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Survival following breast-conserving therapy is equal to that following mastectomy in young women with early-stage invasive lobular carcinoma

第一作者:Yu, TJ

期刊: EJSO, 2018; 44 (无)

Background: Previous observational studies reported the superior survival of patients with early-stage breast cancer who underwent breast-conserving therapy (BCT, lumpectomy plus postsurgical radiation) compared to that of those who underwent mastectomy. Invasive lobular carcinoma (ILC) is not the same disease as invasive ductal carcinoma (IDC) as it has distinct biologic features and thus requires unique consideration and research. Methods: We selected women (<= 50 years of age) from the Surveillance, Epidemiology, and End Results (SEER) database diagnosed with stage T1-2, NO-1, MO primary breast cancer with invasive lobular features between 1998 and 2011, that were treated with either BCT or mastectomy with and without radiation. We assessed survival proportions using the Kaplan-Meier method and hazard ratios using Cox proportional hazards models. Breast cancer-specific survival (BCSS) served as the primary endpoint. Results: A total of 3393 eligible young ILC patients were identified, 1391 (41%) of which underwent lumpectomy followed by radiation. The 10-year BCSS rates for patients who received BCT, mastectomy alone and mastectomy with radiation were 95.7%, 94.2% and 89.3%, respectively. Multivariate analysis showed that BCSS was not improved in patients assigned to mastectomy alone group (HR = 0.86; 95% CI 0.57-1.28) or mastectomy with postsurgical radiation group (HR = 0.97; 95% CI 0.58-1.62) compared to that in those who underwent BCT. The results did not changed when evaluating the 1998-2004 and 2005-2011 time periods separately. Conclusion: None of the treatment demonstrated an absolute superiority in young women with early stage ILC. Future studies with more detailed analyses of the confounding factors are worthwhile. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

IF:3.38

Treatment efficacy between total thyroidectomy and lobectomy for patients with papillary thyroid microcarcinoma: A systemic review and meta-analysis

第一作者:Zheng, WP

期刊: EJSO, 2018; 44 (无)

Introduction: This systemic review and meta-analysis was to determine whether the recurrence and mortality rates in papillary thyroid microcarcinoma (PTMC) patients were lower when treated with total thyroidectomy (TT) compared to thyroid lobectomy (TL). Methods: Using PubMed, Cochrane library and EMBASE databases, we conducted a meta-analysis to assess the clinical outcomes in patients with PTMC based on surgical mode. The relative risk (RR) and 95% confidence interval (CI) were calculated for this meta-analysis. Results: A total of 11 cohort studies that comprised of 13,801 patients met the inclusion criteria for this systematic review and meta-analysis. Overall, low recurrence rates were observed in the TT group compared to the TL group (RR = 0.57, 95% CI = 0.35 to 0.94, P-heterogeneity = 0.002,I-2 = 65.2%), however, no significant differences were observed between the two surgical methods for mortality rates (RR = 0.84, 95% CI = 0.27 to 2.54, Pheterogeneity = 0.023, 12 = 68.5%). For subgroup analysis based on country and sample size, no significant differences were observed between the two groups for recurrence rates. Conclusion: Our meta-analysis indicates that patients who underwent thyroid lobectomy had an increased risk of recurrence but not mortality compared to patients who had total thyroidectomy for papillary thyroid microcarcinoma. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

IF:3.38

Comparison of preoperative concurrent chemoradiotherapy with chemotherapy alone in patients with locally advanced siewert II and III adenocarcinoma of the esophagogastric junction

第一作者:Ge, XK

期刊: EJSO, 2018; 44 (无)

