Lymph Node Ratio Is an Independent Prognostic Factor After Resection of Periampullary Malignancies: Data From a Tertiary Referral Center in the Middle East
The prognostic impact of nodal involvement in resected pancreatic carcinoma and biliary malignancy has been relatively well established. It has been suggested that lymph node ratio (LNR) may be a more informative way of stratifying patients with node positive disease. Our retrospective review aimed...
Gespeichert in:
| Veröffentlicht in: | American journal of clinical oncology 2014-02, Vol.37 (1), p.13-18 |
|---|---|
| Hauptverfasser: | , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 18 |
|---|---|
| container_issue | 1 |
| container_start_page | 13 |
| container_title | American journal of clinical oncology |
| container_volume | 37 |
| creator | SHAMSEDDINE, Ali I MUKHERJI, Deborah MELKI, Christian ELIAS, Elias ELOUBEIDI, Mohammad DIMASSI, Hani KHALIFE, Mohammad ABOU-ALFA, Ghassan O'REILLY, Eileen FARAJ, Walid |
| description | The prognostic impact of nodal involvement in resected pancreatic carcinoma and biliary malignancy has been relatively well established. It has been suggested that lymph node ratio (LNR) may be a more informative way of stratifying patients with node positive disease. Our retrospective review aimed to investigate the significance of such variables and test for independent prognostic factors for survival.
One hundred eighty-three pancreatic and periampullary malignancy cases were registered at the American University of Beirut Medical Center from 1990 to 2004. Of those, 80 had complete data on lymph node status. We analyzed the impact of the number of lymph nodes resected, the number of positive lymph nodes retrieved and LNR using Kaplan-Meier and Cox proportional hazard models. The measured outcome in the KM model was the survival probability at 1, 3, and 5 years while the Cox model was used to measure the hazard ratio (HR) of the previously identified predictors on survival.
For the 80 patients included in this analysis, overall survival rates were 65% (54 to 78), 32% (18 to 47), and 21% (8 to 34) were alive at 1, 3, and 5 years, respectively. The median number of resected lymph nodes was 9. In the node positive patients, those who had >12 nodes examined were found to have a significantly better survival (HR=0.24; P=0.013). On multivariate analysis, our model showed the following factors to be significant: age 60 years or older (HR=5.92; P=0.018), poorly differentiated tumors (HR=21.87; P=0.018), number of lymph nodes examined |
| doi_str_mv | 10.1097/COC.0b013e31826b9c74 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1097_COC_0b013e31826b9c74</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>23111358</sourcerecordid><originalsourceid>FETCH-LOGICAL-c253t-afd1e7f70ebf5c346fdc8a8842b792a9ab52087c58e8f76bf3041024c8665fa83</originalsourceid><addsrcrecordid>eNpdkU1vFDEMhiNE1S6l_wAhXzhOycdkkuVWTbuw0pZWqyJxG3kyTjtovpSkh_4W_ixZtYDUi315H9t6zNgHwc8FX5vP9U19zlsuFClhZdWunSnfsJXQyhSlVj_fshWXxhTKKHnC3sX4i3OuK26O2YlUQgil7Yr93j2NywN8nzuCPaZ-hm0EnGA7dbRQLlOC2zDfT3NMvYMNujQHuPCJAuwpksvIBLOHWwo9jsvjMGB4gmsc-vsJJ9dT_AKXmBA2YR4B4Y5C6g-RPXkKAQeo8448rZ8gPRBc9103EFxhTO_Zkcch0tlLP2U_Nld39bdid_N1W1_sCie1SgX6TpDxhlPrtVNl5Ttn0dpStmYtcY2tltwapy1Zb6rWK14KLktnq0p7tOqUlc9zXZhjDOSbJfRjvrERvDm4brLr5rXrjH18xpbHdqTuH_RXbg58eglgdDj4cPAR_-esUlWVX_UHPfSKSw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Lymph Node Ratio Is an Independent Prognostic Factor After Resection of Periampullary Malignancies: Data From a Tertiary Referral Center in the Middle East</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><creator>SHAMSEDDINE, Ali I ; MUKHERJI, Deborah ; MELKI, Christian ; ELIAS, Elias ; ELOUBEIDI, Mohammad ; DIMASSI, Hani ; KHALIFE, Mohammad ; ABOU-ALFA, Ghassan ; O'REILLY, Eileen ; FARAJ, Walid</creator><creatorcontrib>SHAMSEDDINE, Ali I ; MUKHERJI, Deborah ; MELKI, Christian ; ELIAS, Elias ; ELOUBEIDI, Mohammad ; DIMASSI, Hani ; KHALIFE, Mohammad ; ABOU-ALFA, Ghassan ; O'REILLY, Eileen ; FARAJ, Walid</creatorcontrib><description>The prognostic impact of nodal involvement in resected pancreatic carcinoma and biliary malignancy has been relatively well established. It has been suggested that lymph node ratio (LNR) may be a more informative way of stratifying patients with node positive disease. Our retrospective review aimed to investigate the significance of such variables and test for independent prognostic factors for survival.
One hundred eighty-three pancreatic and periampullary malignancy cases were registered at the American University of Beirut Medical Center from 1990 to 2004. Of those, 80 had complete data on lymph node status. We analyzed the impact of the number of lymph nodes resected, the number of positive lymph nodes retrieved and LNR using Kaplan-Meier and Cox proportional hazard models. The measured outcome in the KM model was the survival probability at 1, 3, and 5 years while the Cox model was used to measure the hazard ratio (HR) of the previously identified predictors on survival.
For the 80 patients included in this analysis, overall survival rates were 65% (54 to 78), 32% (18 to 47), and 21% (8 to 34) were alive at 1, 3, and 5 years, respectively. The median number of resected lymph nodes was 9. In the node positive patients, those who had >12 nodes examined were found to have a significantly better survival (HR=0.24; P=0.013). On multivariate analysis, our model showed the following factors to be significant: age 60 years or older (HR=5.92; P=0.018), poorly differentiated tumors (HR=21.87; P=0.018), number of lymph nodes examined <12 LN (HR=6.77; P=0.022), 3 or more metastatic LN (HR=7.21; P=0.028), and LNR≥0.2 (HR=7.12; P=0.007).
After pancreaticodudonectomy for adenocarcinoma of the pancreas and biliary malignancies, ratio-based lymph node staging is an independent and powerful prognostic factor.</description><identifier>ISSN: 0277-3732</identifier><identifier>EISSN: 1537-453X</identifier><identifier>DOI: 10.1097/COC.0b013e31826b9c74</identifier><identifier>PMID: 23111358</identifier><identifier>CODEN: AJCODI</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adenocarcinoma - mortality ; Adenocarcinoma - pathology ; Adenocarcinoma - surgery ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic agents ; Biological and medical sciences ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; Hematologic and hematopoietic diseases ; Humans ; Kaplan-Meier Estimate ; Lebanon ; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Lymph Node Excision ; Lymph Nodes - pathology ; Lymphatic Metastasis ; Male ; Medical sciences ; Middle Aged ; Multiple tumors. Solid tumors. Tumors in childhood (general aspects) ; Neoplasm Staging ; Pancreatic Neoplasms - mortality ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - surgery ; Pancreaticoduodenectomy ; Pharmacology. Drug treatments ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Tertiary Care Centers ; Tumors</subject><ispartof>American journal of clinical oncology, 2014-02, Vol.37 (1), p.13-18</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c253t-afd1e7f70ebf5c346fdc8a8842b792a9ab52087c58e8f76bf3041024c8665fa83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28336645$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23111358$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>SHAMSEDDINE, Ali