{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:50:28Z","timestamp":1791247828554,"version":"4.1.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":54,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["25K12010"],"award-info":[{"award-number":["25K12010"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The global incidence of early-onset colorectal cancer (EOCRC) is increasing. The prognostic impact of EOCRC remains controversial, as it is largely confounded by hereditary syndromes and mismatch repair deficient (dMMR)\/microsatellite instability-high (MSI-H) tumors. We aimed to evaluate the clinicopathological features and stage-adjusted outcomes of sporadic, proficient MMR\/microsatellite stable (pMMR\/MSS) EOCRC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively reviewed 1,600 consecutive patients who underwent primary tumor resection for Stage 0\u2013IV CRC. After excluding patients with known hereditary cancer syndromes or inflammatory bowel disease (IBD)-related CRC, as well as those with dMMR\/MSI-H tumors or unknown MMR\/MSI status, 1,218 patients with sporadic pMMR\/MSS CRC were analyzed. Patients were stratified into EOCRC (&lt;\u200950 years,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200986) and late-onset CRC (LOCRC, \u2265\u200950 years,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091,132) cohorts. Cancer-specific survival (CSS) and time to recurrence (TTR) were evaluated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients with EOCRC were more often diagnosed at an advanced stage than those with LOCRC (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Unadjusted CSS was worse in the EOCRC group (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.042); however, multivariable analysis showed that EOCRC was not an independent predictor of worse CSS (adjusted hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.49\u20131.37,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.512). Among 987 patients with curatively resected Stage I\u2013III disease, the EOCRC group received significantly more intensive perioperative treatments (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Unadjusted TTR did not significantly differ between the age groups (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.510), and multivariable analysis showed a non-significant tendency toward a lower recurrence risk in patients with EOCRC (adjusted HR 0.52, 95% CI 0.23\u20131.03,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.084).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>After exclusion of hereditary syndromes, IBD-related CRC, and dMMR\/MSI-H tumors, pMMR\/MSS EOCRC more often presented with advanced disease, but its stage-adjusted cancer-specific survival and recurrence outcomes did not significantly differ from those of LOCRC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12876-026-04938-8","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T08:52:57Z","timestamp":1779353577000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinicopathological characteristics and stage-adjusted outcomes of sporadic pMMR\/MSS early-onset colorectal cancer"],"prefix":"10.1186","volume":"26","author":[{"given":"Tomoyuki","family":"Momma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirokazu","family":"Okayama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Hasegawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Kawamata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiaki","family":"Takiguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Fukai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Sato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misato","family":"Ito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Ujiie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shun","family":"Chida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motonobu","family":"Saito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Kono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"issue":"3","key":"4938_CR1","first-page":"229","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229\u201363.","journal-title":"CA Cancer J Clin"},{"issue":"10207","key":"4938_CR2","doi-asserted-by":"publisher","first-page":"1467","DOI":"10.1016\/S0140-6736(19)32319-0","volume":"394","author":"E Dekker","year":"2019","unstructured":"Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. Lancet. 