{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T17:07:54Z","timestamp":1790356074864,"version":"4.1.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Clin Oncol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Enfortumab vedotin plus pembrolizumab (EV\/Pem) has improved the survival of patients with advanced urothelial carcinoma; however, many patients suffer treatment-related adverse events, particularly skin toxicity. This study aimed to clarify the clinical impact of skin-toxicity timing on treatment outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed patients with advanced urothelial carcinoma treated with EV\/Pem. Patients were categorized into three groups according to skin-toxicity timing: no rash, early-onset rash (&lt;\u20091 month), and late-onset rash (\u2265\u20091 month). Baseline clinical and laboratory characteristics were compared among groups and incorporated into multivariable Cox proportional hazards analyses. Kaplan-Meier analyses with pairwise log-rank tests were performed to evaluate progression-free survival (PFS) and overall survival (OS). The 1-month cutoff was selected for clinical interpretability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The three-group analysis included 210 patients: no rash (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200987), early-onset rash (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200984), and late-onset rash (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200939). Late-onset rash was associated with significantly prolonged PFS and OS in conventional analyses. In multivariable analysis, late-onset rash was significantly associated with prolonged PFS (HR 0.34, 95% CI 0.15\u20130.74,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007) and OS (HR 0.25, 95% CI 0.07\u20130.81,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). Because late-onset rash could only be assigned after continued observation, these associations should be interpreted as exploratory and potentially affected by immortal time bias. In the 3-month landmark analysis, PFS remained significantly longer in the late-onset than early-onset rash group, whereas OS did not differ significantly.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Skin toxicity during EV\/Pem therapy appears to have timing-dependent prognostic implications. Late-onset rash showed favorable outcomes in conventional analyses, but these findings should be considered hypothesis-generating.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10147-026-03148-2","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T17:38:00Z","timestamp":1785173880000},"page":"2441-2448","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Timing-dependent skin toxicity phenotypes during enfortumab vedotin plus pembrolizumab therapy for advanced urothelial carcinoma"],"prefix":"10.1007","volume":"31","author":[{"given":"Mamoru","family":"Hashimoto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lan","family":"Inoki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wataru","family":"Fukuokaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takafumi","family":"Yanagisawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiichiro","family":"Mori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryoichi","family":"Maenosono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Yoshikawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Tsujino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanobu","family":"Saruta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuhisa","family":"Nukaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuya","family":"Oishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keita","family":"Tamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seitetsu","family":"Sugiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirofumi","family":"Morinaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazumasa","family":"Komura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyoshi","family":"Takahara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teruo","family":"Inamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6774-7497","authenticated-orcid":false,"given":"Kazutoshi","family":"Fujita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"ULTRA-J group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"3148_CR1","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1056\/NEJMoa2312117","volume":"390","author":"T Powles","year":"2024","unstructured":"Powles T, Valderrama BP, Gupta S et al (2024) Enfortumab vedotin and pembrolizumab in untreated advanced urothelial cancer. N Engl J Med 390:875\u2013888","journal-title":"N Engl J Med"},{"key":"3148_CR2","doi-asserted-by":"publisher","first-page":"3003","DOI":"10.1158\/0008-5472.CAN-15-1313","volume":"76","author":"PM