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Yang Y, Xin X, Chen P, Shi X, Yang C, Fan J, Zhang Y, Jia X. Left compared with right thoracic approach thoracotomy in esophageal cancer: a retrospective cohort study. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04765-4. [PMID: 37071207 DOI: 10.1007/s00432-023-04765-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Esophagectomy is regarded as one of the optimal treatments for resectable esophageal cancer. However, the impact of surgical approach on the long-term prognosis of esophageal cancer remains controversial. This study attempted to compare the long-term survival outcomes of patients receiving left and right thoracic esophagectomy for esophageal cancer. METHODS A total of 985 patients underwent esophagectomy (including 453 left and 532 right thoracic approach) for esophageal cancer in Henan Cancer Hospital from January 2015 to December 2016 were enrolled. Their 5 year overall survival (OS) and disease-free survival (DFS) were retrospectively collected. Cox regression was performed to compare OS and DFS in patients who underwent left and right thoracic esophagectomy. Propensity score matching (PSM) analysis was used to balance confounding factors. RESULTS The 5 year OS rates were 60.21% in the left and 51.60% in the right thoracic esophagectomy, respectively (P = 0.67). The 5 year DFS rates were 56.73% in the left and 47.93% and in the right thoracic esophagectomy, respectively (P = 0.36). Cox regression analysis showed there was no significant difference in long-term survival between patients with left and right surgical access (OS: HR = 0.95, 95% CI 0.77-1.18; DFS: HR = 0.91, 95% CI 0.74-1.12). In the cohort of patients obtained by PSM, Cox regression analysis yielded the similar results. CONCLUSION For patients with resectable esophageal cancer, the surgical treatment through left thoracic approach can achieve the same long-term survival outcomes as the right thoracic approach.
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Affiliation(s)
- Yongli Yang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Xin Xin
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Peinan Chen
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Xuezhong Shi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Chaojun Yang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Jingwen Fan
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Yi Zhang
- Department of Medical Record, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Xiaocan Jia
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China.
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Zhang X, Qi K, Huang W, Liu J, Lin G, Li J. Left versus right approach for middle and lower esophageal squamous cell carcinoma: A propensity score-matched study. Front Oncol 2022; 12:858660. [PMID: 36582805 PMCID: PMC9792602 DOI: 10.3389/fonc.2022.858660] [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: 04/05/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022] Open
Abstract
Background Despite superior short-term outcomes, there is considerable debate about the oncological efficacy of the left approach esophagectomy for middle and lower squamous esophageal carcinoma (ESCC). A propensity score-matched retrospective study was conducted to evaluate the left approach's short- and long-term effects. Methods We recorded data from patients with ESCC who underwent curative resection via the left or right approach between January 2010 and December 2015. Propensity score matching (PSM) was performed, and maximally selected rank statistics (MSRS) were utilized to determine the appropriate number of lymph nodes to resect during esophagectomy. Results One hundred and forty-eight ESCC patients underwent esophagectomy via the right approach, and 108 underwent the left approach esophagectomy. After PSM, the left approach esophagectomy showed statistically significant superiority in operative time and time to oral intake, and there was a trend toward a shorter length of hospital stay. Fewer cervical, upper thoracic, and recurrent laryngeal nerve lymph nodes were harvested via the left approach than the right approach; the total number of lymph nodes harvested via the left and right approaches was similar. Similar long-term survival outcomes were achieved. MSRS suggested that at least 25 lymph nodes are needed to be resected during esophagectomy to improve survival in N0 patients. Conclusions The left approach esophagectomy might facilitate postoperative recovery in patients with middle and lower ESCC. With adequate lymphadenectomy, the left approach esophagectomy might achieve similar long-term outcomes for middle and lower ESCC patients.
