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Suzuki S, Asakura K, Okui M, Izawa N, Sawafuji M, Sakamaki H, Shigenobu T, Tajima A, Oka N, Masai K, Kaseda K, Hishida T, Yasuda H, Fukunaga K, Asamura H. Prognostic factors affecting survival in patients with non-small cell lung cancer treated with salvage surgery after drug therapy: a multi-institutional retrospective study. World J Surg Oncol 2023; 21:290. [PMID: 37715273 PMCID: PMC10503184 DOI: 10.1186/s12957-023-03177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/09/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND The prevalence of salvage surgeries after drug therapy for non-small cell lung cancer (NSCLC) has risen, mainly due to recent progress in molecular-targeted drugs and immune checkpoint inhibitors for NSCLC. While the safety and effectiveness of salvage surgery after drug therapy for NSCLC have been studied, its indications remain unclear. We aimed to identify the prognostic factors affecting survival in patients with advanced-stage (stages III-IV) NSCLC treated with salvage surgery after drug therapy. METHODS A retrospective investigation was conducted on patients who received salvage surgery after drug therapy at four hospitals between 2007 and 2020. Salvage surgery was defined as surgery after drug therapy for local progression, tumor conversion to resectable status, and discontinuation of prior drug therapy owing to serious complications. RESULTS Thirty-two patients received cytotoxic agents alone (n = 12 [38%]), tyrosine kinase inhibitors (TKIs; n = 16 [50%]), or immune checkpoint inhibitors (n = 4 [13%]) as prior drug therapy. In 11 (34%) and 21 (66%) patients, the clinical stage before treatment was III or IV, respectively. The median initial and preoperative serum carcinoembryonic antigen (CEA) levels were 10.2 (range, 0.5-1024) ng/mL and 4.2 (range, 0.6-92.5) ng/mL, respectively. Among the patients, 28 (88%) underwent lobectomy, 2 (6%) underwent segmentectomy, and 2 (6%) underwent wedge resection. Complete resection of the primary lesion was accomplished in 28 (88%) patients. Postoperative complications were documented in six (19%) patients. Mortality rates were 0% at 30 days and 3% at 90 days post-operation. The 5-year overall survival rate stood at 66%, while the 5-year progression-free survival rate was 21%. Multivariate analyses showed that prior TKI therapy and preoperative serum CEA level < 5 ng/mL were prognostic factors influencing overall survival (hazard ratio [95% confidence interval]: 0.06 [0.006-0.68] and 0.03 [0.002-0.41], respectively). The 5-year overall survival in the 11 patients with both favorable prognosticators was 100%. CONCLUSIONS In this study, prior TKI therapy and preoperative serum CEA level < 5 ng/mL were favorable prognostic factors for overall survival in patients with NSCLC treated with salvage surgery. Patients with these prognostic factors are considered good candidates for salvage surgery after drug therapy.
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Affiliation(s)
- Shigeki Suzuki
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Sagamihara, Kanagawa, Japan
| | - Keisuke Asakura
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan.
| | - Masayuki Okui
- Department of General Thoracic Surgery, Kawasaki Municipal Hospital, Kawasaki, Kanagawa, Japan
| | - Naoko Izawa
- Department of General Thoracic Surgery, Kawasaki Municipal Hospital, Kawasaki, Kanagawa, Japan
| | - Makoto Sawafuji
- Department of General Thoracic Surgery, Kawasaki Municipal Hospital, Kawasaki, Kanagawa, Japan
| | - Hiroyuki Sakamaki
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Sagamihara, Kanagawa, Japan
| | - Takao Shigenobu
- Department of General Thoracic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Atsushi Tajima
- Department of General Thoracic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Naoyuki Oka
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Kyohei Masai
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Kaoru Kaseda
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Tomoyuki Hishida
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Hiroyuki Yasuda
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinanomachi, Shinjyuku-ku, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinanomachi, Shinjyuku-ku, Tokyo, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
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Higuchi M, Inomata S, Yamaguchi H, Saito T, Suzuki H. Salvage surgery for advanced non-small cell lung cancer following previous immunotherapy: a retrospective study. J Cardiothorac Surg 2023; 18:235. [PMID: 37475037 PMCID: PMC10360220 DOI: 10.1186/s13019-023-02310-5] [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: 03/08/2023] [Accepted: 06/28/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND The development of systemic chemotherapy including immune checkpoint inhibitors (ICIs) has provided patients with unresectable advanced non-small cell lung cancer (NSCLC) an opportunity to undergo surgical intervention after initial treatment. However, no consensus regarding the indication for salvage surgery in these patients has been reached. METHODS We conducted a retrospective study of patients who underwent salvage surgery for advanced NSCLC (cStage IIIA-IVB) after treatment with ICIs from January 2018 to December 2022 at Aizu Medical Center and Fukushima Medical University Hospital. We evaluated the patients' clinical data, calculated disease-free survival (DFS) and overall survival (OS), and assessed the survival benefit using the Kaplan-Meier method. RESULTS Thirteen patients underwent salvage surgery after immunotherapy. All patients achieved downstaging after initial chemotherapy. Eleven patients underwent lobectomy, and one patient underwent extirpation of intra-abdominal lymph nodes. The mean surgery time and intraoperative blood loss were 242.2 min and 415.1 g, respectively. The mean drainage period was 4.2 days (range, 2-9 days). Grade ≥ 3 postoperative complications were confirmed in three patients. The 2-year DFS rate was 71.2%, and the 2-year OS rate was 76.2%. A pathological complete response compatible with ypStage 0 was achieved in four (30.8%) patients. Patients with ypStage 0 and I achieved significantly better OS than those with ypStage ≥ II (p = 0.044), and patients without severe complications achieved significantly better DFS and OS than those with severe complications (p = 0.001 and p < 0.001, respectively). CONCLUSIONS Salvage surgery after chemotherapy including ICIs is a feasible and effective treatment option for patients with advanced NSCLC, especially those who acquire downstaging to pathological stage 0 or I. However, severe perioperative complications might affect patient survival. A prospective study is urgently needed to evaluate the efficacy of salvage surgery.
