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Zhang J, Tang X, Zhang W, Xu Y, Zhang H, Fan Y. Cancer cachexia as a predictor of adverse outcomes in patients with non-small cell lung cancer: A meta-analysis. Clin Nutr 2024; 43:1618-1625. [PMID: 38788267 DOI: 10.1016/j.clnu.2024.05.025] [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: 02/20/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Cancer cachexia is a complex problem characterized by weight loss due to skeletal muscle and adipose tissue reduction. The purpose of this meta-analysis is to examine the association between cancer cachexia and adverse outcomes in patients with non-small cell lung cancer (NSCLC). METHODS A comprehensive search was conducted in the PubMed, Web of Science, and Embase databases from their inception to January 15, 2024. Retrospective or prospective studies that investigated the cancer cachexia as a predictor of overall survival (OS), progression-free survival (PFS), overall response rate (ORR), or disease control rate (DCR) in NSCLC patients were included in this analysis. RESULTS Sixteen studies, comprising 5919 NSCLC patients, were identified. The pooled prevalence of cachexia in NSCLC patients was 39%, with individual studies reporting rates ranging from 19% to 63.8%. A meta-analysis using a random effects model showed that cachexia was associated with reduced OS (hazard ratio [HR] 1.84; 95% confidence interval [CI] 1.54-2.21) and PFS (HR 1.49; 95% CI 1.27-1.73). Subgroup analysis indicated that cancer cachexia significantly predicted OS, regardless of study design, NSCLC subtypes, cancer stage, definitions of cachexia, or follow-up duration. However, there was no clear association between cancer cachexia and ORR or DCR. CONCLUSIONS Cancer cachexia emerges is a negative prognostic factor for OS and PFS in NSCLC patients. Assessing cancer cachexia can improve risk classification for survival outcomes in this patient population.
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Affiliation(s)
- Junfang Zhang
- Department of Medical Nutrition, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing 211200, China
| | - Xuan Tang
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang 212002, China
| | - Wenbo Zhang
- Department of General Surgery, The Affiliated People's Hospital, Jiangsu University, Zhenjiang 212002, China
| | - Ying Xu
- Department of Laboratory Center, The Affiliated People's Hospital, Jiangsu University, Zhenjiang 212002, China
| | - Heng Zhang
- Department of General Surgery, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing 211200, China.
| | - Yu Fan
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang 212002, China.
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Sun Y, Dang Q, Ge Y, Zhang J, Cheng Q, Sun H, Wang L, Gao A, Sun Y, Li J. Prognostic value of body mass index for first-line chemoimmunotherapy combinations in advanced non-small cell lung cancer in Chinese population. Heliyon 2024; 10:e31863. [PMID: 38841444 PMCID: PMC11152932 DOI: 10.1016/j.heliyon.2024.e31863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024] Open
Abstract
Background Few studies have examined the correlation between body mass index (BMI) and effectiveness of first-line chemoimmunotherapy in patients with advanced non-small cell lung cancer (NSCLC); moreover, the conclusion remains elusive and no such studies have been conducted in the Chinese population. Our study aimed to validate the predictive significance of BMI in Chinese patients with advanced NSCLC receiving first-line chemoimmunotherapy combinations. Methods Data of patients with advanced NSCLC treated with first-line chemoimmunotherapy between June 2018 and February 2022 at three centers were retrieved retrospectively. The association between baseline BMI with progression-free survival (PFS) and overall survival (OS) was evaluated using the Kaplan-Meier method and Cox regression models. BMI was categorized according to the World Health Organization criteria. Results Of the included 805 patients, 5.3 % were underweight, 63.4 % had normal weight, 27.8 % were overweight, and 3.5 % were obese. Survival analysis showed that patients in the high BMI group had significantly better PFS (p = 0.012) and OS (p = 0.014) than those in the low BMI group. Further, patients in the overweight subgroup had better PFS (p = 0.036) and OS (p = 0.043) compared to the normal weight population. The results of Cox regression analysis confirmed the correlations between BMI and prognosis of advanced NSCLC patients receiving first-line chemoimmunotherapy combinations. Conclusions Baseline BMI affected the clinical outcomes of first-line chemoimmunotherapy combinations in patients with advanced NSCLC, and was especially favorable for the overweight subgroup.
