{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:18:03Z","timestamp":1787894283207,"version":"build-2784847793"},"reference-count":35,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82202909"],"award-info":[{"award-number":["82202909"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82002813"],"award-info":[{"award-number":["82002813"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82272074"],"award-info":[{"award-number":["82272074"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"award":["82202909"],"award-info":[{"award-number":["82202909"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"award":["82002813"],"award-info":[{"award-number":["82002813"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"award":["82272074"],"award-info":[{"award-number":["82272074"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Tianjin Key Medical Discipline Construction Project","award":["TJYXZDXK-3-016C"],"award-info":[{"award-number":["TJYXZDXK-3-016C"]}]},{"name":"Xinjiang Uygur Autonomous Region Health Science and Technology Program Project","award":["2026001CXKYXM6532676"],"award-info":[{"award-number":["2026001CXKYXM6532676"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Assessment of lymph node involvement was incorporated into the 2023 International Federation of Gynecology and Obstetrics (FIGO) staging system as a critical determinant of patient management and prognostication. This study aims to validate the prognostic significance of metastatic lymph node characteristics and their correlation with molecular classification. Methods: We conducted a retrospective analysis of 131 patients with stage IIIC endometrial carcinoma who underwent surgical intervention at the Tianjin Medical University Cancer Institute and Hospital from 2010 to 2025. The patients were stratified based on various characteristics of metastatic lymph nodes. Progression-free survival (PFS) was estimated using Kaplan\u2013Meier curves, and group comparisons were performed using the log-rank test. Univariate Cox proportional hazards regression was conducted to identify independent prognostic factors for PFS. Results: In accordance with the 2023 FIGO staging system, within the stage IIIC cohort, patients with concurrent pelvic and para-aortic lymph node metastases and those in the stage IIIC1 cohort with macrometastasis demonstrated decreased PFS (HR = 2.748; 95% CI = 1.227\u20136.151; p = 0.011, and HR = 4.039; 95% CI = 1.232\u201313.240; p = 0.021, respectively). Furthermore, patients with lymph nodes showing extracapsular extension had significantly reduced PFS in the stage IIIC, stage IIIC1, and stage IIIC1ii cohorts (HR = 10.12; 95% CI = 2.38\u201342.99; p &lt; 0.001; HR = 3.58; 95% CI = 1.242\u201310.31; p = 0.011; and HR = 2.32; 95% CI = 0.83\u20136.71; p = 0.037, respectively). The number of involved lymph nodes, the largest diameter of metastatic foci in lymph nodes, and the presence or absence of extracapsular extension of metastatic lymph nodes were significantly different among the NSMP, MMRd, and p53abn molecular classifications (p = 0.033, p &lt; 0.001, and p = 0.002, respectively). Patients with extracapsular extension of metastatic lymph nodes had worse PFS than those without in the MMRd group (p = 0.018). Conclusions: Extracapsular extension (ECE) of metastatic lymph nodes is the strongest predictor of worse progression-free survival in stage IIIC endometrial carcinoma, especially in the IIIC1 and MMRd subgroups, supporting its value for risk stratification and prognostic assessment.<\/jats:p>","DOI":"10.3390\/cancers18172770","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T09:05:46Z","timestamp":1787735146000},"page":"2770","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Extracapsular Nodal Extension as a Key Prognostic Factor in FIGO IIIC Endometrial Carcinoma: A Clinic\u2013Pathologic and Molecular Analysis"],"prefix":"10.3390","volume":"18","author":[{"given":"Lingmei","family":"Li","sequence":"first","affiliation":[{"name":"Department of Pathology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin\u2019s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin 300060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changyu","family":"Geng","sequence":"additional","affiliation":[{"name":"Department of Pathology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin\u2019s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin 300060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ningrui","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Pathology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin\u2019s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin 300060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pathology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin\u2019s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin 300060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Pathology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin\u2019s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin 300060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenfeng","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Pathology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin\u2019s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin 300060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Pathology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin\u2019s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin 300060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaomei","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Gynecology Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin\u2019s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin 300060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gynecology Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin\u2019s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin 