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Sakin A, Aldemir MN. Lymph Node Ratio Predicts Long-Term Survival in Lymph Node-Positive Breast Cancer. Eur J Breast Health 2020; 16:270-275. [PMID: 33062968 DOI: 10.5152/ejbh.2020.5809] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/22/2020] [Indexed: 11/22/2022]
Abstract
Objective In this study, we aimed to evaluate the prognostic value of axillary lymph node ratio (LNR) for disease-free survival (DFS) in node positive breast cancer (BC) patients with long term follow-up. Materials and Methods A total of 179 stage II to III female BC patients, who were followed between December 2001 and January 2019 at the department of medical oncology, were included in this study. Patients were classified into 3 groups based on the LNR as follows; LNR<0.21, LNR=0.21-0.65, and LNR>0.65. SPSS 22 for windows was used for statistical analysis. Results The median age was 49 (range, 24-83) years. The numbers of patients with stage II and stage III disease were 81 (45.3%) and 98 (54.7%), respectively. The median number of lymph node (LN) resected and positive LN were 15 (range, 3-48) and 3 (range, 1-29), respectively. There were 90 patients (50.3%) with LNR <0.21, 62 (34.6%) with LNR=0.21-0.65, and 27 (15.1%) with LNR >0.65. The median disease-free survival (DFS) was not reached in patients with LNR <0.21, 81 months in patients with LNR=0.21-0.65, and 43 months in patients with LNR>0.65 (p<0.001). Overall survival (OS) was found to be significantly related to LNR (p=0.042). In patients with LNR<0.21 and LNR=0.21-0.65, the median OS was not reached. In patients with LNR >0.65, the median OS was 101 months. In multivariate analysis, LNR=0.21-0.65 (Hazard ratio [HR], 6.99), LNR>0.65 (HR, 28.99), and HER-2 negativity (HR, 4.64) were the factors associated with DFS (p<0.05). Conclusion LNR is a more useful prognostic factor than the pathological lymph node staging for predicting survival in patients with nod-positive BC.
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Affiliation(s)
- Ayşegül Sakin
- Department of Internal medicine, University of Health Sciences, Van Research and Training Hospital, Van, Turkey
| | - Mehmet Naci Aldemir
- Department of Medical Oncology, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
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Soran A, Ozmen T, Salamat A, Soybir G, Johnson R. Lymph Node Ratio (LNR): Predicting Prognosis after Neoadjuvant Chemotherapy (NAC) in Breast Cancer Patients. Eur J Breast Health 2019; 15:249-255. [PMID: 31620684 DOI: 10.5152/ejbh.2019.4848] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/21/2019] [Indexed: 11/22/2022]
Abstract
Objective Axillary lymph node status is an important prognostic factor in breast cancer (BC). Residual nodal disease burden after neoadjuvant chemotherapy (NAC) is one of the important prognostic factors to determine the prognosis and in the treatment of BC. Lymph node ratio (LNR) defined as the ratio of the number of positive lymph nodes to total excised axillary lymph nodes, may be a stronger determinant of prognosis than pN in axillary nodal staging, although there is very limited data evaluating its prognostic value in the setting of NAC. In this cohort of patients, we studied the utility of LNR in predicting recurrence and overall survival (OS) after NAC. Materials and Methods An Institutional cancer registry was queried from 2009 to 2014 for women with axillary node-positive BC with no evidence of distant metastasis, and who received NAC followed by surgery for loco-regional treatment (axillary dissection with breast conserving surgery or total mastectomy). Patients with axillary complete response were excluded. Locoregional recurrence (LRR), distant recurrence (DR) and overall survival (OS) rates were reviewed regarding pN and LNR. Results A total of 179 patients were analyzed. Median follow up time was 24 [25%, 75%: 13-42] months. Patients with pN1 in comparison to pN2 and pN3 had lower rate of LRR (9% vs. 15% and 14%, respectively; p=0.41), lower rate of DR (14% vs. 25% and 27%, respectively, p=0.16) and increased rate of OS (89% vs. 79% and 78%, respectively, p=0.04). In comparison to patients with LNR >20%, patients with LNR ≤20% had lower LRR (9% vs. 14%, p=0.25), lower DR (13% vs. 27%, p=0.01) and improved OS (89% vs. 79%, p=0.02) rates. In the pN1 group, patients who had a LNR >20% had higher DR (22% vs. 14%, p=0.48) rates in comparison to patients with LNR ≤20%. In ER/PR (+) patients who had LNR ≤20% DR was 6% compared with 23% in patient who had LNR >20% (p=0.02), and in triple negative patients' OS rate was significantly better compared the LNR less/equal or more than 20% (71% vs 33%, p=0.001). Conclusion Our study demonstrated that LNR adds valuable information for the prognosis after NAC and this additional information should be considered when deciding further treatment and follow-up for patients who had residual tumor burden on the axilla. This observation should be tested in a larger study.
