JAMA Oncology最新文献

{"title":"Prostate-Specific Antigen Levels Among Participants Receiving Annual Testing.","authors":"Nicholas A Pickersgill,Maria M Peré,Emily A Vertosick,Sunny Nalavenkata,Bárbara Vieira Lima Aguiar Melão,Andrew J Vickers,Hans Lilja,James A Eastham,Sigrid V Carlsson","doi":"10.1001/jamaoncol.2025.3386","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.3386","url":null,"abstract":"ImportanceRepeating a prostate-specific antigen (PSA) test after an elevated measurement is a guideline-recommended component of the prebiopsy workup. However, it is unclear whether certain patients can be exempted from repeat PSA testing and proceed directly to further workup.ObjectiveTo determine yearly PSA variability and implications of repeating an elevated PSA in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial.Design, Setting, and ParticipantsThis retrospective multicenter cohort study used data from men aged 54 to 75 years participating in the screening arm of the randomized PLCO trial who received PSA testing annually over 6 years (between 1995 and 2006) without a prostate cancer diagnosis. Data were analyzed from February 10, 2023, to May 23, 2025.Main Outcomes and MeasuresThe primary outcome was the proportion of PSA measurements above 1 of the 3 biopsy thresholds of interest (2.5, 3.0, and 4.0 ng/mL) that decreased below the threshold at the subsequent yearly measurement. Analyses were conducted at both the PSA test and patient levels.ResultsAmong 11 176 eligible patients (median age 60 years, IQR, 57-65 years), 2700 patients were included at a threshold of 2.5 ng/mL, 1928 patients at 3.0 ng/mL, and 952 patients at 4.0 ng/mL at least once. Among PSA measurements greater than or equal to 2.5 ng/mL, 22% (95% CI, 21%-23%) decreased below 2.5 ng/mL the following year; rates were similar for thresholds of 3.0 ng/mL and 4.0 ng/mL. At the patient level, 54% (95% CI, 53%-56%) of men with at least 1 PSA greater than or equal to 2.5 ng/mL had a subsequent level below this threshold, with slightly greater rates for the higher thresholds. A predictive scoring system incorporating current and prior PSA levels showed that patients with PSA levels persistently above thresholds had a low (<10%) probability of PSA decreasing below the threshold.Conclusions and RelevanceIn this study, significant intra-individual variability in PSA levels was observed in this large screening cohort, with many elevated values falling below the threshold at the next yearly measurement. These findings suggest the utility of guideline recommendations to confirm elevated PSA results in most patients before performing further diagnostic evaluation and that patients with a prior PSA score above a given biopsy threshold, and no recent PSA scores below that threshold, could proceed to further diagnostic evaluation without repeat testing.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"80 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145078115","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":"Improving Clinical Decisions Through Primary Trial Data Review-The Regulatory Lens.","authors":"Ning Jiang,Zhaoyi Yang,Ning Li","doi":"10.1001/jamaoncol.2025.3532","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.3532","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"68 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145078119","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":"Patient-Reported Outcomes-The Missing Variable in Survival Prediction.","authors":"Jamie Takayesu,Erin F Gillespie","doi":"10.1001/jamaoncol.2025.3167","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.3167","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"70 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032054","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":"Patient-Reported Outcomes as Prognostic Indicators for Overall Survival in Cancer: A Systematic Review and Meta-Analysis.","authors":"Ryan S Huang,David Chen,Ali Benour,Ryan Cortez,Andrew Mihalache,Carlton Johnny,Andrea Bezjak,Robert A Olson,Srinivas Raman","doi":"10.1001/jamaoncol.2025.3153","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.3153","url":null,"abstract":"ImportancePatient-reported outcomes (PROs) are health data that are collected directly from patients to assess symptoms, functional status, and quality of life. While studies have reported associations between PROs and survival, the prognostic significance of specific PRO domains has not been systematically quantified.ObjectiveTo evaluate the association between baseline PROs and overall survival (OS) in patients with cancer and quantify