Pub Date : 2025-11-26DOI: 10.1001/jamaoncol.2025.5091
Yuzhou Zhu,Ziqiang Wang
{"title":"Clarifying End Point Definitions, Missingness, and Covariate Balance in the International TNT Study.","authors":"Yuzhou Zhu,Ziqiang Wang","doi":"10.1001/jamaoncol.2025.5091","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.5091","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"18 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145600010","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}
Pub Date : 2025-11-26DOI: 10.1001/jamaoncol.2025.4971
Ann Brunson,Ted Wun,Renata Abrahão,Charles P Quesenberry,Jessica Chubak,Kathryn J Ruddy,Chun R Chao,Erin E Hahn,Candice A M Sauder,Hazel B Nichols,Lawrence H Kushi,Theresa H M Keegan
ImportanceDespite treatment advances, metastatic recurrence continues to be a leading cause of morbidity and mortality. Empirical data on the incidence and survival after metastatic recurrence remain limited, as cancer registries historically do not collect data on recurrence.ObjectiveTo estimate the cumulative incidence (CMI) of metastatic recurrence among adolescents and young adults diagnosed with earlier-stage disease and compare survival to those with metastatic disease at diagnosis.Design, Setting, ParticipantsThis was a retrospective cohort study of adolescents and young adults aged 15 to 39 years who were diagnosed with nonmetastatic cancers from 2006 to 2018. Adolescents and young adults were identified from the California Cancer Registry linked with statewide hospitalization, emergency department, and ambulatory surgery encounters from the California Department of Health Care Access and Information. Data were analyzed from December 2023 to June 2025.ExposuresCancer types, including melanoma, sarcoma, and breast, cervical, colorectal, testicular, and thyroid cancers.Main Outcomes and MeasuresMetastatic recurrence was identified using International Classification of Diseases, Ninth Revision, Clinical Modification, and Tenth Revision, Clinical Modification, metastatic disease codes at least 6 months after cancer diagnosis or from an underlying cancer cause of death. Follow-up was through December 31, 2020.ResultsOf a total of 48 406 adolescents and young adults (median [IQR] age at diagnosis, 33.0 [28.0-37.0] years; 67.4% female), 9.2% had metastatic disease at diagnosis, and 9.5% had metastatic recurrence. Among 43 935 adolescents and young adults who presented with nonmetastatic disease, the 5-year CMI of metastatic recurrences was highest among patients with sarcoma (24.5%; 95% CI, 22.6%-26.6%) and colorectal cancer (21.8%; 95% CI, 20.3%-23.4%) and intermediate for cervical (16.3%; 95% CI, 15.0%-17.6%) and breast (14.7%; 95% CI, 14.0%-15.4%) cancers. The CMI for metastatic recurrence increased with increasing stage at diagnosis, with 5-year CMIs higher than 30% for all stage III cancers (except thyroid). The 5-year CMI of metastatic recurrence also increased over time for cervical cancer (2006-2009: 12.7% [95% CI, 10.8%-14.8%]; 2015-2018: 20.4% [95% CI, 17.5%-23.6%]) and decreased for colorectal cancer (2006-2009: 24.4% [95% CI, 21.3%-27.6%]; 2015-2018: 19.2% [95% CI, 16.4%-22.2%]). Survival after metastatic recurrence was worse than metastatic disease at diagnosis for all cancer types, except for testicular and thyroid cancers.Conclusions and RelevanceThe findings from this cohort study highlight the overall burden of metastatic disease in adolescents and young adults, expanding the knowledge of metastatic recurrences that help improve care for adolescent and young adult survivors throughout the cancer survivorship spectrum.
