Analysis Of Japan Research Articles

What the COVID-19 school closure left in its wake: Evidence from a regression discontinuity analysis in Japan

To control the spread of COVID-19, the national government of Japan abruptly started the closure of elementary schools on March 2, 2020, but preschools were exempted from this nationwide school closure. Taking advantage of this natural experiment, we examined how the proactive closure of elementary schools affected various outcomes related to children and family well-being. To identify the causal effects of the school closure, we exploited the discontinuity in the probability of going to school at a certain threshold of age in months and conducted fuzzy regression discontinuity analyses. The data are from a large-scale online survey of mothers whose firstborn children were aged 4 to 10 years. The results revealed a large increase in children’s weight and in mothers’ anxiety over how to raise their children. On the outcomes related to marital relationships, such as the incidence of domestic violence and the quality of marriage, we did not find statistically significant changes. These findings together suggest that school closures could have large unintended detrimental effects on non-academic outcomes among children.

An Analysis of Japan’s Quality Movement from the Meiji Period until the Present Day: A Synthesized Perspective

Manuscript type: Research paper Research aims: This paper has a tri-fold purpose. First, we seek to establish whether Japan’s focus on quality manufacturing was a conscious choice. Second, we attempt to analyse the impact of the external environment on the success/failure of quality upgrading. Third, we investigate whether Japanese businesses, regardless of the shifts in the competitive environment in the last two decades, continue to explore quality management as a strategic weapon for competitiveness. Design/Methodology/Approach: The study is based on a systematic literature review using two of the main scientific databases – JSTOR and Emerald. The scientific papers used for this synthesis – over sixty manuscripts in total – have (predominantly) focused on the quality movement in Japan at a national/country level. These are peerreviewed articles published between 1980 and 2018 that go beyond the field of operations/quality management. Research findings: We show that Japan’s focus on quality upgrading was a conscious choice that sought to elevate the country’s economy.Moreover, we identify a number of external factors (e.g. government support, sound formal institutions) – four, specifically – that, according to our analysis, have been critical to Japan’s success in quality manufacturing. Finally, we show that regardless of the (recent) shifts in the competitive environment, (product) quality improvement continues to take a central part in Japan’s pursuit of global economic dominance. Theoretical contribution/Originality: We claim that that this is the first comprehensive study of Japan’s quality movement to include scientific data from the Meiji Period until the present day (so far the bulk of the scientific papers have focused on the quality movement in post-war Japan). We also bridge a substantial gap in the QM literature regarding the influence of the external environment (e.g. political factors, social factors) on the success/failure in quality upgrading. Practitioner/Policy implication: The insights of this paper provide a valuable lesson to policy makers from developing and/or underdeveloped economies in their pursuit of economic growth. The study is also important to manufacturers from developing and/ or underdeveloped countries to understand their own quality management practices in comparison with those in Japan, which have the highest standards of manufacturing quality. Research limitation/Implication: Our literature search is admittedly not exhaustive as it involves only two of the main scientific databases.

Environmental management practices and financial performance using data envelopment analysis in Japan: The mediating role of environmental performance

AbstractThis study investigates the relationship between environmental management practices (EMPs) and financial performance (FP) and consequently ascertains whether environmental performance (EP) can mediate the EMPs–FP nexus. Distinctly using data envelopment analysis and generalised method of moments techniques to analyse a comprehensive dataset of Nikkei 225 listed firms from 2007 to 2018 (1920 firm‐year observations), our findings first suggest that EMPs have a positive effect on FP. Second, the desired EP can be achieved through the adoption of comprehensive EMPs. Third, improved EP has a substantial impact on shaping the EMPs' effect on FP. These findings are consistent with the predictions of resource‐based view and institutional theories. The results are robust to controlling for different types of alternative measures and endogeneities. The findings have important implications for academics, investors, managers, policymakers and regulators.

