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1.
Artículo en Chino | MEDLINE | ID: mdl-33794633

RESUMEN

Objective:To investigate the clinical characteristics and prognostic factors of esthesioneuroblastoma. Methods:The clinical data of 31 patients with esthesioneuroblastoma were retrospectively studied. Results:The average time from first onset to diagnosis in 31 patients was 7.84 months, among which 3 patients(9.68%) had cervical lymph node metastasis at the first visit. By the end of follow-up, there were 25 coexisting cases and 6 deaths. The mean recurrence time of 6 patients was 10.6 months. There were 6 patients with distant metastasis, including 4 patients with cervical lymph node metastasis, 1 patient with liver metastasis and 1 patient with bone metastasis. Modified Kadish stage, different treatment methods, recurrence, first diagnosis of cervical lymph node metastasis, and distant metastasis were all factors affecting the prognosis of the patients. Conclusion:The incidence of esthesioneuroblastoma is low and the comprehensive treatment of surgery combined with radiotherapy is the optimal treatment plan. Patients with low Kadish staging, surgical combined with radiotherapy, no recurrence, no initial cervical lymph node metastasis, and no distant metastasis have a better prognosis.


Asunto(s)
Estesioneuroblastoma Olfatorio , Neoplasias Nasales , Estesioneuroblastoma Olfatorio/diagnóstico , Estesioneuroblastoma Olfatorio/patología , Estesioneuroblastoma Olfatorio/terapia , Humanos , Ganglios Linfáticos/patología , Cavidad Nasal/patología , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Neoplasias Nasales/diagnóstico , Neoplasias Nasales/patología , Neoplasias Nasales/terapia , Pronóstico , Estudios Retrospectivos
2.
Lancet Oncol ; 22(3): 402-410, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33662287

RESUMEN

BACKGROUND: The international Intermediate Clinical Endpoints in Cancer of the Prostate working group has established metastasis-free survival as a surrogate for overall survival in localised prostate cancer based on the findings of 19 predominantly radiotherapy-based trials. We sought to comprehensively assess aggregate trial-level performance of commonly reported intermediate clinical endpoints across all randomised trials in localised prostate cancer. METHODS: For this meta-analysis, we searched PubMed for all trials in localised or biochemically recurrent prostate cancer published between Jan 1, 1970, and Jan 15, 2020. Eligible trials had to be randomised, therapeutic, reporting overall survival and at least one intermediate clinical endpoint, and with a sample size of at least 70 participants. Trials of metastatic disease were excluded. Intermediate clinical endpoints included biochemical failure, local failure, distant metastases, biochemical failure-free survival, progression-free survival, and metastasis-free survival. Candidacy for surrogacy was assessed using the second condition of the meta-analytical approach (ie, correlation of the treatment effect of the intermediate clinical endpoint and overall survival), using R2 weighted by the inverse variance of the log intermediate clinical endpoint hazard ratio. The intermediate clinical endpoint was deemed to be a surrogate for overall survival if R2 was 0·7 or greater. FINDINGS: 75 trials (53 631 patients) were included in our analysis. Median follow-up was 9·1 years (IQR 5·7-10·6). Biochemical failure (R2 0·38 [95% CI 0·11-0·64]), biochemical failure-free survival (R2 0·12 [0·0030-0·33]), biochemical failure and clinical failure (R2 0·28 [0·0045-0·65]), and local failure (R2 0·085 [0·00-0·37]) correlated poorly with overall survival. Progression-free survival (R2 0·46 [95% CI 0·22-0·67]) showed moderate correlation with overall survival, and metastasis-free survival (R2 0·78 [0·59-0·89]) correlated strongly. INTERPRETATION: Intermediate clinical endpoints based on biochemical and local failure did not meet the second condition of the meta-analytical approach and are not surrogate endpoints for overall survival in localised prostate cancer. Our findings validate metastasis-free survival as the only identified surrogate endpoint for overall survival to date. FUNDING: Prostate Cancer Foundation and National Institutes of Health.


Asunto(s)
Biomarcadores/análisis , Recurrencia Local de Neoplasia/mortalidad , Neoplasias de la Próstata/mortalidad , Anciano , Terapia Combinada , Estudios de Seguimiento , Humanos , Metástasis Linfática , Masculino , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/terapia , Pronóstico , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/terapia , Tasa de Supervivencia
3.
Cancer Radiother ; 25(2): 119-125, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33676829

RESUMEN

PURPOSE: To evaluate the safety and efficacy of Cyberknife® (CK) for the treatment of primary or recurring thymic tumours. MATERIALS AND METHODS: We retrospectively reviewed 12 patients (16 tumour lesions) with primary or recurring thymic tumours who were treated with CK between March 2008 and October 2017. Their data was stored in prospectively collected database. Kaplan-Meier method was used to calculate survival curves. RESULTS: Five patients (41.7%), who had inoperable disease or refused surgery, were treated with CK initially, and 7 patients (58.3%) were treated with CK when they had recurrence diseases. The disease sites treated with CK were primary tumour site (5), regional lymph nodes (4), tumour bed (3), chest wall (2), pleura (1), and bone (1). The median target volume was 43.8 cm3 (range, 13.1-302.5cm3) for the 16 tumour lesions. The median follow-up time was 69.3 months (range, 9.7-124.8 months). The median survival time was 48.2 months, and the 5-year and 10-year OS rates were 68.2% and 45.5%, respectively. A high response rate for the tumour lesions irradiated with CK was obtained. Only one patient (8%) experienced in-field recurrence, and the 5-year local recurrence free survival was 90.9%. A case indicated that CK may induce the abscopal effect, which provides the potential to combine CK and immunotherapy. No severe radiation related toxicities were observed, and no treatment related death occurred. CONCLUSION: CK treatment resulted in good outcomes, particularly local control, with minimal side effects, in highly selected patients with primary and recurring thymic tumours. More studies with larger sample are needed.


