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Oncology Survivorship Care Clinics: Design and Implementation of Survivorship Care Delivery Systems at NCCN Member Institutions. 肿瘤学幸存者关怀诊所:在 NCCN 成员机构设计和实施幸存者护理服务系统。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-11-13 DOI: 10.6004/jnccn.2024.7060
Lindsey Bandini, Rebecca Caires, Linda Jacobs, Dori Klemanski, Donna Berizzi, Sheetal Kircher, Rachael Schmidt, Jessica Sugalski, Crystal S Denlinger, Susan Brown

Background: It is estimated that there are >18 million cancer survivors in the United States, and there is a growing number of survivorship programs across the country to care for these individuals. There is a clear need for survivorship care; however, evidence is still emerging on how to best operationalize the guidance from nationally recognized organizations and clinical practice guidelines.

Methods: The NCCN Best Practices Committee (BPC) recently conducted a survey to better understand survivorship clinics at NCCN Member Institutions. Representatives from 24 of the 33 NCCN Member Institutions (73%) submitted responses to the survey.

Results: Although all responding centers see cancer survivors, most (92%) have ≥1 dedicated survivorship clinics. Of those centers with dedicated survivorship clinics (n=22), 9 (41%) reported general survivorship clinics for all cancer types, and 13 (59%) indicated their center offered ≥1 disease-specific survivorship clinics. Most centers (55%) use a mix of physicians and advanced practice providers (APPs; nurse practitioners and/or physician assistants) to staff survivorship clinics; however, 9 (41%) are staffed entirely by APPs and 1 (4%) is staffed entirely by physicians. The vast majority (91%) have dedicated scheduling templates, and most (73%) have dedicated clinic space for survivorship clinics. The referral process for survivorship clinics varies across centers, with 16 (73%) using algorithms, guidelines, or pathways to determine when a patient is referred to a survivorship clinic. Findings may reflect the evolution of survivorship care and indicate a move toward standardizing which patients are seen and when. It is notable that >50% of institutions reported a model in which they follow survivors for their lifetime.

Conclusions: Given the number of patients impacted by cancer, these data highlight the need to continue refining how survivorship care models are integrated into cancer centers to best serve patients with cancer and cancer survivors.

背景:据估计,美国有超过 1,800 万癌症幸存者,全国各地也有越来越多的幸存者关怀计划为这些人提供关怀。对幸存者关怀的需求显而易见;然而,关于如何最好地落实国家认可的组织和临床实践指南的指导意见的证据仍在不断涌现:NCCN最佳实践委员会(BPC)最近开展了一项调查,以更好地了解NCCN成员机构的幸存者诊所。33家NCCN成员机构中有24家(73%)的代表提交了调查问卷:尽管所有回复的中心都为癌症幸存者提供服务,但大多数中心(92%)都设有≥1个专门的幸存者门诊。在设有专门幸存者门诊的中心(22 家)中,9 家(41%)报告了针对所有癌症类型的一般幸存者门诊,13 家(59%)表示其中心提供≥1 个特定疾病幸存者门诊。大多数中心(55%)混合使用医生和高级医疗服务提供者(APP;执业护士和/或医生助理)为幸存者门诊配备工作人员;但是,有 9 个中心(41%)完全由高级医疗服务提供者配备工作人员,1 个中心(4%)完全由医生配备工作人员。绝大多数(91%)的幸存者门诊都有专门的排班模板,大多数(73%)的幸存者门诊都有专门的诊室空间。各中心的幸存者门诊转诊流程各不相同,16 个中心(73%)使用算法、指南或路径来决定何时将患者转诊至幸存者门诊。这些研究结果可能反映了幸存者治疗的发展,并表明了患者就诊及就诊时间标准化的趋势。值得注意的是,超过50%的机构报告了他们对幸存者进行终生随访的模式:鉴于受癌症影响的患者人数众多,这些数据凸显出有必要继续完善将幸存者护理模式纳入癌症中心的方式,以便为癌症患者和癌症幸存者提供最佳服务。
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引用次数: 0
NCCN Guidelines® Insights: Management of Immunotherapy-Related Toxicities, Version 2.2024. NCCN Guidelines® Insights:免疫疗法相关毒性管理》,2.2024 版。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.6004/jnccn.2024.0057
John A Thompson, Bryan J Schneider, Julie Brahmer, Mohammad Abu Zaid, Amaka Achufusi, Philippe Armand, Meghan K Berkenstock, Bonnie Bermas, Tawnie Braaten, Lihua E Budde, Saurin Chokshi, Zachary D Crees, Marianne Davies, Changchun Deng, Yaron Gesthalter, Michael Jain, Prantesh Jain, Andrew Jallouk, Benjamin H Kaffenberger, Maya Khalil, Melissa G Lechner, Tianhong Li, Alissa Marr, Suzanne McGettigan, Jordan McPherson, Theresa Medina, Nisha A Mohindra, Anthony J Olszanski, Olalekan Oluwole, Sandip P Patel, Jason Prosek, Sunil Reddy, Pankti Reid, John Ryan, Mabel Ryder, Huda Salman, Bianca Santomasso, Scott Shofer, Jeffrey A Sosman, Yinghong Wang, Vlad G Zaha, Stephen Zucker, Megan Lyons, Ajibola Awotiwon, Lisa Hang

