{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T14:24:08Z","timestamp":1771079048367,"version":"3.50.1"},"reference-count":52,"publisher":"Harborside Press, LLC","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> The association between obesity and prognosis in HER2-positive early breast cancer remains unclear, with limited data available. This study aimed to determine the impact of body mass index (BMI) at baseline and weight change after 2 years on outcomes of patients with HER2-positive early breast cancer. <jats:bold>Methods:<\/jats:bold> ALTTO was a randomized phase III trial in patients with HER2-positive early breast cancer. BMI was collected at randomization and 2 years after. WHO BMI categories were used: underweight, &lt;18.5 kg\/m<jats:sup>2<\/jats:sup>; normal weight, 18.5 to &lt;25 kg\/m<jats:sup>2<\/jats:sup>; overweight, \u226525 to &lt;30 kg\/m<jats:sup>2<\/jats:sup>; and obese \u226530 kg\/m<jats:sup>2<\/jats:sup>. A weight change from baseline of \u22655.0% and \u22645.0% was categorized as weight gain and weight loss. The impact of BMI at randomization and of weight change on disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) were investigated with multivariate analyses, adjusting for baseline patients and tumor characteristics. <jats:bold>Results:<\/jats:bold> A total of 8,381 patients were included: 187 (2.2%), 3,797 (45.3%), 2,690 (32.1%), and 1,707 (20.4%) were underweight, normal weight, overweight, and obese at baseline, respectively. Compared with normal weight, being obese at randomization was associated with a significantly worse DDFS (adjusted hazard ratio [aHR], 1.25; 95% CI, 1.04\u20131.50) and OS (aHR, 1.27; 95% CI, 1.01\u20131.60), but no significant difference in DFS (aHR, 1.14; 95% CI, 0.97\u20131.32). Weight loss \u22655.0% at 2 years after randomization was associated with significantly poorer DFS (aHR, 1.34; 95% CI, 1.05\u20131.71), DDFS (aHR, 1.46; 95% CI, 1.07\u20131.98), and OS (aHR, 1.83; 95% CI, 1.18\u20132.84). Hormone receptor and menopausal status but not anti-HER2 treatment type influenced outcomes. Toxicities were more frequent in obese patients. <jats:bold>Conclusions:<\/jats:bold> In patients with HER2-positive early breast cancer, obesity at baseline is a poor prognostic factor. Weight loss during treatment and follow-up negatively impacts clinical outcomes. Dietary counseling should be part of survivorship care programs.<\/jats:p>","DOI":"10.6004\/jnccn.2020.7606","type":"journal-article","created":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T00:30:02Z","timestamp":1612830602000},"page":"181-189","source":"Crossref","is-referenced-by-count":26,"title":["Body Mass Index and Weight Change in Patients With HER2-Positive Early Breast Cancer: Exploratory Analysis of the ALTTO BIG 2-06 Trial"],"prefix":"10.6004","volume":"19","author":[{"given":"Samuel","family":"Martel","sequence":"first","affiliation":[{"name":"1Department of Hemato-Oncology, CISSS Mont\u00e9r\u00e9gie Centre\/H\u00f4pital Charles Le Moyne, Universit\u00e9 de Sherbrooke, Greenfield Park, Quebec, Canada;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Lambertini","sequence":"additional","affiliation":[{"name":"2Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominique","family":"Agbor-Tarh","sequence":"additional","affiliation":[{"name":"3Frontier Science, Kingussie, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noam F.","family":"Ponde","sequence":"additional","affiliation":[{"name":"4Department of Medicine, Camargo Cancer Center, Sao Paulo, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Gombos","sequence":"additional","affiliation":[{"name":"5Institut Jules Bordet and L\u2019Universit\u00e9 Libre de Bruxelles (U.L.B.), Brussels, Belgium;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vicki","family":"Paterson","sequence":"additional","affiliation":[{"name":"3Frontier Science, Kingussie, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florentine","family":"Hilbers","sequence":"additional","affiliation":[{"name":"6Breast International Group, Brussels, Belgium;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Larissa","family":"Korde","sequence":"additional","affiliation":[{"name":"7National Cancer Institute, Bethesda, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Manukyants","sequence":"additional","affiliation":[{"name":"8Novartis Pharma