The Analysis of Japan’s Energy and Climate Policy from the Aspect of Anticipatory Governance

This study is a preliminary and experimental one to analyze Japan’s energy transitions to mitigate climate change from anticipatory governance aspects. Japan’s energy policy principles have been energy security, environmental considerations, economic efficiency, and safety (3E + S). According to the energy agency, the long-term energy outlook is also drawn up by “ambitious multiple track scenarios” and “multilayered and diversified flexible energy supply-demand structure.” This approach resonates with the aspects of anticipatory governance. It promotes the idea of preparing for multiple future scenarios, including the unthinkable worst case future scenario such as a nuclear accident (foresight), the interactions between the policymakers and the public (engagement), and the reflexive processes of policy innovations with a normative decision for the selection of energy mix (integration). However, this study finds that Japan’s energy policy lacks the aspects of anticipatory governance. It sticks to fixed energy policy institutionalized in the 1970s to promote nuclear energy and coal as oil alternatives. It rarely has interactions between the policymakers and the public and thus lacks a societal (normative) decision about a future energy path to energy transitions to mitigate climate change. Instead, Japan’s energy policy has not necessarily met its declared policy objective of 3E + S since the unprecedented Fukushima nuclear accidents occurred and cannot uphold an ambitious target for CO2 emissions reduction.

Efficacy, Prognostic Factors, and Safety Profile of Enzalutamide for Non-metastatic and Metastatic Castration-Resistant Prostate Cancer: A Retrospective Single-Center Analysis in Japan.

Enzalutamide is a novel, non-steroidal anti-androgen that has demonstrated excellent anti-tumor activity for both non-metastatic and metastatic castration-resistant prostate cancer (nmCRPC and mCRPC) patients, and that is being rapidly introduced into clinical practice in Japan. We retrospectively investigated the treatment efficacy, safety profile, and prognostic factors of enzalutamide over a relatively long observation period in Japanese patients with nmCRPC and mCRPC. The medical records of 184 consecutive Japanese patients with nmCRPC and mCRPC who started enzalutamide treatment in our institution between January 2012 and April 2018 were reviewed. Efficacy and safety profiles were assessed and statistically analyzed. Among these 184 patients, 44 (23.9%) nmCRPC patients, 89 (48.4%) docetaxel-naïve mCRPC patients, and 51 docetaxel-pretreated (27.7%) mCRPC patients underwent enzalutamide therapy. The median prostate-specific antigen progression-free survival (PSA-PFS) and overall survival (OS) periods for nmCRPC patients were 39.2months and not reached; those for docetaxel-naïve mCRPC patients were 16.5months and 59.8months; and those for docetaxel-pretreated mCRPC patients were 7.0months and 30.4months, respectively. Multivariate analysis identified performance status ≥ 2, PSA > 8.89ng/mL (median value), hemoglobin < lower limit of normal range, neutrophil to lymphocyte ratio > 3.0, and 4-week PSA decline < 50% as the predictive factors for shorter OS. Our respective prognostic models using these factors successfully demonstrated distinctly separated survival curves (p < 0.001). In addition, among these patients, 30 (16.3%) experienced adverse events and 16 (8.7%) experienced adverse events resulting in the discontinuation of therapy. Fatigue (14%) and appetite loss (7%) were the most common such events. Both the survival period and risk factors were extracted from a relatively long-term observation period. Since enzalutamide was approved for administration to patients with castration-sensitive prostate cancer earlier this year (2020), we believe that the data presented here will be useful for both physicians and patients in clinical practice.

Impact of the number of steroid pulses in tonsillectomy combined with steroid pulse therapy: a nationwide retrospective study in Japan.

