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Article History

Received: 28 February 2026

Accepted: 15 May 2026

First Online: 4 June 2026

Declarations

:

: Kazuhiko Yoshida received honoraria from Bristol-Squibb and Ono Pharmceutical Co., Ltd. Tsunenori Kondo received honoraria from Bristol-Myers Squibb and Ono Pharmaceutical Co. Ltd. Toshio Takagi received honoraria from Bristol Myers Squibb; Ono Pharmaceutical Co., Ltd.; Merck KGaA; and Takeda Pharmaceutical Co., Ltd. Hiroki Ishihara, Takayuki Nakayama, Hironori Fukuda, Nanaka Katsurayama, Yuki Nemoto, Shinsuke Mizoguchi, Hiroaki Shimmura, Yasunobu Hashimoto, Atsuko Seki, Junpei Iizuka, and Yoji Nagashima declare that they have no conflicts of interest that might be relevant to the contents of this manuscript.

: The study protocol was approved by the Institutional Ethics Review Board of Tokyo Women’s Medical University (ID no. 2020-0009 and 382). Tumor samples were obtained after getting written informed consent from all patients. The study was conducted in accordance with the principles outlined in the 1964 Declaration of Helsinki and its later amendments.

: Informed consent was obtained using an opt-out approach, as approved by the institutional review board. Tumor samples were obtained after getting written informed consent from all patients.

: All authors confirm that they have read and approved the manuscript.

: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

: Not applicable.

: Conceptualization: Hiroki Ishihara and Hironori Fukuda. Data curation: Hiroki Ishihara, Takayuki Nakayama, Hironori Fukuda, Nanaka Katsurayama, Yuki Nemoto, Shinsuke Mizoguchi, Hiroaki Shimmura, Yasunobu Hashimoto, Atsuko Seki, Kazuhiko Yoshida, Junpei Iizuka, Tsunenori Kondo, Yoji Nagashima, and Toshio Takagi. Formal analysis: Hiroki Ishihara and Hironori Fukuda. Funding acquisition: Hiroki Ishihara, Hironori Fukuda, and Toshio Takagi. Investigation: Hiroki Ishihara and Hironori Fukuda. Methodology: Hiroki Ishihara and Hironori Fukuda. Project administration: Hiroki Ishihara, Hironori Fukuda, and Toshio Takagi. Resources: Hiroki Ishihara, Hironori Fukuda, Yoji Nagashima, and Toshio Takagi. Supervision: Tsunenori Kondo and Toshio Takagi. Writing—original draft: Hiroki Ishihara and Hironori Fukuda. Writing—review and editing: Takayuki Nakayama, Nanaka Katsurayama, Yuki Nemoto, Shinsuke Mizoguchi, Hiroaki Shimmura, Yasunobu Hashimoto, Atsuko Seki, Kazuhiko Yoshida, Junpei Iizuka, Tsunenori Kondo, Yoji Nagashima, and Toshio Takagi.