Asunto(s)
Recurrencia Local de Neoplasia/radioterapia , Radiocirugia/métodos , Radioterapia Guiada por Imagen/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Timoma/radioterapia , Neoplasias del Timo/radioterapia , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/secundario , Irradiación Linfática , Masculino , Neoplasias del Mediastino/radioterapia , Neoplasias del Mediastino/secundario , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Radiocirugia/efectos adversos , Radioterapia Guiada por Imagen/efectos adversos , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Seguridad , Tasa de Supervivencia , Timoma/mortalidad , Timoma/patología , Timoma/secundario , Neoplasias del Timo/mortalidad , Neoplasias del Timo/patología , Factores de Tiempo
4.
Lancet Oncol ; 22(3): e105-e118, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33662288

RESUMEN

This Policy Review presents the International Myeloma Working Group's clinical practice recommendations for the treatment of relapsed and refractory multiple myeloma. Based on the results of phase 2 and phase 3 trials, these recommendations are proposed for the treatment of patients with relapsed and refractory disease who have received one previous line of therapy, and for patients with relapsed and refractory multiple myeloma who have received two or more previous lines of therapy. These recommendations integrate the issue of drug access in both low-income and middle-income countries and in high-income countries to help guide real-world practice and thus improve patient outcomes.


Asunto(s)
Antineoplásicos/uso terapéutico , Resistencia a Antineoplásicos/efectos de los fármacos , Mieloma Múltiple/tratamiento farmacológico , Recurrencia Local de Neoplasia/tratamiento farmacológico , Guías de Práctica Clínica como Asunto/normas , Terapia Recuperativa , Humanos , Mieloma Múltiple/patología , Recurrencia Local de Neoplasia/patología
5.
Sci Rep ; 11(1): 5282, 2021 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-33674709

RESUMEN

In this study, we evaluated the effectiveness of palliative breast radiation therapy (RT), with single fraction RT compared with fractionated RT. Our study showed that both RT fractionation schemas provide palliation. Single fraction RT allowed for treatment with minimal interference with systemic therapy, whereas fractionated RT provided a more durable palliative response. Due to equivalent palliative response, at our institution we have increasingly been providing single fraction RT palliation during the COVID-19 pandemic.


Asunto(s)
Neoplasias de la Mama/radioterapia , Electrones/uso terapéutico , Recurrencia Local de Neoplasia/radioterapia , Cuidados Paliativos/métodos , Fotones/uso terapéutico , Radiodermatitis/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Mama/patología , Mama/efectos de la radiación , Neoplasias de la Mama/patología , /prevención & control , Fraccionamiento de la Dosis de Radiación , Relación Dosis-Respuesta en la Radiación , Electrones/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Control de Infecciones/normas , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Pandemias/prevención & control , Fotones/efectos adversos , Oncología por Radiación/normas , Radiodermatitis/etiología , Estudios Retrospectivos , Resultado del Tratamiento
6.
Medicine (Baltimore) ; 100(10): e25046, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725888

RESUMEN

RATIONALE: Genotypic and histological evolution of non-small-cell lung cancer (NSCLC) into small-cell lung cancer (SCLC) has been described as a mechanism of acquired resistance to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) therapy. However, the number of clinical cases is rare. PATIENT CONCERNS: Two lung adenocarcinoma patients with EGFR mutations who recurred after radical resection transformed into SCLC under treatment with the sequential first- and third-generation EGFR-TKIs. DIAGNOSIS: The 2 cases were both confirmed as SCLC by pathological rebiopsy after EGFR-TKIs resistance. INTERVENTIONS: Case 1 was treated with etoposide plus cisplatin (EP) regimen and erlotinib, while case 2 was treated with erlotinib and EP followed by oral etoposide. OUTCOMES: Case 1 treated with EP only achieved 3-month progression-free survival (PFS), which is the first case that reported T790 M/C797S cis-mutation for osimertinib resistance before the SCLC transformation. However, case 2 treated with erlotinib and EP followed by oral etoposide, PFS lasted for 8 months. LESSONS: The cases highlighted the importance of rebiopsy that identified pathologically SCLC transformation after EGFR-TKI resistance, and suggested the treatment of erlotinib plus EP followed by etoposide, which could provide a reference for such phenotype.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/terapia , Neoplasias Pulmonares/patología , Recurrencia Local de Neoplasia/terapia , Inhibidores de Proteínas Quinasas/farmacología , Carcinoma Pulmonar de Células Pequeñas/terapia , Acrilamidas/farmacología , Acrilamidas/uso terapéutico , Adulto , Compuestos de Anilina/farmacología , Compuestos de Anilina/uso terapéutico , Biopsia , Carcinoma de Pulmón de Células no Pequeñas/genética , Carcinoma de Pulmón de Células no Pequeñas/patología , Cisplatino/uso terapéutico , Resistencia a Antineoplásicos/efectos de los fármacos , Epirrubicina/uso terapéutico , Receptores ErbB/antagonistas & inhibidores , Receptores ErbB/genética , Clorhidrato de Erlotinib/uso terapéutico , Resultado Fatal , Femenino , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Pulmón/cirugía , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/terapia , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/genética , Recurrencia Local de Neoplasia/patología , Neumonectomía , Inhibidores de Proteínas Quinasas/uso terapéutico , Carcinoma Pulmonar de Células Pequeñas/diagnóstico , Carcinoma Pulmonar de Células Pequeñas/genética , Carcinoma Pulmonar de Células Pequeñas/patología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
7.
BMC Surg ; 21(1): 160, 2021 Mar 23.
Artículo en Inglés | MEDLINE | ID: mdl-33757489