2019;394(10207):1467\u201380.","journal-title":"Lancet"},{"issue":"2","key":"4938_CR3","first-page":"e70067","volume":"76","author":"RL Siegel","year":"2026","unstructured":"Siegel RL, Wagle NS, Star J, Kratzer TB, Smith RA, Jemal A. Colorectal cancer statistics, 2026. CA Cancer J Clin. 2026;76(2):e70067.","journal-title":"CA Cancer J Clin"},{"issue":"1","key":"4938_CR4","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/S1470-2045(24)00600-4","volume":"26","author":"H Sung","year":"2025","unstructured":"Sung H, Siegel RL, Laversanne M, Jiang C, Morgan E, Zahwe M, Cao Y, Bray F, Jemal A. Colorectal cancer incidence trends in younger versus older adults: an analysis of population-based cancer registry data. Lancet Oncol. 2025;26(1):51\u201363.","journal-title":"Lancet Oncol"},{"issue":"4","key":"4938_CR5","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1038\/s41571-020-00445-1","volume":"18","author":"N Akimoto","year":"2021","unstructured":"Akimoto N, Ugai T, Zhong R, Hamada T, Fujiyoshi K, Giannakis M, Wu K, Cao Y, Ng K, Ogino S. Rising incidence of early-onset colorectal cancer - a call to action. Nat Rev Clin Oncol. 2021;18(4):230\u201343.","journal-title":"Nat Rev Clin Oncol"},{"issue":"16","key":"4938_CR6","doi-asserted-by":"publisher","first-page":"1547","DOI":"10.1056\/NEJMra2200869","volume":"386","author":"FA Sinicrope","year":"2022","unstructured":"Sinicrope FA. Increasing Incidence of Early-Onset Colorectal Cancer. N Engl J Med. 2022;386(16):1547\u201358.","journal-title":"N Engl J Med"},{"issue":"3","key":"4938_CR7","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1016\/S2468-1253(21)00426-X","volume":"7","author":"SG Patel","year":"2022","unstructured":"Patel SG, Karlitz JJ, Yen T, Lieu CH, Boland CR. The rising tide of early-onset colorectal cancer: a comprehensive review of epidemiology, clinical features, biology, risk factors, prevention, and early detection. Lancet Gastroenterol Hepatol. 2022;7(3):262\u201374.","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"4938_CR8","doi-asserted-by":"publisher","unstructured":"Char SK, O\u2019Connor CA, Ng K. Early-onset gastrointestinal cancers: comprehensive review and future directions. Br J Surg. 2025;112(7). https:\/\/doi.org\/10.1093\/bjs\/znaf102.","DOI":"10.1093\/bjs\/znaf102"},{"issue":"3","key":"4938_CR9","doi-asserted-by":"publisher","first-page":"e473618","DOI":"10.1200\/EDBK-25-473618","volume":"45","author":"A Turk","year":"2025","unstructured":"Turk A, Mondaca S, Nervi B, Morris AD, Finer Z, Holowatyj AN. Early-Onset Colorectal Cancer: From Genetic Discovery to Clinical Innovation. Am Soc Clin Oncol Educ Book. 2025;45(3):e473618.","journal-title":"Am Soc Clin Oncol Educ Book"},{"key":"4938_CR10","doi-asserted-by":"crossref","unstructured":"Jin Z, Sinicrope FA. Prognostic and Predictive Values of Mismatch Repair Deficiency in Non-Metastatic Colorectal Cancer. Cancers (Basel). 