The NCCN Guidelines for the Management of Immunotherapy-Related Toxicities are intended to provide oncology practitioners with guidance on how to manage the wide-ranging and potentially fatal toxicities that may occur with cancer immunotherapy. The guidelines address immune-related adverse events related to immune checkpoint inhibitors, CAR T-cell therapies, and lymphocyte engagers (which include T-cell-engaging bispecific antibodies). These NCCN Guidelines Insights highlight recent guideline updates pertaining to the management of emerging toxicities related to cancer immunotherapy.

NCCN 《免疫疗法相关毒性管理指南》旨在为肿瘤医生提供指导,帮助他们管理癌症免疫疗法可能出现的各种潜在致命毒性。该指南针对与免疫检查点抑制剂、CAR T 细胞疗法和淋巴细胞激活剂(包括 T 细胞激活双特异性抗体)相关的免疫相关不良事件。这些 "NCCN 指南透视 "重点介绍了与癌症免疫疗法相关的新发毒性管理有关的最新指南更新。
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引用次数: 0
Statin Use During Concurrent Chemoradiotherapy for Advanced Nasopharyngeal Cancer. 在晚期鼻咽癌化疗期间使用他汀类药物
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.6004/jnccn.2024.7046
Jung-Min Yu, Chia-Lun Chang, Kuan-Chou Lin, Wan-Ming Chen, Ben-Chang Shia, Szu-Yuan Wu

Background: The objective of this study was to assess the impact of statin use on overall survival (OS) and nasopharyngeal cancer (NPC)-specific survival in patients with advanced NPC who underwent standard concurrent chemoradiotherapy (CCRT).

Patients and methods: This propensity score matched cohort study used data from the Taiwan Cancer Registry Database and National Health Insurance Research Database to examine the impact of statin use during CCRT on both OS and NPC-specific survival.

Results: Statin use during CCRT demonstrated significant and independent prognostic value for both OS and NPC-specific survival. The adjusted hazard ratio for all-cause mortality in the statin group compared with the nonstatin group was 0.48 (95% CI, 0.34-0.68; P<.0001). Similarly, the adjusted hazard ratio for NPC-specific mortality in the statin group compared with the nonstatin group was 0.43 (95% CI, 0.29-0.65; P<.0001). Rosuvastatin, atorvastatin, and lovastatin demonstrated significant efficacy in improving NPC-specific survival outcomes. Moreover, our findings indicate a dose-response relationship, with higher cumulative defined daily doses and greater daily intensity of statin use associated with reduced mortality.