RESUMEN

BACKGROUND: Neoadjuvant chemotherapy (NAC) has been the standard treatment for locally advanced breast cancer for the purpose of downstaging or for conversion from mastectomy to breast conservation surgery (BCS). Locoregional recurrence (LRR) rate is still high after NAC. The aim of this study was to determine predictive factors for LRR in breast cancer patients in association with the operation types after NAC. METHODS: Between 2005 and 2017, 1047 breast cancer patients underwent BCS or mastectomy after NAC in Chang Gung Memorial Hospital, Linkou. We obtained data regarding patient and tumor characteristics, chemotherapy regimens, clinical tumor response, tumor subtypes and pathological complete response (pCR), type of surgery, and recurrence. RESULTS: The median follow-up time was 59.2 months (range 3.13-186.75 months). The mean initial tumor size was 4.89 cm (SD ± 2.95 cm). Of the 1047 NAC patients, 232 (22.2%) achieved pCR. The BCS and mastectomy rates were 41.3% and 58.7%, respectively. One hundred four patients developed LRR (9.9%). Comparing between patients who underwent BCS and those who underwent mastectomy revealed no significant difference in the overall LRR rate of the two groups, 8.8% in BCS group vs 10.7% in mastectomy group (p = 0.303). Multivariate analysis indicated that independent factors for the prediction of LRR included clinical N2 status, negative estrogen receptor (ER), and failure to achieve pCR. In subgroups of multivariate analysis, only negative ER was the independent factor to predict LRR in mastectomy group (p = 0.025) and hormone receptor negative/human epidermal growth factor receptor 2 positive (HR-/HER2 +) subtype (p = 0.006) was an independent factor to predict LRR in BCS patients. Further investigation according to the molecular subtype showed that following BCS, non-pCR group had significantly increased LRR compared with the pCR group, in HR-/HER2 + subtype (25.0% vs 8.3%, p = 0.037), and HR-/HER2- subtype (20.4% vs 0%, p = 0.002). CONCLUSION: Clinical N2 status, negative ER, and failure to achieve pCR after NAC were independently related to the risk of developing LRR. Operation type did not impact on the LRR. In addition, the LRR rate was higher in non-pCR hormone receptor-negative patients undergoing BCS comparing with pCR patients.


Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Mastectomía , Terapia Neoadyuvante/efectos adversos , Recurrencia Local de Neoplasia/patología , Neoplasias de la Mama/tratamiento farmacológico , Quimioterapia Adyuvante , Femenino , Humanos , Terapia Neoadyuvante/métodos , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/cirugía , Receptor ErbB-2/uso terapéutico , Receptores Estrogénicos/uso terapéutico , Estudios Retrospectivos
8.
Zhonghua Zhong Liu Za Zhi ; 43(3): 345-350, 2021 Mar 23.
Artículo en Chino | MEDLINE | ID: mdl-33752316

RESUMEN

Objective: To analyze the clinicopathological features and prognostic factors of patients with uterine clear cell carcinoma (UCCC). Methods: UCCC patients who underwent surgery and complete follow-up at Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between January 1, 2004 and December 31, 2014 were retrospectively reviewed. The Kaplan-Meier method and Cox regression analysis were used for survival analysis. Results: The study included 34 patients. Only 18 patients (52.9%) were diagnosed with UCCC preoperatively and 8 patients (23.5%) underwent UCCC standard comprehensive staging surgery. Among the 34 patients, stage ⅠA was 17 cases (50.0%), stage ⅠB was 1 case (2.9%), stage Ⅱ was 4 cases (11.8%), stage ⅢA was 2 cases (5.9%), stage ⅢB was 1 case (2.9%), stage ⅢC1 was 5 cases (14.7%) and stage ⅣB was 4 cases (11.8%). The median follow-up period was 72 months, 5-years disease-free survival (DFS) rate and overall survival (OS) rates for all patients were 79.1% and 81.3%, respectively. Univariate analysis result showed that preoperative CA125 level, range of lymphadenectomy, tumor stage and peritoneal cytology were significantly associated with DFS (P<0.05). Preoperative CA125 level, range of lymphadenectomy, tumor stage, peritoneal cytology and lymph vascular space invasion were significantly associated with OS (P<0.05). Multivariate analysis result showed that peritoneal cytology was the only independent prognostic factor for DFS, the relapse risk of peritoneal cytology positive patients was 11.47 folds higher than that of the negative patients (P=0.009). Tumor stage was the only independent prognostic factor for OS, the death risk of ⅣB stage patients was 25.29 folds higher than that of theⅠA stage (P=0.009). Conclusions: The preoperative pathological diagnosis of UCCC is difficult, which results in incomplete surgical staging. Peritoneal cytology and tumor stage are independent prognostic factors for DFS and OS of UCCC patients, which deserve much more attention in clinical practice.


