{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T15:14:10Z","timestamp":1794064450003,"version":"4.8.0"},"reference-count":36,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Observational studies have associated use of aspirin and selective cyclooxygenase inhibitors with decreased recurrence and improved survival in patients with colon cancer. While randomized clinical trials have not shown benefit across all patients, these findings suggest that select subgroups may benefit from their use. Despite the well-established prognostic value of circulating tumor DNA (ctDNA), its role in guiding treatment remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the predictive value of postoperative ctDNA for survival outcomes with adjuvant celecoxib alongside conventional chemotherapy in patients with stage III colon cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This was a post hoc analysis of the phase 3 Cancer and Leukemia Group B (now Alliance)\/Southwest Oncology Group 80702 randomized clinical trial (2010-2015) assessing adjuvant celecoxib vs placebo and 3 vs 6 months of adjuvant 5-fluorouracil, leucovorin, and oxaliplatin for stage III colon cancer. Patients consented to biospecimen collection and had ctDNA analysis performed. Data analysis was performed from September 2024 to June 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Postoperative ctDNA positivity was determined using a clinically validated, tumor-informed 16-plex-polymerase chain reaction-next-generation sequencing assay (Signatera; Natera Inc) performed between surgery and initiation of adjuvant therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Disease-free survival (DFS) and overall survival (OS). Survival by ctDNA status and adjuvant celecoxib use were assessed as part of a post hoc companion study with prespecified statistical analysis plan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 940 patients (mean [SD] age, 60.9 [10.8] years; 426 female [45.3%] and 515 male [54.7%] individuals; 222 [23.6%] with prior low-dose aspirin use; and median follow-up of 6.0 [95% CI, 6.0-6.0] years), 767 (81.6%) were ctDNA negative and 173 (18.4%) were ctDNA positive. ctDNA positivity was highly prognostic of worse DFS (reference, ctDNA negativity; adjusted hazard ratio [aHR], 6.12; 95% CI, 4.66-8.03) and OS (aHR, 5.86; 95% CI, 4.19-8.19). In patients with ctDNA positivity, celecoxib was associated with improved DFS (aHR,\u20090.61; 95% CI, 0.42-0.89) and OS (aHR,\u20090.62; 95% CI, 0.40-0.96) compared to placebo. Among patients with ctDNA negativity, celecoxib did not provide survival benefit (DFS: aHR, 0.76; 95% CI, 0.53-1.09; OS: aHR, 0.85; 95% CI, 0.54-1.36), although the interaction was not significant (\n                      <jats:italic>P<\/jats:italic>\n                      for interaction, .41 and .33 for DFS and OS, respectively). These findings persisted when stratifying patients by microsatellite instability status and\n                      <jats:italic>PIK3CA<\/jats:italic>\n                      mutational status.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion and Relevance<\/jats:title>\n                    <jats:p>The findings of this post hoc analysis suggest that ctDNA status has the potential to inform clinical decision-making among patients with stage III colon cancer who should consider adjuvant celecoxib in addition to conventional chemotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov Identifier:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT01150045\">NCT01150045<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaoncol.2025.5144","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T16:30:53Z","timestamp":1764865853000},"page":"149","source":"Crossref","is-referenced-by-count":14,"title":["Predictive Role of Circulating Tumor DNA in Stage III Colon Cancer Treated With Celecoxib"],"prefix":"10.1001","volume":"12","author":[{"given":"George Q.","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Surgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts"},{"name":"Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Meyerhardt","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Shi","sequence":"additional","affiliation":[{"name":"Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Twombly","sequence":"additional","affiliation":[{"name":"Department of Pathology, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Levi","family":"Pederson","sequence":"additional","affiliation":[{"name":"Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juha P.","family":"V\u00e4yrynen","sequence":"additional","affiliation":[{"name":"Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Pathology, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasutoshi","family":"Takashima","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ardaman","family":"Shergill","sequence":"additional","affiliation":[{"name":"Alliance