Acta Oncologica最新文献

{"title":"Outcome of resectable distal cholangiocarcinoma in a single-centre Western patient cohort: comparison of the 7th and 8th edition of the UICC/AJCC TNM classification.","authors":"Maia Blomhoff Holm, Sondre Busund, Rahul Rihel, Mushegh A Sahakyan, Ivar Prydz Gladhaug, Caroline S Verbeke, Sheraz Yaqub, Dyre Kleive","doi":"10.2340/1651-226X.2026.44965","DOIUrl":"10.2340/1651-226X.2026.44965","url":null,"abstract":"<p><strong>Background and purpose: </strong>Distal cholangiocarcinoma (CCA) is a rare malignancy with poor prognosis, even after surgical resection. Accurate staging is essential for guiding treatment and predicting outcomes. The 8th edition of the Union for International Cancer Control (UICC)/The American Joint Committee on Cancer (AJCC) TNM classification introduced depth of tumour invasion (DOI) as the criterion for T-staging (T1-T3) and a three-tiered lymph node (N) classification. This study evaluates patient stratification and prognostic accuracy of the 8th versus 7th edition in a single-centre Western cohort and discusses difficulties with measuring DOI. Patient/material and methods: Patients undergoing pancreatoduodenectomy for distal CCA at Oslo University Hospital (2015-2021) were retrospectively analysed. Tumours were restaged according to the 7th and 8th TNM editions. Survival was assessed using Kaplan-Meier estimates and log-rank tests to compare prognostic accuracy.</p><p><strong>Results: </strong>Seventy-one patients were included. Using the 7th edition, most cancers (94.4%, 67 patients) were categorised as T3. With the 8th edition, stage redistribution was notable: T2 included 45 patients (63.4%) and T3 included 22 (31.0%). Five-year survival was significantly better for T2 (31.8%) than T3 (10.5%) according to the 8th edition, demonstrating improved discrimination. The revised N classification provided better prognostic distinction, with median survival of 30 months for N1 (1-3 nodes) and 23 months for N2 (≥4 nodes).</p><p><strong>Interpretation: </strong>The 8th edition provides more accurate prognostic stratification of distal CCA compared to the 7th edition but requires meticulous, standardised pathology assessment to ensure accurate prognosis and appropriate post-surgical management.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"148-155"},"PeriodicalIF":2.7,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12931082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146225248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-treatment infection prediction in CLL using domain adaptation of lymphoma electronic health records.","authors":"Mehdi Parviz, Christian Brieghel, Mikkel Werling, Thomas Lacoppidan, Emelie Rotbain, Carsten U Niemann, Rudi Agius","doi":"10.2340/1651-226X.2026.44569","DOIUrl":"10.2340/1651-226X.2026.44569","url":null,"abstract":"<p><strong>Background and purpose: </strong>Infections are the leading cause of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL) and occur during and after treatment. When deciding on the type of CLL treatment, the risk of infections is typically assessed based only on age and comorbidities; therefore, there is a need to develop a predictive model that incorporates information from multiple data sources. However, training an effective machine learning model requires a large sample size. Patient/material and methods: In this study, we developed a machine learning approach using domain adaptation (DA) to predict the risk of severe infection during treatment in patients with CLL. We implemented a DA strategy using lymphoma patient data and compared it with a domain-specific (DS) strategy across multiple models.</p><p><strong>Results: </strong>The DA strategy outperformed the DS strategy across all models, with an odds ratio of 4.43 for infection risk between high-risk and low-risk groups, compared with an odds ratio of 3.69 for the best DS model and 2.27 for the CLL-IPI alone. Explainability analysis identified predictive features for both the DA and DS models, including medication data and biochemistry tests. Specifically, C-reactive protein levels and non-therapeutic drugs were common features identified by both DA and DS models, while the DA models relied more heavily on alimentary tract drugs, solvents and diluting agents, and antibacterial medications.</p><p><strong>Interpretation: </strong>These findings highlight the value of integrating data from different diseases (lymphoma) to improve predictions in a target disease (CLL), and represent a step toward data-driven identification of CLL patients at high risk of infection during treatment.