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Affiliation(s)
- Mitsunori Higuchi
- Department of Thoracic Surgery, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan.
| | - Sho Inomata
- Department of Thoracic Surgery, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Hikaru Yamaguchi
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takuro Saito
- Department of Surgery, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Hiroyuki Suzuki
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
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Djouani A, Maddipati T, Smith A, Okiror L. Resection of Contralateral Scapular Oligometastasis in Non-small Cell Lung Cancer Post Right Salvage Pneumonectomy. Cureus 2023; 15:e39790. [PMID: 37398810 PMCID: PMC10313213 DOI: 10.7759/cureus.39790] [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: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
A 74-year-old male was diagnosed with right hilar T4N1M0 squamous cell carcinoma of the lung. Radical oncological treatment was initiated with curative intent. Despite this, a post-operative computed tomography scan showed residual disease. Therefore, right thoracotomy and salvage pneumonectomy were performed. The patient recovered well post-operatively. Unfortunately, seven months later, he re-presented with a left scapula subcutaneous mass, with a biopsy confirming metastatic lung squamous cell carcinoma. Radiotherapy was not possible as it would have irradiated the remaining lung, and therefore, surgical resection and chest wall reconstruction were undertaken. The patient remains free of disease at 6 months follow-up. We present an interesting case of surgical management of oligometastatic lung cancer.
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Affiliation(s)
- Adam Djouani
- Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, GBR
| | - Teja Maddipati
- Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, GBR
| | - Alexander Smith
- Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, GBR
| | - Lawrence Okiror
- Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, GBR
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Tsai MJ, Hung JY, Ma JY, Tsai YC, Wu KL, Lee MH, Kuo CY, Chuang CH, Lee TH, Lee YL, Huang CM, Shen MC, Yang CJ, Chong IW. Local Consolidative Therapy May Have Prominent Clinical Efficacy in Patients with EGFR-Mutant Advanced Lung Adenocarcinoma Treated with First-Line Afatinib. Cancers (Basel) 2023; 15:cancers15072019. [PMID: 37046679 PMCID: PMC10092956 DOI: 10.3390/cancers15072019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Afatinib is an irreversible tyrosine kinase inhibitor (TKI) targeting the epidermal growth factor receptor (EGFR), which is utilized for the treatment of patients with advanced lung cancer that harbors EGFR mutations. No studies have evaluated the clinical efficacy of LCT in patients treated with first-line afatinib. In this study, we retrospectively enrolled patients with advanced lung adenocarcinomas harboring susceptible EGFR mutations who were diagnosed and treated with first-line afatinib in three hospitals. A total of 254 patients were enrolled, including 30 (12%) patients who received LCT (15 patients received definitive radiotherapy for the primary lung mass and 15 patients received curative surgery). Patients who received LCT had a significantly longer PFS than those who did not (median PFS: 32.8 vs. 14.5 months, p = 0.0008). Patients who received LCT had significantly longer OS than those who did not (median OS: 67.1 vs. 34.5 months, p = 0.0011). Multivariable analysis showed LCT was an independent prognostic factor for improved PFS (adjusted hazard ratio [aHR] [95% confidence interval (CI)]: 0.44 [0.26–0.73], p = 0.0016) and OS (aHR [95% CI]: 0.26 [0.12–0.54], p = 0.0004). The analyses using propensity score-weighting showed consistent results. We conclude that LCT may improve clinical outcomes, in terms of PFS and OS, in patients with advanced EGFR-mutant lung adenocarcinomas who are treated with first-line afatinib.
