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Article History

Received: 23 November 2025

Revised: 2 February 2026

Accepted: 10 March 2026

First Online: 9 April 2026

Competing interests

: The authors declare no competing interests.

: All methods were performed in accordance with the relevant guidelines and regulations and the Declaration of Helsinki. The study protocol was approved by the Institutional Review Board of Wakayama Medical University (No. 3660). The analysis used de-identified data, and no identifiable patient information was accessed. In accordance with the IRB-approved procedure, the requirement for individual informed consent was waived, and an opt-out approach was used.

: Y. Ozawa reports receiving honoraria from AstraZeneca K.K., Chugai Pharmaceutical Co., Ltd, Taiho Pharmaceutical Co., Ltd, Nippon Kayaku Co., Ltd, MSD K.K., Ono Pharmaceutical Co., Ltd, Novartis Pharma K.K., Daiichi Sankyo Company, Ltd, and Takeda Pharmaceutical Company Ltd. K. Yamamoto received research funding from Otsuka Pharmaceutical Co., Ltd, Chugai Pharmaceutical Co., Ltd, Kyowa Kirin Co., Ltd, Euro Doctor Concierge, LLC, Daiichi Sankyo Company, Ltd, and Terumo Corporation. consulting fees from Sysmex Corporation and Delta-Fly Pharma, Inc., and honoraria for lectures from FUJIFILM Toyama Chemical Co., Ltd, CMIC Co., Ltd, Daiichi Sankyo Company, Ltd, TME Therapeutics Inc., Takeda Pharmaceutical Company Limited, CM Plus Corporation, and AstraZeneca K.K. S. Sugawara received institutional research funding from AnHeart Therapeutics, AstraZeneca K.K., Chugai Pharmaceutical Co., Ltd, MSD K.K., Daiichi Sankyo Company Ltd, Bristol-Myers Squibb K.K., Nippon Boehringer Ingelheim Co., Ltd, AbbVie GK, Amgen K.K., Taiho Pharmaceutical Co., Ltd, Parexel International Corp., PPD Inc., IQVIA Solutions Japan G.K., Novocure Ltd, Pharma Mar S.A., GlaxoSmithKline K.K., and Delta-Fly Pharma, Inc., and personal honoraria for lectures from AstraZeneca K.K., Chugai Pharmaceutical Co., Ltd, Ono Pharmaceutical Co., Ltd, Bristol-Myers Squibb K.K., MSD K.K., Nippon Boehringer Ingelheim Co., Ltd, Pfizer Japan Inc., Taiho Pharmaceutical Co., Ltd, Eli Lilly Japan K.K., Novartis Pharma K.K., Kyowa Kirin Co., Ltd, Takeda Pharmaceutical Company Ltd, Nippon Kayaku Co., Ltd, Merck Biopharma Co., Ltd, Amgen K.K., Daiichi Sankyo Company, Ltd, Thermo Fisher Scientific Inc., Sysmex Corporation, and Eisai Co., Ltd. S. Niho received institutional research funding from Chugai Pharmaceutical Co., Ltd, Eli Lilly Japan K.K., Nippon Kayaku Co., Ltd, and Nippon Boehringer Ingelheim Co., Ltd, and personal honoraria for lectures from AstraZeneca K.K., MSD K.K., Chugai Pharmaceutical Co., Ltd, Eli Lilly Japan K.K., Ono Pharmaceutical Co., Ltd, Daiichi Sankyo Company, Ltd, Novartis Pharma K.K., Eisai Co., Ltd, Taiho Pharmaceutical Co., Ltd, Kyowa Kirin Co., Ltd, Pfizer Japan Inc., Nippon Kayaku Co., Ltd, Kyorin Pharmaceutical Co., Ltd, Asahi Kasei Pharma Corporation, Takeda Pharmaceutical Company Ltd, and Nippon Boehringer Ingelheim Co., Ltd. H. Okamoto received institutional research funding from AstraZeneca K.K., Bristol-Myers Squibb K.K., MSD K.K., and Taiho Pharmaceutical Co., Ltd. K. Hotta received institutional research funding from MSD K.K., AstraZeneca K.K., Eli Lilly Japan K.K., Bristol-Myers Squibb K.K., AbbVie GK, Janssen Pharmaceutical K.K., and Ono Pharmaceutical Co., Ltd, and personal