Purpose: Preoperative therapy improves overall survival (OS) after surgery in patients with adenocarcinoma of the esophagogastric junction (AEG). We aimed to retrospectively analyze whether preoperative chemoradiotherapy (CRT) could improve the prognosis of patients with locally advanced Siewert II and III AEG comparing with preoperative chemotherapy alone (CT). Patients and methods: From March 2012 to December 2015, 170 patients with locally advanced (cT3-4NxM0) Siewert II and Ill AEG were treated with preoperative CRT or CT in Hebei Medical University Fourth Hospital, and 123 patients were included in this study to compare the effects of preoperative CRT with CT. Results: RO resection rate was 96.7% in CRT group and 82.5% in CT group (P = .016). The pathological complete response was 16.7% after CRT group and 3.2% after CT (P = .015). The median follow-up time was 20 months. The 1- and 3-year OS were 89.4%, 79.2% in CRT group and 88.2%, 58.0% in CT group (P = .016; HR = 0.40, 95% confidence interval 0.21-0.76). The 1- and 3-year PFS were 87.3%, 73.5% in CRT group and 72.8%, 42.8% in CT group (P = .014; HR = 0.46, 95% confidence interval 0.24-0.86). Multivariate analysis showed that clinical T stage, adjuvant chemotherapy cycles and histologic differentiation were shown to be the independent prognostic factors for OS, and postoperative pathologic N stage was shown to be the independent prognostic factor for PFS. Conclusion: For the patients with locally advanced AEG, the addition of radiotherapy to preoperative chemotherapy can improve survival with safety, but is not an independent prognostic factor for OS and PFS. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

IF:3.38

The development and validation of a novel model for predicting surgical complications in colorectal cancer of elderly patients: Results from 1008 cases

第一作者:Shen, ZL

期刊: EJSO, 2018; 44 (无)

Objective: To establish predicting models of surgical complications in elderly colorectal cancer patients. Background: Surgical complications are usually critical and lethal in the elderly patients. However, none of the current models are specifically designed to predict surgical complications in elderly colorectal cancer patients. Methods: Details of 1008 cases of elderly colorectal cancer patients (age >= 65) were collected retrospectively from January 1998 to December 2013. Seventy-six clinicopathological variables which might affect postoperative complications in elderly patients were recorded. Multivariate stepwise logistic regression analysis was used to develop the risk model equations. The performance of the developed model was evaluated by measures of calibration (Hosmer-Lemeshow test) and discrimination (the area under the receiver-operator characteristic curve, AUC). Results: The AUC of our established Surgical Complication Score for Elderly Colorectal Cancer patients (SCSECC) model was 0.743 (sensitivity, 82.1%; specificity, 78.3%). There was no significant discrepancy between observed and predicted incidence rates of surgical complications (AUC, 0.820; P = .812). The Surgical Site Infection Score for Elderly Colorectal Cancer patients (SSISECC) model showed significantly better prediction power compared to the National Nosocomial Infections Surveillance index (NNIS) (AUC, 0.732; P < 0.001) and Efficacy of Nosocomial Infection Control index (SENIC) (AUC; 0.686; P < 0.001) models. Conclusions: The SCSECC and SSISECC models show good prediction power for postoperative surgical complication morbidity and surgical site infection in elderly colorectal cancer patients. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

IF:3.38

Clinicopathologic features and prognoses of different histologic types of triple-negative breast cancer: A large population-based analysis

第一作者:Zhao, S

期刊: EJSO, 2018; 44 (无)

Purpose: To examine the clinicopathologic characteristics and survival outcomes of different histologic types of triple-negative breast cancer (TNBC). Methods: We used the SEER database to identify patients with TNBC diagnosed between 2010 and 2014. Our analysis focused on the seven most prevalent histologic types. Differences were compared between invasive carcinoma of no special type (NST) and the other six types. Results: Significant differences were observed in age at diagnosis, tumor grade, size, nodal status and treatment. As tumor size increased, the number of positive lymph nodes increased markedly in invasive lobular carcinoma (ILC) and mixed NST and lobular carcinoma (NST-ILC), while in metaplastic carcinoma the number only increased slightly. In multivariate survival analyses, compared with patients with invasive carcinoma NST, breast cancer-specific survival (BCSS) and overall survival (OS) were worse for those with NST-ILC (BCSS: hazard ratio [HR] 1.81, P < .001; OS: HR 1.56, P = .005) or metaplastic carcinoma (BCSS: HR 1.95, P < .001; OS: HR 1.73, P < .001). By contrast, patients with medullary (HR 0.40, P = .010) or apocrine carcinoma (HR 0.27, P = .008) showed better BCSS. Time-dependent receiver operating characteristic (ROC) analyses indicated that T category in ILC and N category in metaplastic carcinoma were of less prognostic value. Conclusions: According to the histologic classification of TNBC, this heterogeneous disease can be divided into several entities with different clinicopathologic features and prognoses. In the era of molecular subtyping of breast cancer, the histologic classification of NBC is still of considerable clinical significance. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