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Affiliation(s)
- Yanxin Sun
- School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong, China
- Phase I Clinical Research Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Qi Dang
- Phase I Clinical Research Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yihui Ge
- Phase I Clinical Research Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Phase I Clinical Research Center, Shandong University Cancer Center, Jinan, Shandong, China
| | - Jian Zhang
- Phase I Clinical Research Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Qinglei Cheng
- Phase I Clinical Research Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Haifeng Sun
- School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong, China
- Phase I Clinical Research Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Leirong Wang
- Phase I Clinical Research Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Aiqin Gao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yuping Sun
- Phase I Clinical Research Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Juan Li
- Phase I Clinical Research Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
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Yu Y, Yan L, Huang T, Wu Z, Liu J. Cancer cachexia reduces the efficacy of immune checkpoint inhibitors in cancer patients. Aging (Albany NY) 2024; 16:5354-5369. [PMID: 38466657 PMCID: PMC11006492 DOI: 10.18632/aging.205652] [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: 10/13/2023] [Accepted: 01/23/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE Cachexia, a multifactorial syndrome, is frequently noticed in cancer patients. A recent study has shown inconsistent findings about the relationship between cachexia and the efficiency of immune checkpoint inhibitors (ICIs). To analyze this disparity, we did a meta-analysis. METHODS From the beginning of each database to July 2023, literature describing the association between cachexia and prognosis of ICI-treated patients with solid malignancies was systematically searched in three online databases. Estimates were pooled, and 95% confidence intervals (CIs) were generated. RESULTS We analyzed a total of 12 articles, which included data from 1407 patients. The combined results of our analysis showed that cancer patients with cachexia had significantly worse overall survival (HR = 1.88, 95% CI: 1.59-2.22, p < 0.001), progression-free survival (HR = 1.84, 95% CI: 1.59-2.12, p < 0.001), and time to treatment failure (HR = 2.15, 95% CI: 1.32-3.50, p = 0.002). These findings were consistent in both univariate and multivariate analyses. Additionally, while not statistically significant, we observed a trend towards a lower objective response rate in cancer patients with cachexia compared to those without cachexia (OR = 0.59, 95% CI: 0.32-1.09, p = 0.093). CONCLUSION Poor survival in cachexia patients suggests a negative relationship between cachexia and ICI efficacy. In clinical practice, the existence of cachexia should be estimated to choose individuals who may benefit from ICIs.
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Affiliation(s)
- Yean Yu
- Department of Nephrology, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, China
| | - Li Yan
- Department of Traditional Chinese Medicine, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, China
| | - Tianhui Huang
- Department of Traditional Chinese Medicine, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, China
| | - Zhenfu Wu
- Department of Abdominal and Pelvic Medical Oncology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, China
| | - Juan Liu
- Department of Critical Care Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Department of Critical Care Medicine, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
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Katsushima U, Hase K, Fukushima T, Kubo T, Nakano J, Ogushi N, Okuno Y, Kamisako K, Nakanishi K, Okazaki Y, Ikoma T, Takeyasu Y, Yamanaka Y, Yoshioka H, Imai Y, Kurata T. Investigation of a practical assessment index to capture the clinical presentation of cachexia in patients with lung cancer. Jpn J Clin Oncol 2024; 54:305-311. [PMID: 38213068 DOI: 10.1093/jjco/hyad177] [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: 08/22/2023] [Accepted: 12/05/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE Cancer cachexia constitutes a poor prognostic factor in patients with lung cancer. However, the factors associated with cancer cachexia remain unclear. This study aimed to identify factors that influence cancer cachexia in patients with lung cancer. METHODS In this retrospective observational study conducted at the Kansai Medical University, 76 patients with lung cancer were evaluated for physical function, nutritional status (Mini Nutritional Assessment-Short Form) and physical activity (International Physical Activity Questionnaire-Short Form) at the first visit to the rehabilitation outpatient clinic. The patients were divided into cachexia and noncachexia groups. The log-rank tests and Cox proportional hazards model were used to investigate the relationship between cachexia and prognosis. To examine the factors that influence cachexia, multivariate regression analysis with significant (P < 0.05) variables in the univariate logistic regression analysis was performed. Spearman's correlation analysis was performed to investigate the association between International Physical Activity Questionnaire-Short Form and performance status. RESULTS Overall, 42 patients (55.2%) had cachexia associated with survival time since their first visit to the outpatient rehabilitation clinic, even after confounders adjustment (hazard ratio: 3.24, 95% confidence interval: 1.12-9.45, P = 0.031). In the multivariate analysis, Mini Nutritional Assessment-Short Form (odds ratio: 20.34, 95% confidence interval: 4.18-99.02, P < 0.001) and International Physical Activity Questionnaire-Short Form (odds ratio: 4.63, 95% confidence interval: 1.20-17.89, P = 0.026) were identified as independent factors for cachexia. There was no correlation between International Physical Activity Questionnaire-Short Form and performance status (r = 0.155, P = 0.181). CONCLUSION Malnutrition and low physical activity were associated with cachexia in patients with lung cancer. The International Physical Activity Questionnaire-Short Form may be a useful indicator of physical activity in cachexia. Regularly assessing these factors and identifying suitable interventions for cachexia remain challenges to be addressed in the future.