Asunto(s)
Neoplasias Uterinas , Supervivencia sin Enfermedad , Femenino , Humanos , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia , Neoplasias Uterinas/cirugía
9.
Bone Joint J ; 103-B(3): 562-568, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33641425

RESUMEN

METHODS: A multicentre retrospective study was carried out at two tertiary sarcoma centres. A database search identified all patients with a CS treated between January 1995 and January 2018. There were 810 CSs of which 76 (9.4%) were located in the fingers, toes, metacarpals, and metatarsal bones. RESULTS: The median age of the study population was 55 years (36 to 68) with a median follow-up of 52 months (22 to 87) months. Overall, 70% of the tumours were in the hand (n = 54) and 30% in the foot (n = 22). Predictors for LR were margin (p = 0.011), anatomical location (p = 0.017), and method of surgical management (p = 0.003). Anatomical location (p = 0.026), histological grade between 1 and 3 (p = 0.004) or 2 and 3 (p = 0.016), and surgical management (p = 0.001) were significant factors for LR-free survival. Disease-specific survival was affected by histological grade (p < 0.001), but not by LR (p = 0.397). CONCLUSION: Intralesional curettage of a low-grade CS is associated with an increased risk of LR, but LR does not affect disease-specific survival. Therefore, for low-grade CSs of the hands and feet, surgical management should aim to preserve function. In grade 2 CS, our study did not show any decreased disease-specific survival after recurrence; however, we suggest a more aggressive surgical approach to these tumours to prevent local recurrence, especially in the metacarpal and metatarsal bones. In high-grade tumours, the incidence of progressive disease is high and, therefore, the treatment of the primary tumour should be aggressive where possible, and patients observed closely for the development of metastatic disease. Cite this article: Bone Joint J 2021;103-B(3):562-568.


Asunto(s)
Neoplasias Óseas/cirugía , Condrosarcoma/cirugía , Pie , Mano , Adulto , Anciano , Neoplasias Óseas/patología , Condrosarcoma/patología , Legrado , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Recurrencia Local de Neoplasia/patología , Pronóstico , Estudios Retrospectivos
10.
Medicine (Baltimore) ; 100(8): e24555, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663063

RESUMEN

ABSTRACT: Some nasopharyngeal carcinoma (NPC) patients may present convincing radiological evidence mimicking residual or recurrent tumor after radiotherapy. However, by means of biopsies and long term follow-up, the radiologically diagnosed residuals/recurrences are not always what they appear to be. We report our experience on this "phantom tumor" phenomenon. This may help to avoid the unnecessary and devastating re-irradiation subsequent to the incorrect diagnosis.In this longitudinal cohort study, we collected 19 patients of image-based diagnosis of residual/recurrent NPC during the period from Feb, 2010 to Nov. 2016, and then observed them until June, 2019. They were subsequently confirmed to have no residual/recurrent lesions by histological or clinical measures. Image findings and pathological features were analyzed.Six patients showed residual tumors after completion of radiotherapy and 13 were radiologically diagnosed to have recurrences based on magnetic resonance imaging (MRI) criteria 6 to 206 months after radiotherapy. There were 3 types of image patterns: extensive recurrent skull base lesions (10/19); a persistent or residual primary lesion (3/19); lesions both in the nasopharynx and skull base (6/19). Fourteen patients had biopsy of the lesions. The histological diagnoses included necrosis/ inflammation in 10 (52.7%), granulation tissue with inflammation in 2, and reactive epithelial cell in 1. Five patients had no pathological proof and were judged to have no real recurrence/residual tumor based on the absence of detectable plasma EB virus DNA and subjective judgment. These 5 patients have remained well after an interval of 38-121 months without anti-cancer treatments.Image-based diagnosis of residual or recurrent nasopharyngeal carcinoma may be unreliable. False positivity, the "phantom tumor phenomenon", is not uncommon in post-radiotherapy MRI. This is particularly true if the images show extensive skull base involvement at 5 years or more after completion of radiotherapy. MRI findings compatible with NPC features must be treated as a real threat until proved otherwise. However, the balance between under- and over-diagnosis must be carefully sought. Without a pathological confirmation, the diagnosis of residual or recurrent NPC must be made taking into account physical examination results, endoscopic findings and Epstein-Barr virus viral load. A subjective medical judgment is needed based on clinical and laboratory data and the unique anatomic complexities of the nasopharynx.


Asunto(s)
Carcinoma Nasofaríngeo/diagnóstico por imagen , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/diagnóstico por imagen , Neoplasias Nasofaríngeas/radioterapia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Femenino , Herpesvirus Humano 4/genética , Humanos , Estudios Longitudinales , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Carcinoma Nasofaríngeo/patología , Carcinoma Nasofaríngeo/terapia , Neoplasias Nasofaríngeas/patología , Neoplasias Nasofaríngeas/terapia , Terapia Neoadyuvante/métodos , Recurrencia Local de Neoplasia/patología , Neoplasia Residual/patología , Carga Viral
11.
J Surg Oncol ; 123(5): 1263-1273, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33524184