300060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiting","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Gynecology Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin\u2019s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin 300060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gynecology Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin\u2019s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin 300060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gynecology Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin\u2019s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin 300060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunxiang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin\u2019s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin 300060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofeng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin\u2019s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin 300060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pathology, Hotan District People\u2019s Hospital, Hotan 848000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8700-4690","authenticated-orcid":false,"given":"Lisha","family":"Qi","sequence":"additional","affiliation":[{"name":"Department of Pathology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin\u2019s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin 300060, China"},{"name":"Department of Pathology, Hotan District People\u2019s Hospital, Hotan 848000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.20892\/j.issn.2095-3941.2022.0231","article-title":"Current cancer burden in China: Epidemiology, etiology, and prevention","volume":"19","author":"Cao","year":"2022","journal-title":"Cancer Biol. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e094304","DOI":"10.1136\/bmjopen-2024-094304","article-title":"Burden of cancer attributable to sedentary behaviour in Germany: An epidemiological analysis of survey data","volume":"15","author":"Schaber","year":"2025","journal-title":"BMJ Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2490","DOI":"10.1200\/JCO.19.00037","article-title":"Uterine Cancer: Adjuvant Therapy and Management of Metastatic Disease","volume":"37","author":"Creutzberg","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Chen, W., Yan, L., Li, Q., Zhou, S., Hou, T., Yang, H., and Ye, S. (2025). Molecular subtype of ovarian clear cell carcinoma: An analysis of 80 Chinese patients using the TCGA molecular classification of endometrial cancer. BMC Cancer, 25.","DOI":"10.1186\/s12885-024-13389-x"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1038\/s44276-024-00105-2","article-title":"Loss of vimentin expression in preoperative biopsies independently predicts poor prognosis, lymph node metastasis and recurrence in endometrial cancer","volume":"2","author":"Hjelmeland","year":"2024","journal-title":"BJC Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"617","DOI":"10.31557\/APJCP.2022.23.2.617","article-title":"Predicting Factors for Pelvic Lymph Node Metastasis in Patients with Apparently Early-Stage Endometrial Cancer","volume":"23","author":"Gumtorntip","year":"2022","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_7","first-page":"206","article-title":"Histopathologic Parameters of Positive Lymph Node Predictability in Endometrial Cancer","volume":"61","author":"Kokanov","year":"2022","journal-title":"Acta Clin. Croat."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1002\/ijgo.14923","article-title":"FIGO staging of endometrial cancer: 2023","volume":"162","author":"Berek","year":"2023","journal-title":"Int. J. Gynaecol. Obs."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1002\/ijgo.70326","article-title":"Cancer of the corpus uteri: A 2025 update","volume":"171","author":"Koskas","year":"2025","journal-title":"Int. J. Gynaecol. Obs."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"113316","DOI":"10.1016\/j.ejca.2023.113316","article-title":"Validation of the 2023 FIGO staging schema for advanced endometrial cancer","volume":"193","author":"Matsuo","year":"2023","journal-title":"Eur. J. Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1038\/bjc.2011.336","article-title":"Prognostic discrimination of subgrouping node-positive endometrioid uterine cancer: Location vs nodal extent","volume":"105","author":"Kapp","year":"2011","journal-title":"Br. J. Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.1097\/COC.0000000000000450","article-title":"Prognostic Significance of Nodal Location and Ratio in Stage IIIC Endometrial Carcinoma Among a Multi-Institutional Academic Collaboration","volume":"41","author":"Mayadev","year":"2018","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.4103\/jcrt.jcrt_2378_21","article-title":"Prognostic value of lymph node features in patients diagnosed with stage IIIC endometrial adenocancer","volume":"19","author":"Kuru","year":"2023","journal-title":"J. Cancer Res. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/PGP.0000000000000977","article-title":"Perceptions of Controversies and Unresolved Issues in the 2014 FIGO Staging System for Endometrial Cancer: Survey Results From Members of the International Society of Gynecological Pathologists and International Gynecologic Cancer Society","volume":"43","author":"Kayraklioglu","year":"2024","journal-title":"Int. J. Gynecol. Pathol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e423","DOI":"10.1016\/S1470-2045(25)00167-6","article-title":"ESGO-ESTRO-ESP guidelines for the management of patients with endometrial carcinoma: Update 2025","volume":"26","author":"Concin","year":"2025","journal-title":"Lancet Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1111\/his.14609","article-title":"Key changes to the World Health Organization (WHO) classification of female genital tumours introduced in the 5th edition (2020)","volume":"80","author":"McCluggage","year":"2022","journal-title":"Histopathology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.ygyno.2023.09.011","article-title":"Utility of the revised FIGO2023 staging with molecular classification in endometrial cancer","volume":"178","author":"Fujii","year":"2023","journal-title":"Gynecol. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Garc\u00eda Pineda, V., Hern\u00e1ndez Guti\u00e9rrez, A., Gracia Segovia, M., Siegrist Ridruejo, J., Diestro Tejeda, M.D., and Zapardiel, I. (2020). Low-Volume Nodal Metastasis in Endometrial Cancer: Risk Factors and Prognostic Significance. J. Clin. Med., 9.","DOI":"10.3390\/jcm9061999"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Yalcin, Y., Ozerkan, K., and Yalcin, S.E. (2026). Predictive clinicopathologic factors for para-aortic nodal involvement in endometrial carcinoma. BMC Cancer, 26.","DOI":"10.1186\/s12885-026-16313-7"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"8380","DOI":"10.1245\/s10434-026-19895-5","article-title":"Predictive Features Specific to FIGO IIIA1 Ovarian Cancer: What Drives Prognosis","volume":"33","author":"Bruno","year":"2026","journal-title":"Ann. Surg. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.3233\/THC-220645","article-title":"Effect of extracapsular lymph node involvement on the prognosis of patients with esophageal squamous cell carcinoma","volume":"31","author":"Wang","year":"2023","journal-title":"Technol. Health Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"108447","DOI":"10.1016\/j.ejso.2024.108447","article-title":"Prognostic characteristics, recurrence patterns, and survival outcomes of vulval squamous cell carcinoma\u2014A twelve-year retrospective analysis of a tertiary centre","volume":"50","author":"Darwish","year":"2024","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"4568","DOI":"10.1007\/s00330-020-07516-y","article-title":"Contrast-enhanced ultrasound: A valuable modality for extracapsular extension assessment in papillary thyroid cancer","volume":"31","author":"Zhang","year":"2021","journal-title":"Eur. Radiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1097\/01.pgp.0000092136.88121.c4","article-title":"Endometrial carcinomas with lymph node involvement: Novel histopathologic factors for predicting prognosis","volume":"22","author":"Yasunaga","year":"2003","journal-title":"Int. J. Gynecol. Pathol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1136\/ijgc-2023-005181","article-title":"Endometrial cancer with positive sentinel lymph nodes: Pathologic characteristics of metastases as predictors of extent of lymphatic dissemination and prognosis","volume":"34","author":"Dinoi","year":"2024","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.ygyno.2019.07.006","article-title":"Predictors of extensive lymphatic dissemination and recurrences in node-positive endometrial cancer","volume":"154","author":"Zanfagnin","year":"2019","journal-title":"Gynecol. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1038\/sj.bjc.6603898","article-title":"The impact of the absolute number and ratio of positive lymph nodes on survival of endometrioid uterine cancer patients","volume":"97","author":"Chan","year":"2007","journal-title":"Br. J. Cancer"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.ygyno.2024.04.016","article-title":"Prognostic performance of the 2023 FIGO staging schema for endometrial cancer","volume":"187","author":"Matsuo","year":"2024","journal-title":"Gynecol. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4535","DOI":"10.21873\/anticanres.15956","article-title":"Molecular Characteristics of Metastatic Lesions Have Superior Prognostic Impact on Endometrial Cancer","volume":"42","author":"Okamoto","year":"2022","journal-title":"Anticancer. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"104480","DOI":"10.1016\/j.ijgc.2026.104480","article-title":"Evaluation of the new European risk classification for endometrial carcinoma: A cohort study","volume":"36","author":"Loukovaara","year":"2026","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1136\/ijgc-2024-005672","article-title":"Impact of molecular classification on recurrence risk in endometrial cancer patients with lymph node metastasis: Multicenter retrospective study","volume":"34","author":"Schivardi","year":"2024","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"102805","DOI":"10.1016\/j.ijgc.2025.102805","article-title":"ESGO-ESTRO-ESP guidelines 2025 vs 2021: Reclassifying risk","volume":"36","author":"Genovesi","year":"2026","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"102753","DOI":"10.1016\/j.ijgc.2025.102753","article-title":"Prevalence and prognosis of extra-capsular extension in isolated lymph nodal recurrence from ovarian cancer: The ECEROC study","volume":"36","author":"Bruno","year":"2026","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1136\/ijgc-2022-003676","article-title":"Biomarker-driven therapy in endometrial cancer","volume":"33","author":"Karpel","year":"2023","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"4368","DOI":"10.1007\/s12094-025-04046-1","article-title":"SEOM-GEICO clinical guidelines on endometrial cancer (2025)","volume":"27","author":"Fidalgo","year":"2025","journal-title":"Clin. Transl. Oncol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/17\/2770\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T04:22:01Z","timestamp":1787890921000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/17\/2770"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":35,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["cancers18172770"],"URL":"https:\/\/doi.org\/10.3390\/cancers18172770","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]}}}