The prognostic significance of preoperative nutritional/inflammatory markers and clinicopathological features in resectable esophagectomy patients: possibility of nutritional intervention
Background Preoperative inflammatory or nutritional biomarkers and clinicopathological features may be survival predictors in resectable esophageal squamous cell carcinoma. Methods We included 118 patients with resectable squamous esophageal carcinoma (stages I–IV), assessing preoperative CRP- and a...
Gespeichert in:
Veröffentlicht in: | Esophagus : official journal of the Japan Esophageal Society 2023-04, Vol.20 (2), p.234-245 |
---|---|
Hauptverfasser: | , , , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 245 |
---|---|
container_issue | 2 |
container_start_page | 234 |
container_title | Esophagus : official journal of the Japan Esophageal Society |
container_volume | 20 |
creator | Fujiwara, Yoshinori Endo, Shunji Higashida, Masaharu Kubota, Hisako Yoshimatsu, Kazuhiko Ueno, Tomio |
description | Background
Preoperative inflammatory or nutritional biomarkers and clinicopathological features may be survival predictors in resectable esophageal squamous cell carcinoma.
Methods
We included 118 patients with resectable squamous esophageal carcinoma (stages I–IV), assessing preoperative CRP- and albumin-based modified Glasgow prognostic score, the modified controlling nutritional status score, C-reactive protein, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, pathologic stage, and tumor location(s), looking for correlation with overall survival and relapse-free survival. Using univariate and Cox analysis, we selected the most reliable prognostic factors.
Results
Five-year overall survival and recurrence-free survival were 54.9% and 48.5%, respectively. C-reactive protein values correlated negatively with hypoalbuminemia (
P
= 0.0036). On univariate analysis, tumor stage, invasion depth, location, nodal involvement, albumin, and modified Glasgow prognostic score were significant prognostic factors for overall and recurrence-free survival. Preoperative C-reactive protein was prognostic factor for overall survival, but not for relapse-free survival (
P
= 0.017, 0.063, respectively). The Cox proportional hazards model showed the modified Glasgow prognostic score to be an independent prognostic factor for relapse-free survival and overall survival after using the stepwise variable selection procedure. Cox analysis including clinicopathological factors and modified Glasgow prognostic scores showed that only tumor location(s) and pathologic stage were independent prognostic factors for overall survival and recurrence-free survival.
Conclusion
Although the modified Glasgow prognostic score is not superior to pathologic stage and tumor location as a biomarker of preoperative nutrition/inflammation and clinicopathological factors, it remains an important prognostic marker in resectable esophageal cancers. Preoperative decreased inflammatory response and improved nutritional status may contribute to prognosis in patients with esophageal cancer. |
doi_str_mv | 10.1007/s10388-022-00961-2 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2731717270</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2890336635</sourcerecordid><originalsourceid>FETCH-LOGICAL-c350t-167904ae9016e1c59a63355b9ff761d0fb757ad9934fdbfe9ebf151d36d6e8c73</originalsourceid><addsrcrecordid>eNp9kc1u1TAQhSMEoqXwAiyQJTZsQu342o7Zoar8SJXYlHXkOONcF8cOtlPpPhsvx5RbCmLBajyab86M5zTNS0bfMkrVeWGU931Lu66lVEvWdo-aUyZZ12oq1eOHt9AnzbNSbijl3a7nT5sTLnmnqOhPmx_XeyBrTnNMpXpLip-jd96aaIEkhyVIK2RT_S2QuNXsq0_RhHMfXTDLYmrKB7KY_A1yISZOxAYfvU2rqfsU0oxSgTgwdctQiI8EA9hqxgAESlr3ZsY0LQeCHR5iLe_Imkrxow--Hu52-GssClTIt4hh-rx54kwo8OI-njVfP1xeX3xqr758_Hzx_qq1XNDaMqk03RnQlElgVmgjORdi1M4pySbqRiWUmbTmOzeNDjSMjgk2cTlJ6K3iZ82boy7e6fsGpQ6LLxZCMBHSVoZOcaaYwosi-vof9CZtGRdHqteUcym5QKo7UjbjTzO4Yc0eb3gYGB3urB2O1g5o7fDL2qHDplf30tu4wPTQ8ttLBPgRKFiKM-Q_s_8j-xOpI7YG</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2890336635</pqid></control><display><type>article</type><title>The prognostic significance of preoperative nutritional/inflammatory markers and clinicopathological features in resectable esophagectomy patients: possibility of nutritional intervention</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Fujiwara, Yoshinori ; Endo, Shunji ; Higashida, Masaharu ; Kubota, Hisako ; Yoshimatsu, Kazuhiko ; Ueno, Tomio</creator><creatorcontrib>Fujiwara, Yoshinori ; Endo, Shunji ; Higashida, Masaharu ; Kubota, Hisako ; Yoshimatsu, Kazuhiko ; Ueno, Tomio</creatorcontrib><description>Background
Preoperative inflammatory or nutritional biomarkers and clinicopathological features may be survival predictors in resectable esophageal squamous cell carcinoma.
