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Wang Q, Ge JT, Wu H, Zhong S, Wu QQ. Impacts of neoadjuvant therapy on the number of dissected lymph nodes in esophagogastric junction cancer patients. BMC Gastroenterol 2023; 23:64. [PMID: 36894903 PMCID: PMC9999651 DOI: 10.1186/s12876-023-02705-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Neoadjuvant therapy favors the prognosis of various cancers, including esophagogastric junction cancer (EGC). However, the impacts of neoadjuvant therapy on the number of dissected lymph nodes (LNs) have not yet been evaluated in EGC. METHODS We selected EGC patients from the Surveillance, Epidemiology, and End Results (SEER) database (2006-2017). The optimal number of resected LNs was determined using X-tile software. Overall survival (OS) curves were plotted with the Kaplan-Meier method. Prognostic factors were evaluated using univariate and multivariate COX regression analyses. RESULTS Neoadjuvant radiotherapy significantly decreased the mean number of LN examination compared to the mean number of patients without neoadjuvant therapy (12.2 vs. 17.5, P = 0.003). The mean LN number of patients with neoadjuvant chemoradiotherapy was 16.3, which was also statistically lower than 17.5 (P = 0.001). In contrast, neoadjuvant chemotherapy caused a significant increase in the number of dissected LNs (21.0, P < 0.001). For patients with neoadjuvant chemotherapy, the optimal cutoff value was 19. Patients with > 19 LNs had a better prognosis than those with 1-19 LNs (P < 0.05). For patients with neoadjuvant chemoradiotherapy, the optimal cutoff value was 9. Patients with > 9 LNs had a better prognosis than those with 1-9 LNs (P < 0.05). CONCLUSIONS Neoadjuvant radiotherapy and chemoradiotherapy decreased the number of dissected LNs, while neoadjuvant chemotherapy increased it in EGC patients. Hence, at least 10 LNs should be dissected for neoadjuvant chemoradiotherapy and 20 for neoadjuvant chemotherapy, which could be applied in clinical practice.
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Affiliation(s)
- Qi Wang
- Department of Thoracic Surgery, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, 223300, Jiangsu, China
| | - Jin-Tong Ge
- Department of Thoracic Surgery, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, 223300, Jiangsu, China
| | - Hua Wu
- Department of Thoracic Surgery, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, 223300, Jiangsu, China
| | - Sheng Zhong
- Department of Thoracic Surgery, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, 223300, Jiangsu, China
| | - Qing-Quan Wu
- Department of Thoracic Surgery, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, 223300, Jiangsu, China.
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Ding B, Yong J, Zhang L, Luo P, Song E, Rankine AN, Wei Z, Wang X, Xu A. Impact of examined lymph node number on accurate nodal staging and long-term survival of resected Siewert type II-III adenocarcinoma of the esophagogastric junction: A large population-based study. Front Oncol 2022; 12:979338. [PMID: 36387223 PMCID: PMC9659734 DOI: 10.3389/fonc.2022.979338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/23/2022] [Indexed: 01/19/2023] Open
Abstract
Background We aimed to investigate the association between the number of examined lymph nodes (ELNs) and accurate nodal staging and long-term survival in Siewert type II-III Adenocarcinoma of the Esophagogastric Junction (AEG) by using large population-based databases and determined the optimal ELN number threshold. Methods Data on Stage I-III Siewert type II-III AEG patients from 2010 to 2014 respectively from the United States (US) SEER database and a Chinese large medical center institutional registry were analyzed for correlation between the ELN number and stage migration (node negative-to-positive) and overall survival (OS) by using multivariable-adjusted logistic and Cox regression models, respectively. The series of odds ratios (ORs), and hazard ratios (HRs) were fitted with a LOWESS smoother, and the structural breakpoints were determined by Chow test. The selected optimal cut point was then validated with the 2015 to 2016 SEER database. Results Both the US cohort(n=1387) and China cohort(n=981) showed significantly increases from node-negative to node-positive disease (ORtheUS1.032,95%CI 1.017–1.046;ORChina1.034,95%CI 1.002–1.065) and enhancements in overall survival (HRtheUS0.970,95%CI 0.961-0.979;HRChina0.960,95%CI 0.940-0.980) with the increasing ELN number after controlling for confounders. Associations for both stage migration and overall survival were still significant in most subgroups’ stratification. Cut point analysis showed a threshold ELN number of 18, which was validated both in the cohorts where it originated and in an independent SEER data cohort(n=379). Conclusions More ELNs are associated with accurate nodal staging(negative-to-positive) as well as higher overall survival in resected Siewert types II-III AEG, We recommend 18 ELNs as the optimal cut point for the quality assessment of postoperative lymph node examination or prognostic stratification in clinical practice.