{"title":"Metastatic Recurrence Among Adolescents and Young Adults With Cancer.","authors":"Ann Brunson,Ted Wun,Renata Abrahão,Charles P Quesenberry,Jessica Chubak,Kathryn J Ruddy,Chun R Chao,Erin E Hahn,Candice A M Sauder,Hazel B Nichols,Lawrence H Kushi,Theresa H M Keegan","doi":"10.1001/jamaoncol.2025.4971","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.4971","url":null,"abstract":"ImportanceDespite treatment advances, metastatic recurrence continues to be a leading cause of morbidity and mortality. Empirical data on the incidence and survival after metastatic recurrence remain limited, as cancer registries historically do not collect data on recurrence.ObjectiveTo estimate the cumulative incidence (CMI) of metastatic recurrence among adolescents and young adults diagnosed with earlier-stage disease and compare survival to those with metastatic disease at diagnosis.Design, Setting, ParticipantsThis was a retrospective cohort study of adolescents and young adults aged 15 to 39 years who were diagnosed with nonmetastatic cancers from 2006 to 2018. Adolescents and young adults were identified from the California Cancer Registry linked with statewide hospitalization, emergency department, and ambulatory surgery encounters from the California Department of Health Care Access and Information. Data were analyzed from December 2023 to June 2025.ExposuresCancer types, including melanoma, sarcoma, and breast, cervical, colorectal, testicular, and thyroid cancers.Main Outcomes and MeasuresMetastatic recurrence was identified using International Classification of Diseases, Ninth Revision, Clinical Modification, and Tenth Revision, Clinical Modification, metastatic disease codes at least 6 months after cancer diagnosis or from an underlying cancer cause of death. Follow-up was through December 31, 2020.ResultsOf a total of 48 406 adolescents and young adults (median [IQR] age at diagnosis, 33.0 [28.0-37.0] years; 67.4% female), 9.2% had metastatic disease at diagnosis, and 9.5% had metastatic recurrence. Among 43 935 adolescents and young adults who presented with nonmetastatic disease, the 5-year CMI of metastatic recurrences was highest among patients with sarcoma (24.5%; 95% CI, 22.6%-26.6%) and colorectal cancer (21.8%; 95% CI, 20.3%-23.4%) and intermediate for cervical (16.3%; 95% CI, 15.0%-17.6%) and breast (14.7%; 95% CI, 14.0%-15.4%) cancers. The CMI for metastatic recurrence increased with increasing stage at diagnosis, with 5-year CMIs higher than 30% for all stage III cancers (except thyroid). The 5-year CMI of metastatic recurrence also increased over time for cervical cancer (2006-2009: 12.7% [95% CI, 10.8%-14.8%]; 2015-2018: 20.4% [95% CI, 17.5%-23.6%]) and decreased for colorectal cancer (2006-2009: 24.4% [95% CI, 21.3%-27.6%]; 2015-2018: 19.2% [95% CI, 16.4%-22.2%]). Survival after metastatic recurrence was worse than metastatic disease at diagnosis for all cancer types, except for testicular and thyroid cancers.Conclusions and RelevanceThe findings from this cohort study highlight the overall burden of metastatic disease in adolescents and young adults, expanding the knowledge of metastatic recurrences that help improve care for adolescent and young adult survivors throughout the cancer survivorship spectrum.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"147 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145600011","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}
Pub Date : 2025-11-20DOI: 10.1001/jamaoncol.2025.4821
Abdurrahman I Islim,Christopher P Millward,Rasheed Zakaria,Rory J Piper,Daniel M Fountain,Shaveta Mehta,Ruwanthi Kolamunnage-Dona,Usama Ali,Shelli D Koszdin,Theo Georgious,Ryan K Mathew,Samantha J Mills,Andrew R Brodbelt,Thomas Santarius,Michael D Jenkinson,
ImportanceIncidental meningiomas are common. There is a need for a validated clinical tool to stratify patients into early intervention, serial monitoring, or safe discharge from outpatient care.ObjectiveTo externally validate the Incidental Meningioma: Prognostic Analysis Using Patient Comorbidity and Magnetic Resonance Imaging Tests (IMPACT) tool.Design, Setting, and ParticipantsThis retrospective cohort study included 33 centers in 15 countries. Adult patients diagnosed with an incidental meningioma from January 2009 to December 2010 were included, up to the point of intervention, death, or last clinical encounter. Patients with radiation-induced meningioma and NF2-related schwannomatosis were excluded. Data collection was completed on December 31, 2023. Statistical analysis was conducted between March 2024 and December 2024.Main Outcomes and MeasuresThe primary outcome of the study was a composite end point comprising growth, symptom development, meningioma-related mortality, and end points related to loss of window of curability. Secondary end points included the occurrence of an intervention and nonmeningioma-related mortality.ResultsOverall, 1248 patients were included. The median (IQR) age was 66 (55-77) years and 999 were female individuals (80%). There were 945 patients (75.7%) who had 1010 treatment-naive meningiomas. During follow-up (median [IQR], 