Steroid pulse therapy with tonsillectomy is known as a major treatment for IgA nephropathy (IgAN). However, its protocol was different among institutions and the effects of varying the number of steroid pulses remain unclear. From a total of 1,174 IgAN patients in a multicenter retrospective cohort analysis in Japan, 195 patients were treated by tonsillectomy combined with corticosteroid. They were divided into four groups based on the number of administered steroid pulses from 0 to three (TSP0-3), and remission of urinary abnormalities and renal survival until 1.5-fold increase in serum creatinine level from baseline were analyzed among the four groups and between TSP1 and TSP3. Among the four groups, renal function was relatively good when the estimated glomerular filtration rate was approximately 80-90mL/min/1.73m2 and proteinuria was relatively mild (< 1.0g/gCre). The ratio of patients who developed renal dysfunction was < 5% in all groups, and the cumulative renal survival rate by Kaplan-Meier analysis was similar among groups (log-rank test, p = 0.37), despite varying clinical backgrounds and treatments. After adjustment of the background variables between TSP1 and TSP3, the remission rates of urinary abnormalities were similar and the renal survival rate also remained similar (66.8 vs. 85.4%, p = 0.45). In patients with mild proteinuria and good renal function, the number of steroid pulses did not affect the renal outcome in steroid pulse therapy with tonsillectomy. The adaptation and protocols, such as the number of steroid pulses, should be determined for each IgAN patient's background.

Feasibility and safety of surgical microwave ablation for hepatocellular carcinoma in elderly patients: a single center analysis in Japan

The feasibility and safety of microwave ablation in elderly hepatocellular carcinoma (HCC) patients remains unknown. The aim of this study was to evaluate the feasibility and safety of surgical microwave ablation for HCC in patients older than 80 years of age. This retrospective study enrolled consecutive 114 patients older than 80 years of age who underwent surgical microwave ablation for HCC between July 1994 and December 2017. We analyzed perioperative outcomes and long-term outcomes to clarify the prognostic factors. The 1-, 3-, 5-year overall survival and recurrence-free survival rates were 97.3%, 76.0%, 49.2% and 84.2%, 44.7%, and 32.5%, respectively. The overall major morbidity rates (Clavien–Dindo grade IIIA or above) were 2.6%. There were no cases of mortality. Multivariate analysis showed that hepatitis C virus antibody (HCV-Ab) positivity and the presence of multiple tumors were independent prognostic factors for long-term outcomes. The overall survival rate of patients with HCV-Ab negative and single tumor was better than that of other patients (p = 0.026). Surgical microwave ablation was feasible and safe for elderly patients with HCC. Elderly patients with HCV-Ab negative and single tumor would be expected to have better long-term outcomes after surgical microwave ablation.

Exploring potential cruisers behavior based on a preference model: the Japanese cruise market

Purpose The purpose of this study is to analyze the preferences of potential Japanese cruise ship tourists and identify the factors influencing their participation in cruise ship tourism. In the analysis, preference for cruise ports in East Asia is also examined. Design/methodology/approach The behavioral model of potential cruiser is developed through a mixed ordered logit approach. The data are collected by means of the stated preference method with the application of a Web-based questionnaire. Multiple answers are collected from each respondent. Hence, panel effects between answers are considered so as to obtain a robust model. Findings The results show that Nagasaki and Hong Kong ports are preferred, and other domestic ports, namely, Kobe, Kagoshima, and Naha are also relatively popular places to visit. However, potential Japanese cruisers are reluctant to visit two South Korean destinations which are frequently selected as cruise lines by avoiding Cabotage rule. Besides, shorter cruise duration and lower prices increase the possibility of participation in cruise tourism, particularly for working people. Retirees tend to have less interest in cruise tourism. However, Japanese-related services will increase retirees’ intentions to participate in cruise tourism. Research limitations/implications This study attempts to analyze potential cruisers’ behavior toward cruise ship tourism in Japan and discusses how to increase the number of cruisers participating in cruise ship tourism. In this vein, repeat behavior should also be analyzed. Repeat behavior contributes to the maintenance and increase in cruisers in Japan. Originality/value There is no study on potential cruiser’s behavior analysis in Japan which is the emerging country as cruise market. Thus, the number of potential cruisers is expected to be high. This study reveals that potential cruisers’ preferences on cruise ship services (e.g. duration, price, on board services, etc.), which are separately analysed for working ages and retirees. Besides, preferences on port of calls in East Asian context are revealed. These results are useful for cruise ship industries, especially for cruise lines.

