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Morra S, Piccinelli ML, Cano Garcia C, Tappero S, Barletta F, Incesu RB, Scheipner L, Baudo A, Tian Z, Saad F, Mirone V, Califano G, Colla' Ruvolo C, Shariat SF, de Cobelli O, Musi G, Chun FKH, Terrone C, Briganti A, Tilki D, Ahyai S, Carmignani L, Longo N, Karakiewicz PI. Differences in future life expectancy of testicular germ-cell tumor patients vs. age-matched male population-based controls. Int Urol Nephrol 2023; 55:3119-3128. [PMID: 37640983 DOI: 10.1007/s11255-023-03763-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND It is unknown whether five-year overall survival (OS) differs and to what extent between testicular germ-cell tumor (TGCT) patients and age-matched male population-based controls. MATERIALS We identified newly diagnosed (2004-2014) TGCT patients within Surveillance Epidemiology and End Results database 2004-2019. We compared OS between non-seminoma (NS-TGCT) and seminoma (S-TGCT) patients relative to age-matched male population-based controls based on Social Security Administration Life-Tables. Smoothed cumulative incidence plots displayed cancer-specific mortality (CSM) vs. other-cause mortality (OCM). RESULTS Of all 20,935 TGCT patients, 43% had NS-TGCT and 57% had S-TGCT. Of NS-TGCT patients, 63% were stage I vs. 16% stage II vs. 21% stage III. Of S-TGCT patients, 86% were stage I vs. 8% were stage II vs. 6% stage III. Five-year OS differences between NS-TGCT patients vs age-matched male population-based controls were 97 vs. 99% (Δ = 2%) for stage I, 96 vs. 99% (Δ = 3%) for stage II, 76 vs 98% (Δ = 22%) for stage III. Five-year OS differences between S-TGCT patients vs age-matched male population-based controls were 97 vs. 98% (Δ = 1%) for stage I, 95 vs. 97% (Δ = 2%) for stage II, 87 vs. 98% (Δ = 11%) for stage III. OCM rates ranged from 1 to 3% in NS-TGCT patients and from 2 to 4% in S-TGCT patients. CONCLUSION The OS difference between NS-TGCT patients vs. age-matched male population-based controls was invariably higher across all stages (2-22%) than for S-TGCT patients (1-11%). Reassuringly, OCM rates were marginal in stage I and stage II patients. Conversely, higher OCM rates were recorded in stage III patients.
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Affiliation(s)
- Simone Morra
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy.
| | - Mattia Luca Piccinelli
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Cristina Cano Garcia
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Stefano Tappero
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Francesco Barletta
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Reha-Baris Incesu
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Scheipner
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Andrea Baudo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Vincenzo Mirone
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy
| | - Gianluigi Califano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy
| | - Claudia Colla' Ruvolo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
- Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
- Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Carlo Terrone
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Sascha Ahyai
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Luca Carmignani
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
- Department of Urology, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Nicola Longo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
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Bastos DA, Gongora ABL, Dzik C, Jardim DL, Piva M, Carcano FM, Bertollo G, Trindade K, Fontes MS, Soares A, Reinert T, De Cassia Costamilan R, Villarroel RU, Watarai G, Gazola AA, Preto DDA, Mutti H, Bonalumi Dos Santos M, Mariano RC, Binotto M, Carvalho MM, Oliveira VPDC, Gomes R, Rebelatto TF, Schutz FA, Smaletz O, Fay AP. Multicenter Database of Patients with Germ-Cell Tumors: A Latin American Cooperative Oncology Group Registry (LACOG 0515). Clin Genitourin Cancer 2022; 21:e104-e113. [PMID: 36509612 DOI: 10.1016/j.clgc.