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1.
Genet Epidemiol ; 47(3): 261-286, 2023 04.
Artículo en Inglés | MEDLINE | ID: mdl-36807383

RESUMEN

Gene-environment (G-E) interaction analysis plays an important role in studying complex diseases. Extensive methodological research has been conducted on G-E interaction analysis, and the existing methods are mostly based on regression techniques. In many fields including biomedicine and omics, it has been increasingly recognized that deep learning may outperform regression with its unique flexibility (e.g., in accommodating unspecified nonlinear effects) and superior prediction performance. However, there has been a lack of development in deep learning for G-E interaction analysis. In this article, we fill this important knowledge gap and develop a new analysis approach based on deep neural network in conjunction with penalization. The proposed approach can simultaneously conduct model estimation and selection (of important main G effects and G-E interactions), while uniquely respecting the "main effects, interactions" variable selection hierarchy. Simulation shows that it has superior prediction and feature selection performance. The analysis of data on lung adenocarcinoma and skin cutaneous melanoma overall survival further establishes its practical utility. Overall, this study can advance G-E interaction analysis by delivering a powerful new analysis approach based on modern deep learning.


Asunto(s)
Aprendizaje Profundo , Melanoma , Neoplasias Cutáneas , Humanos , Interacción Gen-Ambiente , Modelos Genéticos , Melanoma Cutáneo Maligno
2.
Brief Bioinform ; 23(5)2022 09 20.
Artículo en Inglés | MEDLINE | ID: mdl-35876281

RESUMEN

In biomedical research, the replicability of findings across studies is highly desired. In this study, we focus on cancer omics data, for which the examination of replicability has been mostly focused on important omics variables identified in different studies. In published literature, although there have been extensive attention and ad hoc discussions, there is insufficient quantitative research looking into replicability measures and their properties. The goal of this study is to fill this important knowledge gap. In particular, we consider three sensible replicability measures, for which we examine distributional properties and develop a way of making inference. Applying them to three The Cancer Genome Atlas (TCGA) datasets reveals in general low replicability and significant across-data variations. To further comprehend such findings, we resort to simulation, which confirms the validity of the findings with the TCGA data and further informs the dependence of replicability on signal level (or equivalently sample size). Overall, this study can advance our understanding of replicability for cancer omics and other studies that have identification as a key goal.


Asunto(s)
Investigación Biomédica , Neoplasias , Humanos , Neoplasias/genética , Tamaño de la Muestra
3.
Bioinformatics ; 39(12)2023 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-38060266

RESUMEN

SUMMARY: Densely measured SNP data are routinely analyzed but face challenges due to its high dimensionality, especially when gene-environment interactions are incorporated. In recent literature, a functional analysis strategy has been developed, which treats dense SNP measurements as a realization of a genetic function and can 'bypass' the dimensionality challenge. However, there is a lack of portable and friendly software, which hinders practical utilization of these functional methods. We fill this knowledge gap and develop the R package FunctanSNP. This comprehensive package encompasses estimation, identification, and visualization tools and has undergone extensive testing using both simulated and real data, confirming its reliability. FunctanSNP can serve as a convenient and reliable tool for analyzing SNP and other densely measured data. AVAILABILITY AND IMPLEMENTATION: The package is available at https://CRAN.R-project.org/package=FunctanSNP.


Asunto(s)
Programas Informáticos , Reproducibilidad de los Resultados
4.
Artículo en Inglés | MEDLINE | ID: mdl-38098875

RESUMEN

With the development of data collection techniques, analysis with a survival response and high-dimensional covariates has become routine. Here we consider an interaction model, which includes a set of low-dimensional covariates, a set of high-dimensional covariates, and their interactions. This model has been motivated by gene-environment (G-E) interaction analysis, where the E variables have a low dimension, and the G variables have a high dimension. For such a model, there has been extensive research on estimation and variable selection. Comparatively, inference studies with a valid false discovery rate (FDR) control have been very limited. The existing high-dimensional inference tools cannot be directly applied to interaction models, as interactions and main effects are not "equal". In this article, for high-dimensional survival analysis with interactions, we model survival using the Accelerated Failure Time (AFT) model and adopt a "weighted least squares + debiased Lasso" approach for estimation and selection. A hierarchical FDR control approach is developed for inference and respect of the "main effects, interactions" hierarchy. The asymptotic distribution properties of the debiased Lasso estimators are rigorously established. Simulation demonstrates the satisfactory performance of the proposed approach, and the analysis of a breast cancer dataset further establishes its practical utility.