Disclosure of secondary findings in exome sequencing of 2480 Japanese cancer patients.

High-throughput sequencing has greatly contributed to precision medicine. However, challenges remain in reporting secondary findings (SFs) of germline pathogenic variants and managing the affected patients. The aim of this study was to examine the incidence of SFs in Japanese cancer patients using whole exome sequencing (WES) and to understand patient preferences regarding SF disclosure. WES was conducted for 2480 cancer patients. Genomic data were screened and classified for variants of 59 genes listed by the American College of Medical Genetics and Genomics SF v2.0 and for an additional 13 hereditary cancer-related genes. Majority of the participants (68.9%; 1709/2480) opted for disclosure of their SFs. Thirty-two pathogenic or likely pathogenic variants, including BRCA1 (7 patients), BRCA2 (4), CHEK2 (4), PTEN (3), MLH1 (3), SDHB (2), MSH6 (1), NF1 (1), EXT2 (1), NF1 (1), NTRK1 (1), MYH7 (3), MYL2 (1), TNNT2 (1), LDLR (2), FBN1 (1), and KCNH2 (1) were recognized in 36 patients (1.5%). Twenty-eight (77.8%) patients underwent genetic counseling and received their SF results. Eighteen (64.3%) patients underwent clinical management for SFs. Genetic validation tests were administered significantly more frequently to patients with than without a SF-related personal history (P = 0.025). This was a first attempt at a large-scale systematic exome analysis in Japan; nevertheless, many cancer patients opted for disclosure of SFs and accepted or considered clinical management.

The impact of clinicopathological factors on clinical outcomes in patients with salivary gland adenoid cystic carcinoma: a multi-institutional analysis in Japan.

Owing to the low incidence of adenoid cystic carcinoma (AdCC), reliable survival estimates and prognostic factors remained unclarified. In this multi-institutional retrospective analysis, we collected 192 AdCC cases, and investigated the impact of clinicopathological factors on clinical outcomes of the patients. All AdCC cases were of salivary gland origin and were surgically treated with curative intent. Diagnoses of AdCC were validated by a central pathology review by expert pathologists. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 92.5 and 50.0%, respectively. Treatment failure occurred in 89 patients (46%) with the distant failures in 65 (34%). Multivariate analysis indicated that pN2 and a pathologically positive surgical margin were independent prognostic factors for both OS and DFS. Histological grade III was an independent prognostic factor for OS. A primary site in the submandibular gland, pT3/4, pN1, and histological grade II were independent prognostic factors for DFS. Postoperative radiation therapy (PORT) improved the locoregional control (LRC) rate. Prophylactic neck dissection was not associated with a better OS or better LRC among patients with cN0. Facial nerve dissection did not improve clinical outcomes in parotid AdCC cases without facial nerve palsy. A higher TN classification, a pathologically positive surgical margin, and a higher histological grade were associated with a lower OS. PORT improved LRC rates but neck dissection failed to improve clinical outcomes in patients with cN0. As the distant metastasis was frequent, effective systemic therapy is imperative to improve the survival of AdCC patients.

Car-sharing intention analysis in Japan by comparing the utility of car ownership for car-owners and non-car owners