Methods
We included 118 patients with resectable squamous esophageal carcinoma (stages I–IV), assessing preoperative CRP- and albumin-based modified Glasgow prognostic score, the modified controlling nutritional status score, C-reactive protein, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, pathologic stage, and tumor location(s), looking for correlation with overall survival and relapse-free survival. Using univariate and Cox analysis, we selected the most reliable prognostic factors.
Results
Five-year overall survival and recurrence-free survival were 54.9% and 48.5%, respectively. C-reactive protein values correlated negatively with hypoalbuminemia (
P
= 0.0036). On univariate analysis, tumor stage, invasion depth, location, nodal involvement, albumin, and modified Glasgow prognostic score were significant prognostic factors for overall and recurrence-free survival. Preoperative C-reactive protein was prognostic factor for overall survival, but not for relapse-free survival (
P
= 0.017, 0.063, respectively). The Cox proportional hazards model showed the modified Glasgow prognostic score to be an independent prognostic factor for relapse-free survival and overall survival after using the stepwise variable selection procedure. Cox analysis including clinicopathological factors and modified Glasgow prognostic scores showed that only tumor location(s) and pathologic stage were independent prognostic factors for overall survival and recurrence-free survival.
Conclusion
Although the modified Glasgow prognostic score is not superior to pathologic stage and tumor location as a biomarker of preoperative nutrition/inflammation and clinicopathological factors, it remains an important prognostic marker in resectable esophageal cancers. Preoperative decreased inflammatory response and improved nutritional status may contribute to prognosis in patients with esophageal cancer.</description><identifier>ISSN: 1612-9059</identifier><identifier>EISSN: 1612-9067</identifier><identifier>DOI: 10.1007/s10388-022-00961-2</identifier><identifier>PMID: 36327058</identifier><language>eng</language><publisher>Singapore: Springer Nature Singapore</publisher><subject>Biomarkers ; Biomarkers, Tumor - metabolism ; C-Reactive Protein - metabolism ; Carcinoma, Squamous Cell - pathology ; Carcinoma, Squamous Cell - surgery ; Esophageal cancer ; Esophageal Neoplasms - pathology ; Esophageal Squamous Cell Carcinoma - surgery ; Esophagectomy - methods ; Esophagus ; Gastroenterology ; Humans ; Medical prognosis ; Medicine ; Medicine & Public Health ; Neoplasm Recurrence, Local - surgery ; Nutritional status ; Original Article ; Prognosis ; Proteins ; Squamous cell carcinoma ; Surgical Oncology ; Thoracic Surgery</subject><ispartof>Esophagus : official journal of the Japan Esophageal Society, 2023-04, Vol.20 (2), p.234-245</ispartof><rights>The Author(s) under exclusive licence to The Japan Esophageal Society 2022. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. The Author(s) under exclusive licence to The Japan Esophageal Society.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c350t-167904ae9016e1c59a63355b9ff761d0fb757ad9934fdbfe9ebf151d36d6e8c73</cites><orcidid>0000-0003-2925-8905</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10388-022-00961-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10388-022-00961-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36327058$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fujiwara, Yoshinori</creatorcontrib><creatorcontrib>Endo, Shunji</creatorcontrib><creatorcontrib>Higashida, Masaharu</creatorcontrib><creatorcontrib>Kubota, Hisako</creatorcontrib><creatorcontrib>Yoshimatsu, Kazuhiko</creatorcontrib><creatorcontrib>Ueno, Tomio</creatorcontrib><title>The prognostic significance of preoperative nutritional/inflammatory markers and clinicopathological features in resectable esophagectomy patients: possibility of nutritional intervention</title><title>Esophagus : official journal of the Japan Esophageal Society</title><addtitle>Esophagus</addtitle><addtitle>Esophagus</addtitle><description>Background
Preoperative inflammatory or nutritional biomarkers and clinicopathological features may be survival predictors in resectable esophageal squamous cell carcinoma.