RESUMEN

BACKGROUND: The association between the imaging response (structural or metabolic) to neoadjuvant chemotherapy (neoCT) before colorectal liver metastasis (CRLM) and survival is unclear. METHOD: A total of 201 patients underwent their first CRLM resection. A total of 94 (47%) patients were treated with neoCT. A multivariable, Cox proportional hazard regression analysis was performed to compare overall survival (OS) and progression-free survival (PFS) between response groups. RESULTS: Multivariable regression analysis of the CT/MRI (n = 94) group showed no difference in survival (OS and PFS) in patients who had stable disease/partial response (SD/PR) or complete response (CR) versus patients who had progressive disease (PD) (OS: HR, 0.36 (95% CI: 0.11-1.19) p = .094, HR, 0.78 (95% CI: 0.13-4.50) p = .780, respectively), (PFS: HR, 0.70 (95% CI: 0.36-1.35) p = .284, HR, 0.51 (0.18-1.45) p = .203, respectively). In the FDG-PET group (n = 60) there was no difference in the hazard of death for patients with SD/PR or CR versus patients with PD for OS or PFS except for the PFS in the small CR subgroup (OS: HR, 0.75 (95% CI: 0.11-4.88) p = .759, HR, 1.21 (95% CI: 0.15-9.43) p = .857), (PFS: HR, 0.34% (95% CI: 0.09-1.22), p = .097, HR, 0.17 (95% CI: 0.04-0.62) p = .008, respectively). CONCLUSION: There was no convincing evidence of association between imaging response to neoCT and survival following CRLM resection.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia Adyuvante/mortalidad , Neoplasias Colorrectales/mortalidad , Neoplasias Hepáticas/mortalidad , Terapia Neoadyuvante/mortalidad , Recurrencia Local de Neoplasia/mortalidad , Tomografía de Emisión de Positrones/métodos , Neoplasias Colorrectales/diagnóstico por imagen , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/patología , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/patología , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia
12.
J Surg Oncol ; 123(5): 1253-1262, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33524213

RESUMEN

BACKGROUND AND OBJECTIVES: In this retrospective study, we examined the CA17 tissue expression and analyzed its clinical significance in cholangiocarcinoma (CCA). MATERIALS AND METHODS: Immunohistochemistry was performed to assess CA17 expression on tissue microarrays in a training cohort enrolling 120 CCA patients and a validation cohort comprising 60 CCA patients. Image pro plus was applied to score the staining intensity and expression level of CA17 marker. Kaplan-Meier analysis, Cox's proportional hazards regression, and nomogram were applied to evaluate the prognostic significance of CA17. RESULTS: CA17 cancer biomarker over-expression was significantly observed in CCA compared to their non-tumor counterparts, and positively correlated with aggressive tumor phenotypes, like lymph node metastasis. Meanwhile, patients with high expression of CA17 correlated with worse postoperative overall survival (OS) and recurrence-free survival. Besides, multivariate analysis identified that CA17 expression was an independent prognostic factor for cholangiocarcinoma patients, which indicated that the CA17 could be more efficient than serum CA19-9 in predicting the OS of CCA patients. Notably, the nomogram integrating CA17 expression had better prognostic performance as compared with current TNM staging systems. CONCLUSION: CA17 was an independent adverse prognostic factor for CCA patients' survival, which may serve as a promising prognostic biomarker for CCA patients.


Asunto(s)
Neoplasias de los Conductos Biliares/patología , Biomarcadores de Tumor/metabolismo , Cadherinas/metabolismo , Colangiocarcinoma/patología , Recurrencia Local de Neoplasia/patología , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de los Conductos Biliares/metabolismo , Neoplasias de los Conductos Biliares/cirugía , Colangiocarcinoma/metabolismo , Colangiocarcinoma/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/metabolismo , Recurrencia Local de Neoplasia/cirugía , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia
13.
Medicine (Baltimore) ; 100(7): e24767, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607825

RESUMEN

ABSTRACT: Cutaneous squamous cell carcinoma usually extends beyond the visible margin. Little is known about the predictors for cutaneous squamous cell carcinoma with subclinical extension in Chinese individuals. This study aimed to construct a nomogram for predicting the probability of subclinical extension of cutaneous squamous cell carcinoma in Chinese patients.A retrospective analysis was conducted using data from Mohs micrographic surgery-treated cutaneous squamous cell carcinoma patients at a single institution between December 1, 2009 and October 31, 2019. Subclinical extension was defined as a lesion requiring ≥ 2 Mohs stages or with final safe margins of ≥ 5 mm. A nomogram predicting the probability of subclinical extension was constructed using the predictors identified in multivariable analysis.Of 274 patients included, 119 (43.4%) had subclinical extension. In multivariable analysis, male sex (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.40-4.29; P = .002), lesions on mucocutaneous areas (OR, 3.71; 95% CI, 1.34-10.32; P = .012) and extremities (OR, 2.40; 95% CI, 1.20-4.78; P = .013), maximum diameter of 10 to 19 mm (OR, 14.15; 95% CI, 4.24-47.28; P < .001), and 20 to 29 mm (OR, 9.21; 95% CI, 2.80-30.29; P < .001) were associated with subclinical extension. A nomogram incorporating these 3 variables demonstrated promising predictive ability (C statistics = 0.78; 95% CI, 0.67-0.89).The nomogram incorporating sex, tumor location, and maximum diameter can provide individualized prediction for subclinical extension in Chinese patients with cutaneous squamous cell carcinoma. This information may help surgeons determine appropriate margins at the first Mohs stage.


Asunto(s)
Carcinoma de Células Escamosas/cirugía , Márgenes de Escisión , Cirugía de Mohs/métodos , Nomogramas , Neoplasias Cutáneas/cirugía , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Estudios de Casos y Controles , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Cutáneas/patología
14.
Yonsei Med J ; 62(3): 231-239, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33635013