IF:3.38

Enucleation of pancreatic solid pseudopapillary neoplasm: Short-term and long-term outcomes from a 7-year large single-center experience

第一作者:Wang, X

期刊: EJSO, 2018; 44 (无)

Background: Enucleation is increasingly used for pancreatic solid pseudopapillary neoplasm (SPN) to preserve function of the pancreas. The data was limited due to rarity of this low-grade neoplasm. We sought to describe the indications, operative technique, short and long-term outcomes after enucleation with largest series of enucleated SPNs. Methods: Data collected retrospectively from 110 patients with SPN who underwent pancreatectomy between 2009 and 2016 in our institution were reviewed. Thirty-one patients underwent enucleation were identified for analysis, and compared with the 70 patients underwent conventional pancreatic resection. Results: Of the 31 patients, 27 (87.1%) were women, and the mean age was 29.8 years (range, 11-49 years). Enucleated SPNs were mostly located in the headiuncinate process of the pancreas (38.7%). Overall morbidity was 25.8%, mainly due to POPF (19.4%), and severe morbidity was only 6.5% with no death. Compared with conventional pancreatic resection, enucleation had a shorter duration of surgery (P < 0.001), less blood loss (P < 0.001), lower rate of exocrine insufficiency (P = 0.033) and comparable morbidity (P = 1), with no increased risk of tumor recurrence (P = 1). The rate of endocrine insufficiency after enucleation seemed lower (Nil vs. 4.5%, P = 0.55). Conclusions: Enucleation of SPN of the pancreas appears to be feasible and safe for preserving exocrine and endocrine function of the gland. Enucleation with negative surgical margin seems adequate with no increased risk of tumor recurrence. Enucleation could be seriously considered as an alternative to conventional resection for this frequently young population. (C) 2018 Published by Elsevier Ltd.

IF:3.38

Development of a risk-scoring system to evaluate the serosal invasion for macroscopic serosal invasion positive gastric cancer patients

第一作者:Wang, PL

期刊: EJSO, 2018; 44 (无)

Background: The status of serosal invasion is often discordance between pathological and intraoperative evaluation. Our study sought to develop a risk-scoring system (RSS) to predict the probability of pT4a for macroscopic serosal invasion (MSI) positive patients and reevaluate the serosal invasion status. Patients and Methods: A total of 1301 pT3/pT4a gastric cancer patients with curative surgery were reviewed. We constructed the RSS to predict the probability of pT4a and assigned MSI-positive patients into different risk groups based on the risk scores. The prognostic significance of these risk groups was also evaluated. Results: Univariate and multivariate analyses identified that tumor location, Lauren type, Borrmann type, tumor size, lymphovascular invasion and pN stage were risk factors related to pT4a. Survival analyses showed that pT3 MSI-positive patients in high-risk group had similar survival with pT4a patients. We incorporated these two groups into one stage and proposed a novel revised-T stage. Two-step multivariate analyses indicated that the revised-T stage showed better prediction ability for prognosis and peritoneal recurrence assessment than original pT stage and MSI status. Conclusions: In our present study, we developed a RSS to predict the probability of pT4a for MSI-positive patients. Based on our RSS, we proposed a treatment algorithm to reevaluate the tumor invasion for MSI-positive patients in clinical practice. Future studies should include other preoperative predictors to improve the clinical utility of our model. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

IF:3.38

Downregulation of long non-coding RNA ENSG00000241684 is associated with poor prognosis in advanced clear cell renal cell carcinoma

第一作者:Su, HC

期刊: EJSO, 2018; 44 (无)

