JAMA Oncology最新文献

{"title":"Rethinking Platforms in ERBB2-Positive Gastric Cancer-Reply.","authors":"Zhi Peng,Lin Shen","doi":"10.1001/jamaoncol.2025.3326","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.3326","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"21 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962611","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":"A New Age for Trust in Medicine","authors":"Adam René P. Rosenbaum","doi":"10.1001/jamaoncol.2025.2876","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2876","url":null,"abstract":"This Viewpoint discusses eroding trust in medicine due to the COVID-19 pandemic and the ease of obtaining medical information online and offers strategies to help rebuild trust.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"29 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915408","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":"Debt, Bankruptcy, and Credit Scores After Cancer Diagnosis","authors":"Nishant Uppal, Jorge L. Gomez-Mayorga, Ashley L. O’Donoghue, Aaron Fleishman, Anastasia K. Bogdanovski, Eve M. Roth, Jordan M. Broekhuis, Q. Lina Hu-Bianco, Katharine M. Esselen, Benjamin C. James","doi":"10.1001/jamaoncol.2025.3302","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.3302","url":null,"abstract":"ImportanceA cancer diagnosis is a major driver of financial burden for US households, yet longitudinal data on debt, bankruptcy, and credit scores after diagnosis are lacking.ObjectiveTo examine longitudinal changes in adverse financial outcomes for nearly all individuals diagnosed with cancer in Massachusetts over a 10-year period (2010-2019) compared with a Massachusetts control population.Design, Setting, and ParticipantsThis retrospective, population-based cohort study included individuals diagnosed with different cancers in Massachusetts over a 10-year period (2010-2019). Analysis was conducted between April 2024 and February 2025. Individuals with cancer were matched 1:1 with control individuals based on baseline demographic and socioeconomic factors. Using comprehensive financial data, a difference-in-differences design was then used to study debt, bankruptcy, and credit scores over time. Subanalyses across 9 major cancer types were performed to assess heterogeneity in adverse financial outcomes.ExposuresCancer diagnosis during the study period (2010-2019) was used as the primary exposure. Covariates included age, sex, marital status, education, occupation status, and income. In subgroup analyses, exposures were defined based on the cancer subpopulation (ie, bladder, breast, cervical, colorectal, liver, lung, ovarian, thyroid, and uterine cancer) over the same time period.Main Outcomes and MeasuresFinancial outcomes included total debt, total debt in collections, medical debt in collections, credit scores, and bankruptcy rates.ResultsIn a matched difference-in-differences analysis of 74 146 individuals with a cancer diagnosis and 74 146 control individuals (mean [SD] age, 57.2 [14.1] years; 81.2% female), increases in mean medical debt in collections of $15.45 (95% CI, $2.19-$28.71) at 6 years postdiagnosis were observed. There were no changes in mean total debt, total debt in collections, number of bankruptcies, or credit scores after diagnosis. In subgroup analysis, patients with colorectal cancer experienced an increase in mean total debt in collections of $155.55 (95% CI, $0.34-$310.76) at 6 years postdiagnosis, and patients with bladder cancer experienced an increase in mean total debt in collections of $375.77 (95% CI, $5.89-$745.65) at 5.5 years postdiagnosis.Conclusions and RelevanceIn this retrospective cohort study, modest amounts of medical debt in collections persisted for years after cancer diagnosis. Total debt in collections was present at higher amounts for certain cancer subpopulations. The persistence of adverse financial outcomes after cancer diagnosis, despite high rates of insurance coverage in Massachusetts, warrants further research and consideration of broader systemic reforms.