the prognostic significance of various PRO domains through a systematic review and meta-analysis of randomized clinical trials (RCTs).Data SourcesA systematic literature search of PubMed (MEDLINE), Ovid Embase, and the Cochrane Library was conducted to identify eligible studies published between January 1, 2000, and June 1, 2024. The data were analyzed on January 15, 2025.Study SelectionEligible studies were prospective RCTs that enrolled adult patients with cancer (18 years or older) that included at least 1 baseline PRO measure, reported OS as an outcome, and conducted multivariate analyses that adjusted for clinical and disease-related confounders.Data Extraction and SynthesisData from eligible RCTs were extracted independently and in duplicate by 4 reviewers. Studies using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire were meta-analyzed using a random-effects model with an inverse variance-weighted approach.Main Outcome and MeasureThe primary outcome was the association between baseline PROs and OS reported using pooled hazard ratios (HRs) and 95% CIs.ResultsA total of 69 RCTs comprising 44 030 patients were included in the systematic review, with 31 RCTs (44.9%) meeting criteria for the meta-analysis. Higher global health status scores and quality of life were associated with improved OS (hazard ratio [HR], 0.99; 95% CI, 0.98-0.99). Among functional scales, physical functioning (HR, 0.94; 95% CI, 0.92-0.96) and role functioning (HR, 0.96; 95% CI, 0.94-0.98) were associated with improved OS. Conversely, higher symptom burden, including nausea and vomiting (HR, 1.12; 95% CI, 1.04-1.21), fatigue (HR, 1.05; 95% CI, 1.00-1.10), and pain (HR, 1.07; 95% CI, 1.04-1.11), was associated with worse OS. The overall pooled effect demonstrated that increasing individual symptom severity was associated with higher mortality risk (HR, 1.03; 95% CI, 1.01-1.04). The Egger test showed no evidence of publication bias.Conclusions and RelevanceThis systematic review and meta-analysis found that PROs offer independent prognostic information for cancer survival. These findings support the integration of PRO assessments into clinical decision-making and risk stratification in oncology.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"14 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032052","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":"Integrating Oncology Lessons Across Tumor Types From Kidney to Prostate-A Good-Risk Shift.","authors":"Giandomenico Roviello","doi":"10.1001/jamaoncol.2025.3168","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.3168","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"25 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032051","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":"AI to Support Modern Cancer Care-The Augmented Oncologist.","authors":"Samyukta Mullangi,Kanan Shah,Debra Patt","doi":"10.1001/jamaoncol.2025.2888","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2888","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"32 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962609","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":"Current Controversies and Challenges in Non-Oncogene-Addicted Synchronous Oligometastatic Non-Small Cell Lung Cancer: A Review.","authors":"Mandy Jongbloed,Martina Bortolot,Jonas Willmann,Valentina Bartolomeo,Nuria M Novoa,Dirk K M De Ruysscher,Lizza E L Hendriks","doi":"10.1001/jamaoncol.2025.2891","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2891","url":null,"abstract":"ImportanceIt has been stated that especially with the advancements in imaging, systemic therapy, and local radical treatment (LRT) that patients with synchronous oligometastatic disease (sOMD) can potentially benefit from curative-intent treatment. This statement is challenged by the results of the NRG-LU002 randomized phase 2/3 trial, showing no significant progression-free survival and overall survival improvements with the addition of LRT to maintenance systemic therapy in patients with oligometastatic non-small cell lung cancer (NSCLC) who achieved at least stable disease after induction systemic therapy (approximately 90% received an immunotherapy-based regimen). This Review discusses the current challenges and controversies in the treatment of non-oncogene-addicted sOMD.ObservationsWhether LRT indeed can improve survival in a contemporary immunotherapy-based systemic treatment regimen is discussed as well as the optimal treatment sequence. Moreover, the NRG-LU002 trial also sparks debate of whether a true sOMD state exists. Genomic alterations, the tumor microenvironment of