Sporadic Small (≤20 mm) Nonfunctioning Pancreatic Neuroendocrine Neoplasm: is the Risk of Malignancy Negligible When Adopting a More Conservative Strategy? A Systematic Review and Meta-analysis
Background The management of small (≤20 mm), nonfunctioning pancreatic neuroendocrine neoplasms (pNENs) remains under debate. The European Neuroendocrine Tumor Society guidelines advocate the possibility of a conservative approach. Methods A systematic literature search was conducted to identify all...
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| Veröffentlicht in: | Annals of surgical oncology 2017-09, Vol.24 (9), p.2603-2610 |
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| container_title | Annals of surgical oncology |
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| creator | Ricci, Claudio Casadei, Riccardo Taffurelli, Giovanni Pacilio, Carlo Alberto Campana, Davide Ambrosini, Valentina Donatella, Santini Minni, Francesco |
| description | Background
The management of small (≤20 mm), nonfunctioning pancreatic neuroendocrine neoplasms (pNENs) remains under debate. The European Neuroendocrine Tumor Society guidelines advocate the possibility of a conservative approach.
Methods
A systematic literature search was conducted to identify all studies comparing the risk of malignancy in small pNENs with respect to large ones (>20 mm). Malignancy was defined based on the presence of nodal metastases. Distant metastases, tumor grading (G2–3), vascular microscopic invasion, stage III-IV, and overall and disease-free survival also were evaluated. The data were reported in two ways: using the risk difference (RD) and the likelihood of being helped or harmed (LHH).
Results
The search identified only 6 eligible studies with an overall population of 1697 resected pNENs: 382 (22.5%) small and 1315 (77.5%) large. The RD of lymph nodal metastases was −0.26 (95% confidence interval (CI): −0.31 to −0.22;
P
|
| doi_str_mv | 10.1245/s10434-017-5946-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1916712261</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1925068209</sourcerecordid><originalsourceid>FETCH-LOGICAL-c438t-d7da3ea6b402762fd6b0b415451823e9dc4ddd734a16420195e8df9107f9efff3</originalsourceid><addsrcrecordid>eNp1kUFu1DAUhiMEoqVwADbIEpuyCNiO7SRsqtGIAlKnoA6IZeTEz1OXxA62M1WOwC1YcBLESTgJHqYghMTKz8_f-5-lL8seEvyUUMafBYJZwXJMypzXTOTVreyQ8NRhoiK3U41FlddU8IPsXghXOIEF5nezA1olgPDqMPu-Hp2XynRoPci-R8c_Pn-l-NuXYXiCzp3Vk-2icdbYDXorbedBxsSew-QdWOU6byykqxt7GYbnyAQULwFdmPAROY1Wsjcbm-bmxGxSbdoe0IdLsGih3Bh3sRKtnAe0dDaA36b4LaB19DLCZj5BC7SeQ4Th19oL2Bq4RtIqtIIoc2llPwcT7md3tOwDPLg5j7L3py_eLV_lZ29evl4uzvKOFVXMValkAVK0DNNSUK1Ei1tGOOOkogXUqmNKqbJgkghGMak5VErXBJe6Bq11cZQd73NH7z5NEGIzmNBB30sLbgoNqYkoCaWCJPTxP-iVm3z6746iPImhuE4U2VOddyF40M3ozSD93BDc7BQ3e8VNMtfsFDdVmnl0kzy1A6g_E7-dJoDugZCe7Ab8X6v_m_oTDUG1aA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1925068209</pqid></control><display><type>article</type><title>Sporadic Small (≤20 mm) Nonfunctioning Pancreatic Neuroendocrine Neoplasm: is the Risk of Malignancy Negligible When Adopting a More Conservative Strategy? A Systematic Review and Meta-analysis</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Ricci, Claudio ; Casadei, Riccardo ; Taffurelli, Giovanni ; Pacilio, Carlo Alberto ; Campana, Davide ; Ambrosini, Valentina ; Donatella, Santini ; Minni, Francesco</creator><creatorcontrib>Ricci, Claudio ; Casadei, Riccardo ; Taffurelli, Giovanni ; Pacilio, Carlo Alberto ; Campana, Davide ; Ambrosini, Valentina ; Donatella, Santini ; Minni, Francesco</creatorcontrib><description>Background
The management of small (≤20 mm), nonfunctioning pancreatic neuroendocrine neoplasms (pNENs) remains under debate. The European Neuroendocrine Tumor Society guidelines advocate the possibility of a conservative approach.