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Germ-cell tumors (GCTs) are the most common malignancy in young men. There is a paucity of data on GCTs in developing countries. LACOG 0515 study aimed to evaluate clinical characteristics and treatment outcomes in patients with GCTs from Brazilian cancer centers. MATERIALS AND METHODS This is a retrospective cohort study evaluating male patients diagnosed with GCTs from 2000 to 2018 in 13 Brazilian hospitals. We described baseline characteristics, progression-free survival (PFS), and overall survival (OS). RESULTS A total of 1232 patients were included, with a median age of 30 years. Histology was seminoma in 47.1% and non-seminoma GCT (NSGCT) in 52.9%. The primary tumor site was testis in 96.5%. At diagnosis, clinical stage I was present in 68.1% and 34.7% and clinical stages IS/II/III in 31.9% and 65.2% of patients with seminoma and NSCGT, respectively. Following orchiectomy, 55.2% of patients with clinical stage I were managed with surveillance. The 5-year disease-free survival rates among patients with stage I were 98.0% in seminoma and 92.3% in NSGCT, with 5-year OS of 99.6% and 97.6%, respectively. Among patients with advanced disease (IS, II, and III), the 5-year PFS were 88.7% in seminoma and 68.7% in NSGCT, with 5y-OS of 97.6% and 82.8%, respectively. CONCLUSION This is the largest Brazilian cohort of GCTs. Our results show a high rate of adjuvant chemotherapy in patients with clinical stage I. Although our data demonstrate slightly inferior PFS compared with the International Germ Cell Cancer Collaborative Group and other contemporary series, the OS rates were similar.
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Affiliation(s)
- Diogo A Bastos
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Hospital Sírio-Libanês, São Paulo, Brazil.
| | - Aline Bobato Lara Gongora
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Hospital Sírio-Libanês, São Paulo, Brazil
| | - Carlos Dzik
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Denis Leonardo Jardim
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | | | - Karine Trindade
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Oncocentro, Fortaleza, Brazil
| | | | - Andrey Soares
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil; Centro Paulista de Oncologia/Oncoclínicas- São Paulo, São Paulo, Brazil
| | - Tomas Reinert
- Centro de Pesquisa da Serra Gaúcha (CEPESG), Caxias Do Sul, Brazil
| | | | | | - Gabriel Watarai
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Antonia Angeli Gazola
- Hospital São Lucas PUC-RS, Porto Alegre, Brazil; PUC-RS School of Medicine, Porto Alegre, Brazil
| | | | - Haila Mutti
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Monique Binotto
- Centro de Pesquisa da Serra Gaúcha (CEPESG), Caxias Do Sul, Brazil
| | | | | | - Rafaela Gomes
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | | | | | - Oren Smaletz
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Andre P Fay
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Hospital São Lucas PUC-RS, Porto Alegre, Brazil; PUC-RS School of Medicine, Porto Alegre, Brazil
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Abstract
More than 80 % of patient with metastatic germ cell tumor are cured with first line chemotherapy. Twenty to 30 % of patients will experience relapse or refractory disease with a very poor long-term prognosis. Most of them had metastatic germ cell tumors with a poor prognosis according to the international germ cell classification collaborative group (IGCCCG). The role of treatment intensification by high dose chemotherapy (HDCT) followed by stem cell rescue has not been demonstrated yet in the first line setting compared to standard chemotherapy. The role of HDCT in first or second salvage is also not yet demonstrated, many studies have been published in this situation with a lot of different regimen. Outside clinical trial, HDCT remains an option in salvage therapy, depending on many factors including prognostics factors, previous therapy, general condition and reference center consideration to select eligible patient who could benefit the most of this approach. Results from the international randomized trial TIGER will provide evidence-based information for HDCT strategy.