the primary tumor and metastasis, organotropism, and tumor heterogeneity can all influence metastatic potential, giving a biological explanation that there could be existence of a true sOMD state. However, as true sOMD cannot be distinguished from early-detected widespread metastatic disease with the current imaging modalities, it becomes difficult to select patients for a radical strategy and protect patients from futile treatment.Conclusions and RelevanceIt remains under debate whether synchronous oligometastatic NSCLC represents a distinct biological entity or merely a probabilistic imaging finding. Biomarkers such as circulating tumor DNA, microRNA, and radiomics may improve patient selection but require further validation. Clinical trials should prioritize translational research to address these challenges.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"19 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962607","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":"Rethinking Platforms in ERBB2-Positive Gastric Cancer.","authors":"Zemin Tian,Yuan Qiu,Hua Yang","doi":"10.1001/jamaoncol.2025.3323","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.3323","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"36 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962608","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":"Proton Craniospinal Irradiation for Patients With Leptomeningeal Metastasis: A Randomized Clinical Trial.","authors":"Jonathan T Yang,Divya Yerramilli,Elena Pentsova,Suzanne Wolden,Robert J Young,Denise D Correa,Brandon S Imber,N Ari Wijetunga,Alexander G Goglia,Zhigang Zhang,Junting Zheng,Raymond Baser,Ashley Bernstein,Leah Kratochvil,Julie Xiao,Jona Hattangadi-Gluth,Alexandra M Miller,Jessica A Wilcox,Allison Betof Warner,Helena Yu,Mark G Kris,Andrew D Seidman,Simon N Powell,Adrienne Boire","doi":"10.1001/jamaoncol.2025.3007","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.3007","url":null,"abstract":"ImportanceLeptomeningeal metastasis (LM) is associated with limited survival and few treatment options. Photon involved-field radiotherapy (IFRT) is the most common radiotherapy treatment for patients with LM from solid tumors.ObjectiveTo assess whether proton craniospinal irradiation (pCSI) would result in superior central nervous system progression-free survival (CNS-PFS) compared with IFRT.Design, Setting, and ParticipantsA randomized, phase 2 trial of pCSI vs IFRT was conducted between April 16, 2020, and October 11, 2021, and included patients with non-small cell lung cancer and breast cancer with LM. Patients with other solid tumors were also enrolled in an exploratory pCSI cohort.InterventionFor the randomized groups, after stratifying by histology and systemic disease status, patients were assigned (2:1) to pCSI or IFRT.Main Outcomes and MeasuresThe primary end point was CNS-PFS. Secondary end points included overall survival (OS).ResultsOf 98 total patients, 72 individuals (73.5%) were female, and the median (IQR) age was 59 (50-65) years. A total of 42 and 21 patients were randomly assigned to pCSI and IFRT, respectively. At planned interim analysis, a significant benefit in CNS-PFS was observed with pCSI compared with IFRT, leading to the early discontinuation of the trial. In this final analysis, a significant benefit was continually observed in CNS-PFS with pCSI (median, 8.2 months; 95% CI, 6.6-15.3) vs IFRT (median, 2.3 months; 95% CI, 1.2-4.0; P < .001). A statistically significant and clinically meaningful OS benefit with pCSI (median, 11.3 months; 95% CI, 7.5-18.3) vs IFRT (median, 4.9 months; 95% CI, 3.9-15.0; P = .04) was also observed. For the exploratory pCSI cohort (n = 35), the median CNS-PFS was 5.8 months (95% CI, 4.4-9.1) and OS was 7.0 months (95% CI, 5.4-10.6).Conclusions and RelevanceThis randomized clinical trial that assessed the optimal radiotherapy treatment for LM found improved CNS-PFS and OS with pCSI compared with IFRT. The results suggest that pCSI should be considered when available.Trial RegistrationClinicalTrials.gov Identifier: NCT04343573.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"47 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962612","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":"Proton Craniospinal Irradiation for Leptomeningeal Metastases.","authors":"Lauren Boreta,David R Raleigh","doi":"10.1001/jamaoncol.2025.2869","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2869","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"24 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962610","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}