Car sharing (CS) service has grown as one of the components of multimodal mobility in urban transport and it is expected to lead to a reduction in personal car ownership, thereby mitigating urban congestion and parking demand. It also provides last-mile mobility to complement public transport. Against this backdrop, a lot of studies have been conducted to make clear the effectiveness of CS services. However, most of the previous studies were surveys aimed at current CS users, and only a few studies have evaluated whether general car owners and non-owners might become members of CS services in the future.In this study, a survey was conducted among 1000 car owners in Japan as to whether CS services would induce them to stop owning a car. At the time of the survey, the respondents’ current annual cost of owning a car was automatically displayed by calculating the amount from previous answers about their attributes. With this questionnaire method, it is presumed that respondents answered with a stronger awareness of the high cost of car ownership, so their responses might have reflected a consideration of the economic benefits of CS services. The results showed that 74% of car owners answered that they would not stop owning a car no matter how inexpensive CS services were and even if there was no risk of vehicle unavailability. The percentage was almost the same in every range of household income, and 40% said the reason was familiarity with and attachment to a car and 54% cited convenience in emergencies. These results suggest that in order to spread CS services for further reducing personal car ownership, emotional incentives are required to compensate for certain disadvantages of CS services, e.g., the lack of excitement derived from car ownership, potential non-availability in emergencies, and so on.A survey was also conducted among 1000 non-car owners in order to analyze and compare the utility of car ownership. The results showed that the perceived utility of car ownership was 2–10 times greater for owners than for non-owners. CS service providers and urban transport policymakers should be aware of this value when designing businesses and policies. Consideration should also be given to the various objectives of CS services such as between aiming to reducing car ownership and aiming to improve urban transport for non-car owners. Further research is required to optimize CS services for efficient urban transport design.

Estimation of ground thermal conductivity through indicator kriging: Nation-scale application and vertical profile analysis in Japan

The estimation of ground thermal conductivity using indicator kriging and surrounding borehole data at 5-m intervals to a depth of 200 m on regular 0.5-km cells of Japan was demonstrated. The probabilities of occurrence of eight soil/rock types were estimated for their most likely thicknesses and used as weights for estimation of ground thermal conductivity. Individual thermal conductivity of each soil/rock type is determined to obtain sufficient agreements of ground thermal conductivities between estimates and in-situ measurements. The estimation was performed over the land with 46 thousand borehole data. Local maps of Kanto showed the relation of soil/rock types and ground thermal conductivities with five topographic categories. Averaged 10-km-cell maps of Japan indicated the sudden changes of ground thermal conductivity even among adjacent cells due to geologic complexity. Vertical increases of ground thermal conductivity were statistically observed in all topographic categories, and the vertical profile of each location followed a logarithmic curve without or with a peak.

Clinical investigation on sarcoma in oral and maxillofacial regions: A multicenter retrospective analysis in Japan

The aim of the present study was to review the treatment outcomes of oral sarcoma in Japan based on a multicenter retrospective analysis. Between January 2001 and December 2015, 30 patients were histologically diagnosed with sarcoma in the oral and maxillofacial regions and retrospectively reviewed. Osteosarcoma was the most common in 6 (20 %) out of 30 cases, followed by 3 cases (10 %) of fibrosarcoma. The average maximum size of the primary tumor was 42.3 ± 18.7 mm (range: 5−80 mm). The mandible was the most common site of the primary tumor and observed in 15 cases (50 %), followed by the maxilla in 12 cases (40 %). Soft tissue sarcoma was noted in 3 cases (10 %). The average follow-up period was 5.6 ± 4.6 years (range, 0.1–14.7 years). Five- and 10-year OS rates were 81.4 and 62.0 %, respectively. Five- and 10-year OS rates in cases that underwent radical surgery were 95.5 and 72.7 %, respectively, and were significantly higher than those treated with non-surgical therapy (p < 0.0001). The early detection and complete surgical resection of primary tumors with adequate surgical margins appears to be important for improving the prognosis of oral sarcoma patients.

Re-challenge of Platinum-based Chemotherapy for Platinum-refractory Patients with Recurrent or Metastatic Head and Neck Cancer: Claims Data Analysis in Japan.

