JAMA Oncology最新文献

{"title":"Local Control and Extended Survival in Locally Advanced Hepatocellular Carcinoma.","authors":"Alexander D Sherry,Ahmed O Kaseb,Ethan B Ludmir","doi":"10.1001/jamaoncol.2025.0513","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.0513","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"17 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unintended Consequences of Patient Portal Access.","authors":"Dana G Rowe,C Rory Goodwin","doi":"10.1001/jamaoncol.2025.0415","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.0415","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"26 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonoperative Management of Technically Resectable Pancreatic Cancer With Ablative Radiation Therapy","authors":"Marsha Reyngold, Joshua D. Schoenfeld, Eileen M. O’Reilly, Anna M. Varghese, Charlie White, Melissa Zinovoy, Paul B. Romesser, Abraham J. Wu, Carla Hajj, John J. Cuaron, Danny N. Khalil, Wungki Park, Wei Lu, Zhigang Zhang, Kenneth H. Yu, Luis A. Diaz, Christopher H. Crane","doi":"10.1001/jamaoncol.2025.0460","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.0460","url":null,"abstract":"ImportanceSurgical resection of pancreatic ductal adenocarcinoma (PDAC) modestly improves long-term survival due to the competing risk of metastatic disease. However, postoperative morbidity often interferes with administration of systemic therapy and may be unacceptable to some patients. Ablative radiation therapy (A-RT) has emerged as an effective noninvasive local treatment in many tumor types and may provide an alternative to surgery in select patients with resectable PDAC.ObjectiveTo estimate the efficacy of A-RT in technically resectable PDAC.Design, Setting, and ParticipantsThis cohort study of consecutive patients with histologically confirmed, radiographically resectable T1-2N0-1M0 PDAC treated with A-RT at Memorial Sloan Kettering Cancer Center between June 2016 and December 2022 were included from a prospectively maintained database. Patients were not eligible for surgery because of noncancer-related comorbidities. Data were frozen for analysis in December 2023, which took place between March and November 2024.ExposuresAll patients received A-RT exceeding 97.5-Gy biologically effective dose with daily computed tomography or magnetic resonance imaging guidance, motion management, and daily or selective adaptation of the dose distribution.Main Outcomes and MeasuresThe primary outcome was overall survival (OS). Secondary outcomes included biochemical and radiographic objective response rate, cumulative incidence of local progression, progression-free survival, and distant metastasis–free survival.ResultsOf 25 patients with radiographically resectable PDAC who received A-RT, 13 (52%) were male, and the median (IQR) age at time of A-RT was 80 (74-87) years. A total of 20 patients (80%) had a Karnofsky Performance Status score of 80 or lower. A total of 15 tumors (60%) were T2, and 4 (16%) were node positive. A total of 17 patients (68%) received induction chemotherapy for a median (range) of 2.9 (1.0-6.1) months. Radiation therapy regimens delivered with conventional linear accelerators included 75 Gy in 25 fractions among 13 patients, 67.5 Gy in 15 fractions among 9 patients, 50 Gy in 5 fractions among 2 patients (magnetic resonance imaging-guided linear accelerator), and 60 Gy in 10 for 1 patient. OS, local progression, and distant metastasis–free survival at 2 years were 43.7% (95% CI, 27.4%-69.5%), 20.8% (95% CI, 7.3%-39.0%), and 20.0% (95% CI, 9.1%-43.8%), respectively. Grade 3 acute and late gastrointestinal tract toxic effects were noted in 3 and 1 patients, respectively, with no grade 4 or higher events.Conclusions and RelevanceIn this cohort study, A-RT in patients with technically resectable PDAC led to effective local tumor control and favorable OS despite advanced age, poor Karnofsky Performance Status score, and conservative use of chemotherapy in the cohort studied. These data support a prospective study of A-RT for the management of resectable PDAC.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"107 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local Disease Control in Patients With Pancreatic Cancer.","authors":"Douglas B Evans,Beth A Erickson,William A Hall","doi":"10.1001/jamaoncol.2025.0156","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.0156","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"108 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Cancer System Characteristics and Global Pan-Cancer Outcomes","authors":"Edward Christopher Dee, James Fan Wu, Erin Jay G. Feliciano, Frederic Ivan L. Ting, Jonas Willmann, Frances Dominique V. Ho, Bhav Jain, Urvish Jain, Jenny Chen, Fabio Ynoe Moraes, Nancy Y. Lee, Puneeth Iyengar, Paul L. Nguyen","doi":"10.1001/jamaoncol.2025.0473","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.0473","url":null,"abstract":"ImportanceApproximately 29.9 million cancer cases and 15.3 million deaths are anticipated by 2040 globally, necessitating cancer system strengthening. A greater understanding of health system factors that can be leveraged to improve cancer control may guide health system planning.ObjectiveTo evaluate predictors of improved cancer outcomes globally.Design, Setting, and ParticipantsThis pan-cancer ecological study used the most recent available national health system metrics and cancer statistics, spanning