2021;13(2):300.","DOI":"10.3390\/cancers13020300"},{"key":"4938_CR11","doi-asserted-by":"publisher","unstructured":"Momma T, Okayama H, Hayashishita S, Suzuki H, Katagata M, Matsumoto T, Ujiie D, Chida S, Sakamoto W, Kono K. Prognostic Impact of Histologic Subtypes in Mismatch Repair-Deficient\/Microsatellite Instability-High Colorectal Cancer: A Single-Center Retrospective Study of 1127 Stage 0\u2013IV Patients. Ann Gastroenterol Surg. 2025;10(3):760\u201376. https:\/\/doi.org\/10.1002\/ags3.70159.","DOI":"10.1002\/ags3.70159"},{"issue":"24","key":"4938_CR12","doi-asserted-by":"publisher","first-page":"2735","DOI":"10.1200\/JCO.21.02691","volume":"40","author":"Z Jin","year":"2022","unstructured":"Jin Z, Sinicrope FA. Mismatch Repair-Deficient Colorectal Cancer: Building on Checkpoint Blockade. J Clin Oncol. 2022;40(24):2735\u201350.","journal-title":"J Clin Oncol"},{"issue":"1","key":"4938_CR13","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1038\/s41571-019-0241-1","volume":"17","author":"A Sveen","year":"2020","unstructured":"Sveen A, Kopetz S, Lothe RA. Biomarker-guided therapy for colorectal cancer: strength in complexity. Nat Rev Clin Oncol. 2020;17(1):11\u201332.","journal-title":"Nat Rev Clin Oncol"},{"issue":"8","key":"4938_CR14","doi-asserted-by":"publisher","first-page":"4559","DOI":"10.1097\/JS9.0000000000001584","volume":"110","author":"J Tang","year":"2024","unstructured":"Tang J, Peng W, Tian C, Zhang Y, Ji D, Wang L, Jin K, Wang F, Shao Y, Wang X, et al. Molecular characteristics of early-onset compared with late-onset colorectal cancer: a case controlled study. Int J Surg. 2024;110(8):4559\u201370.","journal-title":"Int J Surg"},{"key":"4938_CR15","doi-asserted-by":"publisher","first-page":"102821","DOI":"10.1016\/j.ctrv.2024.102821","volume":"130","author":"A Gandini","year":"2024","unstructured":"Gandini A, Taieb J, Blons H, Netter J, Laurent-Puig P, Gallois C. Early-Onset colorectal Cancer: From the laboratory to the clinic. Cancer Treat Rev. 2024;130:102821.","journal-title":"Cancer Treat Rev"},{"issue":"10","key":"4938_CR16","doi-asserted-by":"publisher","first-page":"1785","DOI":"10.1158\/1055-9965.EPI-21-0507","volume":"30","author":"AA Arif","year":"2021","unstructured":"Arif AA, Chahal D, Ladua GK, Bhang E, Salh B, Rosenfeld G, Loree JM, Donnellan F. Hereditary and Inflammatory Bowel Disease-Related Early Onset Colorectal Cancer Have Unique Characteristics and Clinical Course Compared with Sporadic Disease. Cancer Epidemiol Biomarkers Prev. 2021;30(10):1785\u201391.","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"12","key":"4938_CR17","doi-asserted-by":"publisher","first-page":"e1846","DOI":"10.1200\/OP.20.01010","volume":"17","author":"K Kanter","year":"2021","unstructured":"Kanter K, Fish M, Mauri G, Horick NK, Allen JN, Blaszkowsky LS, Clark JW, Ryan DP, Nipp RD, Giantonio BJ, et al. Care Patterns and Overall Survival in Patients With Early-Onset Metastatic Colorectal Cancer. JCO Oncol Pract. 2021;17(12):e1846\u201355.","journal-title":"JCO Oncol Pract"},{"issue":"36","key":"4938_CR18","doi-asserted-by":"publisher","first-page":"4009","DOI":"10.1200\/JCO.21.02008","volume":"39","author":"E Fontana","year":"2021","unstructured":"Fontana E, Meyers J, Sobrero A, Iveson T, Shields AF, Taieb J, Yoshino T, Souglakos I, Smyth EC, Lordick F, et al. Early-Onset Colorectal Adenocarcinoma in the IDEA Database: Treatment Adherence, Toxicities, and Outcomes With 3 and 6 Months of Adjuvant Fluoropyrimidine and Oxaliplatin. J Clin Oncol. 2021;39(36):4009\u201319.","journal-title":"J Clin Oncol"},{"key":"4938_CR19","doi-asserted-by":"crossref","unstructured":"Suzuki H, Okayama H, Nakajima S, Saito K, Kanoda R, Maruyama Y, Matsuishi A, Matsumoto T, Ito M, Chida S et al. GALNT7 stratifies dMMR\/MSI colorectal cancer into distinct molecular subsets associated with prognosis and PD-L1 expression. Cancer Res Commun. 2025;5(9):1530\u201340.","DOI":"10.1158\/2767-9764.CRC-25-0270"},{"issue":"6","key":"4938_CR20","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1038\/s41416-021-01660-y","volume":"126","author":"T Matsumoto","year":"2022","unstructured":"Matsumoto T, Okayama H, Nakajima S, Saito K, Ito M, Kaneta A, Kanke Y, Onozawa H, Hayase S, Fujita S, et al. SH2D4A downregulation due to loss of chromosome 8p is associated with poor prognosis and low T cell infiltration in colorectal cancer. Br J Cancer. 