61 [17-108] months), 114 tumors (11.3%) in 113 patients (12%) progressed, 132 tumors (13.1%) in 126 patients (13.3%) underwent an intervention, and 383 patients (40.5%) died without progression or intervention, from a nonmeningioma-related cause. The 5- and 10-year progression-free survival rates were 88.1% (95% CI, 85.8%-90.5%) and 85.7% (95% CI, 83.2%-88.2%), respectively. A low-risk meningioma had a disease progression risk of 3.9%, compared with 24.2% in medium-risk meningioma, and 51.6% in high-risk meningioma (χ2 test, P < .001). Measures of external validity were adequate (Brier score = 0.12; C-statistic = 0.80; 10-year area under the curve, 0.83) and the addition of other variables in a Cox regression analysis did not confound the statistical significance of the IMPACT tool. Patients with an age-adjusted Charlson Comorbidity Index score of 6 or higher (eg, a patient aged 80 years with type 2 diabetes and a previous myocardial infarction) and a performance status of 2 to 4 (unable to carry out any work activities or in a chair/bed for 50% or more of the day) were more likely to die of other causes than to receive intervention following diagnosis.Conclusions and RelevanceThis cohort study found that the IMPACT tool accurately predicted the risk of incidental meningioma progression and can be used to stratify patients into early intervention, serial monitoring, or safe discharge from outpatient care.
{"title":"A Clinical Tool to Identify Incidental Meningioma for Early Outpatient Management.","authors":"Abdurrahman I Islim,Christopher P Millward,Rasheed Zakaria,Rory J Piper,Daniel M Fountain,Shaveta Mehta,Ruwanthi Kolamunnage-Dona,Usama Ali,Shelli D Koszdin,Theo Georgious,Ryan K Mathew,Samantha J Mills,Andrew R Brodbelt,Thomas Santarius,Michael D Jenkinson, ","doi":"10.1001/jamaoncol.2025.4821","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.4821","url":null,"abstract":"ImportanceIncidental meningiomas are common. There is a need for a validated clinical tool to stratify patients into early intervention, serial monitoring, or safe discharge from outpatient care.ObjectiveTo externally validate the Incidental Meningioma: Prognostic Analysis Using Patient Comorbidity and Magnetic Resonance Imaging Tests (IMPACT) tool.Design, Setting, and ParticipantsThis retrospective cohort study included 33 centers in 15 countries. Adult patients diagnosed with an incidental meningioma from January 2009 to December 2010 were included, up to the point of intervention, death, or last clinical encounter. Patients with radiation-induced meningioma and NF2-related schwannomatosis were excluded. Data collection was completed on December 31, 2023. Statistical analysis was conducted between March 2024 and December 2024.Main Outcomes and MeasuresThe primary outcome of the study was a composite end point comprising growth, symptom development, meningioma-related mortality, and end points related to loss of window of curability. Secondary end points included the occurrence of an intervention and nonmeningioma-related mortality.ResultsOverall, 1248 patients were included. The median (IQR) age was 66 (55-77) years and 999 were female individuals (80%). There were 945 patients (75.7%) who had 1010 treatment-naive meningiomas. During follow-up (median [IQR], 61 [17-108] months), 114 tumors (11.3%) in 113 patients (12%) progressed, 132 tumors (13.1%) in 126 patients (13.3%) underwent an intervention, and 383 patients (40.5%) died without progression or intervention, from a nonmeningioma-related cause. The 5- and 10-year progression-free survival rates were 88.1% (95% CI, 85.8%-90.5%) and 85.7% (95% CI, 83.2%-88.2%), respectively. A low-risk meningioma had a disease progression risk of 3.9%, compared with 24.2% in medium-risk meningioma, and 51.6% in high-risk meningioma (χ2 test, P < .001). Measures of external validity were adequate (Brier score = 0.12; C-statistic = 0.80; 10-year area under the curve, 0.83) and the addition of other variables in a Cox regression analysis did not confound the statistical significance of the IMPACT tool. Patients with an age-adjusted Charlson Comorbidity Index score of 6 or higher (eg, a patient aged 80 years with type 2 diabetes and a previous myocardial infarction) and a performance status of 2 to 4 (unable to carry out any work activities or in a chair/bed for 50% or more of the day) were more likely to die of other causes than to receive intervention following diagnosis.Conclusions and RelevanceThis cohort study found that the IMPACT tool accurately predicted the risk of incidental meningioma progression and can be used to stratify patients into early intervention, serial monitoring, or safe discharge from outpatient care.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"30 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558976","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}
Pub Date : 2025-11-20DOI: 10.1001/jamaoncol.2025.4733
Sean P. Pitroda, Ralph R. Weichselbaum
This Viewpoint explores radiotherapy in the the metastatic landscape and advocates a more sophisticated framework for evaluating metastasis-directed therapies.