Challita-Eid","year":"2016","unstructured":"Challita-Eid PM, Satpayev D, Yang P et al (2016) Enfortumab vedotin antibody-drug conjugate targeting Nectin-4 is a highly potent therapeutic agent in multiple preclinical cancer models. Cancer Res 76:3003\u20133013","journal-title":"Cancer Res"},{"key":"3148_CR3","doi-asserted-by":"publisher","first-page":"545","DOI":"10.14670\/HH-18-972","volume":"41","author":"M Hashimoto","year":"2026","unstructured":"Hashimoto M, Fukiage K, Minami T, De Velasco MA, Fujita K (2026) Treatment strategies for locally advanced and metastatic urothelial carcinoma based on molecular profiles: a review. Histol Histopathol 41:545\u2013552. https:\/\/doi.org\/10.14670\/HH-18-972","journal-title":"Histol Histopathol"},{"key":"3148_CR4","doi-asserted-by":"publisher","first-page":"167","DOI":"10.21873\/anticanres.16146","volume":"43","author":"M Hashimoto","year":"2023","unstructured":"Hashimoto M, Fujita K, Tomiyama E, Fujimoto S, Toyoda S et al (2023) Immunohistochemical analysis of HER2, EGFR, and Nectin-4 expression in upper urinary tract urothelial carcinoma. Anticancer Res 43:167\u2013174. https:\/\/doi.org\/10.21873\/anticanres.16146","journal-title":"Anticancer Res"},{"key":"3148_CR5","doi-asserted-by":"publisher","first-page":"1747","DOI":"10.21037\/tau-22-457","volume":"11","author":"E Tomiyama","year":"2022","unstructured":"Tomiyama E, Fujita K, Hashimoto M, Adomi S, Kawashima A et al (2022) Comparison of molecular profiles of upper tract urothelial carcinoma vs. urinary bladder cancer in the era of targeted therapy: a narrative review. Transl Androl Urol 11:1747\u20131761. https:\/\/doi.org\/10.21037\/tau-22-457","journal-title":"Transl Androl Urol"},{"key":"3148_CR6","doi-asserted-by":"publisher","DOI":"10.1111\/iju.15338","author":"E Tomiyama","year":"2024","unstructured":"Tomiyama E, Fujita K, Hashimoto M, Uemura H, Nonomura N (2024) Urinary markers for bladder cancer diagnosis: a review of current status and future challenges. Int J Urol. https:\/\/doi.org\/10.1111\/iju.15338","journal-title":"Int J Urol"},{"key":"3148_CR7","doi-asserted-by":"publisher","first-page":"2838","DOI":"10.21037\/tau-21-185","volume":"10","author":"M Hashimoto","year":"2021","unstructured":"Hashimoto M, Fujita K, Uemura H et al (2021) Higher neutrophil-to-lymphocyte ratio after the first cycle of the first-line chemotherapy is associated with poor cancer specific survival of upper urinary tract carcinoma patients. Transl Androl Urol 10:2838\u20132847. https:\/\/doi.org\/10.21037\/tau-21-185","journal-title":"Transl Androl Urol"},{"key":"3148_CR8","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1007\/s11523-024-01068-7","volume":"19","author":"T Uchimoto","year":"2024","unstructured":"Uchimoto T, Tsuchida S, Komura K, Fukuokaya W, Adachi T, Hirasawa Y, Hashimoto T, Yoshizawa A, Saruta M, Hashimoto M et al (2024) C-reactive protein-albumin ratio predicts objective response to enfortumab vedotin in metastatic urothelial carcinoma. Target Oncol 19:635\u2013644. https:\/\/doi.org\/10.1007\/s11523-024-01068-7","journal-title":"Target Oncol"},{"key":"3148_CR9","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1007\/s00432-024-05717-2","volume":"150","author":"Y Hirasawa","year":"2024","unstructured":"Hirasawa Y, Adachi T, Hashimoto T, Ohno Y et al (2024) Comparison of the efficacy of enfortumab vedotin between patients with metastatic urothelial carcinoma who were treated with avelumab or pembrolizumab: real-world data from a multi-institutional study in Japan. J Cancer Res Clin Oncol 150:182. https:\/\/doi.org\/10.1007\/s00432-024-05717-2","journal-title":"J Cancer Res Clin Oncol"},{"key":"3148_CR10","doi-asserted-by":"publisher","first-page":"2279","DOI":"10.21037\/tau-2025-254","volume":"14","author":"M Hashimoto","year":"2025","unstructured":"Hashimoto M, Fukiage K, Taniguchi K, Minami T, Fukuokaya W, Mori K et al (2025) Upper urinary tract urothelial carcinoma patients show better overall response rate than bladder cancer patients during enfortumab vedotin treatment following pembrolizumab. Transl Androl Urol 14:2279\u20132288. https:\/\/doi.org\/10.21037\/tau-2025-254","journal-title":"Transl Androl Urol"},{"key":"3148_CR11","doi-asserted-by":"publisher","first-page":"e223","DOI":"10.1093\/oncolo\/oyac001","volume":"27","author":"ME Lacouture","year":"2022","unstructured":"Lacouture ME, Sibaud V, Gerendash B et al (2022) Management of dermatologic events associated with the Nectin-4-directed antibody-drug conjugate enfortumab vedotin. Oncologist 27:e223\u2013e232","journal-title":"Oncologist"},{"key":"3148_CR12","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1016\/j.jdcr.2024.12.019","volume":"57","author":"IA