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"102 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915451","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":"Survival After Fertility-Preserving Hormonal Therapy vs Hysterectomy for Early-Stage Endometrial Cancer","authors":"Yukio Suzuki, Yongmei Huang, Xiao Xu, Jennifer S. Ferris, Elena B. Elkin, Chung Yin Kong, Evan R. Myers, Haruya Saji, Etsuko Miyagi, Laura J. Havrilesky, Stephanie V. Blank, Dawn L. Hershman, Jason D. Wright","doi":"10.1001/jamaoncol.2025.2761","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2761","url":null,"abstract":"ImportanceAs the number of young women with early-stage endometrial cancer is increasing, there is growing interest in use of progesterone-based therapy to allow fertility preservation.ObjectiveTo ascertain the long-term survival of premenopausal women with clinical stage I endometrial cancer treated primarily with fertility-preserving hormonal therapy compared with hysterectomy.Design, Setting, and ParticipantsThis cohort study used data from the National Cancer Database to identify female patients aged 18 to 49 years with clinical stage I, grade 1 to 2, endometrioid endometrial cancer diagnosed from 2004 through 2020. In addition, trends in and factors associated with the use of fertility-preserving hormonal therapy were examined. Propensity score matching was used to compare survival among patients treated primarily with fertility-preserving hormonal therapy and those treated with hysterectomy. Data were analyzed from November 2023 to January 2024.ExposuresPrimary treatment was defined as hysterectomy or fertility-preserving hormonal therapy based on days from diagnosis to operation or fertility-preserving hormonal therapy.Main Outcomes and MeasuresTime to all-cause mortality was measured in months from cancer diagnosis to death or last follow-up at 2-year, 5-year, and 10-year intervals.ResultsA total of 15 849 women, including 14 662 (92.5%) treated with primary hysterectomy (mean [IQR] age, 44 [39-47] years]) and 1187 (7.5%) who received primary hormonal therapy (mean [IQR] age, 34 [30-38] years) were identified. The use of hormonal treatment increased from 5.2% in 2004 to 13.8% in 2020 (<jats:italic>P</jats:italic> &amp;amp;lt; .001). After propensity score matching, 5-year survival was 98.5% (95% CI, 97.3%-99.2%) for primary hysterectomy and 96.8% (95% CI, 95.3%-97.8%) for primary hormonal therapy (hazard ratio [HR] = 1.84; 95% CI, 1.06-3.21). Among patients younger than 40 years, there was no difference in survival between hysterectomy and hormonal therapy (HR = 1.00; 95% CI, 0.50-2.00). However, for patients aged 40 to 49 years, fertility-preserving hormonal therapy was associated with a significantly increased risk of death (HR = 4.94; 95% CI, 1.89-12.91).Conclusions and RelevanceThis study found that the use of fertility-preserving hormonal therapy among reproductive age patients with early-stage endometrial cancer has increased over time. While overall survival in patients with hormonal therapy is shorter than with hysterectomy, survival for patients younger than 40 years of age is comparable after primary treatment with fertility-preserving hormonal therapy or hysterectomy.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"69 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915407","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":"Iodine Seed−Marking Protocol for Response-Guided Axillary Treatment After Systemic Therapy for Node-Positive Breast Cancer","authors":"Annemiek K. E. van Hemert, Ariane A. van Loevezijn, Marie-Sophie P. D. Baas, Marcel P. M. Stokkel, Emma J. Groen, Vincent van der Noort, Claudette E. Loo, Gabe S. Sonke, Nicola Russell, Frederieke H. van Duijnhoven, Marie-Jeanne T. F. D. Vrancken Peeters","doi":"10.1001/jamaoncol.2025.2752","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2752","url":null,"abstract":"ImportanceMost patients with clinically node-positive (cN<jats:sup>+</jats:sup>) breast cancer receive primary systemic treatment (PST) followed by axillary lymph node dissection (ALND) and/or locoregional radiation (RT). The necessity of axillary treatment in patients achieving nodal pathologic complete response (pCR) after PST remains uncertain.ObjectiveTo