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Affiliation(s)
- Baicheng Ding
- Department of Emergency Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jiahui Yong
- Department of Transfusion, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Lixiang Zhang
- Department of Gastrointestinal Surgery, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Panquan Luo
- Department of Gastrointestinal Surgery, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Endong Song
- Department of Gastrointestinal Surgery, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | | | - Zhijian Wei
- Department of Gastrointestinal Surgery, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Aman Xu, ; Xingyu Wang, ; Zhijian Wei,
| | - Xingyu Wang
- Department of Emergency Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Aman Xu, ; Xingyu Wang, ; Zhijian Wei,
| | - Aman Xu
- Department of Gastrointestinal Surgery, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Aman Xu, ; Xingyu Wang, ; Zhijian Wei,
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Zhang Y, Liu D, Zeng D, Chen C. Lymph Node Ratio Is an Independent Prognostic Factor for Patients with Siewert Type II Adenocarcinoma of Esophagogastric Junction: Results from a 10-Year Follow-up Study. J Gastrointest Cancer 2021; 52:983-992. [PMID: 32954465 DOI: 10.1007/s12029-020-00468-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Emerging evidences suggest that lymph node ratio (LNR), the number of metastatic lymph node (LN) to the total number of dissected lymph nodes (NDLN), may predict survival in multiple types of solid tumor. However, the prognostic role of LNR in adenocarcinoma of the esophagogastric junction (AEG) remains uninvestigated. The present study is intended to determine the prognostic value of LNR in the patients with Siewert type II AEG. METHODS A total of 342 patients with Siewert type II AEG who underwent R0 resection were enrolled in this study. The optimal cutoff of LNR was stratified into tertiles using X-tile software. The log-rank test was used to evaluate the survival differences, and multivariate Cox regression analyses were performed to determine the independent prognostic variables. RESULTS The optimal cutoff of LNR were classified as LNR = 0, LNR between 0.01 and 0.40, and LNR > 0.41. Patients with high LNR had a shorter 5- and 10-year disease-specific survival (DSS) rate (8.5%, 1.4%) compared with those with moderate LNR (20.4%, 4.9%) and low LNR (58.0%, 27.5%) (P < 0.001). Multivariate Cox regression analysis indicated that LNR was an independent factor for DSS after adjusting for confounding variables (P < 0.05). Furthermore, after stratification by NDLN between NDLN < 15 group and NDLN ≥ 15 group, the LNR remained a significant predictor for DSS (P < 0.05). CONCLUSIONS LNR is an independent predictor for DSS in patients with Siewert type II AEG regardless of NDLN. Patients with higher LNR have significantly shorter DSS.
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Affiliation(s)
- Yuling Zhang
- Department of Medical Information, Shantou University Medical College Cancer Hospital, Shantou, China
| | - Ditian Liu
- Department of Thoracic Surgery, Shantou University Medical College Cancer Hospital, Shantou, China
| | - De Zeng
- Department of Medical Oncology, Shantou University Medical College Cancer Hospital, Shantou, China.
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Shantou, China.
| | - Chunfa Chen
- The Breast Centre, Shantou University Medical College Cancer Hospital, Shantou, China.
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Effect of the Number of Removed Lymph Nodes on Survival in Patients with FIGO Stage IB-IIA Cervical Squamous Cell Carcinoma following Open Radical Hysterectomy with Pelvic Lymphadenectomy: A Retrospective Cohort Study. JOURNAL OF ONCOLOGY 2021; 2021:6201634. [PMID: 33936201 PMCID: PMC8062174 DOI: 10.1155/2021/6201634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/22/2020] [Accepted: 03/30/2021] [Indexed: 12/24/2022]
Abstract
Objective To determine whether the number of removed lymph nodes (RLN) is associated with survival in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB-IIA cervical squamous cell carcinoma (CSCC). Methods We reviewed the medical records of FIGO stage IB-IIA CSCC patients who underwent standardized radical hysterectomy with pelvic lymphadenectomy (RHPL) in our center between 2006 and 2014. The X-tile software was performed to calculate the optimal grouping of cutoff points for RLN. The impact of RLN on progression-free survival (PFS) and overall survival (OS) was analyzed using Cox regression analysis. Results Among 3,127 patients, the mean number of RLN was 22, and positive lymph node (LN) was found in 668 (21.4%) patients. X-tile plots identified “21” and “16” as the optimal cutoff value of RLN to divide the patients into two groups in terms of PFS and OS separately. In all patients, the number of RLN was not associated with PFS (P=0.182) or OS (P=0.193). Moreover, in both LN positive and negative patients, the number of RLN was not associated with either PFS (P=0.212 and P=0.540, respectively) or OS (P=0.173 and P=0.497, respectively). Cox regression analysis showed that the number of RLN was not an independent prognostic factor for PFS or OS. Conclusion If standardized RHPL was performed, the number of RLN was not an independent prognostic factor for survival of patients with FIGO stage IB-IIA CSCC.