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"109-118"},"PeriodicalIF":2.7,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146225287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SWE-NEO: Swedish NEO-adjuvant trial comparing anti-PD-1 monotherapy to combined anti-CTLA-4/anti-PD-1 blockade in resectable stage III melanoma: study protocol for a phase III open-label multi-centre trial.","authors":"Hildur Helgadottir, Ana Carneiro, Francesca Portelli, Konstantinos Papadakis, Karl Björkström, Muyi Yang, Iva Johansson, Ingela Skogvall Svensson, Allan Jazrawi, Amanda Hallgren, Katja Harbst, Rusana Bark, Suzanne Egyhazi Brage, Anders Berglund, Karolin Isaksson, Stina Wickström, Jonas Nilsson, Lars Ny, Göran Jönsson, Roger Olofsson Bagge","doi":"10.2340/1651-226X.2026.45174","DOIUrl":"10.2340/1651-226X.2026.45174","url":null,"abstract":"","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"126-130"},"PeriodicalIF":2.7,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12930509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146225306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world outcome of neoadjuvant therapy with or without pembrolizumab for triple-negative breast cancer.","authors":"Meeri Maunu, Juho Lähteenmaa, Peeter Karihtala, Suvi Tuohinen, Joonas Laaksolilja, Anders Ståhls, Tuomo Meretoja, Johanna Mattson","doi":"10.2340/1651-226X.2026.44896","DOIUrl":"10.2340/1651-226X.2026.44896","url":null,"abstract":"<p><strong>Background and purpose: </strong>Neoadjuvant therapy (NAT) has become standard therapy for early triple-negative breast cancer (TNBC). The aim of this study was to report real-world outcome of TNBC treated with NAT with or without pembrolizumab and to identify predictive factors for achieving pathologic complete response (pCR) in the pembrolizumab cohort. Patient/material and methods: The data of 75 consecutive TNBC patients treated with neoadjuvant chemotherapy and pembrolizumab at the Helsinki University Hospital Comprehensive Cancer Center were retrospectively collected. Treatment outcome and predictive factors for pCR were analyzed. Additionally, the outcome of nonmatched 102 consecutive TNBC patients treated without pembrolizumab during the preceding years is reported.</p><p><strong>Results: </strong>Forty-two patients (56.0%) achieved pCR to pembrolizumab-based NAT, while 47 patients (46.1%) without pembrolizumab had pCR. Lymph node metastasis (p = 0.011) and multifocality (p < 0.001) were inversely associated with pCR in the pembrolizumab cohort. Thirty-four patients (45.3%) had immune-related adverse events (irAEs), and 11 patients (14.7%) had grade 1-2 myocarditis in the pembrolizumab cohort. Due to adverse events (AEs), pembrolizumab was discontinued in 22 patients (29.3%) in the neoadjuvant setting, not started postoperatively in 21 patients (28%) and discontinued postoperatively in eight patients (10.7%). The number of preoperative pembrolizumab cycles was not associated with pCR.</p><p><strong>Interpretation: </strong>Despite higher incidence of myocarditis and interruption of the systemic therapy due to irAEs, higher pCR rates were seen with pembrolizumab. Even though the number of  preoperative pembrolizumab cycles was not associated with pCR monitoring and limiting AEs is important.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"131-140"},"PeriodicalIF":2.7,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12931073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146225233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FIN-EGFRprint: a Finnish real-world study on treatments and outcomes in advanced NSCLC with common EGFR mutations.","authors":"Aija Knuuttila, Lalli O Nurmi, Petri M Vänni, Eija K Heikkilä, Joanne Edwards, Monica H Ekblom, Irene Luccarini, Maria Silvoniemi","doi":"10.2340/1651-226X.2026.44731","DOIUrl":"10.2340/1651-226X.2026.44731","url":null,"abstract":"<p><strong>Background and purpose: </strong>The treatment of advanced non-small cell lung cancer (aNSCLC) with common epidermal growth factor receptor (cEGFR) mutations has evolved substantially over the last 15 years, with the discovery of activating epidermal growth factor receptor (EGFR) mutations and introduction of first-, second- and third generation (gen) EGFR tyrosine kinase inhibitors (TKIs) as first-line therapy. This retrospective observational study aimed to evaluate whether the introduction of these treatments has led to improved 'real-world' outcomes over time by analysing time to next treatment (TTNT) and overall survival (OS). Patient/material and methods: Patients (n = 379) with EGFR exon 19 deletion (Del19) or exon 21 L858R (L858R) substitution and aNSCLC were identified from two Finnish university hospital data lakes between 2010 and 2023. TTNT and OS were analysed from first-line treatment initiation using Kaplan-Meier survival and multivariable Cox regression analyses. Patients were stratified into three cohorts based on date of diagnosis and which TKIs were available at that time (1st-gen: 2010-2016, 2nd-gen: 2017-2020 and 3rd-gen: 2020-2023).</p><p><strong>Results: </strong>The use of chemotherapy as first-line therapy declined from 32% (2010-2016) to 6% (2020-2023), while 80% of patients received 3rd-gen TKIs as first-line treatment in 2020-2023. Median TTNT improved over time (9.7 to 13.2 to 21.6), with a significant improvement in 2020-2023 versus 2010-2016 (HR: 0.46; 95% CI: 0.33-0.64; p < 0.001). Median OS also increased over time (19.1 to 23.9 to 29.3 months) and was significantly higher in 2020-2023 versus 2010-2016 (HR: 0.56; 95% CI: 0.39-0.82; p = 0.002).</p><p><strong>Interpretation: </strong>'Real-world' treatment outcomes for aNSCLC with cEGFR mutations have improved over time likely due to the transition from 1st- to 3rd-gen TKIs. However, real-world survival with TKIs remains lower than clinical trials results emphasizing the unmet need.