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Fergadis E, Assi A, Kranidioti E, Kosma A, Karakosta M, Miltiadous C, Dimitriadis GK, Grivas A, Athanasopoulos A, Lianos E, Kosmas C. Plerixafor-aided Mobilization of Peripheral Blood Hematopoietic Stem Cells to Support Subsequent High-dose Chemotherapy After a Prior Autologous Transplant. Clin Lymphoma Myeloma Leuk 2020; 20:e50-7. [PMID: 31884151 DOI: 10.1016/j.clml.2019.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/17/2019] [Accepted: 11/28/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND An appreciable proportion of patients in need of salvage high-dose chemotherapy (HDC) and autologous peripheral blood stem cell (PBSC) transplantation (PBSCT) fail to mobilize adequate numbers of hematopoietic progenitors, and plerixafor is applied for that purpose. Limited data exist on remobilization of PBSCs in patients who have relapsed after prior HDC + PBSCT. Herein, we report on consecutive patients that had undergone successful prior single or tandem HDC for a variety of malignant neoplasms in our institution, and later required re-mobilization of PBSCs in order to support further HDC cycles. PATIENTS AND METHODS Plerixafor was administered in combination with granulocyte-colony stimulating factor alone, or after mobilizing chemotherapy. Five patients, 2 B-cell non-Hodgkin lymphomas, 1 multiple myeloma, 1 germ-cell tumor, and 1 Ewing sarcoma, having relapsed after prior HDC + PBSCT, were deemed candidates for further cycle(s) of PBSC-supported HDC. Plerixafor was applied in a "just-in-time" strategy after low CD34+ numbers were measured on the first day of anticipated hematopoietic stem cell collection (non-Hodgkin lymphoma, germ-cell tumor, and Ewing sarcoma), or pre-emptively in multiple myeloma. RESULTS Successful collection of adequate PBSCs was achieved in all patients, from 1.8 to 3.8 × 106/kg after a median of 2 (range, 1-3) leukaphereses; 4 of 5 patients underwent subsequent HDC + PBSCT and engrafted after a median of 11 days (range, 9-55 days) and 25 days (range, 17-76 days) for neutrophils and platelets, respectively. CONCLUSION Plerixafor proved effective to mobilize adequate numbers of PBSCs in individual patients with relapsed malignancies after prior single or tandem HDC + PBSCT. These PBSCs could establish sustained multi-lineage hematopoietic engraftment without any sequelae.
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Juliano J, Melamed E, Christian E, Tamrazi B, Krieger MD. Imaging Features Predictive of Recurrence in Pediatric Intracranial Germ-Cell Tumors. Pediatr Neurosurg 2019; 54:173-180. [PMID: 30865947 DOI: 10.1159/000493194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 08/18/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Intracranial germ-cell tumors (GCTs) are a heterogeneous group of tumors that vary in their response to treatment. Standard treatment consists of chemotherapy and radiation therapy, with the consideration of second-look surgery in resistant disease. The present study aims to inform therapy by characterizing features on pretreatment imaging associated with recurrence. METHODS Children with intracranial GCTs treated at a single institution between January 2000 and October 2016 were retrospectively reviewed under an Institutional Review Board-approved protocol. Imaging variables identified on pretreatment imaging were calcifications, cysts, heterogeneity of enhancement, blood products, hydrocephalus, gradient echo susceptibility, restricted diffusion, invasiveness, and extent of edema. Tumor recurrence was used as the primary outcome variable. RESULTS AND CONCLUSION Fifty-two patients (39 males, mean age at diagnosis: 13 ± 5 years, 34 germinoma, 18 nongerminomatous GCT [NGGCT]) were reviewed. Thirty-three percent of the patients reviewed had recurrence (7 germinoma, 11 NGGCT). Recurrence was associated with invasiveness as seen on preoperative imaging (p = 0.0385) and cystic tumor (p = 0.048).
