American Journal of Clinical Oncology最新文献

{"title":"Sequencing of Adjuvant Chemoradiation for Advanced Stage Endometrial Cancer: Outcomes and Toxicity Profiles.","authors":"Jessica D Arden,&nbsp;Kimberly Marvin,&nbsp;Sirisha R Nandalur,&nbsp;Zaid Al-Wahab,&nbsp;Jayson Field,&nbsp;Jill Gadzinski,&nbsp;Joseph A Rakowski,&nbsp;Barry Rosen,&nbsp;Maha S Jawad","doi":"10.1097/COC.0000000000000742","DOIUrl":"https://doi.org/10.1097/COC.0000000000000742","url":null,"abstract":"<p><strong>Objectives: </strong>Radiation is frequently added to chemotherapy for adjuvant treatment of advanced stage endometrial cancer. Multiple adjuvant therapy sequencing options exist, and little data is available to compare these. We compared outcomes and toxicities after \"sandwich\" chemoradiation (chemotherapy, then radiation, then chemotherapy) and nonsandwich sequences (chemotherapy then radiation, radiation then chemotherapy, or concurrent chemoradiation).</p><p><strong>Materials and methods: </strong>We recorded baseline characteristics, adjuvant treatment details, clinical outcomes, and toxicities for stage III to IVA patients who underwent surgical staging followed by both adjuvant chemotherapy and radiation therapy at our institution. Effects of adjuvant treatment order (sandwich or nonsandwich) on these outcomes were analyzed. Toxicities were graded according to CTCAE v4.0.</p><p><strong>Results: </strong>We identified 107 patients with a median follow-up of 3.2 years. Five-year local, regional, and distant recurrence were 7%, 15%, and 33%; disease-free and overall survival were 61% and 68%, respectively. Outcomes did not differ by sequence group. The overall rate of acute toxicity did not differ by sequence group. The overall rate of chronic toxicity was significantly lower for sandwich patients (P<0.001), as were overall rates of chronic genitourinary (P=0.048) and gynecologic (P<0.001) toxicities. There were no grade 4 or 5 acute or chronic toxicities.</p><p><strong>Conclusions: </strong>Advanced stage endometrial cancer is an aggressive disease and adjuvant chemotherapy and radiation therapy are indicated. Clinical outcomes were similar amongst the different sequences; however, sandwich therapy led to less chronic toxicity, offering an opportunity for improved quality of life in survivorship.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"755-761"},"PeriodicalIF":2.6,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000742","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40542954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiosarcoma of the Breast: Management and Outcomes.","authors":"Paulina M Gutkin,&nbsp;Kristen N Ganjoo,&nbsp;Marti Lohman,&nbsp;Rie von Eyben,&nbsp;Gregory W Charville,&nbsp;Rahim S Nazerali,&nbsp;Frederick M Dirbas,&nbsp;Kathleen C Horst","doi":"10.1097/COC.0000000000000753","DOIUrl":"https://doi.org/10.1097/COC.0000000000000753","url":null,"abstract":"<p><strong>Objective: </strong>Angiosarcoma of the breast is rare and has a poor prognosis. We reviewed our institution's experience with this disease to characterize presentation, identify management patterns, and report outcomes.</p><p><strong>Methods: </strong>Fifty-eight patients with nonmetastatic angiosarcoma were identified from 1998 to 2019 and retrospectively reviewed. Overall survival (OS) and recurrence-free survival (RFS) were calculated using the Kaplan-Meier analysis and log-rank test.</p><p><strong>Results: </strong>The median follow-up was 43.4 months (range: 1.8 to 203.3 mo). Twenty-four patients had primary angiosarcoma (PAS) and 34 patients had secondary angiosarcoma (SAS). Patients with PAS were significantly younger than those with SAS (P<0.0001). Mastectomy was the main surgical treatment in our cohort (n=47) and 3 underwent a lumpectomy. The multifocal disease was found in 5/23 patients with PAS and 11/35 patients with SAS. Twenty-eight patients received chemotherapy. Radiation was administered to 13 patients with PAS and 3 patients with SAS. Five-year OS was 73.7% for PAS and 63.5% for SAS. Local recurrence occurred in a greater proportion of patients with margins <5 mm than those with margins ≥5 mm. Chemotherapy did not impact RFS and was not associated with OS in PAS (P=0.35). Those with SAS treated with chemotherapy had significantly greater OS than those who did not receive chemotherapy (P=0.043). Radiation did not significantly influence RFS or OS.</p><p><strong>Conclusions: </strong>Five-year OS was higher than anticipated. Margins >5 mm appear important for local control. Patients with SAS, but not PAS, may achieve improved survival with chemotherapy. National trials using prespecified agents may be needed to identify an optimal chemotherapy regimen for women with SAS.