the breadth of global income levels across 185 countries. Estimates of age-standardized mortality to incidence ratios were derived from GLOBOCAN 2022 for patients with cancer of all ages. The analysis took place on November 27, 2024.Main Outcomes and MeasuresHealth spending as a percent of gross domestic product (GDP), physicians per 1000 population, nurses and midwives per 1000 population, surgical workforce per 1000 population, GDP per capita, Universal Health Coverage (UHC) service coverage index, availability of pathology services, human development index, gender inequality index (GII), radiotherapy centers per 1000 population, and out-of-pocket expenditure as percentage of current health expenditure were collected. The association between the mortality to incidence ratio (MIR) and each metric was evaluated using univariable linear regressions (α = .0045), which were used to construct multivariable models (α = .05). Variation inflation factor allowed exclusion of variables with significant multicollinearity. <jats:italic>R<jats:sup>2</jats:sup></jats:italic> measured goodness of fit.ResultsOn univariable analysis, all metrics were significantly associated with MIR of cancer (<jats:italic>P </jats:italic><<jats:italic> </jats:italic>.001 for all), including UHC index (β, −0.0076 [95% CI, −0.0083 to −0.0068]), GDP per capita (β, −5.10 × 10<jats:sup>-6</jats:sup> [95% CI, −5.75 × 10<jats:sup>-6</jats:sup> to −4.46 × 10<jats:sup>-6</jats:sup>]), clinical and workforce capacity, radiotherapy capacity (β, −88.25 [95% CI, −100.43 to −76.06]), and gender inequality index (β, 0.63 [95% CI, 0.57-0.70]). After including metrics significant on univariable analysis and correcting for multicollinearity, on multivariable analysis, greater UHC index and GDP per capita were independently associated with lower (improved) MIR for cancer. The multivariable model had <jats:italic>R<jats:sup>2</jats:sup></jats:italic> of 0.87. On multivariable analysis stratified by sex, greater UHC index and greater GDP per capita were independently associated with improved MIR for all cancers. <jats:italic>R<jats:sup>2</jats:sup></jats:italic> for the multivariable models was 0.87 for females and 0.85 for males.ConclusionsThis study found that global health system metrics related to progress toward universal health care, greater health care spending and GDP per capita, strengthened clinical workforce and capacity, and increased gender equity were associated with impro","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"17 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Risk Factors of Interval and Screen-Detected Breast Cancer","authors":"Yuqi Zhang, Juan Rodriguez, Xinhe Mao, Felix Grassmann, Jose Tapia, Mikael Eriksson, Per Hall, Kamila Czene","doi":"10.1001/jamaoncol.2025.0167","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.0167","url":null,"abstract":"ImportanceMammographic screening is the only proven method for early detection and mortality reduction of breast cancer (BC). However, many patients are missed at prior screening; thus, they receive their diagnosis between the interval of screening rounds, called interval cancer (IntCa). Some IntCas are fast growing between screening rounds.ObjectiveTo investigate the incidence and proportion of IntCa and screen-detected breast cancer (ScrCa) and identify factors associated with IntCa.Design, Setting, and ParticipantsThis population-based cohort study was conducted from January 1989 to March 2020, with follow-up until 2020 and a mean (SD) follow-up of 13 (8.3) years. The statistical analysis was performed from February 2023 to June 2024. It included cancer-free women (N = 527 144) residing in Stockholm, Sweden, who were invited to undergo mammography screening (aged 40-74 years) during 1989 to 2020. An additional cohort of women were included who were participating in the Karolinska Mammography Project for Risk Prediction of Breast Cancer study and had mammography data available.ExposuresFamily cancer history (defined from the Swedish Multi-Generation Register and Cancer Register), mammographic density, and various demographic, reproductive, and other factors (multiple Swedish registers).Main Outcomes and MeasuresIncidence of ScrCa and IntCa (defined from the Swedish Cancer Register in conjunction with individual screening histories).ResultsA total of 29 049 women (5.5%) received a diagnosis of BC, of whom 10 631 (2.0%) had ScrCa and 4369 (0.8%) IntCa. ScrCa and IntCa incidences increased during the period. The proportion of IntCa among screened patients with BC was around 30%, which decreased with older age. Factors associated with increased risk of IntCa included older age at first childbirth, higher education level, hormone replacement therapy, and higher mammographic density. Risk estimates of family cancer history on IntCa were family history of BC (hazard ratio [HR], 1.85; 95% CI, 1.72-1.99), family history of IntCa (HR, 2.92; 95% CI, 2.39-3.55), and hereditary breast and ovarian cancers (HR, 1.45; 95% CI, 1.36-1.54), with risk further elevated with the number of relatives who received a diagnosis when younger than the median age. Women with IntCa were more likely to have estrogen receptor (ER)–negative cancers than women with ScrCa (22% vs 11%), and having family history of ER-negative BC was associated with 3-fold risk for ER-negative IntCa.Conclusions and RelevanceThe results of this cohort study suggest that IntCa rates have not decreased with age-based screening, and implementing risk-based screening considering IntCa-specific risk factors is necessary for improving outcomes.