Methods
We included 118 patients with resectable squamous esophageal carcinoma (stages I–IV), assessing preoperative CRP- and albumin-based modified Glasgow prognostic score, the modified controlling nutritional status score, C-reactive protein, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, pathologic stage, and tumor location(s), looking for correlation with overall survival and relapse-free survival. Using univariate and Cox analysis, we selected the most reliable prognostic factors.
Results
Five-year overall survival and recurrence-free survival were 54.9% and 48.5%, respectively. C-reactive protein values correlated negatively with hypoalbuminemia (
P
= 0.0036). On univariate analysis, tumor stage, invasion depth, location, nodal involvement, albumin, and modified Glasgow prognostic score were significant prognostic factors for overall and recurrence-free survival. Preoperative C-reactive protein was prognostic factor for overall survival, but not for relapse-free survival (
P
= 0.017, 0.063, respectively). The Cox proportional hazards model showed the modified Glasgow prognostic score to be an independent prognostic factor for relapse-free survival and overall survival after using the stepwise variable selection procedure. Cox analysis including clinicopathological factors and modified Glasgow prognostic scores showed that only tumor location(s) and pathologic stage were independent prognostic factors for overall survival and recurrence-free survival.
Conclusion
Although the modified Glasgow prognostic score is not superior to pathologic stage and tumor location as a biomarker of preoperative nutrition/inflammation and clinicopathological factors, it remains an important prognostic marker in resectable esophageal cancers. Preoperative decreased inflammatory response and improved nutritional status may contribute to prognosis in patients with esophageal cancer.</description><subject>Biomarkers</subject><subject>Biomarkers, Tumor - metabolism</subject><subject>C-Reactive Protein - metabolism</subject><subject>Carcinoma, Squamous Cell - pathology</subject><subject>Carcinoma, Squamous Cell - surgery</subject><subject>Esophageal cancer</subject><subject>Esophageal Neoplasms - pathology</subject><subject>Esophageal Squamous Cell Carcinoma - surgery</subject><subject>Esophagectomy - methods</subject><subject>Esophagus</subject><subject>Gastroenterology</subject><subject>Humans</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neoplasm Recurrence, Local - surgery</subject><subject>Nutritional status</subject><subject>Original Article</subject><subject>Prognosis</subject><subject>Proteins</subject><subject>Squamous cell carcinoma</subject><subject>Surgical Oncology</subject><subject>Thoracic Surgery</subject><issn>1612-9059</issn><issn>1612-9067</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kc1u1TAQhSMEoqXwAiyQJTZsQu342o7Zoar8SJXYlHXkOONcF8cOtlPpPhsvx5RbCmLBajyab86M5zTNS0bfMkrVeWGU931Lu66lVEvWdo-aUyZZ12oq1eOHt9AnzbNSbijl3a7nT5sTLnmnqOhPmx_XeyBrTnNMpXpLip-jd96aaIEkhyVIK2RT_S2QuNXsq0_RhHMfXTDLYmrKB7KY_A1yISZOxAYfvU2rqfsU0oxSgTgwdctQiI8EA9hqxgAESlr3ZsY0LQeCHR5iLe_Imkrxow--Hu52-GssClTIt4hh-rx54kwo8OI-njVfP1xeX3xqr758_Hzx_qq1XNDaMqk03RnQlElgVmgjORdi1M4pySbqRiWUmbTmOzeNDjSMjgk2cTlJ6K3iZ82boy7e6fsGpQ6LLxZCMBHSVoZOcaaYwosi-vof9CZtGRdHqteUcym5QKo7UjbjTzO4Yc0eb3gYGB3urB2O1g5o7fDL2qHDplf30tu4wPTQ8ttLBPgRKFiKM-Q_s_8j-xOpI7YG</recordid><startdate>20230401</startdate><enddate>20230401</enddate><creator>Fujiwara, Yoshinori</creator><creator>Endo, Shunji</creator><creator>Higashida, Masaharu</creator><creator>Kubota, Hisako</creator><creator>Yoshimatsu, Kazuhiko</creator><creator>Ueno, Tomio</creator><general>Springer