2022;126(6):917\u201326.","journal-title":"Br J Cancer"},{"issue":"18","key":"4938_CR21","doi-asserted-by":"publisher","first-page":"4468","DOI":"10.1158\/1078-0432.CCR-17-3533","volume":"24","author":"M Noda","year":"2018","unstructured":"Noda M, Okayama H, Tachibana K, Sakamoto W, Saito K, Thar Min AK, Ashizawa M, Nakajima T, Aoto K, Momma T, et al. Glycosyltransferase Gene Expression Identifies a Poor Prognostic Colorectal Cancer Subtype Associated with Mismatch Repair Deficiency and Incomplete Glycan Synthesis. Clin Cancer Res. 2018;24(18):4468\u201381.","journal-title":"Clin Cancer Res"},{"issue":"4","key":"4938_CR22","doi-asserted-by":"publisher","first-page":"175","DOI":"10.23922\/jarc.2019-018","volume":"3","author":"Japanese Society for Cancer of the C, Rectum","year":"2019","unstructured":"Japanese Society for Cancer of the C, Rectum. Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma: the 3d English Edition [Secondary Publication]. J Anus Rectum Colon. 2019;3(4):175\u201395.","journal-title":"J Anus Rectum Colon"},{"issue":"12","key":"4938_CR23","doi-asserted-by":"publisher","first-page":"2340","DOI":"10.1002\/ijc.35336","volume":"156","author":"E Akkus","year":"2025","unstructured":"Akkus E, Karaoglan BB, Kayaalp M, Turmus U, Akyol C, Utkan G. Stage-specific characterization of early-onset colorectal cancer: Localized and synchronous metastatic disease. Int J Cancer. 2025;156(12):2340\u201351.","journal-title":"Int J Cancer"},{"issue":"3","key":"4938_CR24","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1016\/j.cgh.2022.12.006","volume":"21","author":"GM Cavestro","year":"2023","unstructured":"Cavestro GM, Mannucci A, Balaguer F, Hampel H, Kupfer SS, Repici A, Sartore-Bianchi A, Seppala TT, Valentini V, Boland CR, et al. Delphi Initiative for Early-Onset Colorectal Cancer (DIRECt) International Management Guidelines. Clin Gastroenterol Hepatol. 2023;21(3):581\u2013603. e533.","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"12","key":"4938_CR25","doi-asserted-by":"publisher","first-page":"108687","DOI":"10.1016\/j.ejso.2024.108687","volume":"50","author":"CK Liao","year":"2024","unstructured":"Liao CK, Hsu YJ, Chern YJ, Yu YL, Lin YC, Hsieh PS, Chiang JM, You JF. Differences in characteristics and outcomes between early-onset colorectal cancer and late-onset colorectal cancers. Eur J Surg Oncol. 2024;50(12):108687.","journal-title":"Eur J Surg Oncol"},{"issue":"12","key":"4938_CR26","doi-asserted-by":"publisher","first-page":"1683","DOI":"10.1093\/jnci\/djab124","volume":"113","author":"A Cercek","year":"2021","unstructured":"Cercek A, Chatila WK, Yaeger R, Walch H, Fernandes GDS, Krishnan A, Palmaira L, Maio A, Kemel Y, Srinivasan P, et al. A Comprehensive Comparison of Early-Onset and Average-Onset Colorectal Cancers. J Natl Cancer Inst. 2021;113(12):1683\u201392.","journal-title":"J Natl Cancer Inst"},{"issue":"1","key":"4938_CR27","doi-asserted-by":"publisher","first-page":"1840","DOI":"10.1097\/JS9.0000000000003463","volume":"112","author":"QS Huang","year":"2026","unstructured":"Huang QS, Yu XZ, Zhao R, Huang LB, Wen J, Yang L. Clinicopathological characteristics and biomarker alterations in early-onset vs. late-onset colorectal cancer: a systematic review and meta-analysis. Int J Surg. 2026;112(1):1840\u201354.","journal-title":"Int J Surg"},{"issue":"6","key":"4938_CR28","doi-asserted-by":"publisher","first-page":"e2112539","DOI":"10.1001\/jamanetworkopen.2021.12539","volume":"4","author":"E Cheng","year":"2021","unstructured":"Cheng E, Blackburn HN, Ng K, Spiegelman D, Irwin ML, Ma X, Gross CP, Tabung FK, Giovannucci EL, Kunz PL, et al. Analysis of Survival Among Adults With Early-Onset Colorectal Cancer in the National Cancer Database. JAMA Netw Open. 2021;4(6):e2112539.","journal-title":"JAMA Netw Open"},{"issue":"11","key":"4938_CR29","doi-asserted-by":"publisher","first-page":"1400","DOI":"10.1016\/j.annonc.2025.07.019","volume":"36","author":"S Barot","year":"2025","unstructured":"Barot S, Liljegren A, Nordenvall C, Blom J, Radkiewicz C. Incidence trends and long-term survival in early-onset colorectal cancer: a nationwide Swedish study. Ann Oncol. 