5.
Bioinformatics ; 38(11): 3134-3135, 2022 05 26.
Artículo en Inglés | MEDLINE | ID: mdl-35441661

RESUMEN

SUMMARY: In the analysis of high-dimensional omics data, dimension reduction techniques-including principal component analysis (PCA), partial least squares (PLS) and canonical correlation analysis (CCA)-have been extensively used. When there are multiple datasets generated by independent studies with compatible designs, integrative analysis has been developed and shown to outperform meta-analysis, other multidatasets analysis, and individual-data analysis. To facilitate integrative dimension reduction analysis in daily practice, we develop the R package iSFun, which can comprehensively conduct integrative sparse PCA, PLS and CCA, as well as meta-analysis and stacked analysis. The package can conduct analysis under the homogeneity and heterogeneity models and with the magnitude- and sign-based contrasted penalties. As a 'byproduct', this article is the first to develop integrative analysis built on the CCA technique, further expanding the scope of integrative analysis. AVAILABILITY AND IMPLEMENTATION: The package is available at https://CRAN.R-project.org/package=iSFun. SUPPLEMENTARY INFORMATION: Supplementary materials are available at Bioinformatics online.


Asunto(s)
Programas Informáticos , Análisis de los Mínimos Cuadrados , Análisis de Componente Principal
6.
Adv Anat Pathol ; 30(1): 58-68, 2023 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-36136369

RESUMEN

Most pancreatic neuroendocrine neoplasms are slow-growing, and the patients may survive for many years, even after distant metastasis. The tumors usually display characteristic organoid growth patterns with typical neuroendocrine morphology. A smaller portion of the tumors follows a more precipitous clinical course. The classification has evolved from morphologic patterns to the current World Health Organization classification, with better-defined grading and prognostic criteria. Recent advances in molecular pathology have further improved our understanding of the pathogenesis of these tumors. Various issues and challenges remain, including the correct recognition of a neuroendocrine neoplasm, accurate classification and grading of the tumor, and differentiation from mimickers. This review focuses on the practical aspects during the workup of pancreatic neuroendocrine neoplasms and attempts to provide a general framework to help achieve an accurate diagnosis, classification, and grading.


Asunto(s)
Tumores Neuroendocrinos , Neoplasias Pancreáticas , Humanos , Tumores Neuroendocrinos/diagnóstico , Tumores Neuroendocrinos/patología , Páncreas/patología , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patología , Pronóstico , Organización Mundial de la Salud , Clasificación del Tumor
7.
Biometrics ; 79(4): 3883-3894, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37132273

RESUMEN

Gene-environment (G-E) interactions have important implications for cancer outcomes and phenotypes beyond the main G and E effects. Compared to main-effect-only analysis, G-E interaction analysis more seriously suffers from a lack of information caused by higher dimensionality, weaker signals, and other factors. It is also uniquely challenged by the "main effects, interactions" variable selection hierarchy. Effort has been made to bring in additional information to assist cancer G-E interaction analysis. In this study, we take a strategy different from the existing literature and borrow information from pathological imaging data. Such data are a "byproduct" of biopsy, enjoys broad availability and low cost, and has been shown as informative for modeling prognosis and other cancer outcomes/phenotypes in recent studies. Building on penalization, we develop an assisted estimation and variable selection approach for G-E interaction analysis. The approach is intuitive, can be effectively realized, and has competitive performance in simulation. We further analyze The Cancer Genome Atlas (TCGA) data on lung adenocarcinoma (LUAD). The outcome of interest is overall survival, and for G variables, we analyze gene expressions. Assisted by pathological imaging data, our G-E interaction analysis leads to different findings with competitive prediction performance and stability.