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"119-125"},"PeriodicalIF":2.7,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146225298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nordic Society of Paediatric Haematology and Oncology (NOPHO) Radiotherapy Working Group consensus guidelines on radiotherapy for paediatric low-grade gliomas.","authors":"Anna Embring, Tanja Skyttä, Jacob Engellau, Irina Kerna, Daiva Sendiuliene, Malin Blomstrand, Daniel J Indelicato, Beate Timmermann, Yasmin Lassen-Ramshad, Henriette Magelssen","doi":"10.2340/1651-226X.2026.44815","DOIUrl":"10.2340/1651-226X.2026.44815","url":null,"abstract":"<p><strong>Background and purpose: </strong>Paediatric low-grade gliomas (pLGG) are the most common brain tumours in children. Radiotherapy, once the standard treatment for unresectable pLGG, is now used less frequently due to concerns about late side effects. The Nordic Society of Paediatric Haematology and Oncology (NOPHO) Radiotherapy Working Group aims to provide consensus guidelines on the use of radiotherapy for pLGG, addressing the current controversies and facilitating decision-making. Patient/material and methods: The guidelines were developed by clinical/radiation oncologists from the Nordic and Baltic countries and two international experts during a 2-day working group meeting. The meeting included presentations from the international experts and was preceded by a survey on radiotherapy practices and a non-systematic review of the literature on pLGG.</p><p><strong>Results: </strong>We present consensus-based recommendations for radiotherapy of pLGG. The guidelines discuss indications and timing of radiotherapy, age-related considerations, and the impact of genetic predisposition disorders such as neurofibromatosis type 1. Modern radiotherapy techniques, such as proton therapy, are highlighted for their potential to reduce long-term side effects.</p><p><strong>Interpretation: </strong>Radiotherapy remains the most effective treatment for unresectable pLGG, but its use must be carefully weighed against the risk of long-term side effects. The guidelines emphasise a personalised treatment approach, considering the evolving field of targeted therapies and the importance of multidisciplinary input in decision-making.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"101-108"},"PeriodicalIF":2.7,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12926702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146199929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selecting patients with rectal cancer for total neoadjuvant therapy based on clinical lymph node status: do we dare?","authors":"Anna Baech Slipsager, Michael Bødker Lauritzen, Laura Katrine Buskov, Laurids Østergaard Poulsen","doi":"10.2340/1651-226X.2026.45125","DOIUrl":"10.2340/1651-226X.2026.45125","url":null,"abstract":"","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"97-100"},"PeriodicalIF":2.7,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12917723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146199970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic treatment indicates shorter survival in patients with immunotherapy for metastatic kidney cancer.","authors":"Elisa Kankkunen, Kaisa Sunela Sunela, Timo Makkonen Makkonen, Katriina Jalkanen Jalkanen, Kalle Mattila","doi":"10.2340/1651-226X.2026.44974","DOIUrl":"10.2340/1651-226X.2026.44974","url":null,"abstract":"<p><strong>Background and purpose: </strong>Antibiotic treatment (ABT) has been associated with worse outcomes of cancer immunotherapy. However, this association might be confounded by other poor prognostic factors. We aimed to evaluate the use of ABT and outcomes of immune checkpoint inhibitors (ICI) in metastatic kidney cancer (mRCC). Patient/material and methods: We identified retrospectively 192 patients treated with ICI for mRCC between 2015 and 2021 at three academic hospitals in Finland. Information on patient characteristics, ABT, and immunotherapy was collected from electronic medical records. Cox regression and Kaplan-Meier methods were used for survival analyses.</p><p><strong>Results: </strong>A total of 61 (32%) patients had received early ABT (3 months before and 1 month after the first dose of ICI), of whom 31 (51%) had ABT > 7 days. Patients with early ABT had shorter median overall survival (mOS) than patients without early ABT (20.4 vs 27.9 months, p = 0.046). Patients with ABT > 7 days had shorter mOS than patients with ABT 0-7 days (17.2 vs 27.5 months, p = 0.015). After adjustment for International Metastatic Renal Cell Carcinoma Database Consortium risk groups, histological renal cell carcinoma subtype, baseline levels of C-reactive protein, and tumor burden, the risk of death was higher in patients with ABT > 7 days (hazard ratio 1.83 (95% confidence interval 1.06-3.17). No significant differences in progression-free survival times (PFS) were observed.</p><p><strong>Interpretation: </strong>Early ABT and prolonged ABT duration were associated with shorter OS, but not with PFS, in patients treated with ICI for mRCC. Prolonged ABT indicated poor prognosis regardless of other risk factors.