RESUMEN

PURPOSE: To determine whether the prognostic impact of lymph node ratio (LNR), defined as the ratio between the number of positive lymph nodes and removed lymph nodes, differs between open and minimally invasive surgical approaches for radical hysterectomy (RH) in node-positive, early-stage cervical cancer. MATERIALS AND METHODS: We retrospectively identified 2009 International Federation of Gynecology and Obstetrics stage IB1-IIA2 patients who underwent primary type C RH between 2010 and 2018. Among them, only those with pathologically proven lymph node metastases who received adjuvant radiation therapy were included. The prognostic significance of LNR was investigated according to open surgery and minimally invasive surgery (MIS). RESULTS: In total, 55 patients were included. The median LNR (%) was 9.524 (range, 2.083-62.500). Based on receiver operating characteristic curve analysis, the cut-off value for LNR (%) was determined as 8.831. Overall, patients with high LNR (≥8.831%; n=29) showed worse disease-free survival (DFS) than those with low LNR (<8.831%, n=26) (p=0.027), whereas no difference in overall survival was observed. Multivariate analyses adjusting for clinicopathologic factors revealed that DFS was adversely affected by both MIS [adjusted hazard ratio (HR), 8.132; p=0.038] and high LNR (adjusted HR, 10.837; p=0.045). In a subgroup of open surgery cases, LNR was not associated with disease recurrence. However, in a subgroup of MIS cases, high LNR was identified as an independent poor prognostic factor for DFS (adjusted HR, 14.578; p=0.034). CONCLUSION: In patients with node-positive, early-stage cervical cancer, high LNR was associated with a significantly higher disease recurrence rate. This relationship was further consolidated among patients who received MIS RH.


Asunto(s)
Histerectomía , Índice Ganglionar , Procedimientos Quirúrgicos Mínimamente Invasivos , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/cirugía , Adulto , Anciano , Supervivencia sin Enfermedad , Femenino , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática/patología , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Neoplasias del Cuello Uterino/diagnóstico
15.
Nat Med ; 27(2): 301-309, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33558722

RESUMEN

The association among pathological response, recurrence-free survival (RFS) and overall survival (OS) with neoadjuvant therapy in melanoma remains unclear. In this study, we pooled data from six clinical trials of anti-PD-1-based immunotherapy or BRAF/MEK targeted therapy. In total, 192 patients were included; 141 received immunotherapy (104, combination of ipilimumab and nivolumab; 37, anti-PD-1 monotherapy), and 51 received targeted therapy. A pathological complete response (pCR) occurred in 40% of patients: 47% with targeted therapy and 33% with immunotherapy (43% combination and 20% monotherapy). pCR correlated with improved RFS (pCR 2-year 89% versus no pCR 50%, P < 0.001) and OS (pCR 2-year OS 95% versus no pCR 83%, P = 0.027). In patients with pCR, near pCR or partial pathological response with immunotherapy, very few relapses were seen (2-year RFS 96%), and, at this writing, no patient has died from melanoma, whereas, even with pCR from targeted therapy, the 2-year RFS was only 79%, and OS was only 91%. Pathological response should be an early surrogate endpoint for clinical trials and a new benchmark for development and approval in melanoma.


Asunto(s)
Melanoma/tratamiento farmacológico , Recurrencia Local de Neoplasia/tratamiento farmacológico , Proteínas Proto-Oncogénicas B-raf/genética , Neoplasias Cutáneas/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Supervivencia sin Enfermedad , Femenino , Humanos , Inmunoterapia/efectos adversos , Ipilimumab/administración & dosificación , Ipilimumab/efectos adversos , Masculino , Melanoma/genética , Melanoma/inmunología , Melanoma/patología , Persona de Mediana Edad , Terapia Molecular Dirigida , Terapia Neoadyuvante/efectos adversos , Recurrencia Local de Neoplasia/genética , Recurrencia Local de Neoplasia/inmunología , Recurrencia Local de Neoplasia/patología , Nivolumab/administración & dosificación , Nivolumab/efectos adversos , Receptor de Muerte Celular Programada 1/antagonistas & inhibidores , Receptor de Muerte Celular Programada 1/genética , Neoplasias Cutáneas/genética , Neoplasias Cutáneas/inmunología , Neoplasias Cutáneas/patología , Adulto Joven
16.
J Cancer Res Clin Oncol ; 147(5): 1341-1354, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33635431

RESUMEN

PURPOSE: The present study was conducted to clarify the clinicopathological impacts of DNA methylation alterations on pancreatic ductal adenocarcinoma (PDAC). METHODS: Genome-wide DNA methylation screening was performed using the Infinium HumanMethylation450 BeadChip, and DNA methylation quantification was verified using pyrosequencing. We analyzed fresh-frozen tissues from an initial cohort (17 samples of normal control pancreatic tissue [C] from 17 patients without PDAC, and 34 samples of non-cancerous pancreatic tissue [N] and 82 samples of cancerous tissue [T] both obtained from 82 PDAC patients) and formalin-fixed paraffin-embedded T samples from 34 patients in a validation cohort. RESULTS: The DNA methylation profiles of N samples tended to differ from those of C samples, and 91,907 probes showed significant differences in DNA methylation levels between C and T samples. Epigenetic clustering of T samples was significantly correlated with a larger tumor diameter and early recurrence (ER), defined as relapse within 6 months after surgery. Three marker CpG sites, applicable to formalin-fixed paraffin-embedded surgically resected materials regardless of their tumor cell content, were identified for prediction of ER. The sensitivity and specificity for detection of patients belonging to the ER group using a panel combining these three marker CpG sites, including a CpG site in the CDK14 gene, were 81.8% and 71.7% and 88.9% and 70.4% in the initial and validation cohorts, respectively. CONCLUSION: These findings indicate that DNA methylation alterations may have a clinicopathological impact on PDAC. Application of our criteria will ultimately allow prediction of ER after surgery to improve the outcome of PDAC patients.


