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Houda I, Dickhoff C, Uyl-de Groot CA, Reguart N, Provencio M, Levy A, Dziadziuszko R, Pompili C, Di Maio M, Thomas M, Brunelli A, Popat S, Senan S, Bahce I. New systemic treatment paradigms in resectable non-small cell lung cancer and variations in patient access across Europe. THE LANCET REGIONAL HEALTH. EUROPE 2024; 38:100840. [PMID: 38476748 PMCID: PMC10928304 DOI: 10.1016/j.lanepe.2024.100840] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 03/14/2024]
Abstract
The treatment landscape of resectable early-stage non-small cell lung cancer (NSCLC) is set to change significantly due to encouraging results from randomized trials evaluating neoadjuvant and adjuvant immunotherapy, as well as adjuvant targeted therapy. As of January 2024, marketing authorization has been granted for four new indications in Europe, and regulatory approvals for other study regimens are expected. Because cost-effectiveness and reimbursement criteria for novel treatments often differ between European countries, access to emerging developments may lead to inequalities due to variations in recommended and available lung cancer care throughout Europe. This Series paper (i) highlights the clinical studies reshaping the treatment landscape in resectable early-stage NSCLC, (ii) compares and contrasts approaches taken by the European Medicines Agency (EMA) for drug approval to that taken by the United States Food and Drug Administration (FDA), and (iii) evaluates the differences in access to emerging treatments from an availability perspective across European countries.
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Affiliation(s)
- Ilias Houda
- Department of Pulmonary Medicine, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Carin A. Uyl-de Groot
- Erasmus School of Health Policy & Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands
| | - Noemi Reguart
- Department of Medical Oncology, Hospital Clínic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Mariano Provencio
- Department of Medical Oncology, Hospital Universitario Puerta De Hierro, C. Joaquín Rodrigo, 1, 28222, Majadahonda, Madrid, Spain
| | - Antonin Levy
- Department of Radiation Oncology, International Center for Thoracic Cancers (CICT), Université Paris Saclay, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Rafal Dziadziuszko
- Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210, Gdańsk, Poland
| | - Cecilia Pompili
- Department of Thoracic Surgery, University and Hospital Trust – Ospedale Borgo Trento, P.Le A. Stefani, 1, 37126, Verona, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Medical Oncology 1U, AOU Città della Salute e della Scienza di Torino, 10126, Turin, Italy
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), NCT Heidelberg, a Partnership Between DKFZ and Heidelberg University Hospital, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St. James's University Hospital, Beckett Street, LS9 7TF, Leeds, United Kingdom
| | - Sanjay Popat
- Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Idris Bahce
- Department of Pulmonary Medicine, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
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Xu K, Xie E, Lv Y, Gu W, Shi M, Yao J, Wu J, Ye B. Unplanned reoperation after pulmonary surgery: Rate, risk factors and early outcomes at a single center. Heliyon 2023; 9:e20538. [PMID: 37818013 PMCID: PMC10560774 DOI: 10.1016/j.heliyon.2023.e20538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023] Open
Abstract
Background Unplanned reoperation is a potential risk factor for worse prognoses and reflects the quality of surgical treatment. This study compared the short-term outcomes between patients with and without reoperation and identified clinical factors predicting reoperation within 90 days following pulmonary surgery. Methods Consecutive patients undergoing pulmonary resection from January 2012 to August 2021 at our institution were retrospectively reviewed. Clinical and operation-related data were collected and analyzed. Kaplan‒Meier, Cox hazard proportional regression, and propensity score matching were adopted for prognostic evaluation. Results A total of 90263 patients were included: 247 (0.27%) patients required reoperation within 90 days. Patients undergoing unplanned reoperation had higher mortality and more postoperative complications than the nonreoperation group. Reoperation within 24 h was associated with reduced odds of mortality relative to reoperation beyond 24 h. Independent risk factors for unplanned reoperation were male sex, benign lung disease, specific surgical locations, lobectomy, and pneumonectomy. A history of smoking, pulmonary tuberculosis, intraoperative pleural adhesion, and postoperative complications were also identified as predisposing factors. The most common complication was hemorrhage in 75.7% (187 of 247). Conclusion Our study found that unplanned reoperation was a rare but serious event that increased the risk of postoperative complications and mortality. We identified several risk factors that could be used to stratify patients according to their reoperation risk and suggest that high-risk patients should receive more intensive monitoring and preventive measures. Moreover, our study indicated that reoperating within 24 h could improve the outcomes for patients who needed reoperation.
