European Journal of Cancer最新文献

{"title":"PIK3CA mutations and first-line outcomes in endocrine-resistant HR+/HER2- metastatic breast cancer: A multicentric real-world study.","authors":"Maria Vittoria Dieci ,&nbsp;Grazia Vernaci ,&nbsp;Chiara Colangelo ,&nbsp;Emilio Bria ,&nbsp;Davide Massa ,&nbsp;Elisabetta Di Liso ,&nbsp;Carlo Alberto Giorgi ,&nbsp;Tommaso Giarratano ,&nbsp;Davide Napetti ,&nbsp;Giorgio Bonomi ,&nbsp;Francesca Zanghì ,&nbsp;Michele Bottosso ,&nbsp;Elisabetta Lazzarini ,&nbsp;Laura Santarelli ,&nbsp;Andrea Boscolo Bragadin ,&nbsp;Stefano Indraccolo ,&nbsp;Valentina Guarneri","doi":"10.1016/j.ejca.2025.116194","DOIUrl":"10.1016/j.ejca.2025.116194","url":null,"abstract":"<div><h3>Background</h3><div>Outcomes and characteristics of endocrine-resistant, PIK3CA-mutated HR+ /HER2- advanced breast cancer patients in real-world are poorly investigated.</div><div>Here, we explored the role of circulating PIK3CA mutations in endocrine-resistant patients in the ongoing prospective, multicentric CHAMBER study.</div></div><div><h3>Methods</h3><div>PIK3CA was analyzed by NGS panel covering the full exonic region of PIK3CA gene.</div><div>Endocrine resistance was defined as: i) primary: relapse during the first 2 years of adjuvant ET, or ii) secondary: relapse after 2 years of starting or within 1 year of completing ET.</div><div>Overall survival (OS) was calculated from the start of first-line to death from any cause. Progression free survival 1 (PFS1) was calculated from the start of first-line to progression or death.</div></div><div><h3>Results</h3><div>Among the overall CHAMBER population, 22 % patients met the criteria for endocrine-resistance (74/337).</div><div>The study population consisted in 95 % women and 5 % men; median age at diagnosis was 50 years (IQR 44–63); 75 % of the women was postmenopausal;86 % of the total population presented with a secondary endocrine-resistance, 64 % had visceral relapse, 74 % had less than 3 metastatic sites, 79 % had received first-line CDK4/6 inhibitor.</div><div>PIK3CA status was available for 63/74 pts, with a 29 % prevalence of mutation.</div><div>PIK3CAmut was a negative prognostic factor for OS (median 65 [wt] vs 36 months [mut], log-rank p 0.024 HR 2.61 [95 % CI 1.10–6.22]) and PFS1 (median 22 [wt] vs 10 months [mut], log-rank p 0.012, HR 2.24 [95 % CI 1.18–4.26]).</div></div><div><h3>Conclusion</h3><div>The co-occurrence of endocrine-resistance and PIK3CAmut identifies a population with unfavorable prognosis, reinforcing the rationale of escalated therapies.</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"234 ","pages":"Article 116194"},"PeriodicalIF":7.1,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801951","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":"Feasibility of ctDNA-guided precision neoadjuvant therapy in locally advanced rectal cancer: Insights from the ongoing CINTS-R trial","authors":"Xiao Zhang ,&nbsp;Jiaolin Zhou ,&nbsp;Jianhao Geng ,&nbsp;Yongheng Li ,&nbsp;Fei Huang ,&nbsp;Wenlong Shu ,&nbsp;Wei Fu ,&nbsp;Xin Zhou ,&nbsp;Guoju Wu ,&nbsp;Wenzhuo Jia ,&nbsp;Jian Cui ,&nbsp;Zhenjun Wang ,&nbsp;Jiagang Han ,&nbsp;Bohao Shi ,&nbsp;Lifeng Li ,&nbsp;Jinqiu Rui ,&nbsp;Huadan Xue ,&nbsp;Ke Hu ,&nbsp;Tao Xu ,&nbsp;Weijie Chen ,&nbsp;Guole Lin","doi":"10.1016/j.ejca.2025.116193","DOIUrl":"10.1016/j.ejca.2025.116193","url":null,"abstract":"<div><h3>Background</h3><div>Accurate risk stratification is essential to optimize neoadjuvant therapy for locally advanced rectal cancer (LARC) in the era of precision medicine. This study assessed the feasibility and safety of a circulating tumor DNA (ctDNA)-guided neoadjuvant strategy.</div></div><div><h3>Methods</h3><div>This interim analysis included patients with mid-low rectal adenocarcinoma (cT3–4N0M0 or cT1–4N1–2M0) from the multicenter, randomized CINTS-R trial using a 2:1 allocation to an experimental or control group. The control group received conventional nCRT (long-course radiotherapy with concurrent capecitabine followed by one XELOX cycle). In the experimental group, treatment was stratified as follows: (1) ctDNA-defined high-risk patients received TNT, consisting of the same nCRT followed by five additional XELOX cycles (six in total); (2) ctDNA-defined low-risk patients proceeded directly to surgery after nCRT; and (3) patients with dMMR/MSI-H/TMB-H tumors received neoadjuvant tislelizumab (≥6 cycles). The analysis focuses on feasibility and safety outcomes.