAN) score, a composite score comprising the fibrosis-4 index, albumin-bilirubin score, and neutrophil-to-lymphocyte ratio, in patients with advanced urothelial carcinoma treated with enfortumab vedotin (EV) monotherapy.</p><p><strong>Methods: </strong>This multicenter retrospective study included 164 patients with advanced urothelial carcinoma who received EV monotherapy following prior systemic therapy. Patients were classified into three groups (0, 1, and 2-3) based on the FAN score, and progression-free, cancer-specific, and overall survival (OS) outcomes were evaluated.</p><p><strong>Results: </strong>The proportion of patients with FAN scores of 0, 1, and 2-3 were 26.8% (n = 44), 40.2% (n = 66), and 32.9% (n = 54), respectively. Median progression-free survival (PFS) was 8.1, 5.7, and 3.8 months across FAN score groups. A significant difference was observed between the FAN 0 and 2-3 groups (Holm-adjusted P = .025). Median cancer-specific survival (CSS) was 17.5, 12.2, and 7.2 months and differed significantly across groups (Holm-adjusted P = .012). OS showed a similar significant decline (Holm-adjusted P = .013). Multivariable analysis confirmed the FAN score as an independent prognostic factor for OS, CSS, and PFS. Furthermore, adding the FAN score to a model comprising conventional clinical factors improved prognostic accuracy for both CSS and OS (ΔC-index for CSS = 0.067, bootstrap P < .001; ΔC-index for OS = 0.057, bootstrap P < .001).</p><p><strong>Conclusions: </strong>The FAN score is a simple and clinically useful prognostic tool that may improve risk stratification in patients receiving EV monotherapy for advanced urothelial carcinoma.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813055","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":"Stage-specific prognostic impact and recurrence patterns according to tumor location in upper tract urothelial carcinoma following radical nephroureterectomy: a propensity score-matched analysis.","authors":"Yue Ogihara, Fumihiko Urabe, Masataka Kubo, Naoki Uchida, Hirokazu Kagawa, Masaki Hashimoto, Yuhei Koike, Yuya Iwamoto, Shota Kawano, Mimu Ishikawa, Sotaro Kayano, Juria Nakano, Yuzo Inaba, Kosuke Iwatani, Yu Imai, Minoru Nakazono, Keiji Yasue, Kojiro Tashiro, Masaya Murakami, Takaya Sasaki, Shunsuke Tsuzuki, Jun Miki, Takahiro Kimura","doi":"10.1093/jjco/hyag139","DOIUrl":"https://doi.org/10.1093/jjco/hyag139","url":null,"abstract":"<p><strong>Background: </strong>The prognostic significance of the location of the primary tumor in upper tract urothelial carcinoma (UTUC) remains controversial. We evaluated the impact of ureteral urothelial carcinoma (UUC) versus renal pelvic urothelial carcinoma (RPUC) on oncological outcomes and recurrence patterns following radical nephroureterectomy (RNU).</p><p><strong>Methods: </strong>We retrospectively analysed 779 patients with UTUC who underwent RNU between 2012 and 2021 within the JIKEI-YAYOI Collaborative Group. Propensity score matching (PSM) was performed to balance clinicopathological characteristics between UUC and RPUC. The primary endpoints were non-urothelial tract recurrence-free survival (NUTRFS) and overall survival (OS). Cancer-specific survival (CSS), intravesical recurrence-free survival (IVRFS), and recurrence patterns were also evaluated.</p><p><strong>Results: </strong>After PSM, 309 matched pairs were analysed. Compared to RPUC, UUC was associated with significantly shorter NUTRFS (3-year rate: 68.9% vs. 77.6%, P = 0.048), OS (76.4% vs. 83.3%, P = 0.021), and CSS (80.0% vs. 88.1%, P = 0.009). No significant difference was observed in IVRFS (P = 0.90). Stage-specific analyses demonstrated that the adverse prognostic impact of UUC was primarily confined to patients with pT3/4 disease. Among node-negative pT3/4 patients, UUC was associated with significantly worse NUTRFS, OS, and CSS. Recurrence pattern analyses revealed higher rates of local recurrence and regional lymph node recurrence in pT3/4 UUC, whereas pulmonary metastasis was more frequent in RPUC.