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Affiliation(s)
- Kuan Xu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Ermei Xie
- Key Laboratory of Synthetic Biology Regulatory Element, Institute of Systems Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Suzhou Institute of Systems Medicine, Suzhou, China
| | - Yilv Lv
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Wei Gu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Minjun Shi
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Jueya Yao
- Department of General Surgery Department, Shanghai Construction Group Hospital, Shanghai, 200030, China
| | - Jingxiang Wu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Bo Ye
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
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Moret A, Madelaine L, Hanna HA, Bernard A, Pagès PB. [Complications after pulmonary segmentectomy: Impact of the surgical approach]. Rev Mal Respir 2023; 40:666-674. [PMID: 37798174 DOI: 10.1016/j.rmr.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 06/14/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Pulmonary segmentectomy is becoming increasingly widespread but remains technically challenging. The aim of this study was to evaluate the impact of the surgical approach applied on postoperative complications after pulmonary segmentectomy. METHODS All patients having undergone pulmonary segmentectomy by thoracotomy, videothoracoscopy or robot-assisted surgery from 1st January 2018 to 31st December 2021 were included. The primary endpoint was the occurrence of postoperative complications. Secondary endpoints were operative time, length of hospital stay, 30-day readmission rate, 30-day and 90-day mortality. RESULTS Two hundred and twenty-three patients were included, 30% (n=67) in the thoracotomy group, 9.4% (n=21) in the videothoracoscopy group and 60.5% (n=135) in the robot-assisted surgery group. There was no difference in the occurrence of postoperative complications according to type of approach (P=0.564), 26.9% of patients (n=60) had at least one postoperative complication. There was no significant difference between the groups in terms of operative time (P=0.385), length of hospital stay (P=0.107), 30 and 90-day mortality (P=0.124 and P=0.249, respectively). Mini-invasive surgery significantly reduced the 30-day readmission rate (P=0.049). CONCLUSION The surgical approach applied does not influence the postoperative complications of pulmonary segmentectomy.
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Affiliation(s)
- A Moret
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France; Service de chirurgie thoracique, centre hospitalier Métropole Savoie, Chambéry, France
| | - L Madelaine
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France
| | - H Abou Hanna
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France
| | - A Bernard
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France
| | - P-B Pagès
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France; Inserm, UMR 1231, CHU de Dijon, université de Bourgogne, Dijon, France.
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Al-Githmi IS, Alotaibi A, Habeebullah A, Bajunaid W, Jar S, Alharbi NA, Aziz H. Postoperative Pulmonary Complications in Patients Undergoing Elective Thoracotomy Versus Thoracoscopic Surgeries. Cureus 2023; 15:e45367. [PMID: 37849610 PMCID: PMC10578611 DOI: 10.7759/cureus.45367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2023] [Indexed: 10/19/2023] Open
Abstract
Background Postoperative pulmonary complications correlate highly with thoracic surgery compared to other surgeries. Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical approach that provides considerable advantages over major open thoracotomy. Methodology This is a retrospective cohort study. All patients aged 18 years and above of both genders were included in the study. Cases following up outside King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, were excluded from our study. Complications were measured per the records on follow-up day 1, day 7, and day 30. Mortality was measured within 30 days after the surgery. Results A total of 151 patients were included in the study. Age ranged from 18 to 85 years, with males representing 62.3% of the sample, while Saudis represented 59.6%. VATS was performed in 71.5%, while thoracotomy was performed in 28.5%. Of the total, 19.4% had postoperative complications within 30 days in the VATS group, while 23.3% were in the thoracotomy group. No significant differences were found between the rates of complications between the two groups. Additionally, the admission rate to ICU was significantly twice as common in the thoracotomy group (65.1%) compared to the VATS group (33.3%). Besides, the average duration of the chest tube's stay was three to seven days in both groups (62.1% in the VATS group and 70.7% in the thoracotomy group). Lastly, regarding the requirements of opioids, VATS showed more need for opioids (44.4%) compared to thoracotomy (32.6%). Conclusion The rates of postoperative complications were low in both groups, and no significant differences were found between the two procedures. In addition, the VATS group showed significantly higher use of opioids compared to the thoracotomy group. We recommend conducting further studies with larger sample sizes to increase the statistical power of detection.