BackgroundThe role of platinum rechallenge in head and neck cancer (HNC) has not yet been fully evaluated.ObjectivesIt is our goal to assess the real-world treatment patterns and usefulness of platinum rechallenge in patients with platinum-refractory recurrent or metastatic HNC receiving platinum rechallenge.MethodsThis is a retrospective study using data from a Japanese hospital claims database stored in electronic hospital information systems. Patients with HNC or undefined histology with an HNC diagnosis using the disease code, between January 1, 2013 and September 30, 2016, were included. Patients diagnosed with other malignancies on or before the initial diagnosis of HNC and those without cancer stage information in the database were excluded from the study.ResultsA total of 43 994 patients were identified from the database as HNC patients. Of those, in patients who had cancer progression within 6 months after platinum-based chemotherapy administered for primary or recurrent disease (N=842), the median treatment duration of platinum rechallenge for platinum refractory patients was only 1 cycle. The second-line treatment continuation rate at 6 months was 20.1% for patients who received platinum rechallenges and 32.8% for those who received non–platinum-based regimens.ConclusionsThe findings from this study of data from routine clinical practice suggest that the benefit of platinum rechallenge in a platinum-refractory setting would be limited.

Proficiency Testing Schemes for Food Nutrition Analysis in Japan (2017-2018)

This paper deals with proficiency testing schemes for food nutrition analysis in Japan. In schemes in 2017 and 2018, 65 and 73 organizations participated, respectively, and more than 70% of the participants were public organizations responsible for a nutrition-labeling compliance test. The food matrices were pork and chicken sausages, and analytes were protein, fat, ash, moisture, carbohydrate, energy, sodium, salt equivalent, calcium (2018 only), and iron (2018 only). The organizations reporting inadequate laboratory values in one or more nutrients for mandatory declaration (energy, protein, fat, carbohydrate, or salt equivalent) were 11 and 15% of all organizations and 9 and 13% of public organizations in the 2017 and 2018 schemes, respectively. The approximate relative standard deviations for proficiency assessment (RSDr) were as follows: protein, 2%; fat, 3%; ash, 2%; moisture, 0.5%; carbohydrate, 9%; energy, 1%; sodium (salt equivalent), 4%; calcium, 7%; and iron, 7%. Notably, the large RSDr value for carbohydrate may cause inconsistency among laboratories in compliance tests for foods containing several grams or less of carbohydrate per 100 grams.

Anticoagulation with DOAC or Heparin Bridging in Acute Cardioembolic Stroke: Nationwide Retrospective Cohort Study Analysis in Japan (738)

Anticoagulation with DOAC or Heparin Bridging in Acute Cardioembolic Stroke: Nationwide Retrospective Cohort Study Analysis in Japan (738)

Treatment outcomes of adjunctive teriparatide therapy for medication-related osteonecrosis of the jaw (MRONJ): A multicenter retrospective analysis in Japan

BackgroundTherapeutic strategies for patients with medication-related osteonecrosis of the jaw (MRONJ) remain controversial. The aim of the present study was to clarify the effectiveness and safety of teriparatide therapy in Japanese MRONJ patients based on a large number of case series with a multicenter retrospective analysis. Patients and methodsBetween January 2012 and December 2016, 29 patients who were diagnosed with MRONJ at 10 hospitals were treated with teriparatide. The medical records of these patients were retrospectively reviewed to assess the efficacy and safety of teriparatide therapy for MRONJ patients. ResultsAdverse events occurred in 17.2% of patients (5/29). One patient developed severe arthralgia and discontinued teriparatide therapy after 12 days, while others continued the treatment. Among 29 patients, the median period of administration of teriparatide was 14.0 months (range, 0.3–26 months), and treatment outcomes were evaluated as effective in 75.9% of patients with complete resolution in 65.5%. Among patients treated with oral bisphosphonates (BPs), 83.3% were effectively treated with teriparatide and 40% with intravenous BPs. The oral administration of BPs was associated with successful treatment outcomes with teriparatide (p = 0.062). ConclusionsTeriparatide therapy has potential as an effective treatment option for MRONJ.

Workplace and community social capital and burnout among professionals of health and welfare services for the seniors: A multilevel analysis in Japan.