</p><p><strong>Conclusion: </strong>Primary tumor location was significantly associated with oncological outcomes in UTUC. The prognostic disadvantage of UUC is mainly observed in locally advanced disease and appears to be driven by an increased risk of locoregional recurrence. Tumor location may provide additional prognostic information for postoperative risk stratification and surveillance planning.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793010","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 Bayesian reanalysis of the THOR trial cohort 1 using reconstructed individual patient data: interval-specific effects and clinically interpretable estimands under non-proportional hazards.","authors":"Gaku Okumura, Soichiro Yoshida, Kohei Hirose, Shugo Yajima, Wei Chen, Hiroyuki Sato, Akihiro Hirakawa, Motohiro Fujiwara, Yuki Arita, Hiroshi Fukushima, Yosuke Yasuda, Hajime Tanaka, Hitoshi Masuda, Yasuhisa Fujii","doi":"10.1093/jjco/hyag133","DOIUrl":"https://doi.org/10.1093/jjco/hyag133","url":null,"abstract":"<p><strong>Background: </strong>The phase 3 THOR trial (cohort 1) showed improved overall survival (OS) and progression-free survival (PFS) with erdafitinib versus chemotherapy in FGFR2/3-altered advanced urothelial carcinoma after prior programmed cell death protein 1 (PD-1) / programmed death-ligand 1 (PD-L1) inhibitor therapy. When the assumption of proportional hazards (PH) is violated, a single hazard ratio (HR) may be difficult to interpret.</p><p><strong>Methods: </strong>We derived reconstructed individual patient data (rIPD) for OS and PFS from published Kaplan-Meier curves. PH was assessed using scaled Schoenfeld residuals and log-log plots. We fit Bayesian piecewise-exponential models with administrative censoring at τ = 24 months (OS; cut-point 12 months) and τ = 12 months (PFS; cut-point 6 months). We reported interval-specific HRs, landmark survival differences (ΔOS, ΔPFS), number needed to treat (NNT), restricted-mean survival time (RMST), and posterior probabilities for clinically meaningful thresholds.</p><p><strong>Results: </strong>Statistical diagnostics indicated that the PH assumption was violated for both OS and PFS. For OS, HR was 0.59 (95% credible interval 0.41-0.84) in months 0-12 and 1.06 (0.48-2.48) in months 12-24. At 12 months, ΔOS(12) = 0.18 (0.06-0.30); conditional median NNT was 5.45. ΔRMST (0-24) = 3.02 months (0.74-5.23), with P(ΔRMST >0) = 99.5%. For PFS, the HR was 0.64 (0.45-0.89) in months 0-6 and 0.49 (0.25-1.00) in months 6-12; ΔPFS (6) = 0.16 (0.04-0.28) and ΔRMST (0-12) = 1.74 months (0.69-2.76).</p><p><strong>Conclusion: </strong>This Bayesian rIPD-based reanalysis provides PH-robust estimands, indicating early OS benefit with uncertain later effects, and favorable PFS over 0-12 months with erdafitinib.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793015","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":"Letermovir coadministration and tacrolimus concentration-to-dose ratios before and after intravenous-to-oral conversion in allogeneic hematopoietic stem cell transplant recipients receiving isavuconazole.","authors":"Toshihisa Nakashima, Yoshihiro Inamoto, Ayumu Ito, Takahiro Fukuda, Hironobu Hashimoto","doi":"10.1093/jjco/hyag135","DOIUrl":"https://doi.org/10.1093/jjco/hyag135","url":null,"abstract":"<p><p>Letermovir is used for cytomegalovirus prophylaxis after allogeneic hematopoietic cell transplantation (HCT) and reportedly increases tacrolimus exposure. Isavuconazole, a mold-active triazole antifungal, also inhibits cytochrome P450 3A and may affect tacrolimus pharmacokinetics. This retrospective study evaluated tacrolimus concentration-to-dose (C/D) ratios pre- and post-conversion from continuous intravenous infusion to oral administration in allogeneic HCT recipients receiving isavuconazole. Forty-five patients were stratified according to letermovir coadministration into the isavuconazole-alone group (ISCZ-alone; n = 9) and the isavuconazole with letermovir group (ISCZ + LMV; n = 36). The median C/Dciv ratios were 17.00 and 16.40 (ng/ml)/(mg/day), respectively (P = 0.81); the median C/Dpo ratios were 3.25 and 2.60 (ng/ml)/(mg/day), respectively (P = 0.77); and the median (C/Dpo)/(C/Dciv) ratios were 0.154 and 0.173, respectively (P = 0.72). Sensitivity analyses yielded consistent findings. Letermovir coadministration was not associated with significant differences in tacrolimus C/D ratios pre- or post-conversion to oral administration in allogeneic HCT recipients receiving isavuconazole.