assess oncologic outcomes of response-guided axillary treatment determined by marking the axillary lymph node with a radioactive iodine seed (MARI) in patients with cN<jats:sup>+</jats:sup> breast cancer who experience pCR after PST.Design, Setting, and ParticipantsThis cohort study was conducted at a single center including patients with breast cancer with 3 or fewer axillary lymph nodes on fluorodeoxyglucose positron emission tomography−computed tomography who were treated according to the MARI protocol from July 2014 to December 2021. Patients with intramammary or periclavicular lymph node involvement were excluded. Median (IQR) follow-up was 49 (32-70) months. Data were analyzed from March to June 2025.ExposureAfter PST, the MARI-marked lymph node was excised. Patients with pCR of the MARI node (ypN0) received no further axillary treatment, whereas patients with residual disease (ypN<jats:sup>+</jats:sup>) received locoregional radiation therapy.Main Outcomes and MeasuresThe primary outcome measure was axillary recurrence rate. The secondary outcome measures were 5-year invasive disease-free survival (iDFS) and overall survival (OS).ResultsIn total, 350 patients (median [IQR] age, 49 [41-56] years) were included and analyzed; of these, 135 (39%) had ypN0 and received no further axillary treatment. The remaining 215 patients with ypN<jats:sup>+</jats:sup> (61%) received RT. After a median (IQR) follow-up of 49 (32-70) months, axillary recurrence rate was 0.7% (n = 1; 95% CI, 0.04%-4.1%) in patients with ypN0 and 2.3% (n = 7; 95% CI, 1.0%-5.3%) in patients with ypN<jats:sup>+</jats:sup>. In patients with ypN0, the 5-year iDFS was 93% (95% CI, 88%-98%) and the OS was 98% (95% CI, 95%-100%); in patients with ypN<jats:sup>+</jats:sup>, iDFS was 87% (95% CI, 82%-93%) and OS, 93% (95% CI, 89%-97%).Conclusions and RelevanceThis cohort study found that response-guided axillary treatment, using the MARI protocol, in patients with limited nodal disease who received PST was associated with a very low risk of axillary recurrence and should be considered to protect patients from axillary overtreatment.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"106 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915452","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":"Who Needs Axillary Dissection After Neoadjuvant Therapy?","authors":"Abram Recht","doi":"10.1001/jamaoncol.2025.2712","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2712","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"65 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959899","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":"Established Cancer Predisposition Genes in Single and Multiple Cancer Diagnoses","authors":"Jeffrey W. Shevach, Jianfeng Xu, Nathan Snyder, Jun Wei, Zhuqing Shi, Huy Tran, S. Lilly Zheng, Jennifer L. Beebe-Dimmer, Kathleen A. Cooney","doi":"10.1001/jamaoncol.2025.2879","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2879","url":null,"abstract":"ImportanceMuch of the understanding of cancer risk associated with rare pathogenic variants (RPVs) is derived from family-based studies or clinically ascertained samples, which may be limited by ascertainment and selection bias.ObjectiveTo quantify associations between RPVs in previously implicated cancer predisposition genes and single and multiple cancer diagnoses in a large population-based study.Design, Setting, and ParticipantsIn this genetic association study, whole-exome sequencing data were used from the UK Biobank, a UK population–based cohort that enrolled participants aged 40 to 69 years between 2006 and 2010. Participants who were involved in the whole-exome sequencing release of 200 000 genomes in 2020 were included in this study. This analysis included White participants only, as findings in other racial and ethnic groups had small sample sizes. Participants were diagnosed before or after biobank enrollment until March 2024.ExposuresThe sequencing data of a set of 96 previously implicated cancer predisposition genes were analyzed and compared using 2 methods. To determine the statistical significance of an association, a robust optimal sequence