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Affiliation(s)
- Ming-Ju Tsai
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Jen-Yu Hung
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 80145, Taiwan
| | - Juei-Yang Ma
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Yu-Chen Tsai
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 80145, Taiwan
| | - Kuan-Li Wu
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Mei-Hsuan Lee
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Chia-Yu Kuo
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 81267, Taiwan
| | - Cheng-Hao Chuang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Tai-Huang Lee
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 80145, Taiwan
| | - Yen-Lung Lee
- Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 80145, Taiwan
| | - Chun-Ming Huang
- Department of Radiation Oncology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 80145, Taiwan
| | - Mei-Chiou Shen
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Chih-Jen Yang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence: (C.-J.Y.); (I.-W.C.); Tel.: +886-7-320-8159 (C.-J.Y. & I.-W.C.); Fax: +886-7-316-1210 (C.-J.Y. & I.-W.C.)
| | - Inn-Wen Chong
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence: (C.-J.Y.); (I.-W.C.); Tel.: +886-7-320-8159 (C.-J.Y. & I.-W.C.); Fax: +886-7-316-1210 (C.-J.Y. & I.-W.C.)
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Deng HY, Li D, Ren Y, Wang K, Tang X. Targeted Therapy Followed by Salvage Surgery and Adjuvant Therapy: A Promising Therapy for Lung Cancer With Malignant Pleural Effusion From a Case Report. Front Surg 2021; 8:659983. [PMID: 34957195 PMCID: PMC8702428 DOI: 10.3389/fsurg.2021.659983] [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: 01/28/2021] [Accepted: 11/10/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction: Malignant pleural effusion was encountered in about 8–15% of lung cancer patients at initial cancer diagnosis. The optimal therapeutic strategies for lung cancer with malignant pleural effusion (MPE) remain unclear. Case Description: In this study, we reported a case of lung cancer with MPE, which was successfully managed with a multidisciplinary therapeutic strategy. The patient initially received gefitinib for 4 months with excellent response and he underwent salvage thoracoscopic lobectomy and systematic lymphadenectomy. Pathological complete response was confirmed for the patient and he discontinued gefitinib but received 4 cycles of adjuvant chemotherapy instead. The patient is still alive without disease progression for 62 months after surgery. Conclusions: Combining targeted therapy, salvage surgery, and adjuvant therapy may be a promising treatment strategy for lung cancer with MPE harboring oncogene-targeted mutations.
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Affiliation(s)
- Han-Yu Deng
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Deyan Li
- Operating Room, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Ren
- Department of Outpatient, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaojun Tang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Li K, Cao X, Ai B, Xiao H, Huang Q, Zhang Z, Chu Q, Zhang L, Dai X, Liao Y. Salvage surgery following downstaging of advanced non-small cell lung cancer by targeted therapy. Thorac Cancer 2021; 12:2161-2169. [PMID: 34128318 PMCID: PMC8327695 DOI: 10.1111/1759-7714.14044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Advanced non-small cell lung cancer (NSCLC) accounts for a high proportion of lung cancer cases. Targeted therapy improve the survival in these patients, but acquired drug resistance will inevitably occur. If tumor downstaging is achieved after targeted therapy, could surgical resection before drug resistance improve clinical benefits for patients with advanced NSCLC? Here, we conducted a clinical trial showing that for patients with advanced driver gene mutant NSCLC who did not progress after targeted therapy, salvage surgery (SS) could improve progression-free survival (PFS). Herein, we retrospectively reviewed our former clinical trial and thoracic cancer database in our medical institutions. METHODS We identified patients with advanced driver gene mutant NSCLC treated with targeted therapy plus SS or targeted therapy alone in our former clinical trial and our thoracic cancer database from July 2016 to July 2019. PFS was compared between the targeted therapy plus SS group and the targeted therapy only group using the log-rank test. RESULTS We identified 73 patients with driver gene mutant NSCLC who were treated with targeted therapy and 18 treated with targeted therapy plus SS.Among the 18 patients treated with targeted therapy plus SS, there were no obvious perioperative complications and deaths. Targeted therapy followed by SS resulted in a significantly longer PFS compared with targeted therapy alone (23.4 months VS 12.9 months, p = 0.0004). CONCLUSIONS Salvage surgery after tumor downstaging is a promising therapeutic strategy for some patients with advanced (stage IIIB-IV) NSCLC and may offer a new therapeutic option for multidisciplinary comprehensive treatment of lung cancer.
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Affiliation(s)
- Kuo Li
- Department of Thoracic Surgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xiaonian Cao
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Bo Ai
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Han Xiao
- Department of Thoracic Surgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Quanfu Huang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Zheng Zhang
- Department of Thoracic SurgeryThe Affliated Yantai Yuhuangding Hospital of Qingdao UniversityYantaiChina
| | - Qian Chu
- Department of Oncology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Li Zhang
- Department of Oncology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xiaofang Dai
- Department of Oncology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yongde Liao
- Department of Thoracic Surgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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