</div></div><div><h3>Results</h3><div>Between February 2023 and September 2024, 349 patients were randomized and 316 included in analysis (experimental: 210; control: 106). Among the experimental group, 115 were ctDNA-high-risk and 89 ctDNA-low-risk. High-risk patients were significantly older and more often male, with larger tumors, longer tumor-to-anal verge distance, greater circumferential involvement, and higher EMVI rates (all <em>p</em> ＜0.05). Serious adverse events (SAEs, CTCAE v5.0, grade 3–4) occurred in 10.0 % vs. 6.6 % of patients in the experimental and control groups (<em>p</em> = 0.316). Notably, 15.7 % of TNT-treated patients discontinued chemotherapy due to SAEs, whereas all nCRT recipients completed treatment.</div></div><div><h3>Conclusion</h3><div>This interim analysis demonstrates the feasibility and safety of a ctDNA-guided, risk-adapted neoadjuvant strategy for LARC. Final outcomes will further clarify its clinical efficacy.</div></div><div><h3>Trial registration</h3><div>ClinicalTrials.gov identifier: NCT05601505.</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"234 ","pages":"Article 116193"},"PeriodicalIF":7.1,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801952","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":"Risk of pancreatic cancer after eradication treatment of Helicobacter pylori","authors":"Anna-Klara Wiklund ,&nbsp;Giola Santoni ,&nbsp;Cecilia Radkiewicz ,&nbsp;Shaohua Xie ,&nbsp;Helgi Birgisson ,&nbsp;Eivind Ness-Jensen ,&nbsp;My von Euler-Chelpin ,&nbsp;Joonas H. Kauppila ,&nbsp;Jesper Lagergren","doi":"10.1016/j.ejca.2025.116192","DOIUrl":"10.1016/j.ejca.2025.116192","url":null,"abstract":"<div><h3>Objectives</h3><div><em>Helicobacter pylori</em> infection seems to increase the risk of developing pancreatic cancer, but it is unknown whether eradication treatment of this bacterium changes this risk. We hypothesized that the increased risk of pancreatic cancer among individuals infected with <em>Helicobacter pylori</em> decreases over time after eradication treatment.</div></div><div><h3>Methods</h3><div>This multinational and population-based cohort study, using prospectively collected nationwide register data from 1995 to 2019, included all adults who received eradication treatment for <em>Helicobacter pylori</em> in Denmark, Finland, Iceland, Norway, or Sweden. Standardized incidence ratios (SIR) with 95 % confidence intervals (95 %CI) were calculated by dividing the incidence rates of pancreatic cancer in the eradication treatment cohort by that of the entire populations of the corresponding age, sex, calendar year, and country. The main outcome was changes in SIR over time after eradication treatment.</div></div><div><h3>Results</h3><div>During up to 24 years of follow-up of 661,827 participants and 5494,255 person-years in the eradication treatment cohort, 2331 participants developed pancreatic cancer. The risk of pancreatic cancer was increased during the first 1–5 years after eradication treatment (SIR 1.14, 95 % CI 1.07–1.21), after which it decreased and became similar to the level of the background population 6–10 years (SIR 0.99, 95 % CI 0.92–1.07) and 11–24 years (SIR 1.00, 95 % CI 0.92–1.08) after eradication treatment.</div></div><div><h3>Conclusion</h3><div>The elevated risk of developing pancreatic cancer among individuals with <em>Helicobacter pylori</em> infection seems to decrease after eradication treatment, reaching the risk estimates of the background population.