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"820-825"},"PeriodicalIF":2.6,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000753","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40554923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic Reirradiation Utilizing Pulsed Low-dose Rate Radiation Therapy.","authors":"Jonathan J Paly,&nbsp;Mengying Deng,&nbsp;Charles T Lee,&nbsp;Shelly B Hayes,&nbsp;Thomas J Galloway,&nbsp;Mark A Hallman,&nbsp;Stephanie E Weiss,&nbsp;Eric M Horwitz,&nbsp;Robert A Price,&nbsp;C-M Charlie Ma,&nbsp;Joshua E Meyer","doi":"10.1097/COC.0000000000000741","DOIUrl":"https://doi.org/10.1097/COC.0000000000000741","url":null,"abstract":"<p><p>Pulsed low-dose rate radiation therapy has been shown to reduce normal tissue damage while decreasing DNA damage repair in tumor cells. In a cohort of patients treated with palliative or definitive pelvic reirradiation using pulsed low-dose rate radiation therapy, we observed substantial local control and low rates of toxicity.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"748-751"},"PeriodicalIF":2.6,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000741","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40544471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All Positives May Not Be the Same in Pancreatic Cancer: Lessons Learned From the Past.","authors":"Furkan Ceylan,&nbsp;Deniz C Guven,&nbsp;Taha K Sahin,&nbsp;Deniz A Ozbek,&nbsp;Omer Dizdar","doi":"10.1097/COC.0000000000000723","DOIUrl":"https://doi.org/10.1097/COC.0000000000000723","url":null,"abstract":"To the Editor: We read the article “The Role of Radiotherapy in Resected R0/R+ Pancreatic Cancer” Lutsyk et al1 with great interest. The authors retrospectively evaluated the role of adjuvant chemoradiotherapy in 134 localized pancreatic cancer patients operated at their centers. In the study, the margin status was classified as negative and positive with former being R0 and latter including both R1 and R2 resections. We think that the inclusion of R2 patients to the study could falsely augment the the benefit of chemoradiotherapy in the favor of R0 group considering the poor prognosis in the R2 resected patients. R2 resection in pancreatic cancer has not been shown to provide a survival advantage.2,3 The survivals of R2 resected patients are similar to those of patients who were not operated.4 Although, the authors noted similar outcomes fort he R1 and R2 resected patients, the survivals of R1 and R2 resections were not available in the manuscript. This lack of survival difference could simply be due to sample size issues and this issue should be further explained. In this study, it was found that survival was longer (21 vs. 16 mo, P= 0.006) in patients receiving chemoradiotherapy in patients with R+ resection. Chemoradiotherapy is generally applied 5 to 6 months after surgery. Since chemoradiotherapy is applied 5 to 6 months after surgery, it does not affect mortality in the first 6 months. In order to clearly see the contribution of chemoradiotherapy on survival and to exclude perioperative mortality, it is useful to reanalyze by removing those who died within the first 6 months, similar to the studies in the literature.5 We want to ask whether a similar analysis was done in the study group. In conclusion, chemoradiotherapy in pancreatic cancer has been a topic of debate in > 2 decades with studies inheriting selection bias and inadequate subgroup analyses. We think that prospective studies conducting with modern chemotherapy regimens and strict protocols can control the confounders and better delienate the role of chemoradiotherapy in pancreatic cancer.","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"676"},"PeriodicalIF":2.6,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000723","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40566479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply: All Positives May Not Be the Same in Pancreatic Cancer: Lessons Learned From the Past.","authors":"Rahamim Ben-Yosef,&nbsp;Myroslav Lutsyk","doi":"10.1097/COC.0000000000000722","DOIUrl":"https://doi.org/10.1097/COC.0000000000000722","url":null,"abstract":"","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"676-678"},"PeriodicalIF":2.6,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000722","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40554387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Diabetes and Other Clinical and Sociodemographic Factors With Guideline-concordant Breast Cancer Treatment for Breast Cancer.","authors":"Heather T Gold,&nbsp;Huibo Shao,&nbsp;Ruth Oratz,&nbsp;Onchee Yu,&nbsp;Marilyn Hammer,&nbsp;Stephen Richardson,&nbsp;Denise Boudreau","doi":"10.1097/COC.0000000000000638","DOIUrl":"https://doi.org/10.1097/COC.0000000000000638","url":null,"abstract":"<p><strong>Background: </strong>Women with breast cancer have worse health outcomes with co-occurring type 2 diabetes, possibly due to suboptimal breast cancer treatment.