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Affiliation(s)
- Atilla Soran
- Department of Surgical Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, USA
| | - Tolga Ozmen
- Department of General Surgery, University of Miami, Miami, USA
| | - Arsalan Salamat
- Department of Surgery, Southern Illinois University, Illinois, USA
| | - Gürsel Soybir
- Department of Surgery, Memorial Etiler Medical Centre, İstanbul, Turkey
| | - Ronald Johnson
- Department of Surgical Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, USA
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Abd-Elhay FAE, Elhusseiny KM, Kamel MG, Low SK, Sang TK, Mehyar GM, Nhat Minh LH, Hashan MR, Huy NT. Negative Lymph Node Count and Lymph Node Ratio Are Associated With Survival in Male Breast Cancer. Clin Breast Cancer 2018; 18:e1293-e1310. [PMID: 30093263 DOI: 10.1016/j.clbc.2018.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 06/19/2018] [Accepted: 07/03/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Male breast cancer (MBC) is usually diagnosed at late stages and therefore has a worse prognosis than female breast cancer (FBC). MBC is also more likely to have lymph node (LN) involvement than FBC. MATERIALS AND METHODS We sought to determine the prognostic role of the examined lymph node (LN), negative LN (NLN), and positive LN counts and the LN ratio (LNR), defined as (positive LNs/ENLs), on the survival rate among MBC patients. We performed a large population-based study using the data from the Surveillance, Epidemiology, and End Results program. RESULTS Older age, black race, stage IV disease, ≤ 1 NLN, and a > 31.3% LNR were significantly associated with worse survival across all prediction models. Moreover, we demonstrated a decreased risk of mortality in MBC patients across the MBC-specific survival model (hazard ratio, 0.98; 95% confidence interval, 0.96-0.998; P = .03) and 10-year MBC-specific survival model (hazard ratio, 0.98; 95% confidence interval, 0.96-0.999; P = .04). CONCLUSION MBC has had an augmented incidence over the years. We found several independent predictors of MBC survival, including age, race, stage, NLNs, and the LNR. We strongly suggest adding the NLN count and/or LNR into the current staging system. Further studies are needed to provide information on the mechanisms underlying the association between the NLN count and MBC survival and the LNR and MBC survival.
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Affiliation(s)
| | | | - Mohamed Gomaa Kamel
- Faculty of Medicine, Minia University, Minia, Egypt; Online Research Club, Nagasaki, Japan
| | - Soon Khai Low
- Online Research Club, Nagasaki, Japan; School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Selangor, Malaysia
| | - To Kim Sang
- Online Research Club, Nagasaki, Japan; Ho Chi Minh City Oncology Hospital, Ho Chi Minh City, Vietnam
| | | | - Le Huu Nhat Minh
- Online Research Club, Nagasaki, Japan; University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Mohammad Rashidul Hashan
- Online Research Club, Nagasaki, Japan; Division of Infectious Disease, Department of Respiratory and Enteric Infections, International Center for Diarrheal Disease and Research, Dhaka, Bangladesh
| | - Nguyen Tien Huy
- Evidence Based Medicine Research Group & Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam; Department of Clinical Product Development, Institute of Tropical Medicine, Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
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Kim J, Kim JH, Kim OB, Oh YK, Park SG. Clinical significance of the lymph node ratio in N1 breast cancer. Radiat Oncol J 2017; 35:227-232. [PMID: 28893060 PMCID: PMC5647751 DOI: 10.3857/roj.2017.00101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/08/2017] [Accepted: 03/27/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the prognostic value of the lymph node ratio (LNR), which was defined as the proportion of involved nodes of all dissected nodes, in pN1 breast cancer. MATERIALS AND METHODS We retrospectively analyzed the clinical data of patients with pN1 breast cancer (N = 144) treated at Keimyung University Dongsan Medical Center, Daegu, Korea between 2001 and 2010. The median age was 46 years (range, 27 to 66 years). The LNR was 0.01-0.15 (low LNR) in 130 patients and >0.15 (high LNR) in 14 patients. Sixty-five patients (45.1%) had T1 tumors, 74 (51.4%) had T2 tumors, and 5 (3.5%) had T3 tumors. Eighty-eight patients (61.1%) underwent total mastectomy and 56 (38.9%) underwent partial mastectomy. Fifty-nine patients (41.0%) underwent radiotherapy and 12 (8.3%) underwent regional radiotherapy. The median follow-up period was 65 months. RESULTS The 5- and 10-year disease-free survival (DFS) rates were 92.7% and 82.4%, respectively. Univariate analyses revealed that high LNR (p = 0.004), total mastectomy (p = 0.006), no local radiotherapy (p = 0.036), and stage T2 or T3 (p = 0.010) were associated with worse DFS. In multivariable analysis, only high LNR (p = 0.015) was associated with worse DFS. CONCLUSION High LNR is an independent prognostic factor in pN1 breast cancer and could be an indication for adjuvant radiotherapy in these patients.