Egbeto","year":"2025","unstructured":"Egbeto IA, Vlachou E, Herrera DB, Russell S et al (2025) Clinical and histopathological characterization of enfortumab vedotin-associated cutaneous toxicities: a case series. JAAD Case Rep 57:114\u2013121. https:\/\/doi.org\/10.1016\/j.jdcr.2024.12.019","journal-title":"JAAD Case Rep"},{"key":"3148_CR13","doi-asserted-by":"publisher","first-page":"100094","DOI":"10.1016\/j.esmorw.2024.100094","volume":"7","author":"Y Kita","year":"2025","unstructured":"Kita Y, Hara T, Kawahara T, Hashimoto K, Matsushita Y, Ito H et al (2025) Incidence, risk factors, and clinical implications of enfortumab vedotin-related cutaneous toxicity in urothelial carcinoma: a large-scale, real-world study in Japan. ESMO Real World Data Digit Oncol 7:100094. https:\/\/doi.org\/10.1016\/j.esmorw.2024.100094","journal-title":"ESMO Real World Data Digit Oncol"},{"key":"3148_CR14","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.lungcan.2012.06.009","volume":"78","author":"F Petrelli","year":"2012","unstructured":"Petrelli F, Borgonovo K, Cabiddu M, Lonati V, Barni S (2012) Relationship between skin rash and outcome in non-small-cell lung cancer patients treated with anti-EGFR tyrosine kinase inhibitors: a literature-based meta-analysis of 24 trials. Lung Cancer 78:8\u201315","journal-title":"Lung Cancer"},{"key":"3148_CR15","first-page":"167","volume":"85","author":"F Petrelli","year":"2013","unstructured":"Petrelli F, Borgonovo K, Barni S (2013) The predictive role of skin rash with cetuximab and panitumumab in colorectal cancer patients: a systematic review and meta-analysis of published trials. Oncology 85:167\u2013175","journal-title":"Oncology"},{"key":"3148_CR16","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1016\/j.jaad.2024.01.038","volume":"90","author":"H Rashdan","year":"2024","unstructured":"Rashdan H, Zhang S, Wan G et al (2024) Timing of cutaneous immune-related adverse events impacts survival in patients with cancer treated with immune-checkpoint inhibitors: a multi-institutional cohort study. J Am Acad Dermatol 90:1080\u20131083. https:\/\/doi.org\/10.1016\/j.jaad.2024.01.038","journal-title":"J Am Acad Dermatol"},{"key":"3148_CR17","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1038\/bmt.2012.244","volume":"48","author":"Y Kanda","year":"2013","unstructured":"Kanda Y (2013) Investigation of the freely available easy-to-use software \u2018EZR\u2019 for medical statistics. Bone Marrow Transpl 48:452\u2013458","journal-title":"Bone Marrow Transpl"},{"key":"3148_CR18","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.resinv.2012.02.001","volume":"50","author":"N Ishikawa","year":"2012","unstructured":"Ishikawa N, Hattori N, Yokoyama A, Kohno N (2012) Utility of KL-6\/MUC1 in the clinical management of interstitial lung diseases. Respir Investig 50:3\u201313","journal-title":"Respir Investig"},{"key":"3148_CR19","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/1465-9921-12-32","volume":"12","author":"T Kondo","year":"2011","unstructured":"Kondo T, Hattori N, Ishikawa N et al (2011) KL-6 concentration in pulmonary epithelial lining fluid is a useful prognostic indicator in patients with acute respiratory distress syndrome. Respir Res 12:32","journal-title":"Respir Res"},{"key":"3148_CR20","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1186\/1465-9921-12-97","volume":"12","author":"S Kawase","year":"2011","unstructured":"Kawase S, Hattori N, Ishikawa N et al (2011) Change in serum KL-6 level from baseline is useful for predicting life-threatening EGFR-TKIs induced interstitial lung disease. Respir Res 12:97","journal-title":"Respir Res"},{"key":"3148_CR21","doi-asserted-by":"publisher","first-page":"18186","DOI":"10.1038\/s41598-023-45170-8","volume":"13","author":"HK Park","year":"2023","unstructured":"Park HK, Lee Y, Kim Y et al (2023) Serum KL-6 levels predict the occurrence and severity of treatment-related interstitial lung disease in lung cancer. Sci Rep 13:18186","journal-title":"Sci Rep"},{"key":"3148_CR22","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/1477-7827-2-4","volume":"2","author":"M Brayman","year":"2004","unstructured":"Brayman M, Thathiah A, Carson DD (2004) MUC1: a multifunctional cell surface component of reproductive tissue epithelia. Reprod Biol Endocrinol 2:4","journal-title":"Reprod Biol Endocrinol"},{"key":"3148_CR23","doi-asserted-by":"publisher","first-page":"110","DOI":"10.3390\/jcm6120110","volume":"6","author":"K Kato","year":"2017","unstructured":"Kato K, Lillehoj EP, Lu W, Kim KC (2017) MUC1: the first respiratory mucin with an anti-inflammatory function. J Clin Med 6:110","journal-title":"J Clin Med"},{"key":"3148_CR24","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1089\/biores.2013.0045","volume":"3","author":"P