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"3 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143713470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"USPSTF Lung Cancer Screening Guidelines and Disparities in Screening Adherence","authors":"LaShae D. Rolle, Coral Olazagasti, Gilberto Lopes, Estelamari Rodriguez, Tracy E. Crane","doi":"10.1001/jamaoncol.2025.0230","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.0230","url":null,"abstract":"This cross-sectional study evaluates the association of the updated US Preventive Services Task Force (USPSTF) guidelines on lung cancer screening with screening uptake, focusing on changes among disadvantaged and marginalized populations.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"56 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enlargement of Shoulder Muscles in an Older Man","authors":"Mohammad Alhomoud, Ali Alshehri, Hazzaa A. Alzahrani","doi":"10.1001/jamaoncol.2025.0071","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.0071","url":null,"abstract":"A 70-year-old man with a history of hypertension and chronic migraine presented with 10 months of progressive generalized muscle weakness and stiffness. Physical examination revealed generalized muscle wasting except for hypertrophy of bilateral shoulder muscles, and a deltoid muscle biopsy revealed deposition of amorphous material. What is your diagnosis?","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"92 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant Chemoradiotherapy vs Radiotherapy Alone for Patients With Intermediate-Risk Cervical Cancer","authors":"Núria Agustí, David Viveros-Carreño, Chi-Fang Wu, Roni Nitecki Wilke, Alexa Kanbergs, Karla Barajas, Abigail S. Zamorano, René Pareja, Alexander Melamed, J. Alejandro Rauh-Hain","doi":"10.1001/jamaoncol.2025.0146","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.0146","url":null,"abstract":"ImportanceOptimal adjuvant treatment for patients with intermediate-risk cervical cancer remains controversial, and the benefit of adding chemotherapy to radiotherapy in this population is uncertain.ObjectiveTo evaluate whether adjuvant chemoradiotherapy is associated with improved overall survival compared with radiotherapy alone in patients with intermediate-risk cervical cancer. Secondary objectives included identifying clinical factors associated with the use of chemoradiotherapy.Design, Setting, and ParticipantsA cohort study was conducted at Commission on Cancer–accredited centers across the US using prospectively collected data from the National Cancer Database that focused on patients with a diagnosis of 2018 International Federation of Gynecology and Obstetrics stage IB cervical carcinoma (squamous cell carcinoma, adenosquamous carcinoma, or adenocarcinoma) of intermediate risk who were undergoing adjuvant radiotherapy treatment after radical hysterectomy from January 2010 through December 2020. Missing variables were multiple imputed, and propensity score matching (1:1) was performed to balance baseline characteristics. A Kaplan-Meier analysis and proportional hazard models were used to compare the hazard of death between the groups.ExposureAdjuvant radiotherapy alone vs concurrent chemoradiotherapy.Main Outcome and MeasureThe primary outcome was time to death or last follow-up.ResultsA total of 1116 patients (mean [SD] age, 47 [12] years) were identified, of whom 486 (43.5%) received concurrent chemoradiotherapy. Chemotherapy was administered more frequently among those with adenocarcinoma or adenosquamous histology compared with squamous cell carcinoma (risk ratio [RR], 1.26; 95% CI, 1.10-1.44) and those with tumors larger than 4 cm (compared with tumors measuring 2-4 cm; RR, 1.31; 95% CI, 1.14-1.51). Propensity score matching yielded a cohort of 868 patients with balanced covariates. Patients who received chemoradiotherapy had similar overall survival (5- year survival, 87%) as those who received radiotherapy alone (5-year survival, 87%; hazard ratio, 0.85; 95% CI, 0.59-1.23; <jats:italic>P</jats:italic> = .38). There were no significant differences in survival associated with chemotherapy receipt among subgroups defined by tumor size, histology, presence of lymphovascular space invasion, surgical approach, or receipt of adjuvant brachytherapy.Conclusions and RelevanceThe results of this cohort study suggest that adding chemotherapy to radiotherapy was not associated with improved overall survival for patients with intermediate-risk cervical cancer.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"213 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sotorasib’s Accelerated Approval","authors":"Mark J. Ratain, Aaron S. Kesselheim","doi":"10.1001/jamaoncol.2025.0039","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.0039","url":null,"abstract":"This Viewpoint reviews the accelerated approval process and lack of postapproval studies to verify its benefit as it applied to sotorasib, a treatment for non–small cell lung cancer with the <jats:italic>KRAS</jats:italic><jats:sup>g12c</jats:sup> mutation, and recommends measures to ensure confirmatory follow-up studies.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"213 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}