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Affiliation(s)
- Iskander S Al-Githmi
- Cardiothoracic Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | | | - Alaa Habeebullah
- Thoracic Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Weam Bajunaid
- Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Sondos Jar
- Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Nadin A Alharbi
- Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Haneen Aziz
- Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
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Huang L, Frandsen MN, Kehlet H, Petersen RH. Early and Late Readmission after Enhanced Recovery Thoracoscopic Lobectomy. Eur J Cardiothorac Surg 2022; 62:6649683. [PMID: 35880263 DOI: 10.1093/ejcts/ezac385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/22/2022] [Accepted: 07/22/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The purpose of this study was to describe the incidence and reasons for early (0-30 days) and late (31-90 days) readmission after enhanced recovery video-assisted thoracoscopic surgery lobectomy. METHODS We performed a retrospective analysis of prospectively collected consecutive VATS lobectomy data in an institutional database from January 2019 until December 2020. All reasons for readmission with complete follow-up were individually evaluated. Univariable and multivariable analyses were used to assess predictors. RESULTS In total 508 patients were included and median length of stay after surgery was 3 days. Early and late readmission were 77 (15%) and 54 (11%), respectively. Multiple readmissions during postoperative 0-90 days were 33 (7%). Pneumonia (19.8%) and pneumothorax (18.3%) were the dominant reasons for early readmission, and side effects to adjuvant chemotherapy (22.0%) for late readmission. In multivariable analyses, current smoking (P = 0.001), alcohol abuse (P = 0.024) and chronic obstructive pulmonary disease (P = 0.019) were predictors for early readmission, while (Clavien-Dindo I-II grade gastrointestinal complicationspredicted late readmission (P = 0.006) and multiple readmissions (P = 0.007). Early discharge (< 3 days) was not a predictor for readmission. Early readmission does not increase late readmission. CONCLUSIONS Early and late readmission are frequent despite of following enhanced recovery programs after video-assisted thoracoscopic lobectomy. Pulmonary complications and adjuvant chemotherapy are the most predominant reasons for early and late readmission.
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Affiliation(s)
- Lin Huang
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Mikkel Nicklas Frandsen
- Section for Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Henrik Kehlet
- Section for Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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Aigner C. Bouncing back after thoracic surgery. Eur J Cardiothorac Surg 2022; 61:1258-1259. [PMID: 35218342 DOI: 10.1093/ejcts/ezac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Clemens Aigner
- Dept. of Thoracic Surgery, University Medicine Essen, Ruhrlandklinik, Essen, Germany
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Bagan P, Zaimi R, Dakhil B. [Patient outcomes after lung resection. The impact of unplanned readmission]. Rev Mal Respir 2022; 39:34-39. [PMID: 35034830 DOI: 10.1016/j.rmr.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022]
Abstract
Unplanned readmissions after lung cancer surgery impair normal postoperative recovery and are associated with increased postoperative mortality. The objective of this review was to compile a detailed and comprehensive dataset on unplanned readmissions after pulmonary resection so as to better understand the associated factors and how they may be attenuated. Based on the identified risk factors, prevention involves improved preoperative preparation of at-risk patients and preoperative discharge planning so as to help prevent unscheduled readmissions, which are predictive of a poorer prognosis.
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Affiliation(s)
- P Bagan
- Service de chirurgie thoracique et vasculaire, hôpital Victor-Dupouy, Argenteuil, France.