本观点探讨了转移性放射治疗的前景，并提倡一个更复杂的框架来评估转移性定向治疗。
{"title":"Radiotherapy Duality in Metastatic Disease—Inhibiting Seeding, Unmasking Dormancy","authors":"Sean P. Pitroda, Ralph R. Weichselbaum","doi":"10.1001/jamaoncol.2025.4733","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.4733","url":null,"abstract":"This Viewpoint explores radiotherapy in the the metastatic landscape and advocates a more sophisticated framework for evaluating metastasis-directed therapies.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"23 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145554769","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}
Pub Date : 2025-11-20DOI: 10.1001/jamaoncol.2025.4800
Nicholas G. Zaorsky, Yilun Sun, Abdenour Nabid, Almudena Zapatero, Michel Bolla, David Joseph, Philippe Maingon, Araceli Guerrero, Ana Alvarez Gonzalez, Carmen Gonzalez San-Segundo, Maria Ángeles Cabeza Rodríguez, Josep Maria Sole, Agustí Pedro Olivé, Allison Steigler, Luis Souhami, Nathalie Carrier, John G. Armstrong, Charles Gillham, Thomas M. Pisansky, Matthew Schipper, Howard M. Sandler, Jason A. Efstathiou, Colleen Lawton, Theo M. de Reijke, Gerhardt Attard, Soumyajit Roy, Scott C. Morgan, Shawn Malone, William A. Hall, Paul L. Nguyen, Jonathan E. Shoag, Randy A. Vince, Adam Calaway, Jorge A. Garcia, Pedro C. Barata, Prateek Mendiratta, Jason R. Brown, Luca Valle, Matthew Rettig, Robert T. Dess, William C. Jackson, Ting Martin, Angela Y. Jia, Michael Steinberg, Tahmineh Romero, Amar U. Kishan, Daniel E. Spratt
Importance The ideal duration of androgen deprivation therapy (ADT) for treating localized prostate cancer is unknown due to variable adherence and treatment durations tested in clinical trials. Objective To determine the ideal duration of ADT for patients with prostate cancer treated with radiotherapy. Data Sources This individual patient data meta-analysis of 13 randomized phase 3 clinical trials evaluated the use of radiotherapy alone or with ADT. It included patients with a median follow-up of 11.3 (IQR, 9.5-14.5) years and ADT duration of 0 to 36 months. Most patients (7392 [72%]) included had National Comprehensive Cancer Network high-risk or very high-risk disease. Study Selection For this meta-analysis, a systematic literature search from 1980 to 2020 was performed in trial registries (Cochrane Central Register of Controlled Trials and ClinicalTrials.gov), MEDLINE (1966-2020), Embase (1982-2020), Web of Science, and Scopus to identify trials. Data Extraction and Synthesis Intention-to-treat and as-treated analyses were performed. The number needed to treat to prevent 1 distant metastasis at 10 years was calculated based on prognostic risk group. The analyses were conducted from January 5 to August 15, 2023. Main Outcomes and Measures The primary end point for this study was overall survival, defined as time to death or last follow-up from randomization. Secondary end points included biochemical recurrence, distant metastasis (DM), prostate cancer–specific mortality, and other-cause mortality. Results The median (IQR) age among the 10 266 male patients was 70 (65-74) years. Longer durations of ADT were associated with nonlinear improvement in relative benefits of DM, prostate cancer–specific mortality, and overall survival, with reduced estimated benefits beyond 9 to 12 months of ADT based on the end point. There was a near-linear increase in other-cause mortality associated with long-term ADT use (hazard ratio, 1.28; 95% CI, 1.09-1.50; P = .002 for 28 vs 0 months of ADT). The optimal ADT duration based on 10-year DM was 0, 6, 12 months, and undefined for patients with 1 intermediate-risk factor, 2 or more intermediate-risk factors, and National Comprehensive Cancer Network high-risk and very high-risk disease, respectively. Conclusions and Relevance The results of this meta-analysis suggest that, for men with localized prostate cancer treated with definitive radiotherapy and ADT, there are relative and absolute benefits from increasing durations of ADT that help provide individualized risk estimates.