Methods
A systematic literature search was conducted to identify all studies comparing the risk of malignancy in small pNENs with respect to large ones (>20 mm). Malignancy was defined based on the presence of nodal metastases. Distant metastases, tumor grading (G2–3), vascular microscopic invasion, stage III-IV, and overall and disease-free survival also were evaluated. The data were reported in two ways: using the risk difference (RD) and the likelihood of being helped or harmed (LHH).
Results
The search identified only 6 eligible studies with an overall population of 1697 resected pNENs: 382 (22.5%) small and 1315 (77.5%) large. The RD of lymph nodal metastases was −0.26 (95% confidence interval (CI): −0.31 to −0.22;
P
< 0.001). The LHH was 0.34, suggesting that the risk of leaving a malignancy during follow-up due to the adoption of a conservative strategy was three times higher than the benefits. The risk difference of distant metastases, G3 lesions, G2–G3 lesions, stage III/IV, microscopic vascular invasion, death, and recurrence of the disease were lower in small NF-PNETs than large ones. The related LHH values suggested that a watch-and-wait policy never provided a benefit.
Conclusions
Even if the malignancy rate in sporadic, small pancreatic neuroendocrine neoplasms was lower than in large ones, this difference did not justify a watch-and-wait policy.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-017-5946-8</identifier><identifier>PMID: 28681158</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Conservative Treatment ; Endocrine Tumors ; Humans ; Lymph ; Lymph nodes ; Lymphatic Metastasis ; Malignancy ; Medicine ; Medicine & Public Health ; Meta-analysis ; Metastases ; Metastasis ; Neoplasm Invasiveness ; Neoplasm Staging ; Neuroendocrine tumors ; Neuroendocrine Tumors - secondary ; Neuroendocrine Tumors - surgery ; Neuroendocrine Tumors - therapy ; Oncology ; Pancreas ; Pancreatic cancer ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - surgery ; Pancreatic Neoplasms - therapy ; Risk Assessment ; Surgery ; Surgical Oncology ; Survival Rate ; Tumor Burden ; Tumors</subject><ispartof>Annals of surgical oncology, 2017-09, Vol.24 (9), p.2603-2610</ispartof><rights>Society of Surgical Oncology 2017</rights><rights>Annals of Surgical Oncology is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-d7da3ea6b402762fd6b0b415451823e9dc4ddd734a16420195e8df9107f9efff3</citedby><cites>FETCH-LOGICAL-c438t-d7da3ea6b402762fd6b0b415451823e9dc4ddd734a16420195e8df9107f9efff3</cites><orcidid>0000-0002-6638-4479</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-017-5946-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-017-5946-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28681158$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ricci, Claudio</creatorcontrib><creatorcontrib>Casadei, Riccardo</creatorcontrib><creatorcontrib>Taffurelli, Giovanni</creatorcontrib><creatorcontrib>Pacilio, Carlo Alberto</creatorcontrib><creatorcontrib>Campana, Davide</creatorcontrib><creatorcontrib>Ambrosini, Valentina</creatorcontrib><creatorcontrib>Donatella, Santini</creatorcontrib><creatorcontrib>Minni, Francesco</creatorcontrib><title>Sporadic Small (≤20 mm) Nonfunctioning Pancreatic Neuroendocrine Neoplasm: is the Risk of Malignancy Negligible When Adopting a More Conservative Strategy? A Systematic Review and Meta-analysis</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
The management of small (≤20 mm), nonfunctioning pancreatic neuroendocrine neoplasms (pNENs) remains under debate. The European Neuroendocrine Tumor Society guidelines advocate the possibility of a conservative approach.
Methods
A systematic literature search was conducted to identify all studies comparing the risk of malignancy in small pNENs with respect to large ones (>20 mm). Malignancy was defined based on the presence of nodal metastases. Distant metastases, tumor grading (G2–3), vascular microscopic invasion, stage III-IV, and overall and disease-free survival also were evaluated. The data were reported in two ways: using the risk difference (RD) and the likelihood of being helped or harmed (LHH).