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Affiliation(s)
- Jaeho Kim
- Department of Radiation Oncology, Keimyung University School of Medicine, Daegu, Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Keimyung University School of Medicine, Daegu, Korea
| | - Ok Bae Kim
- Department of Radiation Oncology, Keimyung University School of Medicine, Daegu, Korea
| | - Young Kee Oh
- Department of Radiation Oncology, Keimyung University School of Medicine, Daegu, Korea
| | - Seung Gyu Park
- Department of Radiation Oncology, Dogae Health Subcenter, Gumi, Korea
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Chan RCL, Chan JYW. Impact of nodal ratio on survival in recurrent nasopharyngeal carcinoma. Head Neck 2014; 37:12-7. [PMID: 24307492 DOI: 10.1002/hed.23544] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 08/16/2013] [Accepted: 10/31/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Richie Chiu-Lung Chan
- Division of Head and Neck Surgery, Department of Surgery; Queen Mary Hospital; Hong Kong China
| | - Jimmy Yu Wai Chan
- Division of Head and Neck Surgery, Department of Surgery; Queen Mary Hospital; Hong Kong China
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Liu D, Chen Y, Deng M, Xie G, Wang J, Zhang L, Liu Q, Yuan P, Feng X. Lymph node ratio and breast cancer prognosis: a meta-analysis. Breast Cancer 2013; 21:1-9. [DOI: 10.1007/s12282-013-0497-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 09/24/2013] [Indexed: 12/26/2022]
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Koo TR, Eom KY, Kang EY, Kim YJ, Kim SW, Kim JH, Kim JS, Kim IA. Prognostic value of the nodal ratio and ki-67 expression in breast cancer patients treated with postmastectomy radiotherapy. J Breast Cancer 2013; 16:274-84. [PMID: 24155756 PMCID: PMC3800723 DOI: 10.4048/jbc.2013.16.3.274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 07/21/2013] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This pilot study aimed to evaluate prognostic factors of postmastectomy radiotherapy (PMRT) for breast cancer patients undergoing systemic therapy in either preoperative or postoperative setting. METHODS Between 2003 and 2009, 113 patients received PMRT: 61 underwent preoperative systemic therapy (PST subgroup) and 52 received postoperative systemic therapy (non-PST subgroup). RESULTS The median follow-up time was 72.3 months (range, 34.0-109.4 months) for surviving patients. In univariate analysis of all patients, disease-free survival (DFS) was associated with age, nodal ratio (NR), and Ki-67 expression; overall survival (OS) was associated with NR and Ki-67 expression. Pathologic N stage and HER2 expression were marginally associated with DFS and OS. In the non-PST subgroup, DFS was associated with age, NR, venous invasion, and Ki-67 expression; OS was associated with age. In the PST subgroup, DFS was associated with ypN stage and NR; OS was associated with ypN, histologic grade, HER2 expression, and p53 expression. In multivariate analysis of all patients, DFS and OS were significantly associated with NR (p=0.003 and p=0.019, respectively) and Ki-67 expression (p=0.002 and p=0.015, respectively). Patients were classified into low-risk (NR ≤0.2 and Ki-67 ≤20%; n=34), intermediate-risk (NR >0.2 or Ki-67 >20%; n=63), and high-risk (NR >0.2 and Ki-67 >20%; n=16) subgroups. All low-risk patients were alive at the time of analysis. High-risk (p<0.001 and p=0.001, respectively) and intermediate-risk (p=0.022 and p=0.008, respectively) patients had significantly shorter DFS and OS than low-risk patients. This prognostic model was statistically significant for DFS when applied to the PST (p=0.001) and non-PST (p=0.016) subgroups separately. CONCLUSION For breast cancer patients undergoing PMRT, NR and Ki-67 are potential prognostic factors. A model using these factors might help predict a poor prognosis. Whether NR and Ki-67 are also prognostic for different setting of systemic therapy, preoperative or postoperative, warrants further study.