| | - R Zaimi
- Service de chirurgie thoracique et vasculaire, hôpital Victor-Dupouy, Argenteuil, France
| | - B Dakhil
- Service de chirurgie thoracique et vasculaire, hôpital Victor-Dupouy, Argenteuil, France
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Pages PB, Cottenet J, Bonniaud P, Tubert-Bitter P, Piroth L, Cadranel J, Bernard A, Quantin C. Impact of the SARS-CoV-2 Epidemic on Lung Cancer Surgery in France: A Nationwide Study. Cancers (Basel) 2021; 13:cancers13246277. [PMID: 34944896 PMCID: PMC8699699 DOI: 10.3390/cancers13246277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Few studies have investigated the link between SARS-CoV-2 and health restrictions and its effects on the health of lung cancer (LC) patients. This study aimed to assess the impact of SARS-CoV-2 on activity volume, postoperative complications and in-hospital mortality (IHM) for LC resections in 2020 at the national level in France. Our study shows a decrease in the volume of LC resections, especially during the first lockdown. We also show that only 0.43% of patients hospitalized for LC surgery during 2020 developed a SARS-CoV-2 infection, but this low rate is counterbalanced by a high IHM (21%) in these 51 patients. Our findings suggest that, even if the IHM is high, LC surgery is feasible during a pandemic provided that the general guidance protocols edited by the surgical societies are respected. Therefore, this study provides further arguments to encourage teams to test for COVID-19 prior to surgery and patients to be vaccinated. Abstract Few studies have investigated the link between SARS-CoV-2 and health restrictions and its effects on the health of lung cancer (LC) patients. The aim of this study was to assess the impact of the SARS-CoV-2 epidemic on surgical activity volume, postoperative complications and in-hospital mortality (IHM) for LC resections in France. All data for adult patients who underwent pulmonary resection for LC in France in 2020, collected from the national administrative database, were compared to 2018–2019. The effect of SARS-CoV-2 on the risk of IHM and severe complications within 30 days among LC surgery patients was examined using a logistic regression analysis adjusted for age, sex, comorbidities and type of resection. There was a slight decrease in the volume of LC resections in 2020 (n = 11,634), as compared to 2018 (n = 12,153) and 2019 (n = 12,227), with a noticeable decrease in April 2020 (the peak of the first wave of epidemic in France). We found that SARS-CoV-2 (0.43% of 2020 resections) was associated with IHM and severe complications, with, respectively, a sevenfold (aOR = 7.17 (3.30–15.55)) and almost a fivefold (aOR = 4.76 (2.31–9.80)) increase in risk. Our study suggests that LC surgery is feasible even during a pandemic, provided that general guidance protocols edited by the surgical societies are respected.
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Affiliation(s)
- Pierre-Benoit Pages
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Dijon, Bocage Central, 21079 Dijon, France; (P.-B.P.); (A.B.)
- INSERM UMR 1231, Centre Hospitalier Universitaire Bocage, University of Burgundy, 21079 Dijon, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, University of Burgundy Franche-Comté, BP 77908, 21079 Dijon, France;
| | - Philippe Bonniaud
- Faculty of Medicine, University of Bourgogne-Franche-Comté, 21000 Dijon, France; (P.B.); (L.P.)
- Reference Center for Rare Pulmonary Diseases, Pulmonary Medicine and Intensive Care Unit Department, Dijon University Hospital, BP 77908, 21079 Dijon, France
| | - Pascale Tubert-Bitter
- High-Dimensional Biostatistics for Drug Safety and Genomics, Paris-Saclay University, UVSQ, Inserm, CESP, 94800 Villejuif, France;
| | - Lionel Piroth
- Faculty of Medicine, University of Bourgogne-Franche-Comté, 21000 Dijon, France; (P.B.); (L.P.)
- Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, 21079 Dijon, France
- Infectious Diseases Department, Dijon University Hospital, BP 77908, 21079 Dijon, France
| | - Jacques Cadranel
- Chest Department and Constitutive Center for Rare Pulmonary Disease, Hôpital Tenon, AP-HP, Inflammation-Immunopathology-Biotherapy Department (DHU i2B) and Sorbonne University, 75020 Paris, France;
| | - Alain Bernard
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Dijon, Bocage Central, 21079 Dijon, France; (P.-B.P.); (A.B.)
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, University of Burgundy Franche-Comté, BP 77908, 21079 Dijon, France;
- High-Dimensional Biostatistics for Drug Safety and Genomics, Paris-Saclay University, UVSQ, Inserm, CESP, 94800 Villejuif, France;
- Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, 21079 Dijon, France
- Correspondence: ; Tel.: +(33)-3-80-29-34-65; Fax: +(33)-3-80-29-39-73
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