Results
The search identified only 6 eligible studies with an overall population of 1697 resected pNENs: 382 (22.5%) small and 1315 (77.5%) large. The RD of lymph nodal metastases was −0.26 (95% confidence interval (CI): −0.31 to −0.22;
P
< 0.001). The LHH was 0.34, suggesting that the risk of leaving a malignancy during follow-up due to the adoption of a conservative strategy was three times higher than the benefits. The risk difference of distant metastases, G3 lesions, G2–G3 lesions, stage III/IV, microscopic vascular invasion, death, and recurrence of the disease were lower in small NF-PNETs than large ones. The related LHH values suggested that a watch-and-wait policy never provided a benefit.
Conclusions
Even if the malignancy rate in sporadic, small pancreatic neuroendocrine neoplasms was lower than in large ones, this difference did not justify a watch-and-wait policy.</description><subject>Conservative Treatment</subject><subject>Endocrine Tumors</subject><subject>Humans</subject><subject>Lymph</subject><subject>Lymph nodes</subject><subject>Lymphatic Metastasis</subject><subject>Malignancy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Neoplasm Invasiveness</subject><subject>Neoplasm Staging</subject><subject>Neuroendocrine tumors</subject><subject>Neuroendocrine Tumors - secondary</subject><subject>Neuroendocrine Tumors - surgery</subject><subject>Neuroendocrine Tumors - therapy</subject><subject>Oncology</subject><subject>Pancreas</subject><subject>Pancreatic cancer</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Pancreatic Neoplasms - therapy</subject><subject>Risk Assessment</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival Rate</subject><subject>Tumor Burden</subject><subject>Tumors</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kUFu1DAUhiMEoqVwADbIEpuyCNiO7SRsqtGIAlKnoA6IZeTEz1OXxA62M1WOwC1YcBLESTgJHqYghMTKz8_f-5-lL8seEvyUUMafBYJZwXJMypzXTOTVreyQ8NRhoiK3U41FlddU8IPsXghXOIEF5nezA1olgPDqMPu-Hp2XynRoPci-R8c_Pn-l-NuXYXiCzp3Vk-2icdbYDXorbedBxsSew-QdWOU6byykqxt7GYbnyAQULwFdmPAROY1Wsjcbm-bmxGxSbdoe0IdLsGih3Bh3sRKtnAe0dDaA36b4LaB19DLCZj5BC7SeQ4Th19oL2Bq4RtIqtIIoc2llPwcT7md3tOwDPLg5j7L3py_eLV_lZ29evl4uzvKOFVXMValkAVK0DNNSUK1Ei1tGOOOkogXUqmNKqbJgkghGMak5VErXBJe6Bq11cZQd73NH7z5NEGIzmNBB30sLbgoNqYkoCaWCJPTxP-iVm3z6746iPImhuE4U2VOddyF40M3ozSD93BDc7BQ3e8VNMtfsFDdVmnl0kzy1A6g_E7-dJoDugZCe7Ab8X6v_m_oTDUG1aA</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>Ricci, Claudio</creator><creator>Casadei, Riccardo</creator><creator>Taffurelli, Giovanni</creator><creator>Pacilio, Carlo Alberto</creator><creator>Campana, Davide</creator><creator>Ambrosini, Valentina</creator><creator>Donatella, Santini</creator><creator>Minni, Francesco</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6638-4479</orcidid></search><sort><creationdate>20170901</creationdate><title>Sporadic Small (≤20 mm) Nonfunctioning Pancreatic Neuroendocrine Neoplasm: is the Risk of Malignancy Negligible When Adopting a More Conservative Strategy? A Systematic Review and Meta-analysis</title><author>Ricci, Claudio ; Casadei, Riccardo ; Taffurelli, Giovanni ; Pacilio, Carlo Alberto ; Campana, Davide ; Ambrosini, Valentina ; Donatella, Santini ; Minni, Francesco</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-d7da3ea6b402762fd6b0b415451823e9dc4ddd734a16420195e8df9107f9efff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Conservative Treatment</topic><topic>Endocrine Tumors</topic><topic>Humans</topic><topic>Lymph</topic><topic>Lymph nodes</topic><topic>Lymphatic Metastasis</topic><topic>Malignancy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Neoplasm Invasiveness</topic><topic>Neoplasm Staging</topic><topic>Neuroendocrine tumors</topic><topic>Neuroendocrine Tumors - secondary</topic><topic>Neuroendocrine Tumors - surgery</topic><topic>Neuroendocrine Tumors - therapy</topic><topic>Oncology</topic><topic>Pancreas</topic><topic>Pancreatic cancer</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Pancreatic