</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"233 ","pages":"Article 116192"},"PeriodicalIF":7.1,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788072","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":"Ambient air pollution and survival in SCLC/LCNEC: Analysis of a single centre retrospective cohort","authors":"Luca Carlofrancesco Ammoni ,&nbsp;Valentina Cortesi ,&nbsp;Paolo Borghetti ,&nbsp;Alice Baggi ,&nbsp;Camilla Vultaggio ,&nbsp;Vito Amoroso ,&nbsp;Giorgio Facheris ,&nbsp;Mattia Facchetti ,&nbsp;Susanna Bianchi ,&nbsp;Marta Laganà ,&nbsp;Deborah Cosentini ,&nbsp;Daniela Nonnis ,&nbsp;Stefano Maria Magrini ,&nbsp;Alfredo Berruti ,&nbsp;Salvatore Grisanti","doi":"10.1016/j.ejca.2025.116190","DOIUrl":"10.1016/j.ejca.2025.116190","url":null,"abstract":"<div><h3>Background</h3><div>Small cell lung cancer (SCLC) and large cell neuroendocrine carcinoma of the lung (LCNEC) are the deadliest forms of lung cancer with dismal prognosis. Recent evidence suggests that, beyond cigarette smoke, air pollution can have a role in the pathogenesis of non-small cell lung cancer (NSCLC) and is associated with poorer survival. However, whether air pollutants exposure could affect survival outcomes in SCLC/LCNEC is unknown.</div></div><div><h3>Methods</h3><div>We retrospectively analysed data from SCLC/LCNEC cases observed in the province of Brescia province Brescia between 2017 and 2021. Air pollutants mean concentrations were calculated during the same timeframe and the Brescia province was divided in six subareas dichotomized into lightly and heavily polluted areas based on the mean PM_2.5 concentrations. Primary endpoint was to determine the impact of air pollutants exposure on SCLC/LCNEC overall survival (OS). Additionally, we explored the distribution of SCLC/LCNEC across the subareas classified for different air pollutants concentrations.</div></div><div><h3>Findings</h3><div>We observed 221 cases of SCLC/LCNEC, accounting for about 18 % of new lung cancer cases. Residency in heavily polluted areas (HR 1.51, p = 0.03) and extensive stage disease at diagnosis (HR 2.47, p = 0.0001) emerged as independent factors for poorer survival. Exploratory analyses showed an association between the distribution of SCLC/LCNEC cases and higher PM₁₀ and NO₂ concentrations (OR 1.16, p &lt; 0.001 and OR 1.46, p &lt; 0.001, respectively).</div></div><div><h3>Interpretation</h3><div>These results indicate that long-term exposure to high levels of PM_2.5 represent an independent unfavourable prognostic factor for SCLC/LCNEC. Our data suggest that air pollution may also favour the onset of these malignant diseases. Case-control studies are warranted to confirm these preliminary results.</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"234 ","pages":"Article 116190"},"PeriodicalIF":7.1,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862298","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":"The basis for future personalized therapy approaches – Machine learning-generated 1-year survival rate, metastatic status and therapy-dependent survival in pancreatic cancer patients","authors":"François Schneider ,&nbsp;Haotian Chen ,&nbsp;Uwe Pelzer ,&nbsp;Richard G. Compton ,&nbsp;Gregor Duwe ,&nbsp;Mihnea P. Dragomir ,&nbsp;Georg Hilfenhaus ,&nbsp;Loredana Vecchione ,&nbsp;Annabel Alig ,&nbsp;Matthäus Felsenstein ,&nbsp;Markus Lerchbaumer ,&nbsp;Damian T. Rieke ,&nbsp;Marcus Bahra ,&nbsp;Ralf Kutsche ,&nbsp;Kristina Tschulik ,&nbsp;Sebastian Stintzing ,&nbsp;Ulrich Keilholz ,&nbsp;Christopher C.M. Neumann","doi":"10.1016/j.ejca.2025.116189","DOIUrl":"10.1016/j.ejca.2025.116189","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic adenocarcinoma (PDAC) remains one of the most lethal types of cancer, characterized by its unspecific symptoms, aggressive nature and late-stage diagnosis.</div></div><div><h3>Patients and methods</h3><div>In this study, Machine Learning (ML) models were trained and applied on the largest international, monocentric database, comprising over 23 clinical variables from 1040 PDAC patients. In this study, the potential of ML models was assessed for the 1-year survival rate, metastatic M0/M1 status and therapy-dependent survival time generating predictive and prognostic ML-based biomarkers.