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Affiliation(s)
- Joseph Juliano
- Department of Internal Medicine, Kaiser Permanente, Los Angeles, California, USA
| | - Edward Melamed
- Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Eisha Christian
- Department of Neurological Surgery, Kaiser Permanente, Los Angeles, California, USA
| | - Benita Tamrazi
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Mark D Krieger
- Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California, USA,
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Abstract
The last 2 years (2014 and 2015) have witnessed major advances in the treatment of genitourinary malignancies. Of note and in marked contrast to previous years, all four major cancers (prostate cancer, testicular cancer, kidney cancer, and bladder cancer) have benefited from this progress. In prostate cancer, it was clearly demonstrated that a local treatment should be administered for high-risk localised disease. The standard of care was changed for patients with upfront metastatic disease with combined androgen deprivation therapy plus docetaxel becoming the new standard for fit patients with multiple bony metastases. In castrate-resistant disease, AR-V7 variants were shown to be predictive factors for resistance to next-generation AR axis-targeting agents and DNA repair targeting emerged as a promising new strategy. In poor-prognosis advanced non-seminoma, a better outcome was randomly demonstrated for the first time when a switch-intensified treatment was used in patients with a slow tumour marker decline. In metastatic kidney cancer, both cabozantinib and checkpoint inhibitors (nivolumab) are now associated with improved outcomes in pretreated patients and should soon change the standard of care for these patients. Last but not least, in urothelial bladder cancer, molecular classification is evolving and suggesting that immunotherapy with checkpoint inhibitors is active, as demonstrated in early trials.
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Affiliation(s)
- Karim Fizazi
- Department of Cancer Medicine, Gustave Roussy, University Paris Sud, 94800 Villejuif, France.
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Kempf E, Desamericq G, Vieites B, Diaz-Padilla I, Calvo E, Estevez P, Garcia-Arreza A, Martinez-Maestre MA, Duran I. Clinical and pathologic features of patients with non-epithelial ovarian cancer: retrospective analysis of a single institution 15-year experience. Clin Transl Oncol 2016; 19:173-179. [PMID: 27193130 DOI: 10.1007/s12094-016-1517-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/30/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Non-epithelial ovarian cancers (NEOCs) are rare diseases. Despite their overall good prognosis, the best management and current prognostic factors remain unclear. The objective of our study was to assess the clinical and pathological features of NEOC patients treated in our institution in the last 15 years and to explore risk factors for relapse and survival. METHODS/PATIENTS All patients with a pathological diagnosis of NEOC referred to the medical oncology department at Hospital Universitario Virgen del Rocio between 1999 and 2014 were included. Demographics, tumor characteristics, treatment procedures, and clinical follow-up were retrospectively collected. Risk factors for disease-free survival (DFS) and overall survival (OS) were assessed. RESULTS Fifty-seven patients were included, 33 (58 %) had a sex cord-stromal tumor (SCST) and 24 (42 %) had a germ-cell tumor (GCT). Median age, non-conservative surgery rates and DFS were lower in the GCT cohort; however, salvage chemotherapy led to a high proportion of complete responses in this group translating into a 90 % 3-year OS rate in both NEOC subtypes. The only identified risk factors statistically significant were stage and tumour relapse that associated, respectively, with DFS (HR = 8.84; 95 % CI 1.85-42) and OS (HR = 11.02; 95 % CI 1.76-68.7). CONCLUSIONS Despite their rarity, NEOCs remain a highly curable group of neoplasm. In our series, a more conservative treatment approach in ovarian GCTs revealed comparable OS outcomes to SCST. No new risk factors that would help in patient stratification were identified.
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Affiliation(s)
- E Kempf
- Medical Oncology Department, Hospital Universitario Virgen del Rocio, Seville, Spain.,Medical Oncology Department, AP-HP, H. Mondor-A. Chenevier Hospital, Créteil, France
| | - G Desamericq
- Centre de Référence Maladie de Huntington, AP-HP, Hôpital H. Mondor-A. Chenevier, Créteil, France.,Inserm, U955, Equipe 01, Créteil, France.,Faculté de Médecine, Université Paris Est, Créteil, France.,Département d'Etudes Cognitives, Ecole Normale Supérieure, Paris, France
| | - B Vieites
- Department of Pathology, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - I Diaz-Padilla
- Deanery of Doctorate Studies, School of Medicine, University of Seville, Seville, Spain
| | - E Calvo
- Medical Oncology Department, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - P Estevez
- Medical Oncology Department, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - A Garcia-Arreza
- Gynecology Department, Hospital Universitario Virgen del Rocio, Seville, Spain
| | | | - I Duran
- Medical Oncology Department, Hospital Universitario Virgen del Rocio, Seville, Spain. .,Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain.
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