Asunto(s)
Interacción Gen-Ambiente , Neoplasias , Humanos , Neoplasias/genética , Simulación por Computador , Fenotipo , Modelos Genéticos
8.
Stat Med ; 42(10): 1565-1582, 2023 05 10.
Artículo en Inglés | MEDLINE | ID: mdl-36825602

RESUMEN

Clustering for multivariate functional data is a challenging problem since the data are represented by a set of curves and functions belonging to an infinite-dimensional space. In this article, we propose a novel clustering method for multivariate functional data using an adaptive density peak detection technique. It is a quick cluster center identification algorithm based on the two measures of each functional data observation: the functional density estimate and the distance to the closest observation with a higher functional density. We suggest two types of functional density estimators for multivariate functional data. The first one is a functional k $$ k $$ -nearest neighbor density estimator based on (a) an L2 distance between raw functional curves, or (b) a semimetric of multivariate functional principal components. The second one is a k $$ k $$ -nearest neighbor density estimator based on multivariate functional principal scores. Our clustering method is computationally fast since it does not need an iterative process. The flexibility and advantages of the method are examined by comparing it with other existing clustering methods in simulation studies. A user-friendly R package FADPclust is developed for public use. Finally, our method is applied to a real case study in lung cancer research.


Asunto(s)
Algoritmos , Humanos , Análisis por Conglomerados , Simulación por Computador
9.
Stat Sin ; 33(2): 729-758, 2023 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38037567

RESUMEN

This study has been motivated by cancer research, in which heterogeneity analysis plays an important role and can be roughly classified as unsupervised or supervised. In supervised heterogeneity analysis, the finite mixture of regression (FMR) technique is used extensively, under which the covariates affect the response differently in subgroups. High-dimensional molecular and, very recently, histopathological imaging features have been analyzed separately and shown to be effective for heterogeneity analysis. For simpler analysis, they have been shown to contain overlapping, but also independent information. In this article, our goal is to conduct the first and more effective FMR-based cancer heterogeneity analysis by integrating high-dimensional molecular and histopathological imaging features. A penalization approach is developed to regularize estimation, select relevant variables, and, equally importantly, promote the identification of independent information. Consistency properties are rigorously established. An effective computational algorithm is developed. A simulation and an analysis of The Cancer Genome Atlas (TCGA) lung cancer data demonstrate the practical effectiveness of the proposed approach. Overall, this study provides a practical and useful new way of conducting supervised cancer heterogeneity analysis.

10.
Genet Epidemiol ; 45(4): 372-385, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33527531

RESUMEN

In the study of gene expression data, network analysis has played a uniquely important role. To accommodate the high dimensionality and low sample size and generate interpretable results, regularized estimation is usually conducted in the construction of gene expression Gaussian Graphical Models (GGM). Here we use GeO-GGM to represent gene-expression-only GGM. Gene expressions are regulated by regulators. gene-expression-regulator GGMs (GeR-GGMs), which accommodate gene expressions as well as their regulators, have been constructed accordingly. In practical data analysis, with a "lack of information" caused by the large number of model parameters, limited sample size, and weak signals, the construction of both GeO-GGMs and GeR-GGMs is often unsatisfactory. In this article, we recognize that with the regulation between gene expressions and regulators, the sparsity structures of a GeO-GGM and its GeR-GGM counterpart can satisfy a hierarchy. Accordingly, we propose a joint estimation which reinforces the hierarchical structure and use the construction of a GeO-GGM to assist that of its GeR-GGM counterpart and vice versa. Consistency properties are rigorously established, and an effective computational algorithm is developed. In simulation, the assisted construction outperforms the separation construction of GeO-GGM and GeR-GGM. Two The Cancer Genome Atlas data sets are analyzed, leading to findings different from the direct competitors.