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Kandilis A, Iniguez CB, Khalil H, Mazzola E, Jaklitsch MT, Swanson SJ, Bueno R, Wee JO. Residual lymph node disease and mortality following neoadjuvant chemoradiation and curative esophagectomy for distal esophageal adenocarcinoma. JTCVS OPEN 2021; 5:135-147. [PMID: 36003158 PMCID: PMC9390677 DOI: 10.1016/j.xjon.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/30/2022]
Abstract
Objectives Neoadjuvant chemoradiation has been shown to improve survival in locally advanced esophageal and gastroesophageal junction cancer. The purpose of our study was to examine the effects of posttreatment persistent lymph node (LN) disease on overall survival (OS) and recurrence in patients with esophageal adenocarcinoma after neoadjuvant chemoradiation as well as the effect of LN harvest and the potential benefit of adjuvant chemotherapy. Methods The records of patients who underwent esophagectomy in our hospital from January 2005 until December 2016 were analyzed. Our study group consisted of 509 patients. Results Patient groups were created based on pathologic staging after esophagectomy (ypT N) as 22.0% of patients were ypT0 N0, 46.2% had incomplete response only at the primary tumor level (ypT + N0), and 31.8% had at least 1 metastatic lymph node (ypTx N+). Median OS was 58.3 months. The ypTx N+ group was divided into ypTx N1 and ypTx N2 or N3 subgroups based on the number of metastatic lymph nodes. The OS between the 2 groups was not significantly different (median OS, 37.6 vs 29.8 months; P = .097). The disease-free survival did show a statistically significant difference (median disease-free survival, 27.6 vs 13.7 months; P = .007). The LN harvest was not found to be significantly associated with OS. However, administration of adjuvant chemotherapy was a significant prognosticator for increased OS (hazard ratio, 0.590; P = .043). Conclusions Our results demonstrate that residual LN disease after neoadjuvant chemoradiation is associated with increased mortality. Adjuvant chemotherapy, but not number of LNs resected, was correlated with increased OS in this subset of patients.
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Affiliation(s)
- Apostolos Kandilis
- Department of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Carlos Bravo Iniguez
- Department of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Hassan Khalil
- Department of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Emanuele Mazzola
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Mass
| | - Michael T. Jaklitsch
- Department of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Scott J. Swanson
- Department of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Raphael Bueno
- Department of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Jon O. Wee
- Department of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
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Chen XD, He FQ, Chen M, Zhao FZ. Incidence of lymph node metastasis at each station in Siewert types Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction: A systematic review and meta-analysis. Surg Oncol 2020; 35:62-70. [DOI: 10.1016/j.suronc.2020.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/21/2020] [Accepted: 08/02/2020] [Indexed: 02/07/2023]
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Takeda FR, Junior UR, Aissar Sallum RA, Cecconello I. Transhiatal laparoscopic esophagectomy with extended lymphadenectomy guided by green-indocyanine imaging for adenocarcinoma of the esophagogastric junction. Surg Oncol 2020; 33:30-31. [PMID: 32561095 DOI: 10.1016/j.suronc.2019.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/21/2019] [Accepted: 12/29/2019] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Surgical treatment for adenocarcinoma of the esophagogastric junction (AEGJ) has been long-established, from resection margins to the extension of lymphadenectomy [1,2,4]. The addition of cyanine dye, namely indocyanine green (ICG), to identify suspicious lymph nodes (LN) and evaluate organ vascularization may improve results and outcomes [3]. VIDEO A 58-year-old female patient with Siewert type II AEGJ was administered mFLOX neoadjuvant treatment. After three cycles, she underwent surgical treatment. The day before surgery, an upper endoscopy was performed to inject 0.2 ml ICG 0.5 cm from the proximal and distal tumor margins. The patient underwent laparoscopic transhiatal esophagectomy with extended lymphadenectomy due to a 4 cm distal esophagus compromised margin. We describe the primary steps of the procedure and demonstrate the role of the ICG in the lymphadenectomy. RESULTS Surgery was carried out laparoscopically with a cervical approach (McKeown access), and posterior mediastinal gastric tube reconstruction and cervical gastroplasty were performed. During the standard lymphadenectomy, we observed an ICG-positive LN in station 10, which was found positive in the subsequent pathology examination. After these findings, we performed an extended lymphadenectomy through the splenic hilum. The final pathologic assessment was T3N2 (two perigastric and one positive LN at station 10 among 60 retrieved LN). The operative time was 360 min. The patient started a liquid diet on the seventh postoperative day, and she was discharged on the tenth postoperative day. CONCLUSIONS ICG may be helpful to guide both extended lymphadenectomy and distal margin evaluation in transhiatal laparoscopic esophagectomy.
