{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T03:57:03Z","timestamp":1789790223966,"version":"4.0.1"},"reference-count":40,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Paracentesis temporarily relieves malignant ascites but causes hypoalbuminemia. Cell\u2010free and concentrated ascites reinfusion therapy (CART) reinfuses autologous proteins to prevent hypoalbuminemia and has been increasingly used in Japan. However, CART has not been widely adopted outside of Japan, and its benefit remains unclear. We evaluated the clinical outcomes and healthcare costs of CART compared with paracentesis in metastatic cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included hospitalized patients with metastatic solid cancer receiving CART or paracentesis across Japan (April 2016\u2013March 2023). Baseline characteristics were balanced using overlap propensity\u2010score weighting. Primary outcomes were in\u2010hospital mortality, functional disability, and 30\u2010day unplanned readmission. Secondary outcomes were length of stay (LOS), albumin administration or re\u2010drainage rates, and costs. Mortality risk was assessed using a modified Poisson regression. The composite primary outcomes were assessed using a win\u2010ratio approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1159 patients (CART: 457, paracentesis: 702) from 51 hospitals, the CART group had lower mortality than the paracentesis group (28.6% vs. 36.7%; risk ratio: 0.78, 95% confidence intervals [95% CI]: 0.64\u20130.94). The win\u2010ratio analysis also favored the CART group over the paracentesis group (win ratio: 1.34, 95% CI: 1.09\u20131.64). Additionally, CART was associated with lower mortality and better composite outcomes than paracentesis, particularly among males, patients with serum albumin \u2264\u20092.5\u2009g\/dL, and those with non\u2010gastrointestinal cancer. Despite higher procedural costs, CART was associated with shorter median LOS (14.1 vs. 19.0\u2009days), lower albumin administration (11.6% vs. 17.3%) and re\u2010drainage (32.7% vs. 52.7%) rates, and lower total median costs (4490.9 [interquartile range: 2042.3\u20137054.5] vs. 5084.1 [interquartile range: 3054.7\u20138659.7] USD) than paracentesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CART was associated with improved clinical outcomes and healthcare costs over paracentesis among hospitalized patients with metastatic cancer, particularly in males, patients with serum albumin \u2264\u20092.5\u2009g\/dL, and those with non\u2010gastrointestinal cancer. These findings may support clinical decision\u2010making and resource allocation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71491","type":"journal-article","created":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T07:07:49Z","timestamp":1766819269000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Outcomes and Healthcare Costs of\n                    <scp>CART<\/scp>\n                    Versus Paracentesis for Malignant Ascites: A Nationwide Retrospective Cohort Study in Japan"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0629-0814","authenticated-orcid":false,"given":"Yuki","family":"Hashimoto","sequence":"first","affiliation":[{"name":"Department of Clinical Data Management and Research, Clinical Research Center National Hospital Organization Headquarters  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norihiko","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of Clinical Data Management and Research, Clinical Research Center National Hospital Organization Headquarters  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinobu","family":"Imai","sequence":"additional","affiliation":[{"name":"Department of Pharmacoepidemiology Showa University Graduate School of Pharmacy  Tokyo 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