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Affiliation(s)
- Utae Katsushima
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
| | - Kimitaka Hase
- Department of Physical Medicine and Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Takuya Fukushima
- Department of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Takanari Kubo
- Department of Physical Medicine and Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Jiro Nakano
- Department of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Naoya Ogushi
- Department of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Yukiko Okuno
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
| | - Keisuke Kamisako
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
| | - Kentaro Nakanishi
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
| | - Yuta Okazaki
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
| | - Tatsuki Ikoma
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
| | - Yuki Takeyasu
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
| | - Yuta Yamanaka
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
| | - Hiroshige Yoshioka
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
| | - Yoshie Imai
- Department of Cancer Nursing, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takayasu Kurata
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
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Bartolomeo V, Jongbloed M, van de Worp WRPH, Langen R, Degens J, Hendriks LEL, de Ruysscher DKM. Cachexia and Sarcopenia in Oligometastatic Non-Small Cell Lung Cancer: Making a Potential Curable Disease Incurable? Cancers (Basel) 2024; 16:230. [PMID: 38201657 PMCID: PMC10777972 DOI: 10.3390/cancers16010230] [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: 11/27/2023] [Revised: 12/25/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024] Open
Abstract
Among patients with advanced NSCLC, there is a group of patients with synchronous oligometastatic disease (sOMD), defined as a limited number of metastases detected at the time of diagnosis. As cachexia and sarcopenia are linked to poor survival, incorporating this information could assist clinicians in determining whether a radical treatment should be administered. In a retrospective multicenter study, including all patients with adequately staged (FDG-PET, brain imaging) sOMD according to the EORTC definition, we aimed to assess the relationship between cachexia and/or sarcopenia and survival. Of the 439 patients that were identified between 2015 and 2021, 234 met the criteria for inclusion and were included. The median age of the cohort was 67, 52.6% were male, and the median number of metastasis was 1. Forty-six (19.7%) patients had cachexia, thirty-four (14.5%) had sarcopenia and twenty-one (9.0%) had both. With a median follow-up of 49.7 months, median PFS and OS were 8.6 and 17.3 months, respectively. Moreover, a trend toward longer PFS was found in patients without cachexia and sarcopenia compared to those with cachexia and/or sarcopenia. In multivariate analysis, cachexia and sarcopenia were not associated with an inferior survival, irrespective of receiving radical treatment. High CRP was associated with inferior survival and could be a prognostic factor, helping the decision of clinicians in selecting patients who may benefit from the addition of LRT. However, despite the homogeneous definition of oligometastatic disease and the adequate staging, our subgroups were small. Therefore, further studies are needed to better understand our hypothesis and generating findings.
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Affiliation(s)
- Valentina Bartolomeo
- Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Clinical Surgical, Diagnostic and Pediatric Sciences, Pavia University, 27100 Pavia, Italy
- Department of Radiation Oncology (Maastro Clinic), GROW—School for Oncology and Reproduction, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands;
| | - Mandy Jongbloed
- Department of Pulmonary Diseases, GROW—School for Oncology and Reproduction, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands; (M.J.); (L.E.L.H.)
| | - Wouter R. P. H. van de Worp
- Department of Respiratory Medicine, NUTRIM Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Ramon Langen
- Department of Respiratory Medicine, NUTRIM Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Juliette Degens
- Department of Pulmonology, Zuyderland Medical Center, 6419 PC Heerlen, The Netherlands;
| | - Lizza E. L. Hendriks
- Department of Pulmonary Diseases, GROW—School for Oncology and Reproduction, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands; (M.J.); (L.E.L.H.)