Conclusions: This study suggests an association between statin use during the CCRT period for NPC and potential enhancements in both OS and NPC-specific survival. Our findings indicate a possible survival benefit of rosuvastatin, atorvastatin, and lovastatin for patients with NPC undergoing CCRT. The observed dose-response relationship underscores the potential importance of higher statin use in mitigating NPC-specific mortality, but further research is needed to establish a definitive causal relationship.

研究背景本研究旨在评估他汀类药物的使用对接受标准同期化放疗(CCRT)的晚期鼻咽癌患者的总生存期(OS)和鼻咽癌特异性生存期的影响:这项倾向得分匹配队列研究使用了台湾癌症登记数据库和国民健康保险研究数据库的数据,研究在CCRT期间使用他汀类药物对OS和鼻咽癌特异性生存率的影响:结果:CCRT期间使用他汀类药物对OS和NPC特异性生存有显著的独立预后价值。他汀类药物组与非他汀类药物组相比,调整后的全因死亡率危险比为0.48(95% CI,0.34-0.68;PC结论:本研究表明,在鼻咽癌 CCRT 期间使用他汀类药物可能会提高 OS 和鼻咽癌特异性生存率。我们的研究结果表明,洛伐他汀、阿托伐他汀和洛伐他汀可能对接受 CCRT 的鼻咽癌患者的生存有益。观察到的剂量-反应关系强调了更多地使用他汀类药物在降低鼻咽癌特异性死亡率方面的潜在重要性,但要建立明确的因果关系还需要进一步的研究。
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引用次数: 0
Implementation of ePROs Into Multidisciplinary Tumor Board Discussions for Patients With Pancreatic Cancer: The INSPIRE Intervention. 在胰腺癌患者的多学科肿瘤委员会讨论中实施 ePRO:INSPIRE 干预。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.6004/jnccn.2024.7052
Nicole L Henderson, Etzael Ortiz-Olguin, Garrett Bourne, Cameron Pywell, J Bart Rose, Grant R Williams, Ryan D Nipp, Gabrielle B Rocque

Background: The incorporation of electronic patient-reported outcomes (ePROs), such as the Geriatric Assessment (GA) and treatment preferences, into decision-making for pancreatic cancer has been limited by clinician- and system-level barriers concerning workflow. We hypothesized that ePRO inclusion within multidisciplinary tumor boards (MDTBs) would circumvent barriers and provide a venue for systematic consideration of critical patient-provided information.

Patients and methods: The INtegrating Systematic PatIent-Reported Evaluations (INSPIRE) intervention consists of (1) patient survey completion, including GA and patient preferences, and (2) screensharing patient ePROs during MDTBs. Proctor et al's implementation outcomes were assessed, with penetration (the proportion of consented patients who were presented at MDTBs) acting as the primary outcome (considered successful at 70%). Secondary outcomes included adoption, feasibility, acceptability, appropriateness, cost, and sustainability, assessed by clinician post-MDTB exit surveys, clinician postintervention surveys, clinician postintervention semistructured interviews, and time-coding analysis of recorded and transcribed historical (November 2021-February 2022) and intervention (September 2022-June 2023) MDTBs.

Results: A total of 50 patients completed surveys and all were presented at MDTBs (penetration=100%). All eligible clinicians (n=9) enrolled patients (adoption=100%) and reported that ePROs were useful in 90% and led to a change in treatment plan in 30% of cases. In postintervention surveys and interviews, clinicians primarily responded positively to feasibility, acceptability, and appropriateness questions. Time-coding analysis found a modest time cost of an additional 51.1 seconds in mean discussion time-per-patient between preintervention (mean [SD], 172.7 [111.4] seconds) and intervention patients (mean [SD], 223.8 [107.1] seconds); 86% of clinicians reported the intervention did not take too much time. All surveyed clinicians reported interest in continuing the intervention and suggested adaptations to further promote sustainability.

Conclusions: The integration of ePROs into pancreatic MDTBs was feasible and acceptable, providing a potential approach to increase the utilization of ePROs by clinical teams in their management of patients with pancreatic cancer.