Kumar","year":"2014","unstructured":"Kumar P, Ji J, Thirkill TL, Douglas GC (2014) MUC1 is expressed by human skin fibroblasts and plays a role in cell adhesion and migration. Biores Open Access 3:45\u201352. https:\/\/doi.org\/10.1089\/biores.2013.0045","journal-title":"Biores Open Access"},{"key":"3148_CR25","doi-asserted-by":"publisher","first-page":"2418","DOI":"10.1681\/ASN.2018020180","volume":"29","author":"M \u017divn\u00e1","year":"2018","unstructured":"\u017divn\u00e1 M, Kidd K, P\u0159istoupilov\u00e1 A, Bare\u0161ov\u00e1 V, DeFelice M, Blumenstiel B, Harden M, Conlon P, Lavin P, Connaughton DM, Hartmannov\u00e1 H, Hoda\u0148ov\u00e1 K, Str\u00e1neck\u00fd V, Vrback\u00e1 A, Vyle\u0165al P, \u017divn\u00fd J, Votruba M, Sovov\u00e1 J, H\u016flkov\u00e1 H, Robins V, Perry R, Wenzel A, Beck BB, Seeman T, Viklick\u00fd O, Rajnochov\u00e1-Bloud\u00ed\u010dkov\u00e1 S, Papagregoriou G, Deltas CC, Alper SL, Greka A, Bleyer AJ, Kmoch S (2018) Noninvasive immunohistochemical diagnosis and novel MUC1 mutations causing autosomal dominant tubulointerstitial kidney disease. J Am Soc Nephrol 29:2418\u20132431. https:\/\/doi.org\/10.1681\/ASN.2018020180","journal-title":"J Am Soc Nephrol"},{"key":"3148_CR26","doi-asserted-by":"publisher","first-page":"eaba0759","DOI":"10.1126\/sciimmunol.aba0759","volume":"5","author":"JC Lee","year":"2020","unstructured":"Lee JC, Mehdizadeh S, Smith J, Young A, Mufazalov IA, Mowery CT, Daud A, Bluestone JA (2020) Regulatory T cell control of systemic immunity and immunotherapy response in liver metastasis. Sci Immunol 5:eaba0759","journal-title":"Sci Immunol"},{"key":"3148_CR27","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1038\/s41591-020-1131-x","volume":"27","author":"J Yu","year":"2021","unstructured":"Yu J, Green MD, Li S, Sun Y, Journey SN, Choi JE et al (2021) Liver metastasis restrains immunotherapy efficacy via macrophage-mediated T cell elimination. Nat Med 27:152\u2013164","journal-title":"Nat Med"},{"key":"3148_CR28","doi-asserted-by":"publisher","first-page":"1533","DOI":"10.21873\/invivo.13953","volume":"39","author":"M Hashimoto","year":"2025","unstructured":"Hashimoto M, Fukiage K, Taniguchi K, Minami T et al (2025) Cancer-induced pain is associated with poor overall survival of urothelial carcinoma patients treated with enfortumab vedotin. Vivo 39:1533\u20131539. https:\/\/doi.org\/10.21873\/invivo.13953","journal-title":"Vivo"},{"key":"3148_CR29","doi-asserted-by":"publisher","first-page":"4575","DOI":"10.21873\/anticanres.17803","volume":"45","author":"K Nishio","year":"2025","unstructured":"Nishio K, Hirosuna K, Uchimoto T, Niigawa H et al (2025) Real-world outcomes of enfortumab vedotin in elderly patients with metastatic urothelial carcinoma. Anticancer Res 45:4575\u20134583. https:\/\/doi.org\/10.21873\/anticanres.17803","journal-title":"Anticancer Res"},{"key":"3148_CR30","doi-asserted-by":"publisher","DOI":"10.1002\/iju5.70149","author":"K Taniguchi","year":"2026","unstructured":"Taniguchi K, Hashimoto M, Nakayama T, Fujimoto S, Toyoda S et al (2026) A case of upper tract urothelial carcinoma with neuroendocrine differentiation successfully treated with enfortumab vedotin and pembrolizumab. IJU Case Rep. https:\/\/doi.org\/10.1002\/iju5.70149","journal-title":"IJU Case Rep"}],"container-title":["International Journal of Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10147-026-03148-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10147-026-03148-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10147-026-03148-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:50:29Z","timestamp":1790355029000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10147-026-03148-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,27]]},"references-count":30,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["3148"],"URL":"https:\/\/doi.org\/10.1007\/s10147-026-03148-2","relation":{},"ISSN":["1341-9625","1437-7772"],"issn-type":[{"value":"1341-9625","type":"print"},{"value":"1437-7772","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,27]]},"assertion":[{"value":"4 June 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors have no conflicts of interest to declare.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was carried out in accordance with the Declaration of Helsinki and its subsequent amendments. Approval was obtained from the institutional review board of Kindai University Hospital (Approval No. R02-155), and written informed consent was waived due to the retrospective study design.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have completed the STROBE reporting checklist.","order":3,"name":"Ethics","label":"Reporting checklist","group":{"name":"EthicsHeading","label":"Declarations"}}]}}