AG, Basel, Switzerland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amylou","family":"Dueck","sequence":"additional","affiliation":[{"name":"9Mayo Clinic, Jacksonville, Florida;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Maurer","sequence":"additional","affiliation":[{"name":"10University of Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martine","family":"Piccart","sequence":"additional","affiliation":[{"name":"5Institut Jules Bordet and L\u2019Universit\u00e9 Libre de Bruxelles (U.L.B.), Brussels, Belgium;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alvaro","family":"Moreno-Aspitia","sequence":"additional","affiliation":[{"name":"9Mayo Clinic, Jacksonville, Florida;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Desmedt","sequence":"additional","affiliation":[{"name":"11Laboratory for Translational Breast Cancer Research, Department of Oncology, Leuven, Belgium; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serena","family":"Di Cosimo","sequence":"additional","affiliation":[{"name":"12Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evandro","family":"de Azambuja","sequence":"additional","affiliation":[{"name":"5Institut Jules Bordet and L\u2019Universit\u00e9 Libre de Bruxelles (U.L.B.), Brussels, Belgium;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4047","reference":[{"key":"ref01","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1056\/NEJMoa1614362","article-title":"Health Effects of overweight and obesity in 195 countries over 25 years","volume":"377","author":"Afshin","year":"2017","journal-title":"N Engl J Med"},{"key":"ref401","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1200\/JCO.2015.62.1797","article-title":"Adjuvant lapatinib and trastuzumab for early human epidermal growth factor receptor 2-positive breast cancer: results from the randomized phase III Adjuvant Lapatinib and\/or Trastuzumab Treatment Optimization trial","volume":"34","author":"Piccart-Gebhart","year":"2016","journal-title":"J Clin Oncol"},{"key":"ref231","doi-asserted-by":"crossref","first-page":"3568","DOI":"10.1200\/JCO.2014.58.4680","article-title":"American Society of Clinical Oncology position statement on obesity and cancer","volume":"32","author":"Ligibel","year":"2014","journal-title":"J Clin Oncol"},{"key":"ref451","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1038\/nrclinonc.2016.120","article-title":"Cancer, obesity, diabetes, and antidiabetic drugs: is the fog clearing?","volume":"14","author":"Klil-Drori","year":"2017","journal-title":"Nat Rev Clin Oncol"},{"key":"ref571","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1200\/JCO.19.00435","article-title":"Dietary modification and breast cancer mortality: long-term follow-up of the Women\u2019s Health Initiative randomized trial","volume":"38","author":"Chlebowski","year":"2020","journal-title":"J Clin Oncol"},{"key":"ref251","first-page":"9","article-title":"BlackburnGL Final survival analysis from the randomized Women s Intervention Nutrition Study WINS evaluating dietary intervention as adjuvant breast cancer therapy Presented at the San San Texas","author":"ChlebowskiRT","year":"2014","journal-title":"Breast Cancer Symposium"},{"key":"ref511","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1056\/NEJMoa1000367","article-title":"Body-mass index and mortality among 1.46 million white adults","volume":"363","author":"Berrington de Gonzalez","year":"2010","journal-title":"N Engl J Med"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"2475","DOI":"10.1002\/cncr.23455","article-title":"Physical activity and obesity in Canadian cancer survivors: population-based estimates from the 2005 Canadian Community Health Survey","volume":"112","author":"Courneya","year":"2008","journal-title":"Cancer"},{"key":"ref351","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1007\/s10549-012-2073-x","article-title":"Body size and breast cancer prognosis in relation to hormone receptor and menopausal status: a meta-analysis","volume":"134","author":"Niraula","year":"2012","journal-title":"Breast Cancer Res Treat"},{"key":"ref321","doi-asserted-by":"crossref","first-page":"2475","DOI":"10.1002\/cncr.23455","article-title":"Physical activity and obesity in Canadian cancer survivors: population-based estimates from the 2005 Canadian Community Health Survey","volume":"112","author":"Courneya","year":"2008","journal-title":"Cancer"},{"key":"ref81","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1093\/annonc\/mdx152","article-title":"Impact