honoraria for lectures from AstraZeneca K.K., Chugai Pharmaceutical Co., Ltd, Eli Lilly Japan K.K., MSD K.K., Bristol-Myers Squibb K.K., Ono Pharmaceutical Co., Ltd, Nippon Boehringer Ingelheim Co., Ltd, Nippon Kayaku Co., Ltd, Amgen K.K., Taiho Pharmaceutical Co., Ltd, Merck Biopharma Co., Ltd, Janssen Pharmaceutical K.K., and Takeda Pharmaceutical Company Ltd. I. Okamoto received institutional research funding from AstraZeneca K.K., MSD K.K., Chugai Pharmaceutical Co., Ltd, Eli Lilly Japan K.K., Daiichi Sankyo Company Ltd, Taiho Pharmaceutical Co., Ltd, Bristol-Myers Squibb K.K., Nippon Boehringer Ingelheim Co., Ltd, AbbVie GK, Amgen K.K., GlaxoSmithKline K.K., Parexel International Corp., EPS Holdings, Inc., PPD Inc., and Syneos Health Clinical K.K., and personal honoraria for lectures from AstraZeneca K.K., Eli Lilly Japan K.K., Chugai Pharmaceutical Co., Ltd, MSD K.K., Ono Pharmaceutical Co., Ltd, Pfizer Japan Inc., Taiho Pharmaceutical Co., Ltd, Novartis Pharma K.K., Takeda Pharmaceutical Company Ltd, Nippon Kayaku Co., Ltd, Amgen K.K., Thermo Fisher Scientific Inc., and Daiichi Sankyo Company, Ltd. N. Ikeda received institutional research funding (for the department) from Nihon Medi-Physics Co., Ltd, FUJIFILM Toyama Chemical Co., Ltd, Chugai Pharmaceutical Co., Ltd, Nippon Boehringer Ingelheim Co., Ltd, Daiichi Sankyo Company Ltd, Kyowa Kirin Co., Ltd, Taiho Pharmaceutical Co., Ltd, Eli Lilly Japan K.K., Eisai Co., Ltd, Teijin Pharma Ltd, and Shionogi & Co., Ltd, institutional research funding from Delta-Fly Pharma, Inc., and personal honoraria for lectures from AstraZeneca K.K., Chugai Pharmaceutical Co., Ltd, Ono Pharmaceutical Co., Ltd, Bristol-Myers Squibb K.K., MSD K.K., Nippon Boehringer Ingelheim Co., Ltd, Pfizer Japan Inc., Taiho Pharmaceutical Co., Ltd, Eli Lilly Japan K.K., Olympus Corporation, Teijin Pharma Ltd, Takeda Pharmaceutical Company Ltd, Johnson & Johnson K.K., Medtronic Japan Co., Ltd, Nihon Medi-Physics Co., Ltd, Daiichi Sankyo Company Ltd, and Thermo Fisher Scientific Inc. N. Yamamoto received institutional research funding from PRiME-R, Inc., Amgen K.K., EPS Co., Ltd, Ono Pharmaceutical Co., Ltd, GlaxoSmithKline K.K., Chugai Pharmaceutical Co., Ltd, Eli Lilly Japan K.K., Novartis Pharma K.K., Pfizer R&D Japan, Medpace Japan K.K., Janssen Pharmaceutical K.K., IQVIA Solutions Japan G.K., AstraZeneca K.K., AbbVie Inc., A2 Healthcare Corporation, Kyowa Kirin Co., Ltd, Taiho Pharmaceutical Co., Ltd, Syneos Health Clinical K.K., Nippon Boehringer Ingelheim Co., Ltd, Nippon Chemical Industrial Co., Ltd, Bristol-Myers Squibb K.K., Medical Market Vision Co., Ltd, RPM Co., Ltd, and Merck Sharp & Dohme LLC, and personal honoraria for lectures from AstraZeneca K.K., Accuray Japan K.K., Otsuka Pharmaceutical Co., Ltd, Guardant Health Japan Corp., Kyorin Pharmaceutical Co., Ltd, Daiichi Sankyo Company Ltd, Takeda Pharmaceutical Company Ltd, Tsumura & Co., Eli Lilly Japan K.K., Novartis Pharma K.K., Novocure Ltd, Miyarisan Pharmaceutical Co., Ltd, MedPeer, Inc., USACO Corporation, Amgen K.K., AbbVie Inc., Ono Pharmaceutical Co., Ltd, Kyowa Kirin Co., Ltd, GlaxoSmithKline K.K., Taiho Pharmaceutical Co., Ltd, Chugai Pharmaceutical Co., Ltd, Terumo Corporation, Nippon Boehringer Ingelheim Co., Ltd, Nippon Chemical Industrial Co., Ltd, Pfizer Japan Inc., Merck Biopharma Co., Ltd, Janssen Pharmaceutical K.K., and Merck Sharp & Dohme LLC.