for Clinical Trials in Oncology, Chicago, Illinois"},{"name":"Department of Medicine, The University of Chicago Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pankaj","family":"Kumar","sequence":"additional","affiliation":[{"name":"Heartland Cancer Research, National Cancer Institute Community Oncology Research Program, Illinois CancerCare, Peoria, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Couture","sequence":"additional","affiliation":[{"name":"H\u00f4tel-Dieu de Qu\u00e9bec, Qu\u00e9bec City, Qu\u00e9bec, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Kuebler","sequence":"additional","affiliation":[{"name":"Columbus National Cancer Institute Community Oncology Research Program, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Smitha","family":"Krishnamurthi","sequence":"additional","affiliation":[{"name":"Department of Hematology-Oncology, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Tan","sequence":"additional","affiliation":[{"name":"Siteman Cancer Center, Washington University School of Medicine, Saint Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen M.","family":"O\u2019Reilly","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marios","family":"Giannakis","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuji","family":"Ogino","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Pathology, Brigham and Women\u2019s Hospital, Boston, Massachusetts"},{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"},{"name":"Broad Institute of the Massachusetts Institute of Technology and Harvard, Cambridge"},{"name":"Institute of Science Tokyo, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adham","family":"Jurdi","sequence":"additional","affiliation":[{"name":"Natera Inc, Austin, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shruti","family":"Sharma","sequence":"additional","affiliation":[{"name":"Natera Inc, Austin, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexey","family":"Aleshin","sequence":"additional","affiliation":[{"name":"Natera Inc, Austin, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony F.","family":"Shields","sequence":"additional","affiliation":[{"name":"Karmanos Cancer Institute, Wayne State University, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan A.","family":"Nowak","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Pathology, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"coi250074r1","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3322\/caac.21820","article-title":"Cancer statistics, 2024.","volume":"74","author":"Siegel","year":"2024","journal-title":"CA Cancer J Clin"},{"issue":"11","key":"coi250074r2","doi-asserted-by":"publisher","first-page":"2758","DOI":"10.1002\/ijc.31785","article-title":"An overview of 25 years of incidence, treatment and outcome of colorectal cancer patients.","volume":"143","author":"Brouwer","year":"2018","journal-title":"Int J Cancer"},{"issue":"1","key":"coi250074r3","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1186\/1471-2407-14-336","article-title":"Predictors of recurrence free survival for patients with stage II and III colon cancer.","volume":"14","author":"Tsikitis","year":"2014","journal-title":"BMC Cancer"},{"issue":"19","key":"coi250074r4","doi-asserted-by":"publisher","first-page":"3109","DOI":"10.1200\/JCO.2008.20.6771","article-title":"Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial.","volume":"27","author":"Andr\u00e9","year":"2009","journal-title":"J Clin Oncol"},{"issue":"12","key":"coi250074r5","doi-asserted-by":"publisher","first-page":"1620","DOI":"10.1016\/S1470-2045(20)30527-1","article-title":"Effect of duration of adjuvant chemotherapy for patients with stage III colon cancer (IDEA collaboration): final results from a prospective, pooled analysis of six randomised, phase 3 trials.","volume":"21","author":"Andr\u00e9","year":"2020","journal-title":"Lancet Oncol"},{"issue":"2","key":"coi250074r6","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1158\/1940-6207.CAPR-11-0391","article-title":"Aspirin in the chemoprevention of colorectal neoplasia: an overview.","volume":"5","author":"Chan","year":"2012","journal-title":"Cancer Prev Res (Phila)"},{"issue":"21","key":"coi250074r7","doi-asserted-by":"publisher","first-page":"2131","DOI":"10.1056\/NEJMoa067208","article-title":"Aspirin and the risk of colorectal cancer in relation to the expression of COX-2.","volume":"356","author":"Chan","year":"2007","journal-title":"N Engl J Med"},{"issue":"26","key":"coi250074r8","doi-asserted-by":"publisher","first-page":"1960","DOI":"10.1056\/NEJM200006293422606","article-title":"Chemoprevention of colorectal