I</creatorcontrib><creatorcontrib>MUKHERJI, Deborah</creatorcontrib><creatorcontrib>MELKI, Christian</creatorcontrib><creatorcontrib>ELIAS, Elias</creatorcontrib><creatorcontrib>ELOUBEIDI, Mohammad</creatorcontrib><creatorcontrib>DIMASSI, Hani</creatorcontrib><creatorcontrib>KHALIFE, Mohammad</creatorcontrib><creatorcontrib>ABOU-ALFA, Ghassan</creatorcontrib><creatorcontrib>O'REILLY, Eileen</creatorcontrib><creatorcontrib>FARAJ, Walid</creatorcontrib><title>Lymph Node Ratio Is an Independent Prognostic Factor After Resection of Periampullary Malignancies: Data From a Tertiary Referral Center in the Middle East</title><title>American journal of clinical oncology</title><addtitle>Am J Clin Oncol</addtitle><description>The prognostic impact of nodal involvement in resected pancreatic carcinoma and biliary malignancy has been relatively well established. It has been suggested that lymph node ratio (LNR) may be a more informative way of stratifying patients with node positive disease. Our retrospective review aimed to investigate the significance of such variables and test for independent prognostic factors for survival.
One hundred eighty-three pancreatic and periampullary malignancy cases were registered at the American University of Beirut Medical Center from 1990 to 2004. Of those, 80 had complete data on lymph node status. We analyzed the impact of the number of lymph nodes resected, the number of positive lymph nodes retrieved and LNR using Kaplan-Meier and Cox proportional hazard models. The measured outcome in the KM model was the survival probability at 1, 3, and 5 years while the Cox model was used to measure the hazard ratio (HR) of the previously identified predictors on survival.
For the 80 patients included in this analysis, overall survival rates were 65% (54 to 78), 32% (18 to 47), and 21% (8 to 34) were alive at 1, 3, and 5 years, respectively. The median number of resected lymph nodes was 9. In the node positive patients, those who had >12 nodes examined were found to have a significantly better survival (HR=0.24; P=0.013). On multivariate analysis, our model showed the following factors to be significant: age 60 years or older (HR=5.92; P=0.018), poorly differentiated tumors (HR=21.87; P=0.018), number of lymph nodes examined <12 LN (HR=6.77; P=0.022), 3 or more metastatic LN (HR=7.21; P=0.028), and LNR≥0.2 (HR=7.12; P=0.007).
After pancreaticodudonectomy for adenocarcinoma of the pancreas and biliary malignancies, ratio-based lymph node staging is an independent and powerful prognostic factor.</description><subject>Adenocarcinoma - mortality</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - surgery</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antineoplastic agents</subject><subject>Biological and medical sciences</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Lebanon</subject><subject>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Lymph Node Excision</subject><subject>Lymph Nodes - pathology</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multiple tumors. Solid tumors. Tumors in childhood (general aspects)</subject><subject>Neoplasm Staging</subject><subject>Pancreatic Neoplasms - mortality</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Pancreaticoduodenectomy</subject><subject>Pharmacology. Drug treatments</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Tertiary Care Centers</subject><subject>Tumors</subject><issn>0277-3732</issn><issn>1537-453X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU1vFDEMhiNE1S6l_wAhXzhOycdkkuVWTbuw0pZWqyJxG3kyTjtovpSkh_4W_ixZtYDUi315H9t6zNgHwc8FX5vP9U19zlsuFClhZdWunSnfsJXQyhSlVj_fshWXxhTKKHnC3sX4i3OuK26O2YlUQgil7Yr93j2NywN8nzuCPaZ-hm0EnGA7dbRQLlOC2zDfT3NMvYMNujQHuPCJAuwpksvIBLOHWwo9jsvjMGB4gmsc-vsJJ9dT_AKXmBA2YR4B4Y5C6g-RPXkKAQeo8448rZ8gPRBc9103EFxhTO_Zkcch0tlLP2U_Nld39bdid_N1W1_sCie1SgX6TpDxhlPrtVNl5Ttn0dpStmYtcY2tltwapy1Zb6rWK14KLktnq0p7tOqUlc9zXZhjDOSbJfRjvrERvDm4brLr5rXrjH18xpbHdqTuH_RXbg58eglgdDj4cPAR_-esUlWVX_UHPfSKSw</recordid><startdate>20140201</startdate><enddate>20140201</enddate><creator>SHAMSEDDINE, Ali