of baseline BMI and weight change in CCTG adjuvant breast cancer trials","volume":"28","author":"Yerushalmi","year":"2017","journal-title":"Ann Oncol"},{"key":"ref261","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1200\/JCO.19.00435","article-title":"Dietary modification and breast cancer mortality: long-term follow-up of the Women\u2019s Health Initiative randomized trial","volume":"38","author":"Chlebowski","year":"2020","journal-title":"J Clin Oncol"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1093\/annonc\/mdu042","article-title":"Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies","volume":"25","author":"Chan","year":"2014","journal-title":"Ann Oncol"},{"key":"ref311","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1056\/NEJMoa1614362","article-title":"Health Effects of overweight and obesity in 195 countries over 25 years","volume":"377","author":"Afshin","year":"2017","journal-title":"N Engl J Med"},{"key":"ref131","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1038\/sj.ijo.0803175","article-title":"The definition of weight maintenance","volume":"30","author":"Stevens","year":"2006","journal-title":"Int J Obes"},{"key":"ref551","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1093\/jnci\/djj494","article-title":"Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women\u2019s Intervention Nutrition Study","volume":"98","author":"Chlebowski","year":"2006","journal-title":"J Natl Cancer Inst"},{"key":"ref271","doi-asserted-by":"crossref","first-page":"2297","DOI":"10.1007\/s00520-017-3640-9","article-title":"Oncology care provider perspectives on exercise promotion in people with cancer: an examination of knowledge, practices, barriers, and facilitators","volume":"25","author":"Nadler","year":"2017","journal-title":"Support Care Cancer"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1007\/s10549-010-0990-0","article-title":"Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis","volume":"123","author":"Protani","year":"2010","journal-title":"Breast Cancer Res Treat"},{"key":"ref71","doi-asserted-by":"crossref","first-page":"2447","DOI":"10.1002\/cncr.28051","article-title":"Effect of body mass index on tumor characteristics and disease-free survival in patients from the HER2-positive adjuvant trastuzumab trial N9831","volume":"119","author":"Crozier","year":"2013","journal-title":"Cancer"},{"key":"ref361","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1093\/annonc\/mdu042","article-title":"Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies","volume":"25","author":"Chan","year":"2014","journal-title":"Ann Oncol"},{"key":"ref461","doi-asserted-by":"crossref","first-page":"9712","DOI":"10.1158\/0008-5472.CAN-08-1952","article-title":"Bidirectional crosstalk between leptin and insulin-like growth factor-I signaling promotes invasion and migration of breast cancer cells via transactivation of epidermal growth factor receptor","volume":"68","author":"Saxena","year":"2008","journal-title":"Cancer Res"},{"key":"ref591","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1200\/JCO.2011.39.9436","article-title":"Appropriate chemotherapy dosing for obese adult patients with cancer: American Society of Clinical Oncology clinical practice guideline","volume":"30","author":"Griggs","year":"2012","journal-title":"J Clin Oncol"},{"key":"ref141","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1038\/nrclinonc.2016.120","article-title":"Cancer, obesity, diabetes, and antidiabetic drugs: is the fog clearing?","volume":"14","author":"Klil-Drori","year":"2017","journal-title":"Nat Rev Clin Oncol"},{"key":"ref181","doi-asserted-by":"crossref","first-page":"e181771","DOI":"10.1001\/jamaoncol.2018.1771","article-title":"Association of body mass index and age with subsequent breast cancer risk in premenopausal women","volume":"4","author":"Schoemaker","year":"2018","journal-title":"JAMA Oncol"},{"key":"ref581","doi-asserted-by":"crossref","first-page":"2297","DOI":"10.1007\/s00520-017-3640-9","article-title":"Oncology care provider perspectives on exercise promotion in people with cancer: an examination of knowledge, practices, barriers, and facilitators","volume":"25","author":"Nadler","year":"2017","journal-title":"Support Care Cancer"},{"key":"ref501","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10549-014-3211-4","article-title":"Reduced progesterone levels explain