kernel association test was used, while odds ratios (ORs) and 95% CIs were obtained through Firth logistic regression.Main Outcomes and MeasuresThe primary study outcome was the diagnosis of 1 of 11 cancers (bladder, breast, central nervous system, colorectal, lung, melanoma, ovary, pancreatic, prostate, renal, thyroid) defined by relevant diagnosis codes in inpatient hospital diagnosis, cancer registry, and/or death registry data.ResultsData from 183 627 participants (101 414 [55.2%] female) were analyzed, including 25 824 participants with at least 1 cancer diagnosis, of whom 23 704 (91.8%) had a single cancer diagnosis and 2130 (8.2%) had 2 or more cancer diagnoses. A total of 157 793 controls had no cancer diagnosis. The median (IQR) age was 62 (56-65) years in participants with at least 1 cancer diagnosis, compared to 57 (50-63) years in those without a cancer diagnosis. Genetic variation in 16 genes was significantly associated with at least 1 cancer of interest (<jats:italic>ATM</jats:italic>, <jats:italic>BARD1</jats:italic>, <jats:italic>BRCA1</jats:italic>, <jats:italic>BRCA2</jats:italic>, <jats:italic>BRIP1</jats:italic>, <jats:italic>CDKN2A</jats:italic>, <jats:italic>CHEK2</jats:italic>, <jats:italic>HOXB13</jats:italic>, <jats:italic>MITF</jats:italic>, <jats:italic>MLH1</jats:italic>, <jats:italic>MSH2</jats:italic>, <jats:italic>MSH6</jats:italic>, <jats:italic>NF1</jats:italic>, <jats:italic>PALB2</jats:italic>, <jats:italic>RAD51C</jats:italic>, and <jats:italic>RAD51D</jats:italic>). The presence of an RPV in 1 of these 16 genes was associated with increased odds of at least 1 cancer (OR, 1.87; 95% CI, 1.76-1.98) and multiple primary cancers (OR, 2.56; 95% CI, 2.18-2.99). Carrier frequency was 6.28% and 8.36%, respectively.Conclusions and RelevanceThis genetic association ","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"20 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915453","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":"Impact of a Weight Loss Intervention on 1-Year Weight Change in Women With Stage II/III Breast Cancer","authors":"Jennifer A. Ligibel, Karla V. Ballman, Linda McCall, Pamela J. Goodwin, Catherine M. Alfano, Vanessa Bernstein, Tracy E. Crane, Linda M. Delahanty, Elizabeth Frank, Olwen Hahn, Dawn L. Hershman, Judith O. Hopkins, Melinda Irwin, Erica L. Mayer, Lori Minasian, Linda Nebeling, Marian L. Neuhouser, Electra D. Paskett, Patricia A. Spears, Vered Stearns, Cynthia A. Thomson, Anna Weiss, Julia White, Thomas A. Wadden, Eric P. Winer, Clifford Hudis, Ann H. Partridge, Lisa A. Carey","doi":"10.1001/jamaoncol.2025.2738","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2738","url":null,"abstract":"ImportanceObesity is associated with a higher risk of recurrence, mortality, comorbidities, treatment-related adverse effects, and poor quality of life in patients with breast cancer. Scalable interventions are needed to promote weight loss in this population.ObjectiveTo evaluate the impact of a remotely delivered weight loss intervention (WLI) on weight change at 1 year in patients with breast cancer and obesity and to explore factors associated with weight change.Design, Setting, and ParticipantsThe Breast Cancer Weight Loss trial is a phase 3, randomized clinical trial evaluating the impact of a telephone-based WLI on invasive disease–free survival and other outcomes in women with obesity and early breast cancer at 637 sites across the US and Canada. Participants were enrolled to the study between August 2016 and February 2021. Participants included women with stage II to III, &lt;jats:italic&gt;ERBB2&lt;/jats:italic&gt;-negative breast cancer and a body mass index (BMI) of 27 or higher.InterventionsParticipants were randomized to a 2-year, telephone-based WLI plus health education or health education alone control group.Main Outcome and MeasuresThe primary end point for this prespecified secondary analysis was weight change at 1 year. Weight was measured at baseline and 1 year, and changes in weight were compared between groups. Weight change was evaluated with a linear mixed-effects model including treatment group, weight over time, a time-by-group