I</creator><creator>MUKHERJI, Deborah</creator><creator>MELKI, Christian</creator><creator>ELIAS, Elias</creator><creator>ELOUBEIDI, Mohammad</creator><creator>DIMASSI, Hani</creator><creator>KHALIFE, Mohammad</creator><creator>ABOU-ALFA, Ghassan</creator><creator>O'REILLY, Eileen</creator><creator>FARAJ, Walid</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20140201</creationdate><title>Lymph Node Ratio Is an Independent Prognostic Factor After Resection of Periampullary Malignancies: Data From a Tertiary Referral Center in the Middle East</title><author>SHAMSEDDINE, Ali I ; MUKHERJI, Deborah ; MELKI, Christian ; ELIAS, Elias ; ELOUBEIDI, Mohammad ; DIMASSI, Hani ; KHALIFE, Mohammad ; ABOU-ALFA, Ghassan ; O'REILLY, Eileen ; FARAJ, Walid</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c253t-afd1e7f70ebf5c346fdc8a8842b792a9ab52087c58e8f76bf3041024c8665fa83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adenocarcinoma - mortality</topic><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - surgery</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antineoplastic agents</topic><topic>Biological and medical sciences</topic><topic>Female</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Lebanon</topic><topic>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Lymph Node Excision</topic><topic>Lymph Nodes - pathology</topic><topic>Lymphatic Metastasis</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multiple tumors. Solid tumors. Tumors in childhood (general aspects)</topic><topic>Neoplasm Staging</topic><topic>Pancreatic Neoplasms - mortality</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Pancreaticoduodenectomy</topic><topic>Pharmacology. Drug treatments</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Tertiary Care Centers</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SHAMSEDDINE, Ali I</creatorcontrib><creatorcontrib>MUKHERJI, Deborah</creatorcontrib><creatorcontrib>MELKI, Christian</creatorcontrib><creatorcontrib>ELIAS, Elias</creatorcontrib><creatorcontrib>ELOUBEIDI, Mohammad</creatorcontrib><creatorcontrib>DIMASSI, Hani</creatorcontrib><creatorcontrib>KHALIFE, Mohammad</creatorcontrib><creatorcontrib>ABOU-ALFA, Ghassan</creatorcontrib><creatorcontrib>O'REILLY, Eileen</creatorcontrib><creatorcontrib>FARAJ, Walid</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>American journal of clinical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SHAMSEDDINE, Ali I</au><au>MUKHERJI, Deborah</au><au>MELKI, Christian</au><au>ELIAS, Elias</au><au>ELOUBEIDI, Mohammad</au><au>DIMASSI, Hani</au><au>KHALIFE, Mohammad</au><au>ABOU-ALFA, Ghassan</au><au>O'REILLY, Eileen</au><au>FARAJ, Walid</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lymph Node Ratio Is an Independent Prognostic Factor After Resection of Periampullary Malignancies: Data From a Tertiary Referral Center in the Middle East</atitle><jtitle>American journal of clinical oncology</jtitle><addtitle>Am J Clin Oncol</addtitle><date>2014-02-01</date><risdate>2014</risdate><volume>37</volume><issue>1</issue><spage>13</spage><epage>18</epage><pages>13-18</pages><issn>0277-3732</issn><eissn>1537-453X</eissn><coden>AJCODI</coden><abstract>The prognostic impact of nodal involvement in resected pancreatic carcinoma and biliary malignancy has been relatively well established. It has been suggested that lymph node ratio (LNR) may be a more informative way of stratifying patients with node positive disease. Our retrospective review aimed to investigate the significance of such variables and test for independent prognostic factors for survival.