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Affiliation(s)
- Tae Ryool Koo
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
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Wu SG, Chen Y, Sun JY, Li FY, Lin Q, Lin HX, He ZY. Using the lymph nodal ratio to predict the risk of locoregional recurrence in lymph node-positive breast cancer patients treated with mastectomy without radiation therapy. Radiat Oncol 2013; 8:119. [PMID: 23672513 PMCID: PMC3691848 DOI: 10.1186/1748-717x-8-119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 05/08/2013] [Indexed: 11/20/2022] Open
Abstract
Background To evaluate the prognostic value of axillary lymph node ratio (LNR) as compared to the number of involved nodes (pN stage) in patients with axillary lymph node-positive breast cancer treated with mastectomy without radiation. Methods We performed a retrospective analysis of the clinical data of patients with stage II-III node-positive breast cancer (N=1068) between 1998 and 2007. Locoregional recurrence-free survival (LRFS) and overall survival (OS) were compared based on the LNR and pN staging. Results A total of 780 cases were classified as pN1, 183 as pN2, and 105 as pN3. With respect to LNR, 690 cases had a LNR from 0.01-0.20, 269 cases a LNR from 0.21-0.65, and 109 cases a LNR > 0.65. The median follow-up time was 62 months. Univariate analysis showed that both LNR and pN stage were prognostic factors of LRFS and OS (p<0.05). Multivariate analysis indicated that LNR was an independent prognostic factor of LRFS and OS (p<0.05). pN stage had no significant effect on LRFS or OS (p>0.05). In subgroup analysis, the LNR identified groups of patients with different survival rates based on pN stage. Conclusions LNR is superior to pN staging as a prognostic factor in lymph node-positive breast cancer after mastectomy, and should be used as one of the indications for adjuvant radiation therapy.
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Affiliation(s)
- San-Gang Wu
- Xiamen Cancer Center, Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China
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Wu SG, He ZY, Li Q, Sun JY, Li FY, Lin Q, Lin HX, Guan XX. Prognostic value of metastatic axillary lymph node ratio for Chinese breast cancer patients. PLoS One 2013; 8:e61410. [PMID: 23626682 PMCID: PMC3634079 DOI: 10.1371/journal.pone.0061410] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 03/10/2013] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The prevalence of breast cancer varies among countries and regions. This retrospective study investigated the prognostic value of the lymph node ratio (LNR) compared with the number of positive lymph nodes (pN) in Chinese breast cancer patients. METHODS The medical records of female breast cancer patients (N = 2591) were retrospectively evaluated. The association of LNR and TMN staging system were compared with respect to overall, disease-free, and distant metastasis-free survival. RESULTS Out of 2591 patients, 2495 underwent modified radical surgery and 96 received breast conserving surgery. All patients had adjuvant chemotherapy following surgery. The median follow up period 66.9 months (range 5-168 months). The 5-year and 10-year overall survival rates were 89.3% and 78.8%, respectively, and 5-year disease-free survival and distant metastasis-free survival rates were 81.6% and 83.5%, respectively. Univariate analysis indicated that in general T, pN, LNR, as well as tumor expression of the estrogen receptor, progesterone receptor, and HER2 were associated with overall, disease-free, and distant metastasis-free survival (all P-values <0.05). Mutlivariate analysis found pN stage and LNR were independent predictors of overall, disease-free, and distant metastasis-free survival (all P-values <0.001). If pN stage and LNR were both included in a multivariate analysis, LNR was still an independent prognostic factor for overall, disease-free, and distant metastasis-free survival (all P-values <0.001). CONCLUSION Our findings support the use of LNR as a predictor of survival in Chinese patients with breast cancer, and that LNR is superior to pN stage in determining disease prognosis.
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Affiliation(s)
- San-Gang Wu
- Xiamen City Cancer Center, Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
| | - Zhen-Yu He
- Xiamen City Cancer Center, Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
| | - Qun Li
- State Key Laboratory of Oncology in Southern China, Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
- * E-mail:
| | - Jia-Yuan Sun
- State Key Laboratory of Oncology in Southern China, Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Feng-Yan Li
- State Key Laboratory of Oncology in Southern China, Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Qin Lin
- Xiamen City Cancer Center, Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
| | - Huan-Xin Lin
- State Key Laboratory of Oncology in Southern China, Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Xun-Xing Guan
- State Key Laboratory of Oncology in Southern China, Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
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Bai LS, Chen C, Gong YP, Wei W, Tu Y, Yao F, Li JJ, Wang LJ, Sun SR. Lymph Node Ratio is More Predictive than Traditional Lymph Node Stratification in Lymph Node Positive Invasive Breast Cancer. Asian Pac J Cancer Prev 2013; 14:753-7. [DOI: 10.7314/apjcp.2013.14.2.753] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Wang F, He W, Qiu H, Wang X, Guo G, Chen X, Rong Y, Zhou F, Yin C, Yuan Z, Xia L. Lymph Node Ratio and pN Staging Show Different Superiority As Prognostic Predictors Depending on the Number of Lymph Nodes Dissected in Chinese Patients With Luminal A Breast Cancer. Clin Breast Cancer 2012; 12:404-11. [DOI: 10.1016/j.clbc.2012.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 05/16/2012] [Accepted: 07/09/2012] [Indexed: 12/18/2022]
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