背景:在胰腺癌的决策过程中纳入电子患者报告结果(ePRO),如老年评估(GA)和治疗偏好,一直受到临床医生和系统层面工作流程障碍的限制。我们假设,将 ePRO 纳入多学科肿瘤委员会(MDTB)将能规避障碍,并为系统考虑患者提供的关键信息提供场所:整合系统患者报告评估(INSPIRE)干预包括:(1)完成患者调查,包括GA和患者偏好;(2)在MDTB中筛选共享患者的ePRO。对 Proctor 等人的实施结果进行了评估,其中渗透率(在 MDTB 上获得同意的患者比例)是主要结果(成功率达到 70%)。次要结果包括采用率、可行性、可接受性、适宜性、成本和可持续性,通过临床医生 MDTB 后退出调查、临床医生干预后调查、临床医生干预后半结构式访谈,以及对记录和转录的历史(2021 年 11 月至 2022 年 2 月)和干预(2022 年 9 月至 2023 年 6 月)MDTB 进行时间编码分析来评估:共有 50 名患者完成了调查,所有患者都参加了 MDTB(普及率=100%)。所有符合条件的临床医生(人数=9)都登记了患者(采用率=100%),并报告说90%的患者使用了ePRO,30%的患者改变了治疗方案。在干预后的调查和访谈中,临床医生主要对可行性、可接受性和适宜性问题做出了积极回应。时间编码分析发现,干预前(平均值 [SD] 为 172.7 [111.4] 秒)和干预后(平均值 [SD] 为 223.8 [107.1] 秒)每位患者的平均讨论时间增加了 51.1 秒,时间成本并不高。所有接受调查的临床医生都表示有兴趣继续进行干预,并建议进行调整以进一步促进可持续性:将 ePRO 纳入胰腺癌 MDTB 是可行且可接受的,为临床团队在管理胰腺癌患者时更多地使用 ePRO 提供了一种潜在的方法。
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引用次数: 0
Letter to the Editor: Enhancing the Readability of Online Patient-Facing Content Using AI Chatbots. 致编辑的信:使用人工智能聊天机器人提高面向患者的在线内容的可读性。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.6004/jnccn.2024.7054
Qiqi Wu
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引用次数: 0
Prevention and Treatment of Cancer-Related Infections, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology. 癌症相关感染的预防和治疗》,3.2024 版,《NCCN 肿瘤学临床实践指南》。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.6004/jnccn.2024.0056
Lindsey Robert Baden, Sankar Swaminathan, Nikolaos G Almyroudis, Michael Angarone, Aliyah Baluch, Nicolas Barros, Brian Buss, Stuart Cohen, Brenda Cooper, Augusto Dulanto Chiang, Zeinab El Boghdadly, Kevin Gregg, Hana Hakim, Dora Ho, Fareed Khawaja, Rachael Lee, Francesca Lee, Cathy Logan, Kristen Manley, Ashrit Multani, Anupam Pande, Steven Pergam, Jennifer Pisano, Jennifer Saullo, Mindy Schuster, Susan K Seo, Shmuel Shoham, Randy Taplitz, Jeffrey Topal, John W Wilson, Andrea Zimmer, Carly J Cassara, Rashmi Kumar, Zeenat Diwan

There is an increased risk of infection in patients with cancer that results in higher morbidity and mortality. Several risk factors can predispose these patients to infectious complications. Some such factors include immunocompromised states like neutropenia, allogeneic hematopoietic cell transplantation, and graft-versus-host disease, while others include immunosuppressive agents like corticosteroids, purine analogs, monoclonal antibodies, and other emerging cancer therapeutics like CAR T-cell therapy. The NCCN Guidelines for the Prevention and Treatment of Cancer-Related Infections address infection concerns that may be observed in these immunocompromised populations and characterize the major pathogens to which patients with cancer are susceptible, with a focus on the prevention, diagnosis, and treatment of major common and opportunistic infections. This paper highlights 2 recently updated sections of the guidelines, namely, infection concerns related to CAR T-cell therapy and antimicrobial prophylaxis recommendations, including vaccination, in patients at high-risk for infections.