One hundred eighty-three pancreatic and periampullary malignancy cases were registered at the American University of Beirut Medical Center from 1990 to 2004. Of those, 80 had complete data on lymph node status. We analyzed the impact of the number of lymph nodes resected, the number of positive lymph nodes retrieved and LNR using Kaplan-Meier and Cox proportional hazard models. The measured outcome in the KM model was the survival probability at 1, 3, and 5 years while the Cox model was used to measure the hazard ratio (HR) of the previously identified predictors on survival.
For the 80 patients included in this analysis, overall survival rates were 65% (54 to 78), 32% (18 to 47), and 21% (8 to 34) were alive at 1, 3, and 5 years, respectively. The median number of resected lymph nodes was 9. In the node positive patients, those who had >12 nodes examined were found to have a significantly better survival (HR=0.24; P=0.013). On multivariate analysis, our model showed the following factors to be significant: age 60 years or older (HR=5.92; P=0.018), poorly differentiated tumors (HR=21.87; P=0.018), number of lymph nodes examined <12 LN (HR=6.77; P=0.022), 3 or more metastatic LN (HR=7.21; P=0.028), and LNR≥0.2 (HR=7.12; P=0.007).
After pancreaticodudonectomy for adenocarcinoma of the pancreas and biliary malignancies, ratio-based lymph node staging is an independent and powerful prognostic factor.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>23111358</pmid><doi>10.1097/COC.0b013e31826b9c74</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0277-3732 |
| ispartof | American journal of clinical oncology, 2014-02, Vol.37 (1), p.13-18 |
| issn | 0277-3732 1537-453X |
| language | eng |
| recordid | cdi_crossref_primary_10_1097_COC_0b013e31826b9c74 |
| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adenocarcinoma - mortality Adenocarcinoma - pathology Adenocarcinoma - surgery Adolescent Adult Aged Aged, 80 and over Antineoplastic agents Biological and medical sciences Female Gastroenterology. Liver. Pancreas. Abdomen Hematologic and hematopoietic diseases Humans Kaplan-Meier Estimate Lebanon Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis Liver. Biliary tract. Portal circulation. Exocrine pancreas Lymph Node Excision Lymph Nodes - pathology Lymphatic Metastasis Male Medical sciences Middle Aged Multiple tumors. Solid tumors. Tumors in childhood (general aspects) Neoplasm Staging Pancreatic Neoplasms - mortality Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Pancreaticoduodenectomy Pharmacology. Drug treatments Predictive Value of Tests Prognosis Proportional Hazards Models Retrospective Studies Tertiary Care Centers Tumors |
| title | Lymph Node Ratio Is an Independent Prognostic Factor After Resection of Periampullary Malignancies: Data From a Tertiary Referral Center in the Middle East |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-11T21%3A58%3A17IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-pubmed_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Lymph%20Node%20Ratio%20Is%20an%20Independent%20Prognostic%20Factor%20After%20Resection%20of%20Periampullary%20Malignancies:%20Data%20From%20a%20Tertiary%20Referral%20Center%20in%20the%20Middle%20East&rft.jtitle=American%20journal%20of%20clinical%20oncology&rft.au=SHAMSEDDINE,%20Ali%20I&rft.date=2014-02-01&rft.volume=37&rft.issue=1&rft.spage=13&rft.epage=18&rft.pages=13-18&rft.issn=0277-3732&rft.eissn=1537-453X&rft.coden=AJCODI&rft_id=info:doi/10.1097/COC.0b013e31826b9c74&rft_dat=%3Cpubmed_cross%3E23111358%3C/pubmed_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_id=info:pmid/23111358&rfr_iscdi=true |