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Wu H, Zhuang W, Huang S, Guan X, Zheng Y, Xie Z, Chen G, Tang J, Zhou H, Xie L, Ben X, Zhou Z, Li Z, Chen R, Qiao G. Optimal Range of Lymphadenectomy in Pathological Stage T1 and T2 Esophageal Squamous Cell Carcinoma. Front Oncol 2021; 11:619556. [PMID: 34113556 PMCID: PMC8186312 DOI: 10.3389/fonc.2021.619556] [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: 10/20/2020] [Accepted: 04/22/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lymph node metastasis is a primary contributor to tumor progression in esophageal squamous cell carcinoma (ESCC), and the optimal extent of lymphadenectomy during esophagectomy remains controversial. This study aimed to investigate the appropriate number of lymph nodes to be dissected in pT1-2Nany stage ESCC to achieve the best prognosis and avoid missing positive lymph nodes (PLNs). METHODS A total of 497 patients with pT1 to pT2 esophageal cancer from two institutions were retrospectively analyzed and their surgical and pathological records were critically reviewed. Stepwise analyses were conducted by calculating a serial of hazard ratios and odd ratios to determine the optimal range of lymphadenectomy for overall survival (OS). RESULTS The best survival outcome can be obtained when the number of lymph node examined (NLNE) is 10-18 in pT1N0 ESCC, while the NLNE should exceed 24 in pT2N0 diseases. In patients with pT1-2Nany and pT2Nany ESCC, resection of 15-25 and 24-37 lymph nodes, respectively, could provide significant added value for identifying positive nodal metastasis. When the NLNE exceeds this appropriate range, resection of extra lymph node is not helpful to improve the probability of finding PLNs. CONCLUSIONS For ESCC patients undergoing radical esophagectomy, the optimal extent of lymphadenectomy is 15-25 for pT1Nany disease and 24-37 for pT2Nany disease.
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Affiliation(s)
- Hansheng Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weitao Zhuang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Shujie Huang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Xueting Guan
- Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yuju Zheng
- Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zefeng Xie
- Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Gang Chen
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiming Tang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haiyu Zhou
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liang Xie
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaosong Ben
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zihao Zhou
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zijun Li
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Rixin Chen
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Research Center of Medical Sciences, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Guibin Qiao, ; Rixin Chen,
| | - Guibin Qiao
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
- *Correspondence: Guibin Qiao, ; Rixin Chen,
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Xue Y, Chen D, Wang W, Wang W, Chen L, Sang Y, Chen Y, Xu W. Comparison of Ivor Lewis and Sweet esophagectomy for middle and lower esophageal squamous cell carcinoma: A systematic review and pooled analysis. EClinicalMedicine 2020; 27:100497. [PMID: 33089129 PMCID: PMC7559873 DOI: 10.1016/j.eclinm.2020.100497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Lack of robust evidence highlights the important need to address the controversy on the clinical safety and effectiveness between Ivor Lewis versus Sweet procedure for middle and lower esophageal squamous cell carcinoma (ESCC). METHODS Search results were filtered according to certain criteria and were analyzed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. FINDINGS The inter-study heterogeneity was high. Ivor Lewis procedure might be associated with longer operation time (p < 0.01) and higher lymph node yield (p < 0.01) compared with Sweet procedure. There was no significant difference in the length of hospital stay and postoperative complications with similar reoperation rate between the two procedures (p > 0.05). As the combined analysis of survival data revealed, there was no statistical difference in the oncologic efficacy of them (p = 0.97). INTERPRETATION The present study based on retrospective data with high heterogeneity indicated that Ivor Lewis esophagectomy might be associated with increased lymph node yield but longer operation time than Sweet. Prospective studies are warranted to compare the long-term survival of Ivor Lewis esophagectomy versus Sweet for middle and lower ESCC.
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Affiliation(s)
- Yuhang Xue
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Wei Wang
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wenjia Wang
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Lei Chen
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yonghua Sang
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
- Corresponding authors.
| | - Yongbing Chen
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
- Corresponding authors.
| | - Weihua Xu
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
- Corresponding authors.
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Affiliation(s)
- Hui Shi
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Feng Y, Wu N, Yan S, Wang X, Yang Y. Comparison of Ivor Lewis esophagectomy and Sweet esophagectomy for the treatment of middle-lower esophageal squamous cell carcinoma. J Thorac Dis 2019; 11:3584-3592. [PMID: 31559065 DOI: 10.21037/jtd.2019.07.68] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background For cancer of the middle and/or lower segment of thoracic esophagus, the Ivor Lewis esophagectomy is the mainstream standard surgery, whereas the Sweet procedure is widely used in China. As no consensus has been reached about the choice of different thoracic approaches, we designed this retrospective study to investigate and compare oncological benefits of the two surgical approaches. Methods After propensity score matching, 150 patients who underwent the Sweet or Ivor Lewis esophagectomy from August 2003 to December 2009 in the Beijing Cancer Hospital were reviewed. We compared the postoperative recovery, nutritional parameters, and survival of the two different surgical approaches. Results The 5-year overall survival (OS) rate for the whole group was 48.5%, and the 10-year OS rate was 35.6%. The Ivor Lewis group had a longer operation time, longer duration of chest tube drainage, and a larger volume of total thoracic drainage. No significant differences were found between the two groups in terms of the duration of systemic inflammatory response syndrome (SIRS), length of postoperative hospital stay, duration of postoperative nasogastric tube use, incidence of major complications, and nutritional status after the esophagectomy. The OS rates were similar in both groups. Conclusions The Sweet and Ivor Lewis esophagectomy are both safe and effective. A change of the surgical incision may not be the best way to increase survival, and the choice of surgical procedure should depend on the preference of the thoracic surgeon to secure the safety of the operation.