ObjectiveDespite the potential of the social capital approach in preventing burnout, there is sparse evidence of its contextual effect. This study aimed to reveal the contextual association of workplace and community social capital on burnout among professionals of health and welfare services for seniors in Japan.MethodsWe collected data from a cross‐sectional questionnaire survey for all health and welfare professionals working in Community Comprehensive Support Centers (CCSCs) in the central Tokyo area in 2015. We assessed burnout using the Japanese version of the Maslach Burnout Inventory, which consists of three subscales: emotional exhaustion, depersonalization, and reduced personal accomplishment. We prepared social capital items regarding workplace (the CCSC the participants belonged to) and community (the current catchment area of the CCSC). We aggregated individual responses of workplace and community social capital within each CCSC to create group‐level workplace and community social capital indicators.ResultsAmong the 1771 questionnaires distributed, we analyzed 1110 from 211 CCSCs. Multilevel analysis showed that higher group‐level workplace social capital was significantly associated with lower scores of all three subscales after adjusting for covariates. Moreover, we found a significant association between greater group‐level community social capital and lower scores of depersonalization and reduced personal accomplishment.ConclusionWorking in workplaces and communities with higher social capital is related to lower burnout. The findings suggest that strategies to enhance the social capital of their workplace and community would be beneficial in the prevention of burnout among professionals in the field of health and social welfare.

Estimation of the mitigation and the landuse control for climate change based on the flood analysis in Japan

気候変動による洪水被害の影響とそれに対する緩和策と適応策の効果を評価した．二次元不定流モデルと治水経済調査マニュアル（案）を用いて，洪水時の浸水深と被害額を算出した．また21世紀末における洪水被害を推定するため5つのGCMを用いて将来気候における降水量を求め，それを入力値として将来の浸水深と被害額を求めた．また，適応策として土地利用規制に着目し，その被害額軽減効果と費用便益比を検証した．21世紀末におけるRCP8.5からRCP2.6への緩和は洪水の年期待被害額を2465億円/年削減すると推定された．再現期間200年の洪水時に3m以上浸水する箇所を規制する土地利用規制による適応策は現在気候において年期待被害額を26%減少させると推定された．また，費用便益比は緩和策は0.684となる一方，土地利用規制の費用便益比は約0.019と推定された．

Biomarker testing for personalized, first-line therapy in advanced nonsquamous non-small cell lung cancer patients in the real world setting in Japan: a retrospective, multicenter, observational study (the BRAVE study).

Background:Molecular diagnostic testing is necessary to guide optimal first-line treatment. The number of patients who receive first-line treatment based on biomarker analysis in Japan is unknown. We aimed to determine the proportion of nonsquamous non-small cell lung cancer (NSCLC) patients for whom first-line treatment was selected based on biomarker testing.Methods:This retrospective, multicenter, observational study registered patients aged ⩾20 years with locally advanced or metastatic nonsquamous NSCLC who started first-line treatment between August and December 2017 in Japan. Data were collected from medical records between January and May 2018. The primary endpoint was the proportion of patients with confirmed biomarker status for first-line treatment decision.Results:Among 202 patients enrolled from 11 centers, 161 (79.7%; 95% confidence interval, 74.2–85.2%) had confirmed biomarker status. The testing rate was highest for epidermal growth factor receptor (EGFR; 97.5%), followed by anaplastic lymphoma kinase (ALK; 88.1%), programmed death ligand-1 (PD-L1; 87.1%), and ROS1 (67.3%). For first-line treatment, 70/75 patients with EGFR-positive tumors were administered an EGFR-TKI; 14/15 patients with ALK-positive tumors received an ALK inhibitor; 2/2 patients with ROS1-positive tumors received a ROS1 inhibitor; and 29/36 driver mutation-negative patients with a PD-L1 tumor proportion score ⩾50% were administered an anti-PD-1 monoclonal antibody. Median times from confirmed diagnosis date to first-line treatment initiation, and from first biomarker test order to last biomarker test result were 19 and 11 days, respectively.Conclusions:The proportion of nonsquamous NSCLC patients with confirmed biomarker status for first-line treatment was considered insufficient and in need of improvement.