the reduced risk of breast cancer in obese premenopausal women: a new hypothesis","volume":"149","author":"Dowsett","year":"2015","journal-title":"Breast Cancer Res Treat"},{"key":"ref491","doi-asserted-by":"crossref","first-page":"e181771","DOI":"10.1001\/jamaoncol.2018.1771","article-title":"Association of body mass index and age with subsequent breast cancer risk in premenopausal women","volume":"4","author":"Schoemaker","year":"2018","journal-title":"JAMA Oncol"},{"key":"ref541","doi-asserted-by":"crossref","first-page":"3568","DOI":"10.1200\/JCO.2014.58.4680","article-title":"American Society of Clinical Oncology position statement on obesity and cancer","volume":"32","author":"Ligibel","year":"2014","journal-title":"J Clin Oncol"},{"key":"ref221","doi-asserted-by":"crossref","first-page":"w822","DOI":"10.1377\/hlthaff.28.5.w822","article-title":"Annual medical spending attributable to obesity: payer-and service-specific estimates","volume":"28","author":"Finkelstein","year":"2009","journal-title":"Health Aff (Millwood)"},{"key":"ref281","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1200\/JCO.2011.39.9436","article-title":"Appropriate chemotherapy dosing for obese adult patients with cancer: American Society of Clinical Oncology clinical practice guideline","volume":"30","author":"Griggs","year":"2012","journal-title":"J Clin Oncol"},{"key":"ref61","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1158\/1055-9965.EPI-15-0334-T","article-title":"Body mass index at diagnosis and breast cancer survival prognosis in clinical trial populations from NRG Oncology\/NSABP B-30, B-31, B-34, and B-38","volume":"25","author":"Cecchini","year":"2016","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"ref171","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1200\/JCO.2015.64.3809","article-title":"American Cancer Society\/American Society of Clinical Oncology breast cancer survivorship care guideline","volume":"34","author":"Runowicz","year":"2016","journal-title":"J Clin Oncol"},{"key":"ref331","doi-asserted-by":"crossref","first-page":"3133","DOI":"10.1200\/JCO.2016.66.4391","article-title":"Trends in obesity prevalence in adults with a history of cancer: results from the US National Health Interview Survey, 1997 to 2014","volume":"34","author":"Greenlee","year":"2016","journal-title":"J Clin Oncol"},{"key":"ref341","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1007\/s10549-010-0990-0","article-title":"Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis","volume":"123","author":"Protani","year":"2010","journal-title":"Breast Cancer Res Treat"},{"key":"ref201","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1056\/NEJMoa1000367","article-title":"Body-mass index and mortality among 1.46 million white adults","volume":"363","author":"Berrington de Gonzalez","year":"2010","journal-title":"N Engl J Med"},{"key":"ref241","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1093\/jnci\/djj494","article-title":"Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women\u2019s Intervention Nutrition Study","volume":"98","author":"Chlebowski","year":"2006","journal-title":"J Natl Cancer Inst"},{"key":"ref381","doi-asserted-by":"crossref","first-page":"2447","DOI":"10.1002\/cncr.28051","article-title":"Effect of body mass index on tumor characteristics and disease-free survival in patients from the HER2-positive adjuvant trastuzumab trial N9831","volume":"119","author":"Crozier","year":"2013","journal-title":"Cancer"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1007\/s10549-012-2073-x","article-title":"Body size and breast cancer prognosis in relation to hormone receptor and menopausal status: a meta-analysis","volume":"134","author":"Niraula","year":"2012","journal-title":"Breast Cancer Res Treat"},{"key":"ref301","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1177\/216507991406200608","article-title":"Limitations of body mass index to assess body fat","volume":"62","author":"Buss","year":"2014","journal-title":"Workplace Health Saf"},{"key":"ref561","first-page":"9","article-title":"BlackburnGL Final survival analysis from the randomized Women s Intervention Nutrition Study WINS evaluating dietary intervention as adjuvant breast cancer therapy Presented at the San San Texas","author":"ChlebowskiRT","year":"2014","journal-title":"Breast Cancer Symposium"},{"key":"ref151","doi-asserted-by":"crossref","first-page":"9712","DOI":"10.1158\/0008-5472.CAN-08-1952","article-title":"Bidirectional