Asunto(s)
Algoritmos , Modelos Genéticos , Simulación por Computador , Expresión Génica , Humanos , Distribución Normal
11.
Bioinformatics ; 37(18): 3073-3074, 2021 09 29.
Artículo en Inglés | MEDLINE | ID: mdl-33638346

RESUMEN

SUMMARY: Heterogeneity is a hallmark of many complex human diseases, and unsupervised heterogeneity analysis has been extensively conducted using high-throughput molecular measurements and histopathological imaging features. 'Classic' heterogeneity analysis has been based on simple statistics such as mean, variance and correlation. Network-based analysis takes interconnections as well as individual variable properties into consideration and can be more informative. Several Gaussian graphical model (GGM)-based heterogeneity analysis techniques have been developed, but friendly and portable software is still lacking. To facilitate more extensive usage, we develop the R package HeteroGGM, which conducts GGM-based heterogeneity analysis using the advanced penaliztaion techniques, can provide informative summary and graphical presentation, and is efficient and friendly. AVAILABILITYAND IMPLEMENTATION: The package is available at https://CRAN.R-project.org/package=HeteroGGM. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.


Asunto(s)
Programas Informáticos , Humanos , Distribución Normal
12.
Biometrics ; 78(2): 524-535, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-33501648

RESUMEN

Heterogeneity is a hallmark of cancer, diabetes, cardiovascular diseases, and many other complex diseases. This study has been partly motivated by the unsupervised heterogeneity analysis for complex diseases based on molecular and imaging data, for which, network-based analysis, by accommodating the interconnections among variables, can be more informative than that limited to mean, variance, and other simple distributional properties. In the literature, there has been very limited research on network-based heterogeneity analysis, and a common limitation shared by the existing techniques is that the number of subgroups needs to be specified a priori or in an ad hoc manner. In this article, we develop a penalized fusion approach for heterogeneity analysis based on the Gaussian graphical model. It applies penalization to the mean and precision matrix parameters to generate regularized and interpretable estimates. More importantly, a fusion penalty is imposed to "automatedly" determine the number of subgroups and generate more concise, reliable, and interpretable estimation. Consistency properties are rigorously established, and an effective computational algorithm is developed. The heterogeneity analysis of non-small-cell lung cancer based on single-cell gene expression data of the Wnt pathway and that of lung adenocarcinoma based on histopathological imaging data not only demonstrate the practical applicability of the proposed approach but also lead to interesting new findings.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Algoritmos , Humanos , Neoplasias Pulmonares/genética , Distribución Normal
13.
Biometrics ; 78(2): 512-523, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-33527365

RESUMEN

In the analysis of gene expression data, network approaches take a system perspective and have played an irreplaceably important role. Gaussian graphical models (GGMs) have been popular in the network analysis of gene expression data. They investigate the conditional dependence between genes and "transform" the problem of estimating network structures into a sparse estimation of precision matrices. When there is a moderate to large number of genes, the number of parameters to be estimated may overwhelm the limited sample size, leading to unreliable estimation and selection. In this article, we propose incorporating information from previous studies (for example, those deposited at PubMed) to assist estimating the network structure in the present data. It is recognized that such information can be partial, biased, or even wrong. A penalization-based estimation approach is developed, shown to have consistency properties, and realized using an effective computational algorithm. Simulation demonstrates its competitive performance under various information accuracy scenarios. The analysis of TCGA lung cancer prognostic genes leads to network structures different from the alternatives.


Asunto(s)
Redes Reguladoras de Genes , Modelos Estadísticos , Algoritmos , Expresión Génica , Distribución Normal
14.
Biometrics ; 78(4): 1579-1591, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-34390584

RESUMEN

In cancer research, supervised heterogeneity analysis has important implications. Such analysis has been traditionally based on clinical/demographic/molecular variables. Recently, histopathological imaging features, which are generated as a byproduct of biopsy, have been shown as effective for modeling cancer outcomes, and a handful of supervised heterogeneity analysis has been conducted based on such features. There are two types of histopathological imaging features, which are extracted based on specific biological knowledge and using automated imaging processing software, respectively. Using both types of histopathological imaging features, our goal is to conduct the first supervised cancer heterogeneity analysis that satisfies a hierarchical structure. That is, the first type of imaging features defines a rough structure, and the second type defines a nested and more refined structure. A penalization approach is developed, which has been motivated by but differs significantly from penalized fusion and sparse group penalization. It has satisfactory statistical and numerical properties. In the analysis of lung adenocarcinoma data, it identifies a heterogeneity structure significantly different from the alternatives and has satisfactory prediction and stability performance.