| | - Dirk K. M. de Ruysscher
- Department of Radiation Oncology (Maastro Clinic), GROW—School for Oncology and Reproduction, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands;
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Fujii H, Yamada Y, Iihara H, Suzuki A. The role of pharmacists in multimodal cancer cachexia care. Asia Pac J Oncol Nurs 2023; 10:100280. [PMID: 38197038 PMCID: PMC10772181 DOI: 10.1016/j.apjon.2023.100280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/27/2023] [Indexed: 01/11/2024] Open
Abstract
Cancer cachexia is a complex syndrome, and multidisciplinary management has the potential to improve patient outcomes and efficiency of care. Multidisciplinary management consists primarily of exercise, nutrition, and pharmacotherapy. The pharmacist's role in cancer cachexia is to contribute to appropriate pharmacotherapy practices. For example, anamorelin is an oral drug with ghrelin-like effects that may improve the pathogenesis of cancer cachexia by stimulating appetite and increasing food intake and body weight. Many patients with cancer cachexia are under treatment with anticancer agents, and pharmacists need to determine whether symptoms such as anorexia and nausea are due to cancer cachexia or anticancer agents. Based on that determination, they are then expected to suggest supportive care to the physician. Provision of multidisciplinary care for cancer cachexia requires communication with not only physicians but also with nurses, dietitians, and other professionals so that nutritional therapy can be provided at the time cachexia is detected. However, the role of pharmacists in the management of cancer cachexia is not well established, and there is no evidence that pharmacist interventions are of benefit to patients. In this article, to contribute to the treatment of cancer cachexia by multidisciplinary care, we describe the role of pharmacists in cancer cachexia as currently practiced at our hospital. We also consider future challenges to this type of multidisciplinary care. Evidence concerning multidisciplinary treatment of cancer cachexia is scarce, including therapeutic agents, and there is a current lack of collaboration among medical professionals and education in cancer cachexia. Solving these problems will require efforts in the practice and evaluation of treatment for cancer cachexia.
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Affiliation(s)
- Hironori Fujii
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Yunami Yamada
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | | | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
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Murata D, Azuma K, Matsuo N, Murotani K, Matama G, Kawahara A, Sasada T, Tokito T, Hoshino T. Survival and biomarkers for cachexia in non-small cell lung cancer receiving immune checkpoint inhibitors. Cancer Med 2023; 12:19471-19479. [PMID: 37712645 PMCID: PMC10587946 DOI: 10.1002/cam4.6549] [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: 04/20/2023] [Revised: 09/02/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND The presence of cachexia negatively impacts the prognosis of patients with cancer. However, the mechanisms behind the development of cachexia and its prognostic impact on immunotherapy efficacy are not fully understood. MATERIALS AND METHODS We retrospectively screened patients with advanced or recurrent non-small cell lung cancer (NSCLC) who received PD-1/PD-L1 inhibitor monotherapy. Among 183 patients, pre-treatment plasma samples were available from 100 patients. We defined cancer cachexia as weight loss of at least 5% during the past 6 months or weight loss of at least 2% and BMI <20. We analyzed 75 soluble immune mediators in pre-treatment plasma samples to explore the possible mechanisms behind the development of cancer cachexia. We also investigated whether cancer cachexia affects prognosis. RESULTS Among 100 patients, 35 had cancer cachexia. Logistic regression analysis identified ghrelin, c-reactive protein (CRP), pentraxin-3 (PTX-3), and osteopontin (OPN) as factors associated with cachexia. Patients with cachexia had worse progression-free survival (PFS) and overall survival (OS), although we did not detect statistically significant differences. Analyzing the soluble immune mediators associated with cachexia, the combination of cachexia and PTX-3 or OPN expression levels was predictive for PFS and the combination of cachexia and CRP or OPN expression levels was predictive for OS. CONCLUSIONS Pre-treatment ghrelin, CRP, PTX-3, and OPN may be associated with cachexia. Among patients with NSCLC who received PD-1/L1 inhibitor monotherapy, those with cachexia had worse survival than those without cachexia. Larger studies will be required to confirm our data and better understand the mechanisms behind the development of cachexia.
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Affiliation(s)
- Daiki Murata
- Division of Respirology, Neurology, and Rheumatology, Department of Internal MedicineKurume University School of MedicineFukuokaJapan
| | - Koichi Azuma
- Division of Respirology, Neurology, and Rheumatology, Department of Internal MedicineKurume University School of MedicineFukuokaJapan
| | - Norikazu Matsuo
- Division of Respirology, Neurology, and Rheumatology, Department of Internal MedicineKurume University School of MedicineFukuokaJapan
| | - Kenta Murotani
- Biostatistics CenterKurume University School of MedicineFukuokaJapan
| | - Goushi Matama
- Division of Respirology, Neurology, and Rheumatology, Department of Internal MedicineKurume University School of MedicineFukuokaJapan
| | - Akihiko Kawahara
- Department of Diagnostic PathologyKurume University HospitalFukuokaJapan
| | - Tetsuro Sasada
- Cancer Vaccine and Immunotherapy Center and Division of Cancer ImmunotherapyKanagawa Cancer Center Research InstituteKanagawaJapan
| | - Takaaki Tokito
- Division of Respirology, Neurology, and Rheumatology, Department of Internal MedicineKurume University School of MedicineFukuokaJapan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Internal MedicineKurume University School of MedicineFukuokaJapan
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