crosstalk between leptin and insulin-like growth factor-I signaling promotes invasion and migration of breast cancer cells via transactivation of epidermal growth factor receptor","volume":"68","author":"Saxena","year":"2008","journal-title":"Cancer Res"},{"key":"ref391","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1093\/annonc\/mdx152","article-title":"Impact of baseline BMI and weight change in CCTG adjuvant breast cancer trials","volume":"28","author":"Yerushalmi","year":"2017","journal-title":"Ann Oncol"},{"key":"ref441","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1038\/sj.ijo.0803175","article-title":"The definition of weight maintenance","volume":"30","author":"Stevens","year":"2006","journal-title":"Int J Obes"},{"key":"ref431","doi-asserted-by":"crossref","first-page":"djv275","DOI":"10.1093\/jnci\/djv275","article-title":"Weight gain after breast cancer diagnosis and all-cause mortality: systematic review and meta-analysis","volume":"107","author":"Playdon","year":"2015","journal-title":"J Natl Cancer Inst"},{"key":"ref531","doi-asserted-by":"crossref","first-page":"w822","DOI":"10.1377\/hlthaff.28.5.w822","article-title":"Annual medical spending attributable to obesity: payer-and service-specific estimates","volume":"28","author":"Finkelstein","year":"2009","journal-title":"Health Aff (Millwood)"},{"key":"ref191","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10549-014-3211-4","article-title":"Reduced progesterone levels explain the reduced risk of breast cancer in obese premenopausal women: a new hypothesis","volume":"149","author":"Dowsett","year":"2015","journal-title":"Breast Cancer Res Treat"},{"key":"ref91","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1200\/JCO.2015.62.1797","article-title":"Adjuvant lapatinib and trastuzumab for early human epidermal growth factor receptor 2-positive breast cancer: results from the randomized phase III Adjuvant Lapatinib and\/or Trastuzumab Treatment Optimization trial","volume":"34","author":"Piccart-Gebhart","year":"2016","journal-title":"J Clin Oncol"},{"key":"ref371","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1158\/1055-9965.EPI-15-0334-T","article-title":"Body mass index at diagnosis and breast cancer survival prognosis in clinical trial populations from NRG Oncology\/NSABP B-30, B-31, B-34, and B-38","volume":"25","author":"Cecchini","year":"2016","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"3133","DOI":"10.1200\/JCO.2016.66.4391","article-title":"Trends in obesity prevalence in adults with a history of cancer: results from the US National Health Interview Survey, 1997 to 2014","volume":"34","author":"Greenlee","year":"2016","journal-title":"J Clin Oncol"},{"key":"ref611","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1177\/216507991406200608","article-title":"Limitations of body mass index to assess body fat","volume":"62","author":"Buss","year":"2014","journal-title":"Workplace Health Saf"},{"key":"ref121","doi-asserted-by":"crossref","first-page":"djv275","DOI":"10.1093\/jnci\/djv275","article-title":"Weight gain after breast cancer diagnosis and all-cause mortality: systematic review and meta-analysis","volume":"107","author":"Playdon","year":"2015","journal-title":"J Natl Cancer Inst"},{"key":"ref481","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1200\/JCO.2015.64.3809","article-title":"American Cancer Society\/American Society of Clinical Oncology breast cancer survivorship care guideline","volume":"34","author":"Runowicz","year":"2016","journal-title":"J Clin Oncol"}],"container-title":["Journal of the National Comprehensive Cancer Network"],"original-title":[],"link":[{"URL":"https:\/\/jnccn.org\/view\/journals\/jnccn\/19\/2\/article-p181.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/jnccn.org\/downloadpdf\/journals\/jnccn\/19\/2\/article-p181.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T19:15:30Z","timestamp":1629486930000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnccn.org\/view\/journals\/jnccn\/19\/2\/article-p181.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2]]},"references-count":52,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.6004\/jnccn.2020.7606","relation":{},"ISSN":["1540-1405","1540-1413"],"issn-type":[{"value":"1540-1405","type":"print"},{"value":"1540-1413","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2]]}}}