cancer.","volume":"342","author":"J\u00e4nne","year":"2000","journal-title":"N Engl J Med"},{"issue":"1","key":"coi250074r9","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1093\/jnci\/dju345","article-title":"Aspirin and COX-2 inhibitor use in patients with stage III colon cancer.","volume":"107","author":"Ng","year":"2014","journal-title":"J Natl Cancer Inst"},{"issue":"6","key":"coi250074r10","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1001\/jama.2009.1112","article-title":"Aspirin use and survival after diagnosis of colorectal cancer.","volume":"302","author":"Chan","year":"2009","journal-title":"JAMA"},{"issue":"13","key":"coi250074r11","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1001\/jama.2021.2454","article-title":"Effect of celecoxib vs placebo added to standard adjuvant therapy on disease-free survival among patients with stage III colon cancer: the CALGB\/SWOG 80702 (Alliance) randomized clinical trial.","volume":"325","author":"Meyerhardt","year":"2021","journal-title":"JAMA"},{"issue":"13","key":"coi250074r12","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.1056\/NEJMoa1713709","article-title":"Duration of adjuvant chemotherapy for stage III colon cancer.","volume":"378","author":"Grothey","year":"2018","journal-title":"N Engl J Med"},{"issue":"24","key":"coi250074r13","doi-asserted-by":"publisher","first-page":"2261","DOI":"10.1056\/NEJMoa2200075","article-title":"Circulating tumor DNA analysis guiding adjuvant therapy in stage II colon cancer.","volume":"386","author":"Tie","year":"2022","journal-title":"N Engl J Med"},{"issue":"11","key":"coi250074r14","doi-asserted-by":"publisher","first-page":"3272","DOI":"10.1038\/s41591-024-03254-6","article-title":"ctDNA-based molecular residual disease and survival in resectable colorectal cancer.","volume":"30","author":"Nakamura","year":"2024","journal-title":"Nat Med"},{"issue":"11","key":"coi250074r15","doi-asserted-by":"publisher","first-page":"2649","DOI":"10.1002\/1878-0261.13557","article-title":"Correlation between variant allele frequency and mean tumor molecules with tumor burden in patients with solid tumors.","volume":"18","author":"Kalashnikova","year":"2024","journal-title":"Mol Oncol"},{"issue":"24","key":"coi250074r17","doi-asserted-by":"publisher","first-page":"2853","DOI":"10.1200\/JCO.23.01680","article-title":"Improved survival with adjuvant cyclooxygenase 2 inhibition in PIK3CA-activated stage III colon cancer: CALGB\/SWOG 80702 (Alliance).","volume":"42","author":"Nowak","year":"2024","journal-title":"J Clin Oncol"},{"issue":"8","key":"coi250074r18","doi-asserted-by":"publisher","first-page":"1124","DOI":"10.1001\/jamaoncol.2019.0528","article-title":"Analysis of plasma cell-free DNA by ultradeep sequencing in patients with stages I to III colorectal cancer.","volume":"5","author":"Reinert","year":"2019","journal-title":"JAMA Oncol"},{"issue":"23","key":"coi250074r19","first-page":"5473","article-title":"Reduced COX-2 protein in colorectal cancer with defective mismatch repair.","volume":"58","author":"Karnes","year":"1998","journal-title":"Cancer Res"},{"issue":"3","key":"coi250074r20","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1200\/JCO.2024.42.3_suppl.9","article-title":"Circulating tumor DNA (ctDNA) for informing adjuvant chemotherapy (ACT) in stage II\/III colorectal cancer (CRC): interim analysis of BESPOKE CRC study.","volume":"42","author":"Kasi","year":"2024","journal-title":"J Clin Oncol"},{"issue":"12","key":"coi250074r21","doi-asserted-by":"publisher","first-page":"1710","DOI":"10.1001\/jamaoncol.2019.3616","article-title":"Circulating tumor DNA analyses as markers of recurrence risk and benefit of adjuvant therapy for stage III colon cancer.","volume":"5","author":"Tie","year":"2019","journal-title":"JAMA Oncol"},{"issue":"15","key":"coi250074r22","doi-asserted-by":"publisher","first-page":"3540","DOI":"10.1200\/JCO.2021.39.15_suppl.3540","article-title":"Serial circulating tumor DNA analysis to assess recurrence risk, benefit of adjuvant therapy, growth rate and early relapse detection in stage III colorectal cancer patients.","volume":"39","author":"Henriksen","year":"2021","journal-title":"JCO"},{"issue":"10","key":"coi250074r23","doi-asserted-by":"publisher","first-page":"604","DOI":"10.46883\/2022.25920976","article-title":"Minimal residual disease-directed adjuvant therapy for patients with early-stage colon cancer: CIRCULATE-US.","volume":"36","author":"Sahin","year":"2022","journal-title":"Oncology (Williston Park)"},{"issue":"30","key":"coi250074r24","doi-asserted-by":"publisher","first-page":"4575","DOI":"10.1200\/JCO.2010.29.6244","article-title":"Phase III randomized trial assessing rofecoxib in the adjuvant setting of colorectal cancer: final results of the VICTOR