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793033","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":"Endoscopy-assisted precise radical hysterectomy and perioperative chemotherapy for locally advanced cervical cancer: feasibility and clinical outcomes compared with radiotherapy.","authors":"Masato Kita, Yusuke Butsuhara, Tomomi Mizokami, Hiromi Murata, Hiroshi Shiraga, Hidetaka Okada","doi":"10.1093/jjco/hyag132","DOIUrl":"https://doi.org/10.1093/jjco/hyag132","url":null,"abstract":"<p><strong>Aim: </strong>This retrospective comparative study aimed to assess the feasibility and benefits of newly developed pneumovaginoscopy-assisted radical hysterectomy (PVRH) combined with systemic chemotherapy (neoadjuvant and adjuvant) compared to primary concurrent chemoradiotherapy in the treatment of stage IIB-IIIA locally advanced cervical cancer.</p><p><strong>Methods: </strong>Between June 2014 and December 2023, 117 patients with stage IIB-IIIA cervical cancer were treated. Fifty-nine patients were treated with PVRH combined with systemic chemotherapy [45 patients with neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy, 14 patients with adjuvant chemotherapy only)] or with primary concurrent chemoradiotherapy (n = 58).</p><p><strong>Results: </strong>The neoadjuvant chemotherapy, pneumovaginoscopy-assisted radical hysterectomy, and adjuvant chemotherapy (NPA) completion rates were all 100%. The adjuvant radiotherapy avoidance rate was 94.8%. All patients resumed self-urination within 3 months of surgery. The achievement rates of R0 resection were 100% for vagina and 97.8% (1/45 of NAC cases) for parametrium. The adverse events associated with NPA were less severe than those associated with primary concurrent chemoradiotherapy. The patients with complete or partial response by NAC had a prognosis comparable to primary concurrent chemoradiotherapy; however, the patients with stable disease by NAC had a significantly poorer prognosis than primary concurrent chemoradiotherapy. In squamous cell carcinoma, the rate of distant metastasis was numerically lower with NPA group compared to the concurrent chemoradiotherapy group; however, this trend was not observed in the subgroup that showed a poor response to preoperative chemotherapy.</p><p><strong>Conclusions: </strong>Endoscopy-assisted precise RH with perioperative chemotherapy is a feasible multidisciplinary strategy for stage IIB-IIIA cervical cancer, demonstrating high surgical precision and functional preservation. While these results may suggest potential benefits of this treatment, their interpretation requires caution, and patient selection based on the response to preoperative therapy is considered important.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793031","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 significance of spread through air spaces according to EGFR mutation status in lung adenocarcinoma.","authors":"Asato Hashinokuchi, Keisuke Kosai, Naoki Haratake, Takatoshi Fujishita, Shinichiro Shimamatsu, Takuro Kometani, Toshiaki Kawabata, Ryo Toyozawa, Kenichi Taguchi, Mototsugu Shimokawa, Masafumi Yamaguchi","doi":"10.1093/jjco/hyag129","DOIUrl":"https://doi.org/10.1093/jjco/hyag129","url":null,"abstract":"<p><strong>Objectives: </strong>Spread through air spaces (STAS) is a poor prognostic pathological feature recently included as a histological factor in the ninth edition of the TNM (tumor, node, and metastasis) classification. However, its clinical significance in lung adenocarcinoma with epidermal growth factor receptor (EGFR) gene mutations remains unclear. Here, we aimed to evaluate the clinical significance of STAS according to EGFR mutation status.</p><p><strong>Methods: </strong>We retrospectively reviewed 347 patients with completely resected pathological stage 0-IIIB lung adenocarcinoma who were evaluated for both STAS and EGFR mutations between 2015 and 2022. We investigated the association between clinicopathological features and STAS and analyzed its prognostic relevance based on EGFR mutation status.