interaction, menopausal status, race and ethnicity, and hormone receptor status.ResultsA total of 3180 women with breast cancer and BMI of 27 and higher were included in the study; 1591 were randomized to the WLI and 1589 to the control group. At baseline, the mean (SD) age of participants was 53.4 (10.6), and the mean (SD) BMI was 34.4 (5.6). The racial and ethnic breakdown included 406 (12.8%) Black, 231 (7.3%) Hispanic or Latino, 2906 (91.4%) non-Hispanic, and 2555 (80.3%) White participants. WLI participants lost a mean of 4.3 kg (95% CI 3.9-4.6 kg), or 4.7% (95% CI, 4.3%-5.0%) of baseline body weight at 1 year vs control participants, who gained 0.9 kg (95% CI, 0.5-1.3 kg), or 1.0% (95% CI 0.1%-1.4%) of baseline body weight (&lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001). Participants randomized to WLI experienced significant weight loss (vs control group participants) across demographic and tumor factors. WLI effect differed significantly by menopausal status, with postmenopausal participants having greater weight loss than premenopausal participants, and by race and ethnicity, with Black and Hispanic participants having less weight loss compared to other races and ethnicities.Conclusions and RelevanceIn this secondary analysis of a randomized clinical trial, a telephone-based WLI induced significant weight loss in patients with breast cancer with overweight and obesity across demographic and treatment factors. Further follow-up of the Breast Cancer Weight Loss trial will evaluate whether the WLI impro","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"13 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899154","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":"Predicting Chronic Kidney Disease After Cisplatin Treatment Using Population-Level Data","authors":"Robert C. Grant, Jiang Chen He, Ning Liu, Sho Podolsky, Faiyaz Notta, Marzyeh Ghassemi, Steven Gallinger, Andrea Knezevic, Sheron Latcha, Edgar Jaimes, Abhijat Kitchlu, Kelvin Chan","doi":"10.1001/jamaoncol.2025.2590","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2590","url":null,"abstract":"ImportanceCisplatin is a widely used treatment for cancer that can permanently damage the kidneys. Treatment modifications and other strategies may prevent chronic kidney disease (CKD) in patients at risk; however, the incidence and predictability of CKD following cisplatin treatment remain poorly understood.ObjectiveTo characterize the incidence of CKD after cisplatin treatment and evaluate prediction models.Design, Setting, and ParticipantsIn this population-based prognostic study, prediction models were developed based on a retrospective cohort study of patients who received cisplatin chemotherapy for nonhematologic cancer in an outpatient setting between July 1, 2014, and June 30, 2017. Models were tested on a temporal-test cohort of patients from Ontario, Canada, who started treatment between July 1, 2017, and June 30, 2020, and an external-test cohort of patients from a single center in the United States. Data were analyzed from May 1, 2021 to May 7, 2025.ExposuresPredictive features included demographics, cancer diagnosis, cisplatin dose and schedule, comorbidities, laboratory testing, and patient-reported symptoms.Main Outcomes and MeasuresThe outcomes were CKD (estimated glomerular filtration rate [eGFR] &amp;amp;lt;60 mL/min/1.73 m<jats:sup>2</jats:sup>) and the eGFR after cisplatin treatment. Measures included the area under the receiver operating characteristic curve and the mean absolute error (MAE).ResultsThe population-level cohort included 9521 patients (median age, 63 years [IQR, 56-70 years]; 4841 men [50.8%]). Among the 9010 patients without pretreatment CKD, 1228 (13.6%) developed CKD, 81 (0.9%) developed grade 4 or worse CKD, and 16 (0.18%) required dialysis. The eGFR decreased by a mean of 8.1 mL/min/1.73 m<jats:sup>2</jats:sup> (95% CI, 7.8-8.4 mL/min/1.73 m<jats:sup>2</jats:sup>). A simple spline-based regression model based solely on the pretreatment eGFR predicted posttreatment CKD in the temporal-test cohort (area under the curve, 0.80 [95% CI, 0.78-0.82]) and the external-test cohort (area under