</div></div><div><h3>Results</h3><div>Consistent predictive performance was achieved for the 1-year survival rate (accuracy, internal/external cohort 72 % / 70 %) and radiological metastatic M0/M1 status (Accuracy, internal/external cohort 79 % / 72 %). Moreover, distinct ML-based survival models were trained for approved first-line adjuvant and palliative chemotherapy regimen (mFOLFIRINOX, gemcitabine with or without nab-paclitaxel) across resected (C-index = 0.60), locally advanced (C-index = 0.71) and metastatic (C-index = 0.71) PDAC subgroups, demonstrating that predictive performance is best for palliative regimens.</div></div><div><h3>Conclusions</h3><div>The models developed in this study may serve as a foundation for supporting tumor board decisions and demonstrate that personalized, ML-based therapy concepts are feasible in the near future. In addition, the models proposed in this study are helpful for generating ML-based synthetic control arms in future clinical trials.</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"234 ","pages":"Article 116189"},"PeriodicalIF":7.1,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862289","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":"Letter re: Patient-related prognostic factors in older adults with head and neck cancer: The EGeSOR clinical trial\"","authors":"Han-Jie Long,&nbsp;Gui Yang ,&nbsp;Qi-Wei Liang","doi":"10.1016/j.ejca.2025.116169","DOIUrl":"10.1016/j.ejca.2025.116169","url":null,"abstract":"","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"234 ","pages":"Article 116169"},"PeriodicalIF":7.1,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827014","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":"Response to letter Re: “Patient-related prognostic factors in older adults with head and neck cancer: The EGeSOR clinical trial”.","authors":"Charlotte Lafont,&nbsp;Elena Paillaud,&nbsp;Lydia Brugel,&nbsp;Florence Canouï-Poitrine","doi":"10.1016/j.ejca.2025.116170","DOIUrl":"10.1016/j.ejca.2025.116170","url":null,"abstract":"","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"233 ","pages":"Article 116170"},"PeriodicalIF":7.1,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780430","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":"Cardiotoxic effects of BRAF/MEK inhibition: An observational study","authors":"Jannek Brauer ,&nbsp;Daniel Scheidet ,&nbsp;Sebastian Romann ,&nbsp;Christina Zehender ,&nbsp;Jessica Hassel ,&nbsp;Norbert Frey ,&nbsp;Lorenz H. Lehmann","doi":"10.1016/j.ejca.2025.116182","DOIUrl":"10.1016/j.ejca.2025.116182","url":null,"abstract":"<div><h3>Background</h3><div>BRAF/MEK inhibitors are a cornerstone of the therapy of BRAF-mutant cancers. Despite frequent use, the incidence of cardiovascular side effects is still unclear. Data on cancer therapy-related cardiac dysfunction (CTRCD), particularly using contemporary biomarker-inclusive definitions, remain limited.</div></div><div><h3>Objectives</h3><div>To assess the incidence and risk factors of CTRCD in patients receiving BRAF/MEK inhibitors, using the International Cardio-Oncology Society (ICOS) definitions, which include cardiac imaging and biomarker assessments.</div></div><div><h3>Methods</h3><div>A total of 75 patients treated with BRAF/MEK inhibitors underwent prospective cardiotoxicity monitoring with two follow-up visits at 90 days (IQR 36–137 days) and 199 days (IQR 115–266 days). Standardized evaluations included echocardiography with global longitudinal strain (GLS), high-sensitivity cardiac troponin T (hs-cTnT), and NT-proBNP measurements at baseline and follow-up visits. CTRCD was classified according to ICOS criteria. Baseline risk was stratified by European Society of Cardiology (ESC) risk categories.</div></div><div><h3>Results</h3><div>CTRCD occurred in 33 of 75 patients (44 %), with 17 % classified as mild, 23 % moderate, and 4 % severe. Baseline age, sex, BMI, and most cardiovascular risk factors were not significantly associated with CTRCD. Coronary artery disease was the only baseline variable associated with increased CTRCD (OR 11.0, p = 0.029; univariate analysis), whereas elevated hs-cTnT, NT-proBNP, or reduced LVEF at baseline were not predictive. Absolute CTRCD numbers were highest in the high ESC-defined cardiovascular risk category group, while incidence peaked in the low-risk group. Other cardiac complications occurred in 41 patients (55 %).