2025;36(11):1400\u20138.","journal-title":"Ann Oncol"},{"issue":"12","key":"4938_CR30","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1093\/jnci\/djab123","volume":"113","author":"Z Jin","year":"2021","unstructured":"Jin Z, Dixon JG, Fiskum JM, Parekh HD, Sinicrope FA, Yothers G, Allegra CJ, Wolmark N, Haller D, Schmoll HJ, et al. Clinicopathological and Molecular Characteristics of Early-Onset Stage III Colon Adenocarcinoma: An Analysis of the ACCENT Database. J Natl Cancer Inst. 2021;113(12):1693\u2013704.","journal-title":"J Natl Cancer Inst"},{"issue":"5","key":"4938_CR31","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1001\/jamasurg.2014.3572","volume":"150","author":"PJ Kneuertz","year":"2015","unstructured":"Kneuertz PJ, Chang GJ, Hu CY, Rodriguez-Bigas MA, Eng C, Vilar E, Skibber JM, Feig BW, Cormier JN, You YN. Overtreatment of young adults with colon cancer: more intense treatments with unmatched survival gains. JAMA Surg. 2015;150(5):402\u20139.","journal-title":"JAMA Surg"},{"issue":"3","key":"4938_CR32","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1200\/OP.24.00159","volume":"21","author":"JB Leary","year":"2025","unstructured":"Leary JB, Hu J, Leal A, Davis SL, Kim S, Lentz R, Friedrich T, Herter W, Messersmith WA, Lieu CH. Risk Without Reward: Differing Patterns of Chemotherapy Use Do Not Improve Outcomes in Stage II Early-Onset Colon Cancer. JCO Oncol Pract. 2025;21(3):333\u201340.","journal-title":"JCO Oncol Pract"},{"issue":"5","key":"4938_CR33","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1001\/jamasurg.2016.5050","volume":"152","author":"J Manjelievskaia","year":"2017","unstructured":"Manjelievskaia J, Brown D, McGlynn KA, Anderson W, Shriver CD, Zhu K. Chemotherapy Use and Survival Among Young and Middle-Aged Patients With Colon Cancer. JAMA Surg. 2017;152(5):452\u20139.","journal-title":"JAMA Surg"},{"issue":"5","key":"4938_CR34","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1002\/bjs.11526","volume":"107","author":"AM Zaborowski","year":"2020","unstructured":"Zaborowski AM, Murphy B, Creavin B, Rogers AC, Kennelly R, Hanly A, Martin ST, O\u2019Connell PR, Sheahan K, Winter DC. Clinicopathological features and oncological outcomes of patients with young-onset rectal cancer. Br J Surg. 2020;107(5):606\u201312.","journal-title":"Br J Surg"}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-026-04938-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-026-04938-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-026-04938-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T16:03:04Z","timestamp":1784044984000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12876-026-04938-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4938"],"URL":"https:\/\/doi.org\/10.1186\/s12876-026-04938-8","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]},"assertion":[{"value":"5 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was conducted in accordance with the Declaration of Helsinki. This retrospective study was approved by the Institutional Review Board of Fukushima Medical University (approval numbers 30148 and REC2024-041). The requirement for written informed consent was waived due to the retrospective nature of the study, and an opt-out option was provided on the institutional website.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"445"}}