</p><p><strong>Methods: </strong>We created a cohort of women ages 66 to 85 y with stage I to III breast cancer from 1993 to 2012 from an integrated health care delivery system (n=1612) and fee-for-service Medicare beneficiaries (n=98,915), linked to Surveillance, Epidemiology, and End Results (SEER) data (total n=100,527). We evaluated associations between type 2 diabetes and other factors with undergoing guideline-concordant cancer treatment. We estimated χ tests for univariate analysis and relative risks (RRs) using multivariable log-binomial models for outcomes of (1) overall guideline-concordant treatment, (2) definitive surgical therapy (mastectomy or lumpectomy with radiation), (3) chemotherapy if indicated, and (4) endocrine therapy.</p><p><strong>Results: </strong>Our cohort included 60% of subjects with stage 1 tumors, one quarter below 70 years old, 23% had diabetes, 35% underwent overall guideline-concordant treatment, 24% chemotherapy, and 83% endocrine therapy. Women with diabetes were less likely to undergo overall guideline-concordant treatment (RR: 0.96; 95% confidence interval: 0.94-0.98), and only slightly less likely to undergo guideline-concordant definitive surgical therapy (RR: 0.99; 95% confidence interval: 0.99-1.00). No differences were found for chemotherapy or endocrine therapy. Other factors significantly associated with a lower risk of guideline-concordant care were cancer stages II to III (vs. I; RR=0.47-0.69, P<0.0001), older age (vs. 66 to 69 y; RR=0.56-0.90, P<0.0001), higher comorbidity burden, and Medicaid dual-eligibility.</p><p><strong>Conclusions: </strong>Diabetes was associated with lower adherence to overall guideline-concordant breast cancer treatment. However, higher stage, older age, higher comorbidity burden, and Medicaid insurance were more strongly associated with lower use of guideline-concordant treatment. Given the heavy burden of breast cancer and diabetes, long-term outcomes analysis should consider guideline-concordant treatment.</p><p><strong>Impact: </strong>Other factors besides diabetes are more strongly associated with guideline-concordant breast cancer treatment.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"101-106"},"PeriodicalIF":2.6,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000638","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37468670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Competing Mortality in Patients With Neuroendocrine Tumors: Erratum.","authors":"","doi":"10.1097/COC.0000000000000664","DOIUrl":"https://doi.org/10.1097/COC.0000000000000664","url":null,"abstract":"","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"146-147"},"PeriodicalIF":2.6,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000664","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37576150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vincristine Shortage: What Other Options We Have?","authors":"Osama M Al-Quteimat","doi":"10.1097/COC.0000000000000648","DOIUrl":"https://doi.org/10.1097/COC.0000000000000648","url":null,"abstract":"To the Editor: Vincristine is a widely used anticancer medication with Food and Drug Administration (FDA)-approved indications in the treatment of many cancers including acute lymphocytic leukemia (ALL), lymphoid blast crisis of chronic myeloid leukemia, and Hodgkin and nonHodgkin lymphoma.1 The Children’s Oncology Group (COG) has issued a letter to the Childhood Cancer Community sharing information about vincristine shortage. COG stated that Pfizer/Hospira, now the sole supplier of vincristine in the United States, is experiencing a shortage of the drug due to a manufacturing delay. Teva Pharmaceuticals, another manufacturer of vincristine in the United States, made a “business decision” and stopped supplying the drug to the United States in July of 2019.2 The COG also provided guidance for changing treatment protocols to compensate for drug shortages, but, with vincristine, the options are basically delaying, cutting, or skipping doses. Thus, there is an urgent need to investigate other options to identify an appropriate alternative that can safely and effectively substitute vincristine in such scenarios.","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"146-147"},"PeriodicalIF":2.6,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000648","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37576149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lymphovascular Invasion in Endometrial Cancer: Prognostic Value and Implications on Adjuvant Radiation Therapy Use.","authors":"Dustin Boothe,&nbsp;Aaron Wolfson,&nbsp;Michael Christensen,&nbsp;Samual Francis,&nbsp;Theresa L Werner,&nbsp;David K Gaffney","doi":"10.1097/COC.0000000000000559","DOIUrl":"https://doi.org/10.1097/COC.0000000000000559","url":null,"abstract":"<p><strong>Objectives: </strong>Lymphovascular space invasion (LVSI) is a known prognostic factor for endometrial carcinomas. However, LVSI as a determinant of treatment benefit has not been fully elucidated.</p><p><strong>Methods and materials: </strong>Data from the National Cancer Database for endometrial cancer from 2004 to 2012 was obtained. Univariate and multivariate analysis was performed to assess the impact of LVSI on overall survival (OS). Survival analysis was performed utilizing log-rank and Kaplan-Meier analyses. The difference in OS between external beam radiation therapy (EBRT) and vaginal brachytherapy (VBT) in LVSI-positive patients was analyzed with propensity score matching.