Objective: In order to identify potential novel biomarkers of advanced clear cell renal cell carcinoma (ccRCC), we re-evaluated published long non-coding RNA (IncRNA) expression profiling data. Materials and methods: The IncRNA expression profiles in ccRCC microarray dataset GSE47352 were analyzed and an independent cohort of 61 clinical samples including 21 advanced and 40 localized ccRCC patients was used to confirm the most statistically significant IncRNAs by real time PCR. Next, the relationships between the selected IncRNAs and ccRCC patients' clinicopathological features were investigated. The effects of LncRNA5 on the invasion and proliferation of renal carcinoma cells were also investigated. Results: The PCR results in a cohort of 21 advanced ccRCC and 40 localized ccRCC tissues were used for confirmation of the selected IncRNAs which were statistically most significant. The PCR results showed that the expression of three LncRNA (ENSG00000241684, ENSG00000231721 and NEAT1) were significantly downregulated in advanced ccRCC. Kaplan-Meier analysis revealed that reduced expression of LncRNA ENSG00000241684 and NEAT1 were significantly associated with poor overall survival. The univariate and multivariate Cox regression indicated LncRNA ENSG00000241684 had significant hazard ratios for predicting clinical outcome. LncRNA ENSG00000241684 expression was negatively correlated with pTNM stage. Overexpression of ENSG00000241684 significantly impaired cell proliferation and reduced the invasion ability in 786-O and ACHN cells. Conclusion: IncRNAs are involved in renal carcinogenesis and decreased IncRNA ENSG00000241684 expression may be an independent adverse prognostic factor in advanced ccRCC patients. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

IF:3.38

The impact of primary tumour location in patients undergoing hepatic resection for colorectal liver metastasis

第一作者:Wang, K

期刊: EJSO, 2018; 44 (无)

Background: Primary tumour location has long been debated as a prognostic factor in colorectal cancer patients with liver metastases (CRLM) undergoing liver resection. This retrospective study was conducted to clarify the prognostic value of tumour location after radical hepatectomy for CRLM and its underlying causes. Methods: We retrospectively analysed clinical data from 420 patients with CRLM whom underwent liver resection between January 2002 and December 2015. Right-sided (RS) tumours include tumours located in the cecum, ascending colon, and transverse colon, and left-sided (LS) tumours include those located in the splenic flexure, descending colon, sigmoid colon, and rectum. Results: Both overall survival (OS) and disease-free survival (DFS) were similar between patients with RS and LS primary tumours (5-year OS: 46.5% vs 38.3%, P = 0.699; 5-year DFS: 29.1% vs 22.4%, P = 0,536). Specifically, RAS mutation rate was significantly higher in patients with RS tumours (P = 0.007). Subgroup analysis showed that the RAS mutation on the LS and RS tumours have different prognostic impact for CRLM patients on long-term survival after hepatic resection (RS, OS: P = 0.437, DFS: P = 0.471; LS, OS: P < 0.001, DFS: P = 0.002). The multivariable analysis showed that RAS mutant is an independent factor influencing OS in patients with LS primary tumour only. Conclusions: The site of the primary tumour has no significant impact on the long-term survival in patients with CRLM undergoing radical surgery. However, prognostic value of RAS status differs depending on the site of the primary tumour. (C) 2018 Published by Elsevier Ltd.

IF:3.38

Downregulation of RFX1 predicts poor prognosis of patients with small hepatocellular carcinoma

第一作者:Liu, YJ

期刊: EJSO, 2018; 44 (无)