重要性雄激素剥夺疗法（ADT）治疗局限性前列腺癌的理想持续时间尚不清楚，因为在临床试验中测试了不同的依从性和治疗时间。目的探讨前列腺癌放疗患者ADT的理想时间。这项对13项随机3期临床试验的个体患者数据荟萃分析评估了单独放疗或ADT的使用。纳入的患者中位随访时间为11.3年（IQR, 9.5-14.5年），ADT持续时间为0 - 36个月。大多数患者（7392例[72%]）为国家综合癌症网络高危或极高危疾病。研究选择本荟萃分析在1980年至2020年的试验注册库（Cochrane Central Register of Controlled Trials and ClinicalTrials.gov）、MEDLINE（1966-2020）、Embase（1982-2020）、Web of Science和Scopus中进行了系统的文献检索，以确定试验。数据提取和合成进行了意向处理和已处理分析。根据预后风险组计算10年预防1例远处转移所需的治疗次数。分析时间为2023年1月5日至8月15日。本研究的主要终点是总生存期，定义为死亡时间或随机分组后的最后一次随访。次要终点包括生化复发、远处转移（DM）、前列腺癌特异性死亡率和其他原因死亡率。结果10266例男性患者中位（IQR）年龄为70（65 ~ 74）岁。较长的ADT持续时间与糖尿病的相对获益、前列腺癌特异性死亡率和总生存率的非线性改善相关，基于终点的ADT超过9至12个月的估计获益减少。长期ADT使用与其他原因死亡率呈近线性增加（ADT使用28个月vs 0个月的风险比为1.28；95% CI为1.09-1.50;P = 0.002）。基于10年DM的最佳ADT持续时间分别为0、6、12个月，对于具有1个中等危险因素、2个及以上中等危险因素和国家综合癌症网络高风险和非常高风险疾病的患者，ADT持续时间未定义。本荟萃分析的结果表明，对于接受明确放疗和ADT治疗的局限性前列腺癌患者，增加ADT持续时间有相对和绝对益处，有助于提供个体化风险评估。
{"title":"Optimal Duration of Androgen Deprivation Therapy With Definitive Radiotherapy for Localized Prostate Cancer","authors":"Nicholas G. Zaorsky, Yilun Sun, Abdenour Nabid, Almudena Zapatero, Michel Bolla, David Joseph, Philippe Maingon, Araceli Guerrero, Ana Alvarez Gonzalez, Carmen Gonzalez San-Segundo, Maria Ángeles Cabeza Rodríguez, Josep Maria Sole, Agustí Pedro Olivé, Allison Steigler, Luis Souhami, Nathalie Carrier, John G. Armstrong, Charles Gillham, Thomas M. Pisansky, Matthew Schipper, Howard M. Sandler, Jason A. Efstathiou, Colleen Lawton, Theo M. de Reijke, Gerhardt Attard, Soumyajit Roy, Scott C. Morgan, Shawn Malone, William A. Hall, Paul L. Nguyen, Jonathan E. Shoag, Randy A. Vince, Adam Calaway, Jorge A. Garcia, Pedro C. Barata, Prateek Mendiratta, Jason R. Brown, Luca Valle, Matthew Rettig, Robert T. Dess, William C. Jackson, Ting Martin, Angela Y. Jia, Michael Steinberg, Tahmineh Romero, Amar U. Kishan, Daniel E. Spratt","doi":"10.1001/jamaoncol.2025.4800","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.4800","url":null,"abstract":"Importance The ideal duration of androgen deprivation therapy (ADT) for treating localized prostate cancer is unknown due to variable adherence and treatment durations tested in clinical trials. Objective To determine the ideal duration of ADT for patients with prostate cancer treated with radiotherapy. Data Sources This individual patient data meta-analysis of 13 randomized phase 3 clinical trials evaluated the use of radiotherapy alone or with ADT. It included patients with a median follow-up of 11.3 (IQR, 9.5-14.5) years and ADT duration of 0 to 36 months. Most patients (7392 [72%]) included had National Comprehensive Cancer Network high-risk or very high-risk disease. Study Selection For this meta-analysis, a systematic literature search from 1980 to 2020 was performed in trial registries (Cochrane Central Register of Controlled Trials and ClinicalTrials.gov), MEDLINE (1966-2020), Embase (1982-2020), Web of Science, and Scopus to identify trials. Data Extraction and Synthesis Intention-to-treat and as-treated analyses were performed. The number needed to treat to prevent 1 distant metastasis at 10 years was calculated based on prognostic risk group. The analyses were conducted from January 5 to August 15, 2023. Main Outcomes and Measures The primary end point for this study was overall survival, defined as time to death or last follow-up from randomization. Secondary end points included biochemical recurrence, distant metastasis (DM), prostate cancer–specific mortality, and other-cause mortality. Results The median (IQR) age among the 10 266 male patients was 70 (65-74) years. Longer durations of ADT were associated with nonlinear improvement in relative benefits of DM, prostate cancer–specific mortality, and overall survival, with reduced estimated benefits beyond 9 to 12 months of ADT based on the end point. There was a near-linear increase in other-cause mortality associated with long-term ADT use (hazard ratio, 1.28; 95% CI, 1.09-1.50; <jats:italic toggle=\"yes\">P</jats:italic> = .002 for 28 vs 0 months of ADT). The optimal ADT duration based on 10-year DM was 0, 6, 12 months, and undefined for patients with 1 intermediate-risk factor, 2 or more intermediate-risk factors, and National Comprehensive Cancer Network high-risk and very high-risk disease, respectively. Conclusions and Relevance The results of this meta-analysis suggest that, for men with localized prostate cancer treated with definitive radiotherapy and ADT, there are relative and absolute benefits from increasing durations of ADT that help provide individualized risk estimates.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"25 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145554826","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}
Pub Date : 2025-11-20DOI: 10.1001/jamaoncol.2025.4167
Matthew R. Cooperberg, John R. Bihn, John M. Culnan, Jennifer La, Sergey D. Goryachev, Daniel C. R. Chen, Oleg Soloviev, Grace Lee, June K. Corrigan, Kaitlin N. Swinnerton, Nicholas G. Nickols, Karlynn N. Dulberger, Pedro Barata, Rhonda L. Bitting, Mary T. Brophy, Heather H. Cheng, Amanda De Hoedt, Nhan V. Do, Stephen J. Freedland, Isla P. Garraway, J. Michael Gaziano, Susan Halabi, Richard L. Hauger, Stacy Loeb, David M. Nanus, Timothy R. Rebbeck, Matthew B. Rettig, Chong-Xian Pan, Kenute Myrie, Rachel B. Ramoni, Nathanael R. Fillmore, Channing J. Paller
This cohort study compares magnetic resonance imaging with confirmatory biopsy for patients with favorable-risk prostate cancer undergoing active surveilance.