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Affiliation(s)
- Flavio Roberto Takeda
- Department of Gastroenterology, Digestive Surgery Division, Sao Paulo Institute of Cancer, University of São Paulo Medical School, Brazil.
| | - Ulysses Ribeiro Junior
- Department of Gastroenterology, Digestive Surgery Division, Sao Paulo Institute of Cancer, University of São Paulo Medical School, Brazil
| | - Rubens Antonio Aissar Sallum
- Department of Gastroenterology, Digestive Surgery Division, Sao Paulo Institute of Cancer, University of São Paulo Medical School, Brazil
| | - Ivan Cecconello
- Department of Gastroenterology, Digestive Surgery Division, Sao Paulo Institute of Cancer, University of São Paulo Medical School, Brazil
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Zhang S, Orita H, Fukunaga T. Current surgical treatment of esophagogastric junction adenocarcinoma. World J Gastrointest Oncol 2019; 11:567-578. [PMID: 31435459 PMCID: PMC6700029 DOI: 10.4251/wjgo.v11.i8.567] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/26/2019] [Accepted: 07/16/2019] [Indexed: 02/05/2023] Open
Abstract
The incidence of esophagogastric junction (EGJ) adenocarcinoma has shown an upward trend over the past several decades worldwide. In this article, we review previous studies and aimed to provide an update on the factors related to the surgical treatment of EGJ adenocarcinoma. The Siewert classification has implications for lymph node spread and is the most commonly used classification. Different types of EGJ cancer have different incidences of mediastinal and abdominal lymph node metastases, and different surgical approaches have unique advantages and disadvantages. Minimally invasive surgeries have been increasingly applied in clinical practice and show comparable oncologic outcomes. Endoscopic resection may be a good therapy for early EGJ cancer. Additionally, there is still a great need for well-designed, large RCTs to forward our knowledge on the surgical treatment of EGJ cancer.
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Affiliation(s)
- Shun Zhang
- Department of Gastroenterology Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Tokyo 113-8431, Japan
| | - Hajime Orita
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Tokyo 113-8431, Japan
| | - Tetsu Fukunaga
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Tokyo 113-8431, Japan
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Xu Y, Chen Y, Wei L, Lai S, Zheng W, Wu F. Serum tumor-associated glycoprotein 72, a helpful predictor of lymph nodes invasion in esophagogastric junction adenocarcinoma. Biochem Biophys Res Commun 2018; 509:133-137. [PMID: 30579602 DOI: 10.1016/j.bbrc.2018.12.083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 11/11/2018] [Accepted: 12/12/2018] [Indexed: 01/20/2023]
Abstract
Disruption of cell-cell junction and adhesion to vessels are crucial steps in tumor metastasis. Tumor-associated glycoprotein 72 (TAG-72) is a crucial membrane mucin in gastroesophageal mucosa for microenvironment contact with cells. Thus, the TAG-72 value may be an indicator of the malignant involvement of lymph nodes in esophagogastric junction adenocarcinoma (EGAC) patients. Of the 183 patients suspected as gastroesophageal neoplasms, 129 were subsequently diagnosed as EGAC, and 54 were subsequently diagnosed as benign gastroesophageal diseases by imageological or/and histological examination. After we obtained preoperative serum TAG-72 values, the relationship between serum TAG-72 and lymphatic metastasis status, extent of invaded lymph nodes and clinical stage was tested using Spearman correlation analysis and χ2 tests. Compared with those in patients who suffered either benign gastroesophageal diseases or preinvasive carcinoma, the median serum TAG-72 values were statistically higher in EGAC patients with positive lymph nodes (Kruskal-Wallis test; P < 0.001). Serum TAG-72 values were significantly correlated with Lymph Node Ratio (LNR) (Spearman correlation; P < 0.001). Using corresponding ROC (95% CI = 0.621-0.783, P < 0.0001), serum TAG-72 values with an optimal cut-off (2.2 kU/mL) showed a sensitivity of 0.632 and a specificity of 0.690 for predicting malignant lymph node involvement in EGAC. These results suggest that the serum TAG-72 value is a clinically helpful predictor of lymph nodes invasion in resectable EGAC.
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Affiliation(s)
- Yue Xu
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yongkang Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery III, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Lili Wei
- Department of Clinical Laboratory, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Shengming Lai
- Department of Clinical Laboratory, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Wenwen Zheng
- Department of Clinical Laboratory, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Feng Wu
- Department of Clinical Laboratory, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China.
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