Objective: Regulatory factor X1 (RFX1) deletion has been reported to be correlated with poor prognosis of some types of cancer. The present study aimed to investigate the prognostic value of RFXI in HCC, especially in small hepatocellular carcinoma. Methods: Immunohistochemical assay was used to investigate RFXI expression in 221 HCC tissues and another validation cohort of 71 small HCC samples. We also performed in vitro experiments to investigate if RFX1 regulated invasive capacity of HCC cells and expression of epithelial-mesenchymal transition (EMT) markers. Results: We found that RFX1 expression was significantly lower in HCC tissues compared to the corresponding non-tumor tissues. Further survival analysis suggested that the downregulation of RFX1 correlated with poor prognosis and a high recurrence risk in HCC patients, particularly in small HCC patients. Furthermore, another validation cohort of small HCC samples confirmed that downregulation of RFXI in HCC tissues predicted high recurrence risk and poor prognosis for early stage HCC patients. In vitro studies suggested that knocking down RFX1 facilitated HCC cell invasion, while overexpression of RFXI reduced the invasion of HCC cells. Western blot assays also indicated that RFX1 regulated expression of some EMT markers. Knocking down RFXI decreased E-cadherin and increased vimentin expression, while RFXI overexpression enhanced E-cadherin and decreased vimentin expression. Conclusions: Our study demonstrated that RFXI downregulation is a new predictive marker of high recurrence risk and poor prognosis of HCC; It has potential to help guide treatment for postoperative HCC patients, especially for small HCC patients. (C) 2018 Published by Elsevier Ltd.

IF:3.38

Contribution of lymph node staging method and prognostic factors in malignant ovarian sex cord-stromal tumors: A world wide database analysis

第一作者:Wang, JY

期刊: EJSO, 2018; 44 (无)

Objective: To investigate the clinicopathologic prognostic factors in patients with malignant sex cord-stromal tumors (SCSTs) with lymph node dissection, and at the same time, to evaluate the influence of the log odds of positive lymph nodes (LODDS) on their survival. Methods: Patients diagnosed with malignant SCSTs who underwent lymph node dissection were extracted from the 1988-2013 Surveillance, Epidemiology, and End Results (SEER) database. Overall survival (OS) and cancer-specific survival (CSS) were estimated by Kaplan-Meier curves. The Cox proportional hazards regression model was used to identify independent predictors of survival. Results: 576 patients with malignant SCSTs and with lymphadenectomy were identified, including 468 (81.3%) patients with granulosa cell tumors (GCTs) and 80 (13.9%) patients with Sertoli-Leydig cell tumors (SLCTs). 399 (69.3%) patients and 118 (20.5%) patients were in the LODDS < -1 group and -1 <= LODDS < -0.5 group, respectively. The 10-year OS rate was 80.9% and CSS was 87.2% in the LODDS < -0.5 group, whereas the survival rates for other groups were 68.5% and 733%. On multivariate analysis, age 50 years or less (p < 0.001), tumor size of 10 cm or less (p < 0.001), early-stage disease (p < 0.001), and GO' histology (p <= 0.001) were the significant prognostic factors for improved survival. LODDS < -0.5 was associated with a favorable prognosis (OS: p = 0.051; CSS:P = 0.055). Conclusions: Younger age, smaller tumor size, early stage, and GCT histologic type are independent prognostic factors for improved survival in patients with malignant SCST with lymphadenectomy. Stratified LODDS could be regarded as an effective value to assess the lymph node status, and to predict the survival status of patients. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

IF:3.38

Correlation of IDH1 and B7-H3 expression with prognosis of CRC patients

第一作者:Wu, JY

期刊: EJSO, 2018; 44 (无)

Background: B7-H3 is an immuno-stimulatory glycoprotein that is overexpressed in cancer. However, its functional contributions to cancer development and progression are not well understood. In several reports, it was demonstrated that B7-H3 reprograms lipid metabolism and regulates glucose metabolism. Isocitrate dehydrogenase 1 (IDH1), a metabolic enzyme in the TCA cycle, its reaction product is involved in lipid synthesis. Thus, we aimed to identify a novel marker to predict the prognosis of CRC patients and to investigate the relationship between IDH1 and B7-H3. Methods: We analyzed IDH1 and B7-H3 expression levels in 225 CRC specimens by immunochemistry. Moreover, in vitro studies were performed to demonstrate the correlation between IDH1 and B7-H3. Results: Among 225 tissues, the positive rates of IDH1 and B7-H3 were 37.8% (85/225) and 87.6% (197/225), respectively. In CRC samples, IDH1 significantly correlated with B7-H3 expression (P = 0.044). Moreover, multivariate analyses revealed that high expression of both B7-H3 and IDH1 and a high tumor grade were related to the prognosis of CRC patients. Kaplan-Meier survival analysis revealed that patients with co-expression of IDH1 and B7-H3 had a poor overall survival. In SW480-B7-H3-EGFP cells, which highly express B7-H3, IDH1 was up-regulated. Similarly, knockdown of B7-H3 expression in Caco-2-shB7-H3 contributed to reduced IDH1 levels. Conclusions: Although IDH1 and B7-H3 cannot be used as independent prognostic factors, co-expression of IDH1 and B7-H3 significantly correlated with the prognosis of CRC patients and may serve as a combined predictive marker. Thus, the correlation between IDH1 and B7-H3 has been proven in vivo and in vitro. (C) 2018 Published by Elsevier Ltd.