癌症患者的感染风险增加,导致发病率和死亡率升高。有几种风险因素会使这些患者容易出现感染并发症。其中一些因素包括中性粒细胞减少症、异基因造血细胞移植和移植物抗宿主病等免疫功能低下状态,而其他因素则包括皮质类固醇、嘌呤类似物、单克隆抗体等免疫抑制剂,以及 CAR T 细胞疗法等其他新兴癌症疗法。NCCN 癌症相关感染的预防和治疗指南》解决了这些免疫力低下人群可能出现的感染问题,并描述了癌症患者易感的主要病原体,重点关注主要常见感染和机会性感染的预防、诊断和治疗。本文重点介绍了指南中最近更新的两个部分,即与 CAR T 细胞疗法相关的感染问题和感染高危患者的抗菌药物预防建议,包括疫苗接种。
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引用次数: 0
Authors' Reply to the Letter to the Editor by Wu Re: Enhancing the Readability of Online Patient-Facing Content Using AI Chatbots. 作者对 Wu Re:使用人工智能聊天机器人提高面向患者的在线内容的可读性。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.6004/jnccn.2024.7081
Andres A Abreu, Ricardo E Nunez-Rocha, Gilbert Z Murimwa, Patricio M Polanco
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引用次数: 0
Progress in Cancer 2024. 癌症进展 2024》。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.6004/jnccn.2024.0058
Daniel M Geynisman
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引用次数: 0
Long-Term Pattern of Psychotropic Medication Uses Among Swedish Parents of Children Diagnosed With Cancer. 瑞典癌症患儿父母长期使用精神药物的模式。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.6004/jnccn.2024.7048
Yishan Liu, Zheshun Jiang, Jan Sundquist, Kristina Sundquist, Jianguang Ji

Background: Parents experience a range of mental health disorders following their child's cancer diagnosis. It is thus essential to explore how the child's cancer diagnosis affects the dosage of psychotropic medication in both short- and long-term use, as well as potential disparities in utilization patterns between mothers and fathers.

Patients and methods: Using Swedish registers, we identified all parents whose children were diagnosed with cancer from July 2009 to December 2015 in Sweden. We randomly matched up to 5 parents of cancer-free children conditional on their baseline characteristics. All parents were followed up from 4 years before to 4 years after their child's diagnosis. Psychotropic medication cumulative defined daily doses (DDDs) were retrieved from the Swedish Prescribed Drug Register. Using interrupted time series analyses, we sought to investigate how childhood cancer diagnosis influences the evolving pattern of parental psychotropic medication dosage across time with consideration for potential differences compared with matched parents before the child's cancer diagnosis. We calculated the attributable proportion due to the diagnosis of childhood cancer.

Results: Following a child's cancer diagnosis, mothers experienced a steady increase in psychotropic medication use, averaging 4.9 DDDs per year compared with matched comparisons, with a 46.0% adjusted attributable proportion in the initial year. Fathers had an abrupt increase in psychotropic medication use in the first year after diagnosis, with an adjusted attributable proportion of 72.1%. Parents with lower education attainment tended to use more psychotropic medication.

Conclusions: In response to a child's cancer diagnosis, parents showed increased use of psychotropic medication compared with matched comparisons. Additionally, utilization patterns differed between mothers and fathers. Timely prevention and early support for parents are needed to alleviate their psychological challenges, potentially mitigating the strain on medical resources associated with increased psychotropic medication use.