</p><p><strong>Results: </strong>A total of 32,150 patients with surgical stage I to III endometrial carcinomas were available for analysis with a median follow-up of 30 months. Twenty-nine percent were LVSI positive and received adjuvant radiotherapy (aRT) more often than if LVSI negative (57% vs. 37%). On multivariate analysis, LVSI (hazard ratio, 1.94; P<0.01) was associated with an increased risk of death. aRT improved OS for LVSI-negative patients (87% without aRT, 90% with aRT; P=0.006). aRT was particularly effective in LVSI-positive patients: all stages of LVSI-positive patients were associated with an OS benefit (P<0.01), whereas among LVSI-negative patients, only stage III benefited from aRT (P<0.01). After propensity score match, there was no OS difference between EBRT and VBT among LVSI-positive patients (hazard ratio, 1.15; P=0.44).</p><p><strong>Conclusions: </strong>LVSI is an independent prognostic factor in locoregional endometrial carcinomas. aRT benefited all stages of LVSI-positive patients, but only stage III of LVSI-negative patients. Among LVSI-positive patients, we did not find an OS difference between adjuvant EBRT versus VBT.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"549-554"},"PeriodicalIF":2.6,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000559","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40450382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Statins be Protagonists in Our Approach to Cancer Treatment?","authors":"Ali Fatehi Hassanabad","doi":"10.1097/COC.0000000000000562","DOIUrl":"https://doi.org/10.1097/COC.0000000000000562","url":null,"abstract":"COMMENTARY Cancer is a disease in which malignant cells are thought to accumulate as a result of the acquisition of several capabilities: independence in growth signals, escaping growth inhibition signals, avoiding apoptosis, unlimited replicative capability, continued angiogenesis, and tissue invasion and metastasis.1 In 2011, Hanahan and Weinberg2 updated the original hallmarks of cancer to include deregulating cellular energetics and avoiding immune destruction as emerging hallmarks of cancer. Chemotherapy has been a common approach to cancer management. It has been leveraged in a curative, palliative, or adjuvant capacity. Over the past decades, different types of chemotherapeutic drugs have been introduced. These include DNA alkylating agents, platinating agents, and antimetabolites.3 Each of these agents has had clinical success. However, they have also posed significant issues with respect to their undesired side effect profiles, which have limited their utility.4 Broadly, many current chemotherapeutics exert their effects through activating the apoptotic pathway or affecting key steps and mediators of that pathway.4 Apoptosis, or programmed cell death, requires an array of functional interactions to ensure it is completed effectively. However, a tumor can acquire a host of mutations or alterations and evade apoptosis. Thus, a number of therapeutics specifically kill tumor cells by targeting pathways not typically associated with apoptosis. It is thought that these drugs function by exploiting abnormalities within the tumor cells themselves.5 A family of drugs that have been shown to possess apoptosis-inducing effects is statins: a class of medications which was originally developed in the 1970s to manage hypercholesterolemia.6–9 Statins inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMGCR), the highly regulated rate-limiting enzyme of the mevalonate (MVA) pathway.10 The downstream products of this pathway are required for a variety of important cellular functions, including membrane integrity and steroid production (cholesterol), cellular respiration (ubiquinone), proper protein localization and function (farnesylpyrophosphate and geranylgeranylpyrophosphate), and glycosylation (dolichol).7,10 Many studies have shown the positive effects statins have in inducing apoptosis in a subset of cell lines derived from tumors in in vitro.9,11–20 These observations have generated a lot of excitement as they imply that the corresponding cancers could also potentially be sensitive to statin-specific apoptosis in the clinical setting. Promisingly, some of these studies have highlighted the tumor-specificity of statins in promoting apoptosis. For instance, in a study on acute myelogenous leukemia, whereas the tumor cells underwent statin-induced apoptosis, normal peripheral blood–derived progenitor cells were insensitive to statins.21–23 Clinically, the safety and efficacy of statins as possible chemotherapeutic agents has been evaluated both in monoth","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"547-548"},"PeriodicalIF":2.6,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/COC.0000000000000562","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40539848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}