</p><p><strong>Results: </strong>STAS and EGFR mutations were present in 85 (24.5%) and 178 (51.3%) patients, respectively. In patients with EGFR-mutated lung adenocarcinoma, STAS was significantly more prevalent in those with exon 19 deletions than those with the L858R mutation (P = .012). STAS was significantly markedly associated with poorer recurrence-free and overall survival in patients both with (P < .001 and P < .001, respectively) and without (P = .003 and P = .023, respectively) EGFR mutations. Multivariable analysis revealed that STAS was an independent prognostic factor for recurrence-free and overall survival in patients with EGFR mutations (P < .001 and P = .020, respectively). However, STAS was not an independent predictor in patients without EGFR mutations.</p><p><strong>Conclusions: </strong>STAS is a key pathological feature of lung adenocarcinoma and holds considerable clinical relevance, particularly in EGFR-mutated lung adenocarcinoma.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792997","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":"Long-term care needs and service use in terminally ill patients with cancer: a nationwide claims data study.","authors":"Richi Takahashi, Takaaki Konishi, Yoko Nakazawa, Daisuke Fujisawa","doi":"10.1093/jjco/hyag130","DOIUrl":"https://doi.org/10.1093/jjco/hyag130","url":null,"abstract":"<p><strong>Background: </strong>Terminally ill patients with cancer may have difficulty using Japan's public long-term care insurance system because functional decline often occurs rapidly near death. We examined care-need levels, service use, and factors associated with timely service use in this population.</p><p><strong>Methods: </strong>We used anonymized long-term care insurance claims data from January 2018 to August 2025. Patients who died of cancer and whose first observed certification was granted within 1 year before death were included. Certification levels, certification period, and service use were described. Logistic regression examined factors associated with service use within 30 days after first certification.</p><p><strong>Results: </strong>Among 10 491 patients, 17.8% were initially classified as support levels 1 and 2, and 62.0% were first certified within 3 months before death. Overall, 6740 (64.2%) used long-term care services during observation, and 4822 (46.0%) used services within 30 days. Compared with patients certified 6 to ≤ 12 months before death, those certified closer to death had higher odds of service use within 30 days: adjusted odds ratios were 1.63 (95% CI, 1.43-1.84) for ≤ 1 month, 1.23 (1.09-1.40) for 1 to ≤ 3 months, and 1.17 (1.02-1.34) for 3 to ≤6 months. Higher initial care-need levels were also associated with greater service use within 30 days, peaking at care-need level 2 (5.73; 4.78-6.88).</p><p><strong>Conclusions: </strong>Many patients were first certified shortly before death. Certification closer to death was associated with prompt service use, possibly reflecting urgent care coordination. Earlier information provision and timely certification may help patients access long-term care services before death.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792983","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":"De-escalation of perioperative systemic therapy for early breast cancer.","authors":"Makiko Ono, Yasuaki Sagara, Toshiyuki Ishiba, Yukinori Ozaki, Takehiko Sakai, Hideo Shigematsu, Akihiko Shimomura, Kazuki Sudo, Kaori Terata, Yoichi Naito, Kazuki Nozawa, Fumikata Hara, Tomomi Fujisawa, Tadahiko Shien","doi":"10.1093/jjco/hyag131","DOIUrl":"https://doi.org/10.1093/jjco/hyag131","url":null,"abstract":"<p><p>Breast cancer is the most common malignancy among women worldwide, and the number of survivors continues to increase owing to earlier detection and advances in treatment. As long-term survivorship becomes increasingly important, minimizing treatment-related toxicity without compromising oncologic outcomes has become a major goal in the management of early breast cancer. Treatment de-escalation strategies have therefore attracted considerable