背景:孩子被诊断出癌症后,父母会经历一系列的心理健康障碍。因此,有必要探讨儿童癌症诊断如何影响精神药物的短期和长期使用剂量,以及母亲和父亲在使用模式上的潜在差异:我们利用瑞典登记册,确定了 2009 年 7 月至 2015 年 12 月期间瑞典所有子女被诊断患有癌症的父母。根据基线特征,我们随机匹配了多达 5 名未患癌症儿童的父母。我们对所有父母进行了从孩子确诊前 4 年到确诊后 4 年的随访。我们从瑞典处方药登记册中检索到了精神药物的累计定义日剂量(DDDs)。通过间断时间序列分析,我们试图研究儿童癌症诊断如何影响父母精神药物用量在不同时期的演变模式,并考虑与儿童癌症诊断前的匹配父母相比可能存在的差异。我们计算了因儿童癌症诊断而产生的可归因比例:孩子确诊癌症后,母亲的精神药物用量稳步增加,与匹配的比较者相比,平均每年增加 4.9 个剂量点,最初一年的调整后可归因比例为 46.0%。父亲在确诊后第一年的精神药物使用量突然增加,调整后的可归因比例为 72.1%。教育程度较低的父母倾向于使用更多的精神药物:结论:与匹配的比较组相比,父母在孩子确诊癌症后会增加精神药物的使用。此外,母亲和父亲的用药模式也有所不同。需要为父母提供及时的预防和早期支持,以缓解他们的心理挑战,从而减轻与精神药物用量增加相关的医疗资源压力。
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引用次数: 0
Up-Front Treatment of Elderly (Age ≥75 Years) and Frail Patients With Multiple Myeloma. 对老年(年龄≥75 岁)和体弱的多发性骨髓瘤患者进行先期治疗。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.6004/jnccn.2024.7039
Nadine Abdallah, Shaji K Kumar

Older patients with multiple myeloma (MM) exhibit wide heterogeneity in their baseline physiologic and functional status, which demands an individualized treatment approach based on biological rather than chronological age. Various frailty scores have been developed for older patients with MM, but they are underutilized in clinical trials and in practice. Older patients with MM are underrepresented in therapeutic clinical trials, and treatment recommendations are currently derived from clinical trials of transplant-ineligible patients. This article provides a summary of phase II and III clinical trials in transplant-ineligible patients with newly diagnosed MM, highlighting outcomes in patients aged ≥75 years and frailty-based outcomes. The data available thus far show that triplet regimens are more efficacious than doublets in older patients but may be associated with higher toxicity. DRd (daratumumab/lenalidomide/dexamethasone) and VRd (bortezomib/lenalidomide/dexamethasone) are good options in patients who are nonfrail, whereas dose-adjusted DRd and VRd-lite should be offered to frail patients. Frailty should be assessed regularly to guide treatment intensification and/or deescalation. It is important that frailty measures are incorporated in clinical trials evaluating novel treatments to inform how older and frail patients will benefit from these treatments.

老年多发性骨髓瘤(MM)患者的基线生理和功能状态表现出很大的异质性,这就要求根据生理年龄而非实际年龄采取个体化治疗方法。目前已为老年多发性骨髓瘤患者制定了各种虚弱评分标准,但在临床试验和实践中并未得到充分利用。在治疗性临床试验中,老年 MM 患者的比例偏低,目前的治疗建议均来自于对不符合移植条件的患者进行的临床试验。本文总结了针对符合移植条件的新诊断 MM 患者的 II 期和 III 期临床试验,重点介绍了年龄≥75 岁患者的疗效和基于虚弱程度的疗效。目前已有的数据显示,在老年患者中,三联方案比二联方案更有效,但可能会有较高的毒性。DRd(daratumumab/来那度胺/地塞米松)和VRd(硼替佐米/来那度胺/地塞米松)是非体弱患者的良好选择,而体弱患者则应接受剂量调整后的DRd和VRd-lite。应定期评估患者的虚弱程度,以指导加强和/或减少治疗。重要的是,在评估新型疗法的临床试验中纳入虚弱程度测量,以便了解年老体弱的患者将如何从这些疗法中获益。
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引用次数: 0
期刊
Journal of the National Comprehensive Cancer Network
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