the curve, 0.73 [95% CI, 0.66-0.78]). Similarly, the posttreatment eGFR was predicted by a spline regression based solely on the pretreatment eGFR (temporal-test MAE, 12.6 mL/min/1.73 m<jats:sup>2</jats:sup> [95% CI, 12.3-13.0 mL/min/1.73 m<jats:sup>2</jats:sup>]; external-test MAE, 14.3 mL/min/1.73 m<jats:sup>2</jats:sup> [95% CI, 13.2-15.5 mL/min/1.73 m<jats:sup>2</jats:sup>]). Complex machine learning systems incorporating all features failed to improve predictions over the univariable models.Conclusions and RelevanceThis study found that cisplatin treatment was followed by a predictable decrease in the eGFR, placing patients with a lower baseline eGFR at the highest risk of CKD. A simple model based on the pretreatment eGFR predicts CKD risk and could guide clinical decision-making.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"22 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899153","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":"GLP-1 Receptor Agonists and Cancer Risk in Adults With Obesity","authors":"Hao Dai, Yongqiu Li, Yao An Lee, Ying Lu, Thomas J. George, William T. Donahoo, Kelvin P. Lee, Harikrishna Nakshatri, John Allen, Yi Guo, Ramon C. Sun, Jingchuan Guo, Jiang Bian","doi":"10.1001/jamaoncol.2025.2681","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2681","url":null,"abstract":"ImportanceGlucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely prescribed for glycemic control in type 2 diabetes and have recently gained popularity for weight management. However, their long-term impact on cancer risk remains uncertain. Understanding this association is crucial for patient safety.ObjectiveTo compare the incidence of 14 cancers among adults with obesity prescribed GLP-1RAs vs nonusers.Design, Setting, and ParticipantsThis retrospective cohort study followed a target trial emulation design using 2014 to 2024 electronic health record data from OneFlorida+, a multicenter health research network that integrates real-world clinical data from diverse health care settings. Adults 18 years or older eligible for antiobesity medications without prior cancer history were included. Participants were categorized as GLP-1RA users or nonusers, matched 1:1 using propensity scores.ExposureIndividuals taking vs not taking GLP-1RAs.Main Outcomes and MeasuresThe primary outcomes were the incidence of 14 cancer types, including 13 obesity-associated cancers (liver, thyroid, pancreatic, bladder, colorectal, kidney, breast, endometrial, meningioma, upper gastrointestinal, ovarian, multiple myeloma, and prostate) and lung cancer.ResultsA total of 86 632 matched adults (mean [SD] age, 52.4 [14.5] years; 68.2% female) were included, comprising 43 317 GLP-1RA users and 43 315 otherwise eligible nonusers. The incidence rates of the 14 cancers were 13.6 vs 16.4 per 1000 person-years, respectively, indicating a significantly lower overall cancer risk among individuals taking GLP-1RAs (hazard ratio [HR], 0.83 [95% CI, 0.76-0.91]; <jats:italic>P</jats:italic> = .002) compared with nonusers. In particular, taking GLP-1RAs was associated with a reduced risk of endometrial cancer (HR, 0.75 [95% CI, 0.57-0.99]; <jats:italic>P</jats:italic> = .05), ovarian cancer (HR, 0.53 [95% CI, 0.29-0.96]; <jats:italic>P</jats:italic> = .04), and meningioma (HR, 0.69 [95% CI, 0.48-0.97]; <jats:italic>P</jats:italic> = .05). However, GLP-1RAs were associated with a marginally nonsignificant increased risk of kidney cancer (HR, 1.38 [95% CI, 0.99-1.93]; <jats:italic>P</jats:italic> = .04).Conclusions and RelevanceThis retrospective cohort study found that taking GLP-1RAs was associated with a reduced overall risk of cancer, including lower risks of endometrial, ovarian, and meningioma cancers, among patients with obesity or overweight. However, taking GLP-1RAs may be associated with an increased risk of kidney cancer, highlighting the need for longer-term follow-up to clarify the underlying mechanisms and clinical implications of these findings.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"27 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899156","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}