这项队列研究比较了磁共振成像和确诊活检对积极监测的有利风险前列腺癌患者的影响。
{"title":"Magnetic Resonance Imaging or Confirmatory Biopsy for Patients With Prostate Cancer Receiving Active Surveillance","authors":"Matthew R. Cooperberg, John R. Bihn, John M. Culnan, Jennifer La, Sergey D. Goryachev, Daniel C. R. Chen, Oleg Soloviev, Grace Lee, June K. Corrigan, Kaitlin N. Swinnerton, Nicholas G. Nickols, Karlynn N. Dulberger, Pedro Barata, Rhonda L. Bitting, Mary T. Brophy, Heather H. Cheng, Amanda De Hoedt, Nhan V. Do, Stephen J. Freedland, Isla P. Garraway, J. Michael Gaziano, Susan Halabi, Richard L. Hauger, Stacy Loeb, David M. Nanus, Timothy R. Rebbeck, Matthew B. Rettig, Chong-Xian Pan, Kenute Myrie, Rachel B. Ramoni, Nathanael R. Fillmore, Channing J. Paller","doi":"10.1001/jamaoncol.2025.4167","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.4167","url":null,"abstract":"This cohort study compares magnetic resonance imaging with confirmatory biopsy for patients with favorable-risk prostate cancer undergoing active surveilance.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"54 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145554775","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}
Pub Date : 2025-11-13DOI: 10.1001/jamaoncol.2025.4777
Chen Wang, Mengxi Du, Hanseul Kim, Long H. Nguyen, Qiao-Li Wang, David A. Drew, Emily R. Leeming, Neha Khandpur, Qi Sun, Xiaoyu Zong, Tae-Geun Gweon, Shuji Ogino, Kimmie Ng, Sarah Berry, Edward L. Giovannucci, Mingyang Song, Yin Cao, Andrew T. Chan
Importance Early-onset colorectal cancer (EOCRC) (diagnosed age &lt;50 years) incidence is increasing globally, in parallel with increased consumption of ultraprocessed foods (UPFs). The role of UPFs in early-onset colorectal neoplasia remains underexplored. Objective To evaluate the association between UPF consumption and risk of EOCRC precursors. Design, Setting, and Participants This prospective cohort study included participants of the Nurses’ Health Study II, an ongoing US prospective cohort of female registered nurses established in 1989. Participants were followed up from June 1, 1991, through June 1, 2015. Data were analyzed from October 2024 to July 2025. UPF intake, derived from food-frequency questionnaires administered every 4 years and classified using the Nova system, was modeled as quintiles of energy-adjusted servings per day. Of the nurses enrolled, those who had completed the baseline 1991 food-frequency questionnaire, undergone at least 1 lower endoscopy before age 50 years after baseline, had no history of cancer (except for nonmelanoma skin cancer) before endoscopy, and no colorectal polyp or inflammatory bowel disease were included. Main Outcomes and Measures Incidence of EOCRC precursors, including conventional adenomas and serrated lesions, confirmed via medical records and pathology reports. Multivariable logistic regression models with generalized estimating equations for clustered data were used to estimate adjusted odds ratios (AORs) and 95% CIs, accounting for known and putative risk factors. Results Among 29 105 female participants (mean [SD] age, 45.2 [4.5] years) over 24 years of follow-up, 1189 cases were documented of early-onset conventional adenomas and 1598 serrated lesions. UPFs provided 34.8% of total daily calories (median, 5.7 [IQR, 4.5-7.4] servings per day). Participants with higher UPF intake had an increased risk of early-onset conventional adenomas (highest vs lowest intake: AOR, 1.45; 95% CI, 1.19-1.77; overall P &lt; .001) but not serrated lesions (AOR, 1.04; 95% CI, 0.89-1.22; P = .48 for trend). Findings were consistent after further adjustment for body mass index, type 2 diabetes, dietary factors (fiber, folate, calcium, and vitamin D), and Alternative Healthy Eating Index–2010 score. Conclusions and Relevance In this study, higher UPF intake was associated with increased risk of early-onset colorectal conventional adenomas. These data highlight the important role of UPFs in early-onset colorectal tumorigenesis and support improving dietary quality as a strategy to mitigate the increasing burden of EOCRC.
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