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Affiliation(s)
- Yuan Feng
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
| | - Nan Wu
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
| | - Shi Yan
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
| | - Xing Wang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
| | - Yue Yang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
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Comparison of Long-term Quality of Life in Patients with Esophageal Cancer after Ivor-Lewis, Mckeown, or Sweet Esophagectomy. J Gastrointest Surg 2019; 23:225-231. [PMID: 30298418 DOI: 10.1007/s11605-018-3999-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/26/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of this study was to compare the long-term quality of life (QoL) in patients after Sweet, Ivor-Lewis, or Mckeown esophagectomy. METHODS Esophageal cancer patients after Sweet, Ivor-Lewis, or Mckeown esophagectomy from 2010 to 2012 were included. QoL was assessed according to the European Organization for Research and Treatment of Cancer general questionnaire: QLQ-C30 and esophagus-specific questionnaire: QLQ-OES18. RESULTS A total of 126 qualified patients who have been alive for more than 3 years without tumor recurrence were divided into three groups: the Sweet group (n = 40), Ivor-Lewis group (n = 38), and Mckeown group (n = 48). Among these three groups, the QLQ-C30 mean scores of global health status, functional and symptom scales, and general QoL were similar. The symptom scales of QLQ-OSE18 showed that patients who had a Mckeown operation experienced more problem of eating (P = 0.029), choking when swallowing (P = 0.010) and coughing (P = 0.016), while patients undergoing Sweet operation complained more symptom of reflux (P = 0.003) and pain (P = 0.000). CONCLUSIONS All three types of esophagectomy provided a generally good long-term QoL. However, patients in Sweet and Mckeown group tend to suffer from a higher symptomatic burden as compared to Ivor-Lewis approach.
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Response to: "Sweet Versus Ivor-Lewis: Is It Time To Draw a Conclusion?". Ann Surg 2018; 268:e35-e36. [PMID: 29985813 DOI: 10.1097/sla.0000000000002476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Li H, Fang W, Yu Z, Mao Y, Chen L, He J, Rong T, Chen C, Chen H, Chen K, Du M, Han Y, Hu J, Fu J, Hou X, Gong T, Li Y, Liu J, Liu S, Tan L, Tian H, Wang Q, Xiang J, Xu M, Ye X, You B, Zhang R, Zhao Y. Chinese expert consensus on mediastinal lymph node dissection in esophagectomy for esophageal cancer (2017 edition). J Thorac Dis 2018; 10:2481-2489. [PMID: 29850156 DOI: 10.21037/jtd.2018.03.175] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University Medical School, Shanghai 200030, China
| | - Zhentao Yu
- Department of Esophageal Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021,China
| | - Longqi Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Tiehua Rong
- Department of Thoracic Surgery, San Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fujian 350001, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Cancer Hospital, Fudan University, Shanghai 200032, China
| | - Keneng Chen
- Department of Thoracic Surgery, Beijing University Cancer Center, Beijing 100142, China
| | - Ming Du
- Department of Thoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yongtao Han
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Chengdu 610041, China
| | - Jian Hu
- Department of Thoracic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jianhua Fu
- Department of Thoracic Surgery, San Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xiaobin Hou
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Taiqian Gong
- Department of Thoracic Surgery, Navy General Hospital of PLA, Beijing 100037, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Junfeng Liu
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Shuoyan Liu
- Department of Thoracic Surgery, Fujian Provincial Tumor Hospital, Fuzhou 350014, China
| | - Lijie Tan
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jiaqing Xiang
- Department of Thoracic Surgery, Cancer Hospital, Fudan University, Shanghai 200032, China
| | - Meiqing Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei 230001, China
| | | | | | - Renquan Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yan Zhao
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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