Nature Singapore</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>7RV</scope><scope>7X7</scope><scope>7XB</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>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2925-8905</orcidid></search><sort><creationdate>20230401</creationdate><title>The prognostic significance of preoperative nutritional/inflammatory markers and clinicopathological features in resectable esophagectomy patients: possibility of nutritional intervention</title><author>Fujiwara, Yoshinori ; Endo, Shunji ; Higashida, Masaharu ; Kubota, Hisako ; Yoshimatsu, Kazuhiko ; Ueno, Tomio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c350t-167904ae9016e1c59a63355b9ff761d0fb757ad9934fdbfe9ebf151d36d6e8c73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Biomarkers</topic><topic>Biomarkers, Tumor - metabolism</topic><topic>C-Reactive Protein - metabolism</topic><topic>Carcinoma, Squamous Cell - pathology</topic><topic>Carcinoma, Squamous Cell - surgery</topic><topic>Esophageal cancer</topic><topic>Esophageal Neoplasms - pathology</topic><topic>Esophageal Squamous Cell Carcinoma - surgery</topic><topic>Esophagectomy - methods</topic><topic>Esophagus</topic><topic>Gastroenterology</topic><topic>Humans</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neoplasm Recurrence, Local - surgery</topic><topic>Nutritional status</topic><topic>Original Article</topic><topic>Prognosis</topic><topic>Proteins</topic><topic>Squamous cell carcinoma</topic><topic>Surgical Oncology</topic><topic>Thoracic Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fujiwara, Yoshinori</creatorcontrib><creatorcontrib>Endo, Shunji</creatorcontrib><creatorcontrib>Higashida, Masaharu</creatorcontrib><creatorcontrib>Kubota, Hisako</creatorcontrib><creatorcontrib>Yoshimatsu, Kazuhiko</creatorcontrib><creatorcontrib>Ueno, Tomio</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>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</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>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Esophagus : official journal of the Japan Esophageal Society</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fujiwara, Yoshinori</au><au>Endo, Shunji</au><au>Higashida, Masaharu</au><au>Kubota, Hisako</au><au>Yoshimatsu, Kazuhiko</au><au>Ueno, Tomio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The prognostic significance of preoperative nutritional/inflammatory markers and clinicopathological features in resectable esophagectomy patients: possibility of nutritional intervention</atitle><jtitle>Esophagus : official journal of the Japan Esophageal Society</jtitle><stitle>Esophagus</stitle><addtitle>Esophagus</addtitle><date>2023-04-01</date><risdate>2023</risdate><volume>20</volume><issue>2</issue><spage>234</spage><epage>245</epage><pages>234-245</pages><issn>1612-9059</issn><eissn>1612-9067</eissn><abstract>Background
Preoperative inflammatory or nutritional biomarkers and clinicopathological features may be survival predictors in resectable esophageal squamous cell carcinoma.