Asunto(s)
Carcinoma Ductal Pancreático/genética , Carcinoma Ductal Pancreático/patología , Metilación de ADN/genética , Recurrencia Local de Neoplasia/genética , Recurrencia Local de Neoplasia/patología , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/patología , Biomarcadores de Tumor/genética , Estudios de Cohortes , Islas de CpG/genética , Quinasas Ciclina-Dependientes/genética , Epigénesis Genética/genética , Femenino , Estudio de Asociación del Genoma Completo/métodos , Humanos , Masculino , Adhesión en Parafina/métodos , Fijación del Tejido/métodos
17.
Lancet Oncol ; 22(2): 246-255, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33539743

RESUMEN

BACKGROUND: Two radiotherapy fractionation schedules are used to treat locally advanced bladder cancer: 64 Gy in 32 fractions over 6·5 weeks and a hypofractionated schedule of 55 Gy in 20 fractions over 4 weeks. Long-term outcomes of these schedules in several cohort studies and case series suggest that response, survival, and toxicity are similar, but no direct comparison has been published. The present study aimed to assess the non-inferiority of 55 Gy in 20 fractions to 64 Gy in 32 fractions in terms of invasive locoregional control and late toxicity in patients with locally advanced bladder cancer. METHODS: We did a meta-analysis of individual patient data from patients (age ≥18 years) with locally advanced bladder cancer (T1G3 [high-grade non-muscle invasive] or T2-T4, N0M0) enrolled in two multicentre, randomised, controlled, phase 3 trials done in the UK: BC2001 (NCT00024349; assessing addition of chemotherapy to radiotherapy) and BCON (NCT00033436; assessing hypoxia-modifying therapy combined with radiotherapy). In each trial, the fractionation schedule was chosen according to local standard practice. Co-primary endpoints were invasive locoregional control (non-inferiority margin hazard ratio [HR]=1·25); and late bladder or rectum toxicity, assessed with the Late Effects Normal Tissue Task Force-Subjective, Objective, Management, Analytic tool (non-inferiority margin for absolute risk difference [RD]=10%). If non-inferiority was met for invasive locoregional control, superiority could be considered if the 95% CI for the treatment effect excluded the null effect (HR=1). One-stage individual patient data meta-analysis models for the time-to-event and binary outcomes were used, accounting for trial differences, within-centre correlation, randomised treatment received, baseline variable imbalances, and potential confounding from relevant prognostic factors. FINDINGS: 782 patients with known fractionation schedules (456 from the BC2001 trial and 326 from the BCON trial; 376 (48%) received 64 Gy in 32 fractions and 406 (52%) received 55 Gy in 20 fractions) were included in our meta-analysis. Median follow-up was 120 months (IQR 99-159). Patients who received 55 Gy in 20 fractions had a lower risk of invasive locoregional recurrence than those who received 64 Gy in 32 fractions (adjusted HR 0·71 [95% CI 0·52-0·96]). Both schedules had similar toxicity profiles (adjusted RD -3·37% [95% CI -11·85 to 5·10]). INTERPRETATION: A hypofractionated schedule of 55 Gy in 20 fractions is non-inferior to 64 Gy in 32 fractions with regard to both invasive locoregional control and toxicity, and is superior with regard to invasive locoregional control. 55 Gy in 20 fractions should be adopted as a standard of care for bladder preservation in patients with locally advanced bladder cancer. FUNDING: Cancer Research UK.


Asunto(s)
Fraccionamiento de la Dosis de Radiación , Recurrencia Local de Neoplasia/radioterapia , Hipofraccionamiento de la Dosis de Radiación/normas , Neoplasias de la Vejiga Urinaria/radioterapia , Supervivencia sin Enfermedad , Humanos , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/patología , Factores de Riesgo , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/epidemiología , Neoplasias de la Vejiga Urinaria/patología
18.
Medicine (Baltimore) ; 100(6): e24711, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578611

RESUMEN

RATIONALE: Recurrent liposarcoma, previously confirmed as lipoma, has rarely been reported. However, the risk factors for recurrence and the correlation between benign lipoma and malignant liposarcoma remain unclear. In this case study, we suggest a precise diagnostic strategy to minimize recurrence and malignant transformation. PATIENT CONCERNS: A 60-year-old male patient with a history of left chest wall swelling without any symptoms underwent excisional surgery, and the mass was confirmed as a benign lipoma in 2015. In 2019, the patient returned to the hospital with symptoms of a palpable mass on the left chest wall. DIAGNOSIS: The mass was considered a recurrent lipomatous tumor with the possibility of malignant transformation. Magnetic resonance imaging (MRI) revealed a deep-seated, septate, intramuscular, irregular margin, and large lipomatous tumor invading the ribs, pleura, and adjacent muscle, suggestive of malignancy. The MRI findings were similar to those 4 years ago, except for margin irregularity and invasion to adjacent tissue. INTERVENTIONS: Wide en bloc excisions encompassing the 5th to 7th ribs, pleura, and adjacent muscle were followed by reconstruction with a pedicled latissimus dorsi muscle flap. OUTCOMES: The recurrent large lipomatous tumor was confirmed as well-differentiated liposarcomas through histological and MDM2-FISH immunohistochemical staining. Postoperatively, follow-up visits continued for 1.5 years without recurrence. LESSONS: We suggest that deep-seated, septate, and giant lipomatous tumors should be considered as risk factors for recurrence with the possibility of malignancy and misdiagnosis. It is important to inform patients of all these possibilities and plan close and long-term follow-up.