</div></div><div><h3>Conclusions</h3><div>CTRCD is frequent among patients treated with BRAF/MEK inhibitors. Traditional cardiovascular risk factors were not predictive, although coronary artery disease emerged as a strong risk marker. These findings highlight the need for dynamic surveillance strategies.</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"233 ","pages":"Article 116182"},"PeriodicalIF":7.1,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788030","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":"Review and comment on the retrospective analyses of the effect of immunotherapy-infusion time of day on outcome in patients with advanced non-small cell lung cancer","authors":"Van Tai Nguyen ,&nbsp;Rufina Binoy,&nbsp;Foteini Kalofonou,&nbsp;Michael Davidson,&nbsp;Mary O’Brien","doi":"10.1016/j.ejca.2025.116171","DOIUrl":"10.1016/j.ejca.2025.116171","url":null,"abstract":"","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"233 ","pages":"Article 116171"},"PeriodicalIF":7.1,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773938","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":"Enhancing clinicians’ trust in large language models via transparent source attribution: A randomized controlled evaluation in uro-oncology","authors":"Nicolas Carl ,&nbsp;Martin Joachim Hetz ,&nbsp;Christoph Wies ,&nbsp;Sarah Haggenmüller ,&nbsp;Jana Theres Winterstein ,&nbsp;Maurin Helen Mangold ,&nbsp;Lasse Maywald ,&nbsp;Thomas Stefan Worst ,&nbsp;Niklas Westhoff ,&nbsp;Maurice Stephan Michel ,&nbsp;Frederik Wessels ,&nbsp;Titus Josef Brinker","doi":"10.1016/j.ejca.2025.116168","DOIUrl":"10.1016/j.ejca.2025.116168","url":null,"abstract":"<div><h3>Introduction</h3><div>Large language models (LLMs) are utilized to answer queries in urology and oncology, yet the performance is limited due to outdated data and missing source transparency, which undermines clinical reliability and therefore adoption.</div></div><div><h3>Material and methods</h3><div>We developed UroBot, a urology-specific chatbot integrating retrieval-augmented generation (RAG) to provide in-line references and source text previews for each response. In a randomized controlled reader study, UroBot and ChatGPT were compared across ten uro-oncological case rounds. Thirty urologists assessed recommendation correctness, source verifiability and trust with preference ratings collected after each round.</div></div><div><h3>Results</h3><div>UroBot performed significantly better than ChatGPT in recommendation correctness (73 % vs. 50 %; p &lt; 0.001), source attribution (74 % vs. 30 %; p &lt; 0.001) and verifiability of sources (84 % vs. 35 %; p &lt; 0.001). Furthermore, clinicians consistently preferred UroBot for accuracy, source verifiability and trust. Qualitative analysis showed that ChatGPT often produced vague or incorrect citations, with 28 % being non-existent or outdated and 83 % lacking specific sections, whereas UroBot achieved complete alignment on guideline sub-section and page level. These gains in citation precision were mirrored by higher clinician ratings for verifiability and trust. Limitations include the small sample size of ten cases due to feasibility, which may not cover the full uro-oncological spectrum.</div></div><div><h3>Conclusion</h3><div>Our findings show that combining LLMs with RAG with in-line references and source text previews markedly enhances perceived source attribution and verifiability compared to state-of-the-art conventional LLMs. Importantly, this approach is readily transferable across medical subspecialties, enabling reliable and up-to-date clinical decision support.</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"233 ","pages":"Article 116168"},"PeriodicalIF":7.1,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767342","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}