Methods
We included 118 patients with resectable squamous esophageal carcinoma (stages I–IV), assessing preoperative CRP- and albumin-based modified Glasgow prognostic score, the modified controlling nutritional status score, C-reactive protein, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, pathologic stage, and tumor location(s), looking for correlation with overall survival and relapse-free survival. Using univariate and Cox analysis, we selected the most reliable prognostic factors.
Results
Five-year overall survival and recurrence-free survival were 54.9% and 48.5%, respectively. C-reactive protein values correlated negatively with hypoalbuminemia (
P
= 0.0036). On univariate analysis, tumor stage, invasion depth, location, nodal involvement, albumin, and modified Glasgow prognostic score were significant prognostic factors for overall and recurrence-free survival. Preoperative C-reactive protein was prognostic factor for overall survival, but not for relapse-free survival (
P
= 0.017, 0.063, respectively). The Cox proportional hazards model showed the modified Glasgow prognostic score to be an independent prognostic factor for relapse-free survival and overall survival after using the stepwise variable selection procedure. Cox analysis including clinicopathological factors and modified Glasgow prognostic scores showed that only tumor location(s) and pathologic stage were independent prognostic factors for overall survival and recurrence-free survival.
Conclusion
Although the modified Glasgow prognostic score is not superior to pathologic stage and tumor location as a biomarker of preoperative nutrition/inflammation and clinicopathological factors, it remains an important prognostic marker in resectable esophageal cancers. Preoperative decreased inflammatory response and improved nutritional status may contribute to prognosis in patients with esophageal cancer.</abstract><cop>Singapore</cop><pub>Springer Nature Singapore</pub><pmid>36327058</pmid><doi>10.1007/s10388-022-00961-2</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-2925-8905</orcidid></addata></record> |
fulltext | fulltext |
identifier | ISSN: 1612-9059 |
ispartof | Esophagus : official journal of the Japan Esophageal Society, 2023-04, Vol.20 (2), p.234-245 |
issn | 1612-9059 1612-9067 |
language | eng |
recordid | cdi_proquest_miscellaneous_2731717270 |
source | MEDLINE; SpringerLink Journals - AutoHoldings |
subjects | Biomarkers Biomarkers, Tumor - metabolism C-Reactive Protein - metabolism Carcinoma, Squamous Cell - pathology Carcinoma, Squamous Cell - surgery Esophageal cancer Esophageal Neoplasms - pathology Esophageal Squamous Cell Carcinoma - surgery Esophagectomy - methods Esophagus Gastroenterology Humans Medical prognosis Medicine Medicine & Public Health Neoplasm Recurrence, Local - surgery Nutritional status Original Article Prognosis Proteins Squamous cell carcinoma Surgical Oncology Thoracic Surgery |
title | The prognostic significance of preoperative nutritional/inflammatory markers and clinicopathological features in resectable esophagectomy patients: possibility of nutritional intervention |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-27T23%3A28%3A15IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20prognostic%20significance%20of%20preoperative%20nutritional/inflammatory%20markers%20and%20clinicopathological%20features%20in%20resectable%20esophagectomy%20patients:%20possibility%20of%20nutritional%20intervention&rft.jtitle=Esophagus%20:%20official%20journal%20of%20the%20Japan%20Esophageal%20Society&rft.au=Fujiwara,%20Yoshinori&rft.date=2023-04-01&rft.volume=20&rft.issue=2&rft.spage=234&rft.epage=245&rft.pages=234-245&rft.issn=1612-9059&rft.eissn=1612-9067&rft_id=info:doi/10.1007/s10388-022-00961-2&rft_dat=%3Cproquest_cross%3E2890336635%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2890336635&rft_id=info:pmid/36327058&rfr_iscdi=true |