trial.","volume":"28","author":"Midgley","year":"2010","journal-title":"J Clin Oncol"},{"issue":"3","key":"coi250074r25","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1016\/S2468-1253(24)00387-X","article-title":"Aspirin after completion of standard adjuvant therapy for colorectal cancer (ASCOLT): an international, multicentre, phase 3, randomised, double-blind, placebo-controlled trial.","volume":"10","author":"Chia","year":"2025","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"9","key":"coi250074r26","doi-asserted-by":"publisher","first-page":"1477","DOI":"10.1200\/JCO.2008.18.6544","article-title":"PIK3CA mutation is associated with poor prognosis among patients with curatively resected colon cancer.","volume":"27","author":"Ogino","year":"2009","journal-title":"J Clin Oncol"},{"issue":"7","key":"coi250074r27","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1016\/j.cell.2007.06.009","article-title":"AKT\/PKB signaling: navigating downstream.","volume":"129","author":"Manning","year":"2007","journal-title":"Cell"},{"issue":"4","key":"coi250074r28","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2025.43.4_suppl.LBA125","article-title":"Low-dose aspirin to reduce recurrence rate in colorectal cancer patients with PI3K pathway alterations: 3-year results from a randomized placebo-controlled trial.","volume":"43","author":"Martling","year":"2025","journal-title":"J Clin Oncol"},{"issue":"8","key":"coi250074r29","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1038\/s41568-021-00363-z","article-title":"Interleukins in cancer: from biology to therapy.","volume":"21","author":"Briukhovetska","year":"2021","journal-title":"Nat Rev Cancer"},{"issue":"9","key":"coi250074r30","doi-asserted-by":"publisher","first-page":"1367","DOI":"10.1038\/s41416-020-0780-3","article-title":"An integrated analysis of lymphocytic reaction, tumour molecular characteristics and patient survival in colorectal cancer.","volume":"122","author":"Haruki","year":"2020","journal-title":"Br J Cancer"},{"issue":"4","key":"coi250074r31","doi-asserted-by":"publisher","DOI":"10.1136\/jitc-2020-002297","article-title":"Prognostic significance of myeloid immune cells and their spatial distribution in the colorectal cancer microenvironment.","volume":"9","author":"V\u00e4yrynen","year":"2021","journal-title":"J Immunother Cancer"},{"issue":"1","key":"coi250074r32","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1158\/2326-6066.CIR-20-0527","article-title":"The prognostic role of macrophage polarization in the colorectal cancer microenvironment.","volume":"9","author":"V\u00e4yrynen","year":"2021","journal-title":"Cancer Immunol Res"},{"issue":"3","key":"coi250074r33","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1001\/jamaoncol.2022.6911","article-title":"Association of inflammatory biomarkers with survival among patients with stage III colon cancer.","volume":"9","author":"Cheng","year":"2023","journal-title":"JAMA Oncol"},{"issue":"6","key":"coi250074r34","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.1038\/bjc.2015.61","article-title":"Cytokine profile and prognostic significance of high neutrophil-lymphocyte ratio in colorectal cancer.","volume":"112","author":"Chen","year":"2015","journal-title":"Br J Cancer"},{"key":"coi250074r35","doi-asserted-by":"publisher","DOI":"10.1155\/2010\/215158","article-title":"The role of cyclooxygenase-2 in cell proliferation and cell death in human malignancies.","volume":"2010","author":"Sobolewski","year":"2010","journal-title":"Int J Cell Biol"},{"key":"coi250074r36","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.1055968","article-title":"Tumor-informed or tumor-agnostic circulating tumor DNA as a biomarker for risk of recurrence in resected colorectal cancer patients.","volume":"12","author":"Chan","year":"2023","journal-title":"Front Oncol"},{"key":"coi250074r16","unstructured":"National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Colon Cancer. Accessed October 31, 2025. https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/colon.pdf"}],"container-title":["JAMA Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaoncology\/articlepdf\/2842596\/jamaoncology_zhang_2025_oi_250074_1771446074.71846.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T16:01:06Z","timestamp":1771516866000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaoncology\/fullarticle\/2842596"}},"subtitle":["A Post Hoc Analysis of the CALGB (Alliance)\/SWOG 80702 Phase 3 Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,2,1]]},"references-count":36,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoncol.2025.5144","relation":{},"ISSN":["2374-2437"],"issn-type":[{"value":"2374-2437","type":"print"}],"subject":[],"published":{"date-parts":[[2026,2,1]]}}}