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"83-89"},"PeriodicalIF":2.7,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12902910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of genomically guided trametinib monotherapy across cancer types: results from the IMPRESS-Norway trial.","authors":"Kathinka Schmidt Slørdahl, Katarina Puco, Ragnhild Sørum Falk, Ingrid Dyvik, Sigmund Brabrand, Pitt Niehusmann, Eli Sihn Samdal Steinskog, Egil S Blix, Åsmund Flobak, Irja Alida Oppedal, Sebastian Meltzer, Cecilie Fredvik Torkildsen, Hanne Blakstad, Kristina Lindemann, Sigbjørn Smeland, Anita Amundsen, Kjetil Taskén, Åslaug Helland","doi":"10.2340/1651-226X.2026.45086","DOIUrl":"10.2340/1651-226X.2026.45086","url":null,"abstract":"<p><strong>Background and purpose: </strong>Molecular profiling guides cancer treatment, by identifying actionable genomic alterations. The IMPRESS-Norway trial (NCT04817956) is a nation-wide precision medicine trial evaluating the efficacy of approved cancer drugs on a novel indication in patients with advanced cancers harbouring potentially actionable alterations. Trametinib, a selective MEK1/2 inhibitor targeting the Mitogen-Activated Protein Kinase (MAPK) signalling pathway, is approved for BRAF V600 mutant melanoma but may also show activity in tumours with other alterations. This sub-study aimed to assess the efficacy of trametinib monotherapy across tumour types with alterations activating the MAPK signalling pathway. Patient/material and methods: In the IMPRESS-Norway trial patients are screened with the TruSight Oncology 500 panel or circulating tumour DNA profiling. Eligible patients are offered biomarker matched targeted therapies. In this subgroup analysis, we identified patients treated with trametinib monotherapy. Primary endpoints were disease control rate (DCR) after 16 weeks and safety. Secondary endpoints included progression-free survival (PFS) and overall survival (OS).</p><p><strong>Results: </strong>DCR after 16 weeks of treatment was 39% in 52 response evaluable patients, with four patients (8%) experiencing partial response, and 16 (31%) stable disease. Responses were seen in tumours harbouring BRAF fusions, GNA11, GNAQ, KRAS, NF1, and NRAS alterations, most frequently in low-grade serous ovarian cancer, central nervous system tumours, and uveal melanoma. Forty-eight percent of patients experienced treatment-related adverse events, including two treatment related deaths. Median PFS and OS were 4 and 9 months, respectively.</p><p><strong>Interpretation: </strong>Trametinib monotherapy achieved a 39% DCR in patients lacking standard options, supporting further studies to confirm efficacy and identify predictive biomarkers for treatment response.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"90-96"},"PeriodicalIF":2.7,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12902912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare costs and resource use in advanced breast cancer at the end of life: a register study.","authors":"Giovanni Galvis Rojas, Peter Strang, Torbjörn Schultz, Lars-Åke Levin","doi":"10.2340/1651-226X.2026.44970","DOIUrl":"10.2340/1651-226X.2026.44970","url":null,"abstract":"<p><strong>Background and purpose: </strong>Advanced breast cancer (ABC) involves substantial end-of-life (EOL) healthcare use and costs. Understanding cost drivers can inform care delivery and resource allocation. Patient/material and methods: We conducted a retrospective, population-based study of individuals (n = 1,437) who died with breast cancer in the Stockholm Region (2015-2023). Healthcare utilization and costs during the last 12 months of life were obtained from the Stockholm Regional Healthcare Data Repository (VAL) and estimated using the Region Stockholm cost model. Variables included age, sex, socioeconomic status (Mosaic), Charlson Comorbidity Index, Hospital Frailty Risk Score (HFRS), systemic therapy, and place of death. Descriptive statistics and generalized linear models assessed cost associations.</p><p><strong>Results: </strong>Total costs rose toward EOL, increasing 140% in the final 3 months versus the prior quarter. Hospitalizations and specialized palliative care drove costs, while outpatient visits declined. Younger age (18-69 years), high frailty (HFRS > 15), and systemic therapy were independently associated with higher costs. Hospital death was associated with lower expenditures than dying elsewhere (rate ratio [RR]: 0.84, 95% confidence interval [CI]: 0.78-0.91). The top 5% of cost users were mainly younger, frail patients receiving systemic therapy.</p><p><strong>Interpretation: </strong>ABC-related costs escalate in the final year of life, driven by hospitalizations, palliative care, and systemic therapies. Younger, frailer patients incur higher costs, while those dying in hospital settings are associated with lower costs. Early palliative integration and frailty-based risk stratification were associated with distinct patterns of healthcare utilization and costs toward the EOL.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"75-82"},"PeriodicalIF":2.7,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12887754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146123454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}