IF:3.38

Predicting prognosis in resected esophageal squamous cell carcinoma using a clinical nomogram and recursive partitioning analysis

第一作者:Zheng, YZ

期刊: EJSO, 2018; 44 (无)

Background: Development demand of precise medicine in resectable esophageal squamous cell carcinoma (ESCC) require to recognize patients at high risk treated by surgery alone. Thus, our aim was to construct a clinical nomogram and recursive partitioning analysis (RPA) to predict long-term survival in ESCC treated by surgery alone. Methods: Based on the patients with ESCC who treated by three-incisional esophagectomy and two-field lymphadenectomy alone, we identified and integrated significant prognostic factors for survival to build a nomogram. The nomogram was calibrated for overall survival (OS) and the predictive accuracy and discriminative ability was measured by concordance index (c-index) and Akaike information criterion (AIC). Based on the nomogram, the RPA was performed for risk stratification. Results: A total of 747 patients were included for analysis. Five independent prognostic factors were identified and entered into the nomogram. The calibration curves for probability of 1-, 3-, and 5-year OS showed optimal agreement between nomogram prediction and actual observation. The AIC value of the nomogram was lower than that of the 7th edition staging system, whereas the c-index of the nomogram was higher than that of the 7th edition staging system. The risk groups stratified by RPA allowed significant distinction between survival curves within respective TNM categories. Conclusion: The RPA based on a clinical nomogram appears to be suitable for risk stratification in OS for resected ESCC. This practical system may help clinicians in decision making and design of clinical studies. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

IF:3.38

A Comparative study of two types of organ-sparing surgeries for early stage penile cancer: Wide local excision vs partial penectomy

第一作者:Wan, X

期刊: EJSO, 2018; 44 (无)

Introduction: Till date, there have been few reports of comparative studies on the outcomes of these different treatment modalities. In this study, we have aimed to comparatively evaluate the quality-of-life parameters, including sexual function, urinary function, and health-related quality of life (HRQOL), in patients with early stage penile cancers who underwent two different organ-sparing surgeries. Material and Methods: From March 2012 to March 2015, we enrolled 15 patients with early stage penile cancers who underwent either wide local excision or partial penectomy as organ-sparing surgical treatments. We assessed their sexual and urinary functions and their HRQOL, using the International Index of Erectile Function (IIEF-15), Self-Esteem and Relationship (SEAR), and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires and urodynamic determinations, and comparatively analyzed the outcomes of these patients who underwent either type of surgery. Results: All patients who underwent these two types of surgeries experienced satisfactory outcomes. The patients who underwent wide local excision performed relatively better, in terms of their sexual functions, urinary functions, and HRQOL, but no statistically significant differences were observed in the data collected via the IIEF-15, SEAR, EDITS, and EORTC-QLQ-C30 questionnaires and urodynamic determinations (p > 0.05), except in the data corresponding to the orgasmic function (p = 0.033). Conclusion: Both types of organ-sparing surgeries assessed in this study achieved good outcomes, in terms of the aesthetics, sexual functions, urinary functions, and HRQOL in patients, without compromising the therapeutic effects of these surgeries. However, the observed decreases in orgasmic function will need to be addressed further. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

IF:3.38

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