attention. In HER2-positive disease, several approaches have been explored, including reduction of chemotherapy intensity, shortening the duration of anti-HER2 therapy, chemotherapy-free regimens in selected patients, and response-guided strategies based on pathologic complete response following neoadjuvant therapy. In hormone receptor-positive HER2-negative breast cancer, multigene expression assays have enabled more precise risk stratification and have allowed omission of adjuvant chemotherapy in patients with biologically low-risk tumors. In addition, the neoadjuvant setting provides an opportunity to evaluate treatment response using biomarkers such as Ki67, which may help identify patients who can safely avoid chemotherapy. Ongoing clinical trials are further evaluating response-guided treatment strategies, particularly in premenopausal patients. Furthermore, circulating tumor DNA has recently emerged as a promising biomarker for detecting minimal residual disease and monitoring treatment response. Integration of molecular biomarkers with response-adapted strategies may further refine risk stratification and support personalized treatment approaches. This review summarizes current evidence and ongoing studies on treatment de-escalation across breast cancer subtypes.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793029","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 severe postoperative complications on oncologic outcomes after curative resection for stage I-III colorectal cancer: a multicenter study.","authors":"Shintaro Hashimoto, Tetsuro Tominaga, Keisuke Noda, Toshio Shiraishi, Hiroki Katayama, Shoko Tei, Taiji Hida, Kazuki Motoyama, Shoto Yamazaki, Takashi Ohnoda, Hiroshi Maruta, Yuma Takamura, Rika Ono, Nobuhito Ogata, Makoto Hisanaga, Mitsutoshi Ishii, Masaaki Moriyama, Hidetoshi Fukuoka, Kazuo To, Kaido Oishi, Takashi Nonaka, Keitaro Matsumoto","doi":"10.1093/jjco/hyag126","DOIUrl":"https://doi.org/10.1093/jjco/hyag126","url":null,"abstract":"<p><strong>Background: </strong>Severe postoperative complications (Clavien-Dindo [CD] grade ≥ 3) may compromise long-term oncologic outcomes after colorectal cancer (CRC) surgery, but their impact across all pathological stages remains unclear.</p><p><strong>Methods: </strong>We retrospectively analyzed 1990 patients who underwent curative resection for pStage I-III CRC at six hospitals (2016-2021). Multivariable Cox proportional hazards models were used to evaluate recurrence-free survival (RFS), overall survival (OS), cancer-specific survival (CSS), and time to recurrence (TTR). Stratified analyses were performed by pathological stage and complication type (intra-abdominal infectious complications [IAI] vs. non-IAI), and a 30-day landmark analysis was conducted.</p><p><strong>Results: </strong>CD ≥3 complications occurred in 128 patients (6.4%). On multivariable analysis, CD ≥3 complications were independent adverse prognostic factors for RFS (hazard ratio [HR] 1.84, P < .001), OS (HR 2.52, P < .001), and CSS (HR 2.04, P = .024), but not for TTR (HR 1.22, P = .451). Stage-stratified analyses showed significant associations with worse RFS and OS in pStage II-III, with trends in pStage I. CSS was significantly worse in pStage III (HR 3.06, P < .001). TTR showed no significant association with CD ≥3 complications in any pStage. IAI complications were independently associated with worse CSS (HR 2.21, P = .039), whereas non-IAI complications were not. These adverse effects persisted after 30-day landmark analysis.</p><p><strong>Conclusions: </strong>CD ≥3 complications independently worsen RFS, OS, and CSS but do not significantly affect TTR after curative resection for pStage I-III CRC. IAI complications are particularly associated with worse cancer-specific mortality. This discordance suggests that severe complications may not primarily accelerate recurrence itself, but may instead impair survival after recurrence, highlighting possible mechanisms beyond direct recurrence acceleration.</p>","PeriodicalId":14656,"journal":{"name":"Japanese journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761185","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}