Asunto(s)
Lipoma/patología , Liposarcoma/patología , Recurrencia Local de Neoplasia/patología , Neoplasias Torácicas/patología , Pared Torácica/patología , Humanos , Lipoma/diagnóstico por imagen , Lipoma/cirugía , Liposarcoma/diagnóstico por imagen , Liposarcoma/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/cirugía , Neoplasias Torácicas/diagnóstico por imagen , Neoplasias Torácicas/cirugía , Pared Torácica/diagnóstico por imagen , Pared Torácica/cirugía
19.
J Surg Oncol ; 123(2): 622-629, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33616972

RESUMEN

BACKGROUND: A subset of metachronous colon cancer recurrence manifests as peritoneal metastases (PM). Risk factors for metachronous PM recurrence are not well-defined in patients with stage II or III colon cancers after curative resection and standard adjuvant treatments. METHODS: Population data from the California Cancer Registry for patients with Stage II or III colon cancer were collected between 2004 and 2012. Multivariate analysis was used to identify factors associated with metachronous PM. RESULTS: Of the 2077 patients with stage II or III colon cancer, female patients (odds ratio [OR] = 1.84, p = 0.02), T4 primary tumor (OR = 2.36, p = 0.02), mucinous (OR = 3.97, p < 0.01) or signet-ring histology (OR = 6.01, p = 0.01), and right-sided cancer (OR = 2.2, p < 0.01) were found with increased risk of metachronous isolated PM recurrence after curative resection. Median survival after diagnosis for patients without PM recurrence was 22 months, compared with 12 months for PM recurrence (p < 0.001). CONCLUSION: PM recurrence groups have a worse overall survival than patients with recurrent disease in other sites. A better understanding of the tumor biology and molecular characteristics of colon cancers likely to recur as PM is needed to explain behavior and identify potential targeted therapy.


Asunto(s)
Colectomía/efectos adversos , Neoplasias del Colon/cirugía , Recurrencia Local de Neoplasia/patología , Neoplasias Primarias Secundarias/secundario , Neoplasias Peritoneales/secundario , Anciano , Neoplasias del Colon/patología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Estadificación de Neoplasias , Neoplasias Primarias Secundarias/epidemiología , Neoplasias Peritoneales/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia
20.
Lancet Oncol ; 22(3): 381-390, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33600761

RESUMEN

BACKGROUND: The role of surgery compared with reirradiation in the primary treatment of patients with resectable, locally recurrent nasopharyngeal carcinoma (NPC) who have previously received radiotherapy is a matter of debate. In this trial, we compared the efficacy and safety outcomes of salvage endoscopic surgery versus intensity-modulated radiotherapy (IMRT) in patients with resectable locally recurrent NPC. METHODS: This multicentre, open-label, randomised, controlled, phase 3 trial was done in three hospitals in southern China. We included patients aged 18-70 years with a Karnofsky Performance Status score of at least 70 who were histopathologically diagnosed with undifferentiated or differentiated, non-keratinising, locally recurrent NPC with tumours confined to the nasopharyngeal cavity, the post-naris or nasal septum, the superficial parapharyngeal space, or the base wall of the sphenoid sinus. Eligible patients were randomly assigned (1:1) to receive either endoscopic nasopharyngectomy (ENPG group) or IMRT (IMRT group). Randomisation was done manually using a computer-generated random number code and patients were stratified by treatment centre. Treatment group assignment was not masked. The primary endpoint was overall survival, compared between the groups at 3 years. Efficacy analyses were done by intention to treat. Safety analysis was done in patients who received treatment according to the treatment they actually received. This trial was prospectively registered at the Chinese Clinical Trial Registry, ChiCTR-TRC-11001573, and is currently in follow-up. FINDINGS: Between Sept 30, 2011, and Jan 16, 2017, 200 eligible patients were randomly assigned to receive either ENPG (n=100) or IMRT (n=100). At a median follow-up of 56·0 months (IQR 42·0-69·0), 74 patients had died (29 [29%] of 100 patients in the ENPG group and 45 [45%] of 100 patients in the IMRT group). The 3-year overall survival was 85·8% (95% CI 78·9-92·7) in the ENPG group and 68·0% (58·6-77·4) in the IMRT group (hazard ratio 0·47, 95% CI 0·29-0·76; p=0·0015). The most common grade 3 or worse radiation-related late adverse event was pharyngeal mucositis (in five [5%] of 99 patients who underwent ENPG and 26 [26%] of 101 patients who underwent IMRT). Five [5%] of the 99 patients who underwent ENPG and 20 [20%] of the 101 patients who underwent IMRT died due to late toxic effects specific to radiotherapy; attribution to previous radiotherapy or trial radiotherapy is unclear due to the long-term nature of radiation-related toxicity. INTERPRETATION: Endoscopic surgery significantly improved overall survival compared with IMRT in patients with resectable locally recurrent NPC. These results suggest that ENPG could be considered as the standard treatment option for this patient population, although long-term follow-up is needed to further determine the efficacy and toxicity of this strategy. FUNDING: Sun Yat-sen University Clinical Research 5010 Program.


Asunto(s)
Carcinoma Nasofaríngeo/mortalidad , Neoplasias Nasofaríngeas/mortalidad , Cirugía Endoscópica por Orificios Naturales/mortalidad , Recurrencia Local de Neoplasia/mortalidad , Radioterapia de Intensidad Modulada/mortalidad , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Carcinoma Nasofaríngeo/patología , Carcinoma Nasofaríngeo/radioterapia , Carcinoma Nasofaríngeo/cirugía , Neoplasias Nasofaríngeas/patología , Neoplasias Nasofaríngeas/radioterapia , Neoplasias Nasofaríngeas/cirugía , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/radioterapia , Recurrencia Local de Neoplasia/cirugía , Pronóstico , Tasa de Supervivencia
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