Neoplasms - therapy</topic><topic>Risk Assessment</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Survival Rate</topic><topic>Tumor Burden</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ricci, Claudio</creatorcontrib><creatorcontrib>Casadei, Riccardo</creatorcontrib><creatorcontrib>Taffurelli, Giovanni</creatorcontrib><creatorcontrib>Pacilio, Carlo Alberto</creatorcontrib><creatorcontrib>Campana, Davide</creatorcontrib><creatorcontrib>Ambrosini, Valentina</creatorcontrib><creatorcontrib>Donatella, Santini</creatorcontrib><creatorcontrib>Minni, Francesco</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ricci, Claudio</au><au>Casadei, Riccardo</au><au>Taffurelli, Giovanni</au><au>Pacilio, Carlo Alberto</au><au>Campana, Davide</au><au>Ambrosini, Valentina</au><au>Donatella, Santini</au><au>Minni, Francesco</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sporadic Small (≤20 mm) Nonfunctioning Pancreatic Neuroendocrine Neoplasm: is the Risk of Malignancy Negligible When Adopting a More Conservative Strategy? A Systematic Review and Meta-analysis</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>24</volume><issue>9</issue><spage>2603</spage><epage>2610</epage><pages>2603-2610</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
The management of small (≤20 mm), nonfunctioning pancreatic neuroendocrine neoplasms (pNENs) remains under debate. The European Neuroendocrine Tumor Society guidelines advocate the possibility of a conservative approach.
Methods
A systematic literature search was conducted to identify all studies comparing the risk of malignancy in small pNENs with respect to large ones (>20 mm). Malignancy was defined based on the presence of nodal metastases. Distant metastases, tumor grading (G2–3), vascular microscopic invasion, stage III-IV, and overall and disease-free survival also were evaluated. The data were reported in two ways: using the risk difference (RD) and the likelihood of being helped or harmed (LHH).
Results
The search identified only 6 eligible studies with an overall population of 1697 resected pNENs: 382 (22.5%) small and 1315 (77.5%) large. The RD of lymph nodal metastases was −0.26 (95% confidence interval (CI): −0.31 to −0.22;
P
< 0.001). The LHH was 0.34, suggesting that the risk of leaving a malignancy during follow-up due to the adoption of a conservative strategy was three times higher than the benefits. The risk difference of distant metastases, G3 lesions, G2–G3 lesions, stage III/IV, microscopic vascular invasion, death, and recurrence of the disease were lower in small NF-PNETs than large ones. The related LHH values suggested that a watch-and-wait policy never provided a benefit.
Conclusions
Even if the malignancy rate in sporadic, small pancreatic neuroendocrine neoplasms was lower than in large ones, this difference did not justify a watch-and-wait policy.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>28681158</pmid><doi>10.1245/s10434-017-5946-8</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-6638-4479</orcidid></addata></record> |
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| subjects | Conservative Treatment Endocrine Tumors Humans Lymph Lymph nodes Lymphatic Metastasis Malignancy Medicine Medicine & Public Health Meta-analysis Metastases Metastasis Neoplasm Invasiveness Neoplasm Staging Neuroendocrine tumors Neuroendocrine Tumors - secondary Neuroendocrine Tumors - surgery Neuroendocrine Tumors - therapy Oncology Pancreas Pancreatic cancer Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Pancreatic Neoplasms - therapy Risk Assessment Surgery Surgical Oncology Survival Rate Tumor Burden Tumors |
| title | Sporadic Small (≤20 mm) Nonfunctioning Pancreatic Neuroendocrine Neoplasm: is the Risk of Malignancy Negligible When Adopting a More Conservative Strategy? A Systematic Review and Meta-analysis |
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