Asunto(s)
Neoplasias , Humanos , Neoplasias/diagnóstico por imagen , Programas Informáticos
15.
Biom J ; 64(3): 461-480, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-34725857

RESUMEN

In high-throughput cancer studies, gene-environment interactions associated with outcomes have important implications. Some commonly adopted identification methods do not respect the "main effect, interaction" hierarchical structure. In addition, they can be challenged by data contamination and/or long-tailed distributions, which are not uncommon. In this article, robust methods based on γ$\gamma$ -divergence and density power divergence are proposed to accommodate contaminated data/long-tailed distributions. A hierarchical sparse group penalty is adopted for regularized estimation and selection and can identify important gene-environment interactions and respect the "main effect, interaction" hierarchical structure. The proposed methods are implemented using an effective group coordinate descent algorithm. Simulation shows that when contamination occurs, the proposed methods can significantly outperform the existing alternatives with more accurate identification. The proposed approach is applied to the analysis of The Cancer Genome Atlas (TCGA) triple-negative breast cancer data and Gene Environment Association Studies (GENEVA) Type 2 Diabetes data.


Asunto(s)
Diabetes Mellitus Tipo 2 , Neoplasias , Algoritmos , Simulación por Computador , Diabetes Mellitus Tipo 2/genética , Interacción Gen-Ambiente , Humanos , Neoplasias/genética
16.
Genet Epidemiol ; 44(2): 159-196, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31724772

RESUMEN

Gene-environment (G-E) interaction analysis has been extensively conducted for complex diseases. In marginal analysis, the common practice is to conduct likelihood-based (and other "standard") estimation with each marginal model, and then select significant G-E interactions and main effects based on p values and multiple comparisons adjustment. One limitation of this approach is that the identification results often do not respect the "main effects, interactions" hierarchy, which has been stressed in recent G-E interaction analyses. There is some recent effort tackling this problem, however, with very complex formulations. Another limitation of the common practice is that it may not perform well when regularization is needed, for example, because of "non-normal" distributions. In this article, we propose a marginal penalization approach which adopts a novel penalty to directly tackle the aforementioned problems. The proposed approach has a framework more coherent with that of the recently developed joint analysis methods and an intuitive formulation, and can be effectively realized. In simulation, it outperforms the popular significance-based analysis and simple penalization-based alternatives. Promising findings are made in the analysis of a single-nucleotide polymorphism and a gene expression data.


Asunto(s)
Interacción Gen-Ambiente , Modelos Genéticos , Simulación por Computador , Diabetes Mellitus/genética , Genoma Humano , Humanos , Melanoma/genética , Polimorfismo de Nucleótido Simple/genética , Neoplasias Cutáneas/genética
17.
Biometrics ; 77(4): 1397-1408, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-32822084

RESUMEN

Heterogeneity is a hallmark of cancer. For various cancer outcomes/phenotypes, supervised heterogeneity analysis has been conducted, leading to a deeper understanding of disease biology and customized clinical decisions. In the literature, such analysis has been oftentimes based on demographic, clinical, and omics measurements. Recent studies have shown that high-dimensional histopathological imaging features contain valuable information on cancer outcomes. However, comparatively, heterogeneity analysis based on imaging features has been very limited. In this article, we conduct supervised cancer heterogeneity analysis using histopathological imaging features. The penalized fusion technique, which has notable advantages-such as greater flexibility-over the finite mixture modeling and other techniques, is adopted. A sparse penalization is further imposed to accommodate high dimensionality and select relevant imaging features. To improve computational feasibility and generate more reliable estimation, we employ model averaging. Computational and statistical properties of the proposed approach are carefully investigated. Simulation demonstrates its favorable performance. The analysis of The Cancer Genome Atlas (TCGA) data may provide a new way of defining/examining breast cancer heterogeneity.


Asunto(s)
Neoplasias de la Mama , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/genética , Simulación por Computador , Femenino , Humanos
18.
Stat Med ; 40(9): 2239-2256, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33559203

RESUMEN

Partial least squares, as a dimension reduction technique, has become increasingly important for its ability to deal with problems with a large number of variables. Since noisy variables may weaken estimation performance, the sparse partial least squares (SPLS) technique has been proposed to identify important variables and generate more interpretable results. However, the small sample size of a single dataset limits the performance of conventional methods. An effective solution comes from gathering information from multiple comparable studies. Integrative analysis has essential importance in multidatasets analysis. The main idea is to improve performance by assembling raw data from multiple independent datasets and analyzing them jointly. In this article, we develop an integrative SPLS (iSPLS) method using penalization based on the SPLS technique. The proposed approach consists of two penalties. The first penalty conducts variable selection under the context of integrative analysis. The second penalty, a contrasted penalty, is imposed to encourage the similarity of estimates across datasets and generate more sensible and accurate results. Computational algorithms are developed. Simulation experiments are conducted to compare iSPLS with alternative approaches. The practical utility of iSPLS is shown in the analysis of two TCGA gene expression data.


Asunto(s)
Algoritmos , Simulación por Computador , Humanos , Análisis de los Mínimos Cuadrados , Tamaño de la Muestra
19.
Brief Bioinform ; 19(4): 545-553, 2018 07 20.
Artículo en Inglés | MEDLINE | ID: mdl-28200018

RESUMEN

Genome-wide association studies (GWASs) generally focus on a single marker, which limits the elucidation of the genetic architecture of complex traits. Herein, we present a new computational framework, termed probabilistic natural mapping (PALM), for performing gene-level association tests. PALM robustly reveals the inherent genomic structures of genes and generates feature representations that can be seamlessly incorporated into conventional statistic tests. Our approach substantially improves the effectiveness of uncovering associations derived from a subgroup of variants with weak effects, which represents a known challenge associated with existing methods. We applied PALM in a gastric cancer GWAS and identified two additional gastric cancer-associated susceptibility genes, NOC3L and RUNDC2A. The robust susceptibility discoveries of PALM are widely supported by existing studies from other biological perspectives. PALM will be useful for further GWAS analytical strategies that use gene-level analyses.


Asunto(s)
Biomarcadores de Tumor/genética , Estudio de Asociación del Genoma Completo , Polimorfismo de Nucleótido Simple , Neoplasias Gástricas/genética , Genómica , Genotipo , Humanos , Modelos Genéticos , Fenotipo , Sitios de Carácter Cuantitativo
20.
Biometrics ; 76(1): 23-35, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31424088

RESUMEN

For the etiology, progression, and treatment of complex diseases, gene-environment (G-E) interactions have important implications beyond the main G and E effects. G-E interaction analysis can be more challenging with higher dimensionality and need for accommodating the "main effects, interactions" hierarchy. In recent literature, an array of novel methods, many of which are based on the penalization technique, have been developed. In most of these studies, however, the structures of G measurements, for example, the adjacency structure of single nucleotide polymorphisms (SNPs; attributable to their physical adjacency on the chromosomes) and the network structure of gene expressions (attributable to their coordinated biological functions and correlated measurements) have not been well accommodated. In this study, we develop structured G-E interaction analysis, where such structures are accommodated using penalization for both the main G effects and interactions. Penalization is also applied for regularized estimation and selection. The proposed structured interaction analysis can be effectively realized. It is shown to have consistency properties under high-dimensional settings. Simulations and analysis of GENEVA diabetes data with SNP measurements and TCGA melanoma data with gene expression measurements demonstrate its competitive practical performance.


Asunto(s)
Biometría/métodos , Interacción Gen-Ambiente , Simulación por Computador , Bases de Datos Genéticas/estadística & datos numéricos , Diabetes Mellitus/etiología , Diabetes Mellitus/genética , Redes Reguladoras de Genes , Humanos , Modelos Lineales , Melanoma/etiología , Melanoma/genética , Modelos Genéticos , Polimorfismo de Nucleótido Simple , Neoplasias Cutáneas/etiología , Neoplasias Cutáneas/genética
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