Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are commonly used to manage diabetes and are known to cause weight loss. This study aimed to clarify whether SGLT2i-induced weight loss influences survival or toxicity during systemic therapy in patients with advanced non-small cell lung cancer (NSCLC) and comorbid diabetes. We conducted a retrospective analysis of patients with advanced NSCLC and diabetes who received first-line systemic therapy. Patients with an Eastern Cooperative Oncology Group performance status (PS) ≥ 3, driver mutations, interstitial lung disease, untreated diabetes, or missing data were excluded. We compared weight changes, progression-free survival (PFS), overall survival (OS), and adverse events between patients with and without SGLT2i. We defined cachexia as either 5
BACKGROUND:To evaluate the dissemination and real-world implementation of recommendations from the 5th Edition of the Japanese Esophageal Cancer Practice Guidelines and to inform development of the upcoming 6th Edition, the Guideline Committee of the Japanese Esophageal Society conducted a nationwide Quality Indicator (QI) survey in Japan. METHODS:A nationwide, cross-sectional, web-based questionnaire survey was distributed to 381 certified institutions participating in the 2023 National Registry of Esophageal Cancer in Japan. Conducted in November 2024, the survey covered six domains-epidemiology, surgery, endoscopy, chemotherapy, radiation therapy, and pathology-reflecting key recommendations of the 5th Edition. Responses were summarized descriptively at the institutional level. RESULTS:Valid responses were obtained from 190 institutions (49.9%). Smoking cessation guidance was implemented in more than 90% of institutions, and over 90% also provided guidance on alcohol abstinence or moderation, although complete alcohol abstinence was less uniformly recommended. Minimally invasive, including robot-assisted, esophagectomy was adopted by over 90% of institutions. The proportion of institutions performing prophylactic cervical lymph node dissection varied by tumor location and stage, reflecting contemporary staging concepts. The DCF regimen was the predominant neoadjuvant therapy for stage II/III disease (94.7%), and immune checkpoint inhibitor-based chemotherapy was widely used for unresectable or recurrent disease. Advanced endoscopic diagnostic modalities, including magnifying and image-enhanced endoscopy, were widely adopted. CONCLUSIONS:This nationwide QI survey demonstrates broad adherence to guideline-based multidisciplinary management of esophageal cancer in Japan and provides an evidence base for refining recommendations in the 6th Edition of the Japanese Esophageal Cancer Practice Guidelines.
BACKGROUND: Japan Clinical Oncology Group (JCOG) defined gastric cancer (GC) with bulky lymph node (Bulky N) and/or para-aortic lymph node (PAN) as extensive lymph node metastasis (ELM), and has developed neoadjuvant chemotherapy followed by D2 gastrectomy with PAN dissection (PAND) through three phase II trials using different regimens (JCOG0001: irinotecan/cisplatin, JCOG0405: cisplatin/S-1, JCOG1002: docetaxel/cisplatin/S-1). However, whether PAND provides survival benefit remains uncertain. METHODS: The therapeutic value index was investigated using integrated data from JCOG0001, JCOG0405, and JCOG1002. Patients were classified into Bulky N group (only bulky N without PAN) and PAN group (PAN regardless of bulky N) based on the clinical diagnosis. The index was calculated by multiplication of incidence of metastasis and percentage 5-year relapse-free survival (5yRFS) of patients with metastasis for each lymph node area. RESULTS: A total of 122 patients were analyzed (Bulky N group: 68, PAN group: 54). In Bulky N group, the proportion of metastasis/5yRFS/index in the PAN area was 15.2%/30.0%/4.5 (JCOG0001: 27.8%/20.0%/5.6, JCOG0405: 13.6%/33.3%/4.5, JCOG1002: 7.7%/50.0%/3.8). The proportion of metastasis decreased across trials. In PAN group, the proportion of metastasis/5yRFS/index in the PAN area was 44.4%/4.2%/1.9 (JCOG0001: 81.3%/7.7%/6.3, JCOG0405: 30.0%/0.0%/0.0, JCOG1002: 27.8%/0.0%/0.0). Notably, the indices of the recent two trials were zero. CONCLUSIONS: PAND may retain a potential role in the Bulky N group, whereas its benefit appears limited in the PAN group. Decreasing trends in PAN metastasis and therapeutic value were observed in both groups. Given the distinct characteristics of these subgroups, the omission of PAND should be determined through separate future validation.
BackgroundComprehensive genomic profiling (CGP) has been reimbursed under Japan's universal health coverage since 2019, yet access remains uneven because designated institutions are concentrated in urban areas. Although CGP can identify actionable alterations, fewer than 10% of patients receive matched therapies, often due to geographic barriers to clinical trial enrollment. This nationwide survey evaluated institutional challenges in CGP implementation and explored the perceived role of telemedicine and decentralized clinical trials (DCTs) in improving equitable access.MethodsA web-based questionnaire was distributed to professionals involved in CGP across government-designated hospitals for cancer genomic medicine between December 2024 and February 2025. Respondents provided institutional data and perceptions regarding CGP access, telemedicine use, and barriers to trial participation.ResultsA total of 194 professionals from 140 hospitals responded. On average, 23.5% of CGP-tested patients were referred from non-designated hospitals, often requiring multiple in-person visits. Fifty-eight percent of respondents supported telemedicine for both informed consent and result disclosure, citing reduced travel burden, while concerns included digital literacy and institutional workload. Sixty-one percent reported that over half of eligible patients declined genotype-matched trials due to travel distance. Institutions facing higher dropout rates expressed greater support for DCTs (67% "strongly needed").ConclusionThis nationwide study identified major geographic and logistical barriers to equitable precision oncology in Japan. Most institutions view telemedicine and DCTs as essential to expanding access to genomic testing and clinical trials. Japan's experience may offer insights for other healthcare systems considering integration of telemedicine into national precision oncology frameworks under universal health coverage.
The modified age-adjusted Charlson Comorbidity Index (mACCI) is associated with postoperative complications and long-term survival after gastrectomy. However, whether robotic gastrectomy (RG) provides clinical advantages over laparoscopic gastrectomy (LG) in high-risk patients remains unclear. This study evaluated short- and long-term outcomes of RG compared with LG according to mACCI. A total of 1501 patients who underwent minimally invasive gastrectomy for clinical stage I–II gastric cancer between 2012 and 2021 were retrospectively analyzed. Patients were stratified by mACCI (< 4 and ≥ 4), and propensity score matching was performed within each stratum. Short-term outcomes, overall survival (OS), recurrence-free survival (RFS), and cumulative incidence of other